Thursday, 16 October 2008

Blood disorder

Over the years I've given 29 blood donations, pleased that in this simple way I could help save a few lives. Now it turns out I may have been killing people.

New research shows that blood transfusions actually increase the risk of a patient dying or having a post-operative illness. Many surgeons are now reluctant to given any blood transfusions unless it's an emergency.

The reason for the increased risk, it seems, is toxic chemicals produced in stored blood when red blood cells die.

When these chemicals are produced in the human body, the body can process or excrete them so they're harmless. But in stored blood, the toxins simply accumulate and endanger whoever gets the blood.

They can cause widespread inflammation, damage vital organs, and trigger heart attacks and strokes.

Good grief! Why did we not know this earlier? How come me and other donors have given millions of donations in blissful ignorance of the possible lethal effects?

Of course, transfusions are still necessary in emergencies, where they're the only way of keeping someone alive. Then obviously the risk is worth taking.

But if it wasn't an emergency and my blood was merrily poisoning someone, how tragic is that? Am I an unwitting NHS serial killer?

Don't worry, I'm not having a nervous breakdown from this shocking discovery. After all, I was ignorant. But it shows that good intentions are not enough. And that medicine is still fallible.

PS: So maybe the Jehovah's Witnesses aren't that crazy after all?

21 comments:

Hullaballoo said...

I have written something for you over at mine. xx

Nick said...

Hulla, your flattery is shameless. What a lovely appreciation of all your visitors. I love reading your blog, it's always so humorous and full of life.

Aidan said...

That is scary. I tried to give blood here but I am not allowed because I lived in the UK during the mad cow disease years and therefore the land of the giants does not need my polluted blood cells.

Nick said...

Aidan - So you haven't poisoned anyone! You can sleep easy in your bed tonight. Well, until you start thinking of the credit crunch, unemployment, tax rises etc.

Baino said...

Good grief! I had no idea although the benefits must outweigh the risks. My father in law is now 76 and has given blood twice a year since he was 18! He was even invited to a Royal Garden Party as a thank you! Nobody wants mine, it's a bit rare and hard to match!

Nick said...

Baino - Not sure there are benefits at all, except in a dire life-threatening emergency. Surgeons who did cardiac ops without blood transfusions found the result was similar to those that did use transfusions.

So you're another one who can sleep soundly!

gaudiumdelingua said...

So does it mean that if the blood was freshly donated, there would be less risk involved as the red blood cells haven't had a chance to die yet?
I always wanted to give blood, the one time I tried I was told I couldn't because I had a condition within 6 months of my wanting to donate.
Maybe next time, I will just go to the emergency room and wait for someone to come in with dire need of blood transfusion, someone who is the same blood type as me, and then I can just say "Hey, look at me, I am here, I can donate my blood, I have been waiting for this all my life!"
In Australia they don't allow people who lived in the UK during certain period (like Aidan said) to donate blood.

Gx

Nick said...

GayƩ - Yes, you're probably right, if you donate on the spot the blood's presumably okay. Except that I think they have to do tests on it first to make sure it's free of certain infections etc.

Research is also going on into artificial blood substitutes, but the ones developed so far have been inadequate.

Quickroute said...

I dread the day I ever need a transfusion - really dread it!

Nick said...

Quicky, I dread going into hospital, period. Too many people die of superbugs, blood clots, surgical errors, drug errors etc. And now blood transfusions are yet another risk factor.

Caro said...

I've never given blood - I'm a bit anaemic so I never bothered as I'm sure they wouldn't accept it. My uncle in the States had an operation a few years ago and they collected his own blood to give back to him before the operation. I wonder are people immune to their own toxic chemicals?

Nick said...

Caro - A good question. Are they immune to the toxins or do they receive the blood so quickly that the toxins are negligible? The article didn't go into that point.

My mum has said for years that if she needed a transfusion she would only accept her own blood given in advance.

Wisewebwoman said...

Me too, Nick, I've given so much blood over the years. Hospitals are the most dangerous place to be when one is ill for sure!
XO
WWW

Nick said...

www - Blood clots alone kill over 25,000 hospital patients a year in Britain. Many of these deaths are preventable with quite simple measures but it's just not seen as a priority. I think I'd have to be dragged kicking and screaming into a hospital!

Dave Hampton said...

Hi, Nick, Your observation was a new one to me (even though I work in the cardiac field) so I went back and looked at the literature. It does seem to bear out what you are saying: a good article by Koch appeared in the New England Journal of Medicine in the March 20, 2008 issue. It does conclude a higher rate of death or complication in blood over two weeks old, although the 3% increments reported wouldn't suggest that people shouldn't get transfusions.

Certainly people with blood loss due to trauma have no other choice: it's life or death. In the case of cardiac surgery, it's a bit more of a back-up and I always thought self-donation was the best practice. But this article makes me take the longevity into account.

Like Aidan, I've been a donor for years, but was barred from being one after 2003 because I'd spent too many cumulative days in the UK. So, never again, according to the rules...

Nick said...

Dave - Thanks for the professional input. When you mention a 3% increment, presumably you're saying that the extra risk is small enough to be worth taking? Interesting that you've always thought self-donation was the best practice. And these rules for donors re UK residence must mean an awful lot of lost donations.

Dave Hampton said...

The data suggests that, all other things being equal, cardiac surgery patients getting older blood had higher complication rates than patients getting newer blood. There was no control case where people didn't get blood at all, so it cannot be concluded (nor do the authors suggest) that blood transfusions should be avoided in general.
For myself, I will use this information to try to arrange for a dedicated donation within two weeks of my procedure, but I would not avoid transfusions.
Here are the authors results from the public abstract:
====================
Patients who were given older units had higher rates of in-hospital mortality (2.8% vs. 1.7%, P=0.004), intubation beyond 72 hours (9.7% vs. 5.6%, P<0.001), renal failure (2.7% vs. 1.6%, P=0.003), and sepsis or septicemia (4.0% vs. 2.8%, P=0.01). A composite of complications was more common in patients given older blood (25.9% vs. 22.4%, P=0.001). At 1 year, mortality was significantly less in patients given newer blood (7.4% vs. 11.0%, P<0.001). So, in patients undergoing cardiac surgery, transfusion of red cells that had been stored for more than 2 weeks was associated with a significantly increased risk of postoperative complications as well as reduced short-term and long-term survival.

Dave Hampton said...

Regarding rules for blood donation, I agree that they are excluding a lot of people. It really surprised me to get turned away (along with most travelers!)

The American Red Cross exclusion is 'From January 1, 1980, through December 31, 1996, you spent a cumulative time of 3 months or more in the United Kingdom (UK), or a cumulative time of 5 years or more in any combination of countries in Europe.'

Nick said...

Dave - I didn't realise there was no control group. That might have made a difference to the results. I won't pretend to understand all the figures but if there are any health pros visiting my blog they might be interested!

To have such a massive residential exclusion simply because of the risk of vCJD seems crazy to me. The number of people who contracted the disease is still miniscule. Is the risk really that great?

Dave Hampton said...

Sorry, let me decode a bit of the conclusion I offered.

The operative numbers were the composite of all adverse complications and the increase in one-year mortality, both having a significant ~3 percentage point excess. The other figures give detailed incidence of respiratory problems, infections, and kidney problems, again showing an excess in patients transfused with older blood.

In general, the finding is precautionary, alerting physicians to the potential adverse effects of using older blood, and the potential need for vigilance and preventative measures when they do.

From a research perspective, scientists will figure out what the toxic agents are and, hopefully, improve procedures for handling or processing blood to address the problem.

Thanks again for posting and hosting a discussion on this topic: it's been a good thread!

Nick said...

Dave - Thanks for contributing so much to the debate. As you say, hopefully there'll be improved procedures for handling blood. And thanks to the rest of you - some great questions and useful bits of info.