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10/13/08
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March 24,
2008 The common practice of storing blood for more than two weeks could be proving fatal for thousands of heart surgery patients, according to a major study. Doctors at the Cleveland Clinic in Ohio have found that patients who receive blood that is more than 14 days old are nearly two-thirds more likely to die than those who get newer blood. … Koch's team note that in the US the average age of transfused blood is more than two weeks - and that around half of all heart surgery patients receive blood transfusions. The most common practice for planned procedures is for the patient to arrange to donate their own blood for use in his/her surgery. This autologous blood donation is obviously best for many reasons, though is not always possible. Friends or family can also dontate blood to be specifically reserved as well. So, blood donated by a stranger would, ideally, only be needed for an emergency. Even then, there are well proven techniques to capture the patient's own blood during surgery and reinfuse it. There are other possible answers available as well. I was not able to find any other studies of this "old blood" problem, but it seems fairly reasonable to expect a time limit for viability of whole blood. If it won't be used right away, it should be converted to plasma which can be frozen and kept viable for a very long time. Current FDA regulations allow blood to be stored for up to 42 days, but nothing requires it to be kept that long, of course. I have not been involved in any kind of surgery for more than 20 years, so I'm not aware of all the latest techniques or advances, but I do know that almost every kind of surgery has been modified and improved to vastly reduce the amount of whole blood and blood products used simply as a response to ongoing shortages of blood donors. In the absence of a free market, shortages are bound to continue and get worse. Given the constant shortages, it's hard to believe much of the supply ever gets that old to start with, but it could happen. Free markets have long proven to be the best way to ensure a steady supply of a product AND the highest quality of product available to buyers; there is no reason for it not to work with blood in the same way it works with food, computers, and clothing. The problem is that blood is NOT available on a free market: not only are the processors and distributors not allowed to purchase blood from producers (as the common name "donor" tells us - people generally don't sell blood but "donate" it), but they are not allowed to sell the blood on an open market in which supply and demand set the price both for the raw product and for the processed materials. In addition, all of the hysteria about diseases like HIV and hepatitis, the serious and very expensive testing required to screen donors, and all sorts of useless regulations that hamper the whole process tend to discourage even those who would gladly donate their blood. Currently, the donor rate is 5% or less of the population. Any government-funded study like this requires careful review, in part because it IS a government study. Even so, I would have to know far more about the study to accept an assertion that use of "old blood" is killing so many people. It is highly unlikely that "old blood" is the deciding factor in most cases, let alone all of them. Remember that correlation is not causation. Some number MORE of those who received the older blood died, but we can't forget that almost as many of those who got the fresher blood died too. Most in both groups LIVED, so the older blood didn't automatically harm anyone either. The potential risk factors in major surgery are many, and there is no indication that this "study" included only autopsy results that determined the exact cause of death. So, at best, older blood may simply be ONE additional risk. Though the size of this study is good, it would be much more meaningful if thousands of hospitals in the country pooled their information and it was analyzed statistically by people who had no ax to grind. This sounds too much like a scrap of fact that has been pumped up and wrapped in hype to make another horrible sounding thing to fear - to agitate for government to "do something"... think of the "Alar" scare, or the bird flu that was going to kill us all years ago. And this: "New measures are urgently needed, say the researchers," raises the red flag of even more "regulation" that will only increase the shortages and muddy the waters further. If hospitals have identified this as a real problem, it seems a simple thing for them to take steps on their own to solve it; just stop using blood that old, work harder to get self and other donated blood, use other techniques. Prospective patients and concerned doctors need to ask the hard questions and satisfy themselves that the best methods and products are being used. That doesn't require government interventions or new "regulations," just personal responsibility and intelligent choices by those who will be affected. Which one would you trust? I keep asking people to point out even one government "law" or regulation that actually guarantees them safety and makes personal involvement in wise choices unnecessary... I've never had a rational response.
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