Bloody dilemma.

Bloody dilemma

After weighing the risks of blood transfusions, now charged with occasionally transmitting hepatitis and AIDS and causing immunosuppression, a panel of experts covened at the National Institutes of Health recently recommended eliminating the old "10/30" rule. The rule dictates a transfusion when a surgical patient's hemoglobin value falls below 10 grams per deciliter and the hematocrit -- the percentage of red blood cells in a blood sample -- becomes less than 30 percent. Improved surgical and anesthetic techniques figured in the reevaluation, as well as clinical experience showing that patients could survive surgery with lower blood-test values. Recognizing that "with every unit you get, the risk incrementally increases, therefore, the fewer the better," conference chairman Tibor J. Greenwalt of the University of Cincinnati says the decision to transfuse should be left to physicians. "We didn't want to set another irrational number," he says.

In reviewing alternatives to standard transfusion, Margot S. Kruskall of Harvard Medical School in Boston reports that the use of a patient's own blood, donated earlier -- overall the safest alternative -- is limited. Although such autologous transfusion has increased dramatically, she says, it accounts for only 2 percent of transfusions. She attributes this to indifference by some physicians and a lack of patient education and public knowledge of the process, as well as the lack of a well-organized system for dealing with this blood. Moreover, misconceptions remain about hazards of donation. "What are you going to do when much of the population still thinks you can get AIDS by giving blood?" Greenwalt asks.

The panel says other safe alternatives, such as intraoperative blood salvage (collecting blood from a patient during an operation for subsequent use) and hemodilution (removing blood and substituting other fluids to keep blood volume up) are useful in selected cases, while some of the more innovative approaches, including artificial blood, remain experimental. Standard, homologous transfusions will be the mainstay in the foreseeable future, it concludes.