Is the blood supply safe? The question has seemed less urgent since blood and organ banks started screening donors for the AIDS virus six years ago, but it was back in the news last week. First came the disclosure that at least six people had contracted the virus after receiving tissue or organ transplants from a 22-year-old murder victim who had apparently been infected too recently to test positive. Just days later the American Red Cross, which manages half of the nation's blood supply, announced sweeping changes in the way it manages the vital resource. Conceding that the organization could no longer "patch and bandage a system that evolved in the 1940s," Red Cross president Elizabeth Dole called for "nothing short of a transformation."
Though far from risk-free, the blood supply is now safer than ever. Thanks to universal screening for the AIDS virus (HIV), the odds of getting infected from a transfusion are less than one in 40,000. Yet the task of testing and tracking 6 million units of blood each year has overwhelmed the Red Cross's antique administrative system. Last year a federal investigation found that the organization had failed to inform the government of hundreds of potentially dangerous clerical errors. Congressional inquiries have since uncovered further evidence of sloppy record keeping, poorly trained personnel and inadequate blood-testing procedures. None of the deficiencies have caused known harm to patients, but the potential has alarmed health officials.
The Red Cross will now spend more than two years and $120 million cleaning up its act. Starting early next year, each of its 53 regional centers will be temporarily shut down and reorganized. The revamped centers will continue to recruit donors, collect blood and separate it into useful components. But all blood-testing operations will be transferred to 10 larger laboratories with better-trained staffs. At the same time the organization's 10 separate computer systems will be consolidated into one.
Blood transfusion has always posed hazards, but they didn't receive much attention until the AIDS epidemic struck. Thousands of Americans-including half of the nation's 25,000 hemophiliacs-contracted the AIDS virus through blood products during the early 1980s. Blood banks responded in 1985 by initiating universal screening for HIV. Today they screen all potential donors for a range of infections, including syphilis, three strains of hepatitis and HTLV-1, a virus that causes leukemia.
No one can say precisely how effective the effort has been. Of the 12 million units of blood the Red Cross and other organizations release each year, the FDA estimates that 50,000 may now carry hepatitis (down from 1.2 million a decade ago) and that 100 to 400 may contain HIV (down from 8,400 a year in the early '80s). How many of those theoretically tainted units end up spreading infection is unknown. In six years, experts have traced only 15 actual cases of AIDS to transfusions of screened blood. Still, says Dr. Gerald Quinnan, head of the FDA office that oversees blood banks, "there will never be a zero risk."
One reason, where AIDS is concerned, is that the standard screening tests detect antibodies to the virus. Because those antibodies don't typically show up in the blood for six weeks, a newly infected person-someone like the 22-year-old organ donor who made headlines last week may appear perfectly safe. Two firms have developed blood tests that look for the AIDS virus itself But in large trials, the new tests have yet to detect an infection that the standard tests missed.
Even if AIDS, hepatitis and the like could be purged from the blood supply, other threats would remain. Infections that blood banks don't always screen for, but that recipients sometimes contract, range from Epstein-Barr and cytomegalovirus (common bugs that can devastate people with weak immune systems) to malaria and Chagas' disease (a South American variant of African sleeping sickness). To minimize the risks, many Americans now have their own blood stored before surgery. Experts applaud the trend, but they note that it won't eliminate the greatest danger of all-that of receiving incompatible blood through mislabeling or a bedside mixup. Bedside errors are not hard to prevent; one system involves placing a lock on each blood bag and recording the combination on the intended recipient's bracelet. But when it comes to trusting what's in the bag, there's no substitute for a well-managed blood system. Overhauling the Red Cross could be a big step in that direction.
Uncommon Knowledge
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
