While the risk of receiving contaminated blood in South African hospitals is minimal, some people prefer to self-donate blood – or have friends and family give blood - before elective surgery. What are the advantages, and how does one go about it?
Belinda* had had a bowel autopsy, and something wasn’t right. She was bleeding, and the doctors wanted to go in, to find out what was wrong. But they knew the operation was going to require a transfusion, and Belinda was refusing to have one – stressed and frightened as she was, she had become convinced that the hospital’s blood wasn’t safe.
Friends and family rallied around, a compatible donor was identified, and a direct donation took place.
Was Belinda right? Is there, in fact, a question mark over the safety of blood in South Africa – is it safer to get blood from yourself, or from someone you know personally?
Not necessarily, says Dr Arthur Bird, Chief Executive of the Western Province Blood Transfusion Service. "Volunteer donors are screened no less carefully than direct donors are."
In fact, he says, blood from a close family member carries its own risks. "There is a rare, but preventable, disease called Graft versus Host disease. The risk may be as high as one in 400 when you receive blood from a close relative. It develops when the white blood cells from a blood-related donor interfere with the recipient's immune system, skin and liver, leading to severe infection and in some cases to death.
“To prevent this disease it is necessary to irradiate the blood before it is transfused to the patient. This is done in all cases of direct donation."
That’s not a risk, of course, when you self-donate blood in anticipation of a transfusion. It’s called autologous donation, and it may be appropriate, says Dr Bird, before you undergo certain elective surgeries, which may result in moderate to major blood loss.
"People who choose to donate their own blood, do so before elective surgery, most often orthopaedic operations, plastic surgery or urological procedures. The Western Province Blood Transfusion Service deals with 350 – 400 cases annually," he says.
"By receiving your own blood you run no risk of contracting any infection carried by a volunteer donor. Your blood is always the right 'type' for you and therefore there is no risk of incompatible reactions."
Who can donate their own blood?
Most of the health requirements of normal donors apply here. Donors have to be healthy, aged 12 and 70 years, and preferably weigh over 50kg. Their haemoglobin level must be 11g/dL or more, and their blood pressure and pulse rate within normal limits. Even pregnant women can donate their own blood, provided there are no pregnancy complications.
Those people advised against autologous donation include people with:
- cardiac disease, or a history of aneurysms or strokes;
- severe respiratory disorders such as asthma and emphysema. In the case of asthma, this is not a rigid regulation – people with well-controlled asthma can donate. The fear exists that severe asthmatics can become anxious when they have to donate blood, thereby bringing on an asthmatic attack;
- uncontrolled insulin-dependent diabetes. Blood donation may result in hypoglycaemia in certain people who have Type 1 diabetes. Anxiety, brought about by having to donate blood, could also lead to fluctuations in blood glucose levels;
- epilepsy. Once again this is not a completely hard-and-fast rule and it depends on the severity of the condition. The important thing is that the condition must be mentioned to the blood transfusion service, who will then make the decision on whether to go ahead;
- some blood cancers, such as leukaemia, lymphoma and multiple myeloma as well as bleeding disorders or other major blood diseases. A patient who has gone into remission from one of the cancers mentioned above, may be considered for self- donation;
- dental work within three days of the donation. There’s a high possibility of bacterial infections following dental work, especially root canal treatment and tooth extractions;
- current bacterial or viral infections.
When and how should you donate blood for yourself?
Self-donation should be planned well in advance of surgery. Your doctor will determine how many units are likely to be needed. A unit of blood can be donated at intervals of four to seven days.
Therefore, if you need four units, you should start the donation process at least four weeks before the surgery. The last donation should not be less than three to seven days before the surgery, thus allowing you to recover from the temporary loss of blood volume and proteins.
Discuss this with your doctor well in advance of surgery to allow enough time for self-donation or direct donation. You and your doctor will have to complete forms, which are available from your nearest branch of the South African National Blood Service. Further arrangements for testing and donation can be made at the branch.
What are the costs?
There are additional blood tests and administration, so it costs more to donate your own blood than it does to receive donor blood. Even if you end up not needing the blood, you will still be charged for the procedure.
Where can you have this done?
Only the South African National Blood Service or the Western Province Blood Transfusion Service may handle blood donations. It cannot be done by your doctor or by another institution.
What happens if you don't use the blood yourself?
Your blood does not get pooled with other blood donations. "Usually, this blood gets discarded, as self-donations are not seen as truly voluntary donations," says Dr Bird. "Only in rare cases, where the self-donor is also a regular blood donor (who has donated blood in the previous 12 months), could the blood be crossed over to the general pool, but this does not happen often. The fact that this blood often gets discarded, also adds to the price of the whole procedure."
What if friends or family want to donate blood for you?
As long as blood groups are compatible, donations by friends or family, called direct donation, can be done. It takes at least two working days for all the testing and processing to be completed satisfactorily, though, so this is suitable only for elective surgery procedures, and not in the case of medical emergencies.
The same health criteria apply to family and friends as to volunteer donors.
People who may be excluded are those who have:
- a history of hepatitis;
- recently visited a malaria area;
- had diarrhoea or who have vomited in the last 30 days;
- had dental work within the last three days;
- have current minor infections;
- have a history of sexually transmitted infections;
- have had a recent change of sexual partner;
- have any serious medical condition.
Again the costs are slightly higher, for the same reasons.
* Not her real name