| MOST of us would expect to receive someone else’s blood if we needed a transfusion during surgery; blood that was carefully stored, screened and matched with our own, but, nevertheless, someone else’s. But it needn’t be like that. It is possible to have a transfusion of your own blood — a process called autologous transfusion. The practice is rare in the UK, but given concerns about the cost and shortage of donor blood it may become more common. Why have someone else’s blood when you can have your own? Caroline Richmond heard about predeposit autologous transfusion from a neurologist friend, who, before a hip-replacement operation, paid to have blood taken from him ready to be transfused. So when she was booked in for a hip replacement at the Chelsea and Westminster Hospital last year, she asked whether she could do the same on the NHS. “It was partly because blood is in such short supply and I didn’t want to take any out of the blood pool, but also for health reasons — your own blood is obviously far more compatible than anyone else’s,” says Richmond, 62, an obituary writer from South London. She had to fill out a form, obtain her doctor’s approval that she was fit to give blood before an operation, and then was called in to her local blood clinic three times: four weeks, three weeks and two weeks before the operation. She took iron tablets to boost her red blood cells in those weeks. In the event, she required two of the three pints she had donated. But Richmond says that the process was difficult to arrange because no one was switched on to the option. “When I was in hospital, the blood transfusion nurse came up specially to see this remarkable patient,” she says. “At the clinic where I gave blood, they get only two cases like me a month, and at the Chelsea and Westminster they have only a handful of such patients every year.” Things are different in the US, where 8 per cent of blood transfused comes from the patients. The US pioneered the process in the 1970s and 1980s when there was an increasing demand for blood because of surgical techniques such as heart bypasses, and because of fears that Aids would be transmitted through donated blood. Several states made predeposit transfusion an option, and soon autotransfusion became a civil rights issue — people demanded the right to be safe from infection. Several European countries have followed America’s lead. In Italy, 9 per cent of blood transfusion is autologous; 7 per cent in Germany and France. The EU has called on member states to promote autotransfusion programmes to encourage safety and self-sufficiency in blood supplies. Yet in the UK, fewer than 1 per cent of transfusions are autologous. Why? The question has become the subject of debate among NHS transfusion experts in the past decade. Autologous blood supply has had its supporters since the mid-Eighties, but until recently there has been little evidence that it is as cost-effective or practicable. Only from the mid-Nineties have UK blood specialists examined the feasibility of autologous transfusion on a national basis. They have been pushed by the economic necessity of using scarce and expensive volunteer blood stocks more sparingly. Because of improved screening processes, the cost of processing and storing a unit of blood has risen from £30 to £100 since 1998. There has also been a scientific impetus to make blood transfusion safer. The risk of contracting Creutzfeldt Jakob disease (CJD, the human form of mad cow disease) through infected blood added to professional concerns that, although donor blood is carefully screened, it has a greater risk of carrying disease and causing immunological side-effects than blood from the patient. A recent review of the evidence published in the British Medical Journal concluded that autologous transfusion is cost-effective and might reduce the chances of post-operative infections. At last the Government and the National Blood Service (NBS) are advocating it. Last year the Department for Health urged NHS trusts to use autologous blood transfusions. But the way ahead is by no means clear. There are several types of autologous blood transfusion, but the benefits of each are still contested. The best known is a predeposit transfusion — the type that Richmond chose. The disadvantage of this technique, the type most vigorously pursued in the US, is that it is wasteful of time and resources — up to half the blood collected is thrown away. Only patients considered fit before their operation are suitable candidates, and the donation may leave them anaemic for surgery. There is also a bureaucratic disincentive: getting the blood to the right place at the right time is complex and time-consuming. So another type of autologous transfusion is finding favour in cash-conscious trusts — cell salvage. This technique recycles the blood that patients lose in an operation and injects it back into them. Much of the UK pioneering work on this has been carried out by Dafydd Thomas and his colleagues at the Morriston Hospital in Swansea. He conducted trials demonstrating that recycling the patient’s blood in knee-replacement operations reduced the need for volunteer blood transfusion by 72 per cent. “It’s a conservation technique, preserving the donor supply for people who need it,” Thomas says. During surgery, blood is drained from the wound with suction pipes which simultaneously add the anti-clotting agent heparin. The blood-heparin mix is fed to a machine, where it is spun round in a centrifuge. This separates out the red blood cells, which are then washed in a saline solution, resuspended in saline and then pumped back into the patient’s bloodstream, either during or immediately after surgery. Although there is a tiny risk of blood contamination if the machinery is not working properly, or if blood is not washed, specialists have concluded that salvaged blood is safer for patients than volunteer blood. Widespread use of cell salvage would bring savings to the NHS in the long term. In Swansea, Jehovah’s Witnesses — who find salvage one of the acceptable means of blood transfusion on religious grounds — have donated machines to the hospital. “Cell salvage won’t replace volunteer transfusion,” says Thomas, a consultant anaesthetist. “But it has huge potential. In my hospital, we supply 20 per cent of the overall surgical need.” Less than a quarter of hospitals currently use any cell salvage, but Thomas, having been regarded as a renegade a decade ago, now has official backing from the NBS in his attempts to publicise the potential of salvage to NHS trusts. “It’s not just that it’s safer than other means of transfusion; there are also financial benefits,” says Chris Harley, of the NBS. End. Englishman. | 
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