Frozen-Blood Banks Draw Interest : Experts Debate Cost, Health Benefits of Storing Your Own
If Dr. Robert Elson had his way, President Reagan would deposit some blood in a stainless-steel freezer on the fifth floor of a West Los Angeles medical office building.
There, chilled to an Antarctic 85 degrees below zero Celsius (about 120 degrees below zero Fahrenheit), the President’s blood would await the uncertainties of the future, pint-sized packets of insurance against the day when the Chief Executive might need a transfusion. By storing his own blood, the President would be protected from the threat of AIDS and other blood-transmitted diseases, Elson maintains.
For Elson, this is not a fantasy. It is the logical extension of remarks the President made in an interview with The Times recently when he suggested that people worried about contracting acquired immune deficiency syndrome from transfusions stockpile their own blood. “Why don’t healthy and well people give blood for themselves?” Reagan said.
Letter to President
In response, Elson, who has frozen his own blood and plans later to have his wife’s blood frozen, said he sent a letter to Reagan, offering to preserve the President’s blood for use when he is on the West Coast.
Elson, a gastroenterologist, is the medical consultant and spokesman for HemaCare-Westside, one of a half-dozen or so private blood banks around the country that specialize in storing or freezing blood for those who don’t trust the traditional blood supply. Scattered across the country from California to New York, these private blood banks account for an infinitesimal amount of the nation’s blood supply. But what they represent--as a potential threat to traditional blood suppliers such as the Red Cross--and what these companies allege about the nation’s blood supply have been big enough to create a raging debate.
For instance, Reagan’s remarks sparked widespread criticism, including a statement from the American Red Cross charging that stored or frozen blood was useful only “for the relatively few people who know that they will require blood in the near future and are able to donate the blood needed in advance.”
There is general agreement on only one point: An individual’s blood--technically known as “autologous” blood--is indeed the safest source for transfusions. Beyond that, the reasons for disagreement multiply almost endlessly.
On one side, the country’s biggest suppliers of blood (most of it donated) say that the blood supply, while not perfectly safe, is as safe as practical. They note that current tests, including one for AIDS antibodies, virtually eliminate the chance of receiving tainted blood.
Frozen blood, they say, is expensive and highly unlikely to be available for immediate use in case of severe traumas. They also charge that private companies freezing blood--which can be stored for as long as three years--are out to make a quick dollar by playing on the public’s fear of AIDS and other diseases. Furthermore, such private blood banks could create a climate in which the country’s supply of blood for general use--already subject to periodic or chronic shortages in many places --would be further reduced.
Currently about 4 million people require transfusions of 14 million units of blood and blood components each year, according to the American Assn. of Blood Banks. Transfusions caused 2%--or 171 out of 8,529--of all AIDS cases last year, and officials attribute most such cases to transfusions made before a national blood-screening program against AIDS was started in April 1985.
From 2,500 to 5,000 Americans are estimated to have received blood that contained AIDS antibodies. Health authorities say the test is not perfect and generates some false positives and false negatives for exposure to AIDS antibodies. As of mid-June, 21,726 cases of AIDS had been reported in this country.
On the other side, the private blood bank operators say they have responded to a public need, that their methods--including testing beyond normal requirements--are safer and that the risk of disease or adverse reaction through transfusions from the general blood supply has been downplayed and distorted.
The Financial Side
While private frozen-blood banks have been in operation less than a year, the operators say it’s obvious that no one is going to get rich quick. A Phoenix-based company is “restructuring” its prices and a spokesman for a New York company said some frozen-blood businesses are likely to fail because they can’t weather the start-up period.
In personal and telephone interviews around the country, it became clear that opponents and supporters of frozen blood are passionate defenders of their positions and that emotions are seldom far removed from the scientific discussions of blood, blood components and the elusive agents of disease.
For instance, Elson said operations such as HemaCare may be the pathfinders for a revolution in the blood business.
“I agree we shouldn’t panic the public but they should be educated and they should be concerned about the blood supply,” he said. “It may be that we have to change the entire blood industry, that we have to promote blood banks in the truest sense of the world: Bank your blood. Have your family’s blood banked and when you need blood you’ll have a safer supply.”
But Dr. George Smith, who is in charge of UCLA Medical Center’s blood bank, one of the West’s biggest users of blood, views frozen blood as “a pig in a poke that will make some people some money but will not solve the problems it’s reputed to solve.” Several years ago UCLA considered developing a nonprofit frozen-blood bank but rejected the idea, Smith said.
He and others cited logistics as one of their chief objections. “People frequently aren’t sick where the blood is stored and it isn’t immediately available,” Smith said. “You just can’t take it off the shelf and give it in two minutes.” Even using emergency procedures, it would take at least an hour to thaw the blood, he said.
Smith and others noted that patients planning surgery frequently donate their own blood for future use, although long-term storage is not often available at hospitals. The maximum storage period for whole, unfrozen blood is 35 days.
If frozen-blood businesses become successful, Smith said, people may start “hoarding” their own blood, reducing the already small percentage of blood donors, about 5% of the population. Noting that perhaps 30% to 50% of the population is healthy enough to give blood, Smith said, “It’s too bad that our society hasn’t found a way of motivating the right people to donate blood.”
Elson responded to such charges by saying that donors are told that their frozen blood won’t be of much use in case of gunshot wounds or injuries in accidents. But he said HemaCare is committed to delivering blood to hospitals in case of emergencies and will take steps to ensure that the blood is available for planned surgery or other needs.
So far the frozen-blood operations have not collected significant amounts of blood.
HemaCare, which started up in March, has only 10 to 15 units in its 200-pint capacity freezer, Elson said. A spokesman for YourBlood Inc. of Phoenix said the company has collected blood from five donors since it started a pilot program in February at a Boston hospital. The National Frozen Blood Repository Corp. in Manhasset, N.Y., reported that it has had 12 donors of frozen blood since it opened four months ago.
However, the oldest of the frozen-blood companies, the Daxor-Ident Division in New York, reported that it had collected slightly fewer than 200 units of frozen blood since it began operating late last year. Even though it is apparently the biggest of these businesses, Daxor’s Dr. Joseph Feldschuh said it will be quite a while before the company begins breaks even on frozen blood.
While people usually are receptive to the idea of frozen blood, they often balk at storing their own, Feldschuh said. “It’s going to take a period of education for people to accept what appears to be a revolutionary idea,” he said. “. . . No one likes to contemplate the fact that they might need blood.”
Prices Vary
Prices may be responsible for some of the public’s resistance, said Rod Groen, vice president of YourBlood. Costs range from HemaCare’s $235 for three years for the first pint with reduced prices for additional units, to $150 a year per pint at Daxor.
Groen said that his company is restructuring its prices from the $319 for three years’ storage. A spokesman for HemaCare said it isn’t clear what policies health insurance companies will adopt regarding frozen blood. In some cases companies have paid, in others they haven’t, the spokesman said.
Whoever is paying, the frozen-blood companies maintained that their prices are reasonable, given the amount of equipment, security and staffing required for their centers.
Opponents say that whatever the price, many people will not be able to store their own blood, and that such a service is a refuge for the well-to-do.
The debate between the frozen-blood companies and established blood suppliers is a contest over whose blood is safest.
In the best of all possible worlds, everyone agrees, everybody would receive his or her own blood. But, they also agree, that isn’t always possible.
The next-best thing, frozen-blood banks say, is to use “designated donors” whose blood has been more extensively tested than blood from community blood banks.
Community blood banks say that designated donors such as friends and relatives are no more likely to have disease-free blood than the population at large.
Daxor’s Feldschuh said that his company administers as many as 40 tests on blood from donors. Feldschuh and Elson said that their companies administer tests which are indirect indicators of a form of hepatitis for which there is no direct test. In addition to these tests, Elson said HemaCare administers other tests, requires a more extensive medical history than normally required and checks for such symptoms as swollen lymph nodes, none of which are required by state or federal regulations or the American Assn. of Blood Banks.
UCLA’s Smith said all blood donors are required to give a medical history and their blood is tested for hepatitis-B, syphilis and antibodies to the AIDS virus HTLV-III. If a person tests positive for the AIDS antibodies, it indicates that the person has been exposed to the virus and may develop the disease. The test for AIDS antibodies began to be required of all blood donations in spring of 1985. Smith also said that by the end of the year the two indirect tests for hepatitis will be in use nationwide.
Stricter Regulations
Even when these tests are implemented nationally, Elson said, the standards applied to the use of blood may not be as rigid as that at his company, which will not allow designated donations from health-care professionals and others who may have come in contact with those who suffer from AIDS and other blood-transmitted diseases. By HemaCare’s standards, Elson said, his own blood can’t be used for transfusions for others.
There apparently is no estimate on the number of people who yearly contract diseases or suffer reactions from transfused blood. Feldschuh said there may be 200,000 to 400,000 cases of blood-transmitted hepatitis each year. Conceding that many of these cases are mild or “asymptomatic,” Feldschuh said the incidence of hepatitis from transfusions has been “covered up because nobody very famous has died from transfusion hepatitis.”
James McPherson, executive director of the Council of Community Blood Centers, a Fairfax, Va., trade group that represents 32 community blood centers around the country, said, “I would argue that the blood supply is as safe as practical.” He said it is important to maintain “national confidence in the blood supply.”
HemaCare’s Elson said, “Even doing everything that we do here, when you get somebody else’s blood, there’s still a risk.” But, he said, thorough screening can considerably reduce the risk and minimizing risk ought to be the goal of all blood programs.
“It’s always easy in medicine to say, ‘Oh, the risk is only 1 out of 100,000.’ If you’re in the 99,999, the risk for you is small and doesn’t matter but if you’re that one individual, particularly with regard to AIDS, the minimal expense of paying for one unit of frozen blood, compared with the death sentence of getting AIDS, it just seems to me to make sense,” Elson said.
