Rakesh was a victim of a road accident, like so many others in the chaos corridors of Calcutta. He was rushed to a local nursing home after being knocked down by a minibus, but by the time doctors could attend to him, he had lost a lot of blood. An immediate transfusion was required.
The 30-year-old computer engineer started responding to treatment following the transfusion, but a couple of days on, he started running a slight temperature. Doctors initially dismissed it as after-affects of trauma.
But the fever persisted, accompanied by bouts of shivering. Subsequent tests revealed that Rakesh had contracted malaria, and the only possible culprit could be the donated blood.
His is not an isolated case. Doctors often have to deal with infections caused by blood transfusion. “Any person receiving blood from another person runs the risk of being infected by a number of viruses, bacteria and protozoa (say, malaria), despite the best efforts and finest testing technology of any transfusion service in the world,” observes Pankaj Srivastav, consultant, transfusion medicine, Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS).
Being exposed to foreign protein present in the donated blood makes the recipient vulnerable to multiple reactions, adds Srivastav, who feels the safest blood that a person can receive is his own. “This is called autologous blood transfusion. However, when transfusion is needed due to reduced production of blood or blood loss due to injury, there is no option but to replenish the lost amount from other persons, or allo-transfusion,” he says.
In such cases, doctors take every possible step to avoid any untoward reaction, ranging from innocuous fever to life-threatening anaphylaxis. But even after proper testing of the donor’s blood, complications like incompatibility reaction or infection can crop up.
“Sometimes a dreaded condition like hepatitis-C or even AIDS can be missed if the blood is screened during the incubation period of the micro-organism, or the ‘window’ period, when the symptoms are not yet manifest,” says senior pathologist and former dean, faculty of medicine, Calcutta University, Subir Kumar Dutta.
In cases where the patient is to undergo a planned surgery, he/she can avoid possible complications of ‘allo-transfusion’ by choosing autologous transfusion. “It is the safest method of transfusion, as the patient donates his/her own (auto-self) blood, sufficiently ahead of the surgery, to be re-infused after surgery,” according to Srivastav.
A patient can donate as much as four units of blood in an interval of three days and in case of children, as much as two units can be drawn. The withdrawal must stop three days before surgery. “Autologous transfusion is, indeed, the ideal situation in planned surgeries,” agrees Dutta, “since one can never be sure even if blood is drawn from friends or relatives”.
There are two prerequisites for autologous transfusion — the patient’s haemoglobin count should not be less than 11gm/dL and his/her general health condition should be good enough to withstand blood withdrawal.
Autologous transfusion is effective in almost all planned surgeries, including coronary artery bypass grafting (CABG). “Blood transfusion can become so much safer if more people agree to be their own donors,” concludes Srivastav.