Plastic surgeon Bernard Scott Teunis hasn't given a patient a transfusion from a blood donor in the last three years.
New techniques have greatly decreased blood loss in surgery. But there is another reason, too. If Teunis suspects a transfusion may be required, he recommends that patients have their own blood drawn and stored in advance.
"Then it's available if we need it, " he says. "It's to the patient's advantage to do this."
The reinfusion of a patient's own blood, known as autologous transfusion, was common early in the century, but it was abandoned when safe methods of collecting, storing and transfusing donor blood were developed.
Today there is renewed interest in the procedure, primarily because of concern about transmission of disease -- particularly acquired immune deficiency syndrome (AIDS), although hepatitis is a greater risk -- through blood transfusions.
"When the doctor scheduled me for a total hip replacement, I told him there was one condition -- no blood transfusions," said John Collins of Annapolis, a biologist with the Food and Drug Administration.
Four years ago, Collins, now 53, had emergency surgery for bleeding ulcers. "They gave me 12 transfusions . . . They saved my life, but I developed a transfusion-related hepatitis."
Because of his concerns about another transfusion, Collin's surgeon, Dr. Charles Rogers of Arlington, sent him to the Fairfax Hospital blood bank, where four units of blood were drawn over time and stored. All four units were used during surgery without incident.
The concept of autologous transfusion is beginning to gain some popular support. "I've told all my friends about it," says Joanne Jones of Savage, Md., who recently has had blood drawn at the Washington Hospital Center in advance of extensive oral surgery.
"Everyone is worried about AIDS," Jones said, "and they all say they would have the same thing done if they were having an operation."
The chance of contracting AIDS from a transfusion is extremely remote, but according to the Clincial Center at the National Institutes of Health, 7 to 10 percent of all persons receiving blood transfusions nationwide last year contracted non-A non-B hepatitis, a disease that can lead to either mild or very grave symptoms.
Autologous transfusion eliminates the danger of disease, as well as the possiblity of adverse transfusion reactions -- usually chills and fever -- because it's the patient's own blood. For patients with rare blood types, donating their own blood ensures the availability of a proper blood supply.
"When you're talking about transfusion," says Dr. Susan Leitman, acting chief of the blood services section of NIH's department of transfusion medicine, " 'ideal' blood is your own blood."
On the other hand, having blood drawn and processed in advance is inconvenient for the doctor and patient. It is also extremely inconvenient for the blood bank, which must provide exact record-keeping so the blood gets back to the correct patient.
Even if everyone supports it, it won't work in every situation. Autologous donation is not possible for emergency surgery, during which large amounts of blood are often required, or when the patient has a specific health problem that will not allow him to qualify to donate blood even for himself.
The procedure for drawing blood for a patient's own use is identical to a routine blood donation. The patient will have one unit (450 cubic centimeters, or about a pint) drawn at a time, up to a total of seven or eight units depending on the type of surgery to be performed and the length of time before the operation.
Most people in good health can donate one unit safely every 10 days and as close to surgery as three days, but when time allows it is common for blood to be donated at four week intervals, with a cut-off date of seven to 10 days before surgery.
Fresh blood has a shelf life of 35 to 49 days, depending on the preservatives used. Blood drawn further in advance can be frozen and stored for as long as three years.
Blood designated for the donor's own use can be drawn only at a blood collection center, such as those operated by the American Red Cross, or a hospital blood bank.
The informed consent signed by the donor at the Red Cross includes permission for "use or disposal of the blood in any manner deemed appropriate by the American Red Cross" if the blood is not required during surgery.
In most instances this means the blood will be added to the community supply. For this reason the Red Cross, with very few exceptions, requires that donors for autologous use meet the same federally set health standards as other donors.
Exceptions to those standards are more likely to be made at hospital blood banks, when the surgeon believes that autologous transfusion is strongly recommended for a patient who fails to qualify. If, for example, a patient has had syphilis or hepatitis, the blood is unacceptable for other use but can do no harm to the person from whom it was drawn.
Blood from patients who fail to meet the federal donor standards will be discarded if autologous transfusion does not take place.
Certain conditions, including pregnancy, genuine anemia and poor general health, are generally viewed as disqualifications for any blood donation.
A cancer patient preparing for surgery almost never will qualify because of fear that blood donation may produce further debilitation. Patients scheduled for open heart surgery are not considered candidates in most hospitals, although there are exceptions, most notably the Walter Reed Army Hospital program.
In the District, most autologous donation is for major orthopedic procedures such as hip replacement surgery; for certain plastic and reconstructive surgery such as breast reduction and fat suction; for ear, nose and throat surgery, most commonly a bite-correcting procedure known as sliding osteotomy; and in some gynecological surgery, most often hysterectomy.
Although 546 hospitals nationwide have established procedures for autologous transfusion, only a small percentage of the patients who might donate blood for themselves are doing so.
In the Washington area the Red Cross, which supplies 60 local hospitals, handled 144 autologous donations between January and October 1984. At Fairfax Hospital, where 16,000 units of blood are drawn each year, 200 were drawn for autologous procedures in 1984.
At the Washington Hospital Center, the estimate is 10 to 15 units a month. Dr. William Battle, director of the department of pathology and nuclear medicine at Sibley Hospital, reports that only 25 to 30 units of pre-deposit blood were drawn there last year.
The use of autologous transfusion is low, in part, because the largest share of the blood is used for emergency surgery. The Washington Hospital Center, for example, uses more blood than any hospital in the region because of its Medstar Unit, which treats severe emergencies, its burn unit and its extensive open-heart surgery program.
The proponents of autologous transfusion, however, say the practice could be more widely used if doctors were better educated about its benefits.
The American Association of Blood Banks, a professional organization, has set up standards for autologous transfusion and is planning to make presentations at major medical meetings promoting the practice.
Dr. Robert Thurer, a Boston surgeon who heads the committee on autologous transfusion of the American Association of Blood Banks, says encouraging patients to donate blood for themselves is a complex question.
"When you promote autologous transfusion, you raise anxiety about the safety of the community blood supply in people who must get other people's blood," he said. "We are asking ourselves how we should be going about instituting a broad program of physician education . . . Just because you think something's wonderful, it doesn't mean you can tell people that without creating a lot of havoc."