TRANSFUSION

1992-Vol.

191

LETTERS TO THE EDITOR

32. No. 2

2. Silvergleid AJ. Preoperative autologous donation: what have we learned? (editorial). Transfusion 1991;31:99-101. 3. Friedman BA, Oberman HA, Chadwick AR, Kingdon KI. The maximum surgical blood order schedule and surgical blood use in the United States. Transfusion 1976;16:380-7. 4. Axelrod FB, Pepkowitz SH, Goldfinger D. Establishment of a schedule of optimal preoperative collection of autologous blood. Transfusion 1989;29:677-80.

The above two letters were sent to Dr. Kruskall, who offered the following reply. The schedule for autologous blood donations (SOPCAB) developed by Axelrod and colleagues1 is a useful approach for targeting the appropriate number of preoperative collections for given surgical procedures, and I am happy to support it in this letter. However, the purpose of my editorial* was to propose that indications for the collection of autologous blood are limited. I intentionally skirted Axelrod’s article because their SOPCAB calculations, based on current transfusion practices at Cedars-Sinai Medical Center, suggest the use of autologous blood in situations that I consider questionable, such as transurethral prostate resections. Daneshvar believes that patients should be able to choose to donate autologous blood whenever they wish. I disagree for both medical and economic reasons. As Daneshvar himself points out, the risks of transfusion-transmitted disease and the likelihood of a transfusion being needed are just two of the many aspects of transfusion therapy that are very difficult for patients without medical backgrounds to comprehend. Therefore, the decision to collect and use autologous blood should be one of the many made by a physician in the process of caring for a patient. Certainly patients should be educated about autologous blood usage techniques, just as they are about other aspects of their surgery. However, the donation of autologous blood is not a patient’s right, anymore than it would be, for example, his or her right to insist on antibiotics to treat a cold. Although I agree that the donation process is safe, the effort and costs entailed are substantial. Resources for medical care are finite; to conserve them, autologous blood usage techniques, like other medical procedures, should be used only for solid indications. MARGOTS . KRUSKALL,MD Blood Bank Beth Israel Hospital 330 Brookline Avenue Boston, U A 02215

References 1. Axclrod FB, Pepkowitz SH, Goldfinger D. Establishment of a schcdule of optimal preoperative collection of autologous blood.

to transfusion recipients. However, at a meeting earlier this year of the Food and Drug Administration’s Blood Products Advisory Committee, epidemiologists from the Centers for Disease Control said that although two-thirds of the blood donors implicated in an episode of transfusion-associated Yersinia toxemia had gastrointestinal illness before donation, most had mild or moderate rather than severe symptoms or diarrhea. In an unpublished study, four members of the Council of Community Blood Centers questioned almost 6000 donors on more general symptomatologyof gastrointestinal illness no more than 30 days before donation; 9.7 percent gave a positive response. While a deferral rate approaching 1 in 10 prospective donors would cause unacceptable blood shortages, such donation criteria might prevent two-thirds of such transfusionassociated reactions and deaths. Fortunately, the incidence of fatal posttransfusion Yersinia toxemia appears to be extremely rare. Communications with staff of the Food and Drug Administration confirm there has been only one Yersinia-related fatality reported in the last 2 years. However, should the threat resurface, public health authorities might consider shortdating units of blood collected from individuals with a history of any gastrointestinal illness in the 30 days before donation. Almost all Yersinia-associated transfusion toxemias in the United States have occurred more than 26 days into the storage of red cells. If the situation requires some action, selective shortdating of blood collections could serve the dual purpose of protecting blood recipients while making otherwise acceptable donations available for transfusion. LOUIS KATZ, MD Mississippi Valley Blood Services 3425 East Locust Street Davenport, LA 52803 JAMES L. MACPHERSON Council of Community Blood Services Washington, DC THOMAS F. ZUCK, MD Hawvorih Blood Center University of Cincinnati Cincinnati, OH

Reference 1. Grossman BJ, Kollins P, Lau PM, et al. Screening blood donors

for gastrointestinal illness: a strategy to eliminate carriers of Yersiniu enterocoliticu. Transfusion 1991;31:500-1.

The above letter was sent to Dr. Grossman and colleagues, who elected not to publish a response.

Transfusion 1989;29:677-80. 2. Kruskall MS. On measuring the success of an autologous blood donation program (editorial). Transfusion 1991;31:481-2.

Comparison of two approved enzyme immunoassays for the detection of antibodies to the hepatitis C virus in 5216 United States blood donors

Yersinia and blood donation

To the Editor: Testing for antibody to the hepatitis C virus (anti-HCV) by using licensed enzyme immunoassays (EIA-1) should reduce the risk of transfusion-associated HCV infections. The licensed first-generation anti-HCV EIA-1 tests appear to have good sensitivity and specificity, but confirmatory assays for differentiating true-positive from false-positive results are not yet approved by the United States (US) Food and Drug Administration (FDA). This differentiation is especially important in low-risk US populations, such as healthy blood donors. Whereas

To the Editor: In a recent issue of this journal, Grossman et al.’ suggested that asking blood donors about recent history of diarrhea or severe abdominal pain might intercept a majority of individuals infected with Yersiniu enterocolitica and thus prevent potentially fatal posttransfusion toxemia. According to those authors, this strategy would defer about 4 percent of potential donors, the vast majority of whom would represent no threat