Blood Filtration Debate Highlights Cost vs. Care Dilemma
Jan. 26, 2001 (Washington) -- Most Americans probably do not know why more than half of the nation's blood supply is filtered to remove the white blood cells, a process called leuko-reduction. But Nancy Chance, a blood-bank coordinator at a small hospital in Noblesville, Ind., can explain why the expensive filtration process is an important one for patient safety.
Several years ago, her brother-in-law's 39-year-old twin received unfiltered blood while being treated for a cancer of the bone marrow. When the body receives substances that it recognizes as foreign, the immune system is triggered to form antibodies. These antibodies can be reactivated when the body is exposed to a foreign substance on a separate occasion. In the case of her relative, antibodies were triggered against the bone marrow transplant meant to save his life, and he died a few months later.
Now a panel of experts has advised the government to require all blood to undergo leuko-reduction as soon as it is feasible. They believe the filtering process will make the nation's blood supply safer for organ transplant recipients and protect others from transfusion-related side effects, like viral infections, fevers, and chills caused by the unnecessary white blood cells.
On face value, the decision made Friday -- after two days of heated discussion -- appears to make sense. But it lacks universal support. Why?
Cost vs. Care
No one questions the benefits of leuko-reduction for at least a certain group of patients who are at a greater risk of suffering transfusion-related side effects. But there are those that say that the cost, estimated at $500 million per year, simply does not justify doing it for everyone.
Among those is Gerald Sandler, MD, director of the blood bank at Georgetown University Hospital in Washington, D.C.
He says the money would be better spent on other patient protections, and that evidence supporting its wide use is scanty. He also is fearful that adopting this universal approach now would halt vital ongoing research in this area.
People who support universal leuko-reduction, however, say that available evidence is more than adequate.
"There are ... clear benefits to universal leuko-reduction," Paul Ness, director of transfusion for John Hopkins Medical Institutions, tells WebMD. He says that in crowded wards, at-risk patients could inadvertently be given the unfiltered blood.
"If you want a reliable system, you have got to keep things simple," Ness says.
Better Product or a Worse Process
In general, most experts agree the filtered blood is a better product. But some question whether this better product will indeed lead to a better process.
For instance, the filtering process would reduce the nation's blood supply by nearly 10% at a time when further shortages are possible. They also say that the filtering process could undermine stepped-up efforts to encourage badly needed donations by minority donors.