Blood Filtration Debate Highlights Cost vs. Care Dilemma
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.
Cleso Bianco, MD, director of the New York Blood Centers, explains that the filtering process would eliminate some donations from African-Americans because they carry a gene for sickle cell anemia, a disease in which red blood cells become abnormally shaped. While blood from sickle cell anemics cannot be used for transfusions, certain blood components -- components that are in short supply -- could still be used to treat others in the community.
"This universal leuko-reduction shouldn't go forward until the implications are understood," says Bianco, who also has served as president of America's Blood Centers, which collects about half of the nation's blood supply. "The impact on African-Americans needs to be examined."
A Divided Front
But universal leuko-reduction enjoys the support of the American Red Cross, which collects the other half of the nation's blood supply.
The issues raised by filtration are not insurmountable, and even a small benefit would justify requiring universal leuko-reduction, the organization says.
In addition, Jacquelyn Fredrick, executive vice president of the American Red Cross, argues that selective leuko-reduction essentially discriminates against at least half of patients getting blood transfusions because only half of the nation's blood supply is filtered.
"It's not an either/or issue," she tells WebMD. "If costs were off the table, I bet almost everyone would already be using leuko-reduced blood."
Leuko-reduction could save money in the long run. Use of filtered blood would lead to shorter hospital stays, according to Edward Snyder, MD, director of transfusion at Yale-New Haven Hospital. In addition, adopting universal leuko-reduction would eliminate screening blood for common blood-borne viruses, which essentially are eliminated by the filtering process, he says.
At present, the decision of when to use leuko-reduced blood is left up to individual medical institutions. The FDA does believe that the process leads to a better product. But unlike health officials in Canada and some European countries, where leuko-reduction is required, U.S. health authorities have stopped short of requiring universal filtration.
The panel's Friday decision, however, opens the door for the FDA to move ahead with a rule requiring universal use of leuko-reduced blood.