Dáil Éireann díospóireacht -
Tuesday, 23 May 2000

Vol. 519 No. 5

Adjournment Debate. - Blood Transfusion Service.

Mr. Stanton:

I thank the Ceann Comhairle for allowing me to raise this issue. The issue of autologous transfusions was brought to my notice by a doctor and a patient. The patient has to go to hospital for surgery and the surgery will probably require a blood transfusion. She was anxious to donate her own blood in advance so that this blood could be used in the transfusion during the operation. To the surprise of this woman and her GP, this facility is available from the Irish Blood Transfusion Service in Dublin but not in Cork or, to my knowledge, in any other part of the country.

I ask the Minister to arrange for this important service to be made available both in Cork and in other parts of the country. The number of people who might opt for this service is small but using one's own blood is the safest method of blood transfusion. The blood is a perfect match and there will not be an adverse reaction due to mismatched blood types. If one is disease free, one obviously cannot contract a disease from the blood. In addition, it gives a person great peace of mind to know that his or her own blood is to be used – this was at the heart of the matter which the lady in question brought to my attention.

I made inquiries with the BTSB about this, and was told it is possible and it would not take much to make this available to citizens. I want to impress on the Minister the importance of doing this, especially in light of all the fear and disquiet which exists around blood transfusion. I did some research into it and discovered that this is readily available, especially in America where they can freeze blood for up to ten years if people want to use it in blood transfusions.

Furthermore, in certain cases it has been shown that the use of one's own blood reduces patient recovery time which can obviously lead to less time spent in hospital and a financial saving to the Exchequer and insurance companies like VHI. In addition, it seems that using one's own blood in certain cases, especially in operations on cancer of the neck, head, etc., where transfusions are necessary, reduces the risk the cancer recurring. I came across studies which indicate this, whereby if one gets somebody else's blood in these operations, the risk of getting cancer again is actually increased.

I ask the Minister to set in train a study in this area and put in place resources and personnel, if it is merited as I think it is, to enable citizens to avail of this service not only in Dublin, where it is available, but across the country.

Minister of State at the Department of Health and Children (Dr. Moffatt):

I thank Deputy Stanton for raising this issue on the Adjournment. Autologous blood transfusion is the facility whereby a patient donates or pre-deposits blood for his or her own use prior to elective surgery. Decisions regarding the utilisation of autologous procedures in individual cases are a matter for the hospital consultant with clinical responsibility for the patient. However, the Irish Blood Transfusion Service, formerly the Blood Transfusion Service Board, has a policy of providing an autologous blood transfusion service on request subject to strict guidelines, fully informed consent and on the basis of referral from a hospital consultant.

In addition to the IBTS, some hospitals provide their own autologous service. For example, in the Southern Health Board region this service is provided by Cork University Hospital and, through CUH, to all other hospitals in the Southern Health Board area. The autologous service in the Southern Health Board must be requested by the surgeon in charge of the case, and the procedure is carried out by appointment with the clinical haematology team at CUH.

Autologous pre-deposit is appropriate only in a minority of elective procedures and there is lack of unanimous agreement among clinicians about its value. Decisions regarding the utilisation of autologous procedures in individual cases, as I have said, are a matter for the patient's clinician. I would advise any patient who wishes to avail of this service to discuss the matter with his or her consultant, who will provide the appropriate advice.

It is also important to appreciate that not all patients undergoing surgery will be suitable to pre-deposit their blood. Some may not meet the medical criteria, and other factors such as adequate venous access are essential consider ations. The policy of the IBTS, on the recommendation of its medical consultants, is that in general autologous donors should meet the service's guidelines set down for donors. These guidelines are in line with the recommendations of the Council of Europe Guide to the Preparation, Use and Quality Assurance of Blood Components.

The Council of Europe's guidelines stipulate that autologous blood components obtained from pre-operative donations must be collected, prepared and stored in the same conditions as donations for other persons, or allogenic donations. Blood typing and microbiological screening for autologous transfusion should be the same as the minimum required for allogenic components, and methods of preparation should be the same, except that autologous donations should be maintained in separate batches. All the same pre-tranfusion tests must be carried out as for allogenic donations. For the reasons outlined, the pre-deposit procedures must be performed in, or under the control of, blood transfusion centres or hospital haematology departments.

In cases of elective surgery where a blood transfusion is expected, the responsible clinician, usually the surgeon or anaesthetist, must prescribe pre-operative donations. The decision to do so will include the type and number of components required.

The guidelines stipulate that the patient must be informed of the respective risks and constraints of both autologous and allogenic transfusion, and that allogenic transfusion may also have to be used if necessary. The guidelines also state that the patient should be informed that unused units of blood will be destroyed. Having been fully informed of the procedure, the patient should then be in a position to give written informed consent.

The final responsibility for ensuring that the patient's health is satisfactory to allow donation of the required number of units rests with the doctor who undertakes the pre-deposit procedures. The patient's status with regard to virological markers must also be established before the final decision is made. The Council of Europe's recommendations are that pre-deposit donations may be safely carried out in elderly patients, although more careful consideration is advised in the case of patients over 70.

I understand that most cases of autologous transfusion tend to be associated with orthopaedic surgery but may also be carried out in respect of other procedures. With regard to cardiac surgery, autologous transfusion may sometimes be appropriate, subject to the assessment of a cardiologist. However some conditions, including unstable angina or uncontrolled hypertension, would normally rule a person out from availing of the opportunity to pre-deposit.

I reiterate that autologous transfusion is available to suitable patients in the Cork region through both the IBTS and Cork University Hospital, and that patients in the region who wish to avail of the procedure should discuss the matter with their consultant in the first instance. I realise that differs from what Deputy Stanton said but—

Mr. Stanton:

The IBTS is not able to carry out this in Cork.

Dr. Moffatt:

I understand that it is, if it is requested to do so on a case by case basis.

Mr. Stanton:

No. That is not true.

Dr. Moffatt:

I will check it out further and come back to the Deputy on it. That is the information which is available to me tonight.

Mr. Stanton:

That was the point of raising the matter.