BAD BLOOD

The National Institute of Health announced last week that two patients who received blood supplied by the Korea National Red Cross’s Jeolla province station had been infected with AIDS.
The incident points to a critical error in the Red Cross system, which provides Korea with 99 percent of its medical blood supplies.
The roots of this problem go back to December, when the blood agency was alerted that some blood donated that month may have been infected with the AIDS virus.
Red Cross officials immediately launched an internal investigation of 79 suspected blood donors. Among those scrutinized, one person was infected by the insidious virus while three others had received blood donations from that person.
Nevertheless, since the Red Cross did not have any of the three recipients’ blood specimens, it took officials five months to determine who had received the tainted blood.
By the time they tracked down the source, one donor recipient had died while two others were in critical condition.
Medical accidents involving blood donations are not isolated cases. According to a 1999 study by a graduate student at Hanyang University, 49 percent of 1,329 hemophiliacs surveyed were also diagnosed as carrying hepatitis C.
Hepatitis C often gets transferred through blood and hemophiliacs, whose blood will not clot and therefore requires extra blood coagulants1, are often exposed to infected blood used in making the coagulant.
The problem lies in the limited ability of the Red Cross and healthcare institutions to detect infected blood. Experts at both kinds of organizations concur that a nucleic acid testing method needs to be introduced for better detection accuracy. The current equine infectious anemia method cannot detect dormant viruses.
In Japan and France in the 1980s, 1,800 and 4,200 people, respectively, were infected with the AIDS virus from blood donations, because the coagulants were infected with the virus.
However, the chance of obtaining the funding necessary to maintain a more secure blood supply in the near future remains slim, according to Red Cross official Kim Young-seob.
Under former President Kim Dae-jung, in 1999 the National Assembly altered blood supply management laws to open the floodgates for a market-driven system that would groom private companies.
Health industry experts have pointed out that private companies facing competition from the Red Cross would likely try to lobby hospitals or offer them rebates. These companies would then attempt to lower costs during the blood testing stage to account for the money doled out on lobbyists, they said.
At the end of the day, patients will have a higher risk of receiving inadequately screened ― or tainted ― blood.
Problems persist in all sectors of the blood supply process, including the hospitals that use donated blood. In a survey conducted by the Korean Blood Transfusion Society, 29 percent of 98 hospitals surveyed have been reprimanded by the Health Insurance Review Agency for either improperly storing or using blood.
As the safety of Korea’s blood supply comes under scrutiny, some patients are exploring their options.
Consider hemophiliac Chung Chang-hoon, who uses imported recombinant blood, which is costlier than blood from Korean supplies. Although his blood product uses cells produced by hamsters, Mr. Chung prefers it to the domestic supply. But this product is restricted to patients who have not previously used domestic blood products.
Cho Nam-sun, a director of blood quality control at the Red Cross, says the demand for blood in medical procedures has grown, but appropriate safety measures have not kept up. “What we need is a major investment in facilities but that’s something that I don’t see happening in the near future,” Mr. Cho says.

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The task for some patients: Find donors or die

It wasn’t enough that Kim Sang-deuk had leukemia. He also had one hell of a time finding blood donors for his bone marrow transplant operation.
After being told in April, 1998 that he had a severe case of leukemia, Mr. Kim was scheduled for an operation at a Seoul hospital that August. However, doctors told Mr. Kim that he needed to find 40 blood donors for his surgery to proceed.
For Mr. Kim, a native of Chungcheong province who knew few people in Seoul, that challenge was akin to summiting Mount Everest. It got so bad, he says, that his mother would even beg passersby on the street to donate blood for her son; not many people responded.
For most leukemia patients it is tougher to find blood donors than someone to donate bone marrow. After a bone marrow transplant, the patient needs to receive copious quantities of blood to supplement their loss of blood platelets, the body’s cells that help in blood clotting.
Not only does the donor’s blood type need to match the patient’s, but the donated blood needs to be tested to ensure it does not cause harmful side effects after transfusion to the patient. In addition, drawing blood platelets is a more time-consuming procedure than a regular blood donation.
“Luckily, my cousin is a high school teacher so after much persuasion I finally could attract 40 donors,” Mr. Kim says.
There are two ways of drawing platelets. The first method, called plateletpheresis, draws only one portion of the blood platelet using a machine called a blood cell separator. The other method, known as platelet concentrate, mirrors a regular blood donation by drawing the blood whole, then separating the platelets.
Though plateletpheresis involves expensive equipment, it is the recommended route in developed countries since one unit of platelets drawn by this method equals the number of platelets collected from six people using the latter method.
In addition, the chances of getting infected from diseases after a transfusion are less likely with plateletpheresis because fewer people’s blood is involved.
Leukemia patients and other advocacy groups argue patients must often track down platelet donors on their own. They also accuse the Red Cross of failing to supply platelets to hospitals in large quantities using the plateletpheresis method.
The Korean Red Cross, meanwhile, insists it can meet the blood platelet supply levels needed across the country,
“The accusation is not true,” says Lee Jae-seung, an official with the Korea Red Cross’s blood donation division. “We are a not-for-profit organization. And we have met every demand from hospitals [for plateletpheresis] since 2000,” when the method began in Korea. “We’re even cutting our own budget and pushing this method,” Mr. Lee added.
Critics remain at loggerheads with them. They explain that in supplying a hospital with six platelet units via the platelet concentrate method, the Red Cross earns 169,380 won ($141). By contrast, the Red Cross earns only 32,530 won from a platelet unit taken by plateletpheresis, which equals six platelet concentrate units.
In sum, the plateletpheresis method is a costlier way for the Red Cross to supply blood; without government support, the Red Cross has a hard time coping with the disparity in costs, critics say.
“Although the Red Cross never admitted it in public, it feels burdened using plateletpheresis, as it widens their deficit gap,” said one Red Cross official who insisted on anonymity.
Hospitals are also looking out for their own interests in blood management, contend patient rights groups. They collect 10,000 won ($8) from patients who receive platelet concentrate, but 100,000 won from those who receives platelets abstracted from plateletpheresis.
If a hospital asks a patient to find its own donors and abstracts the platelets using their equipment, the hospital can charge the patient 330,000 won.
“Because of the immoral acts of the Red Cross and hospitals, the patients are suffering,” asserted Kim Myeong-hee, a doctor and activist of a Catholic civic group.

by Park Seong-won, Song Seong-hui