November 28, 2012

Blood supply key to world campaign to eradicate HIV/AIDS

"They [Red Cross] make it so easy for you to donate blood," comments Kaiser-Permanente's Director of Special Marketing Programs, Tom Hussey. Photo from Factors, Pacific Northwest Regional Blood Services newsletter (American Red Cross) June/July 1984

Contributed by Lincoln Cushing, Archivist and Historian

The WHO adopted one theme for the years 2011 to 2015: “Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.” One focus of “Getting to zero” has been a global effort to ensure a safe and ample supply of that renewable potion of life ⁠— human blood.

In its 67 years of operation, Kaiser Permanente has been an active partner in the ongoing quest to keep blood available and free of dangerous contaminants.

In 1948, 3 years after the Permanente Health Plan was opened to the public, the Permanente Hospital in Oakland started its own blood bank. It was the only private hospital in the San Francisco Bay Area to offer such a service to patients. The single requirement was that blood recipients had to arrange to replace the blood. Members could give blood ahead of time to ensure availability when they needed it.

Kaiser Permanente gets out of blood bank business

By the mid-1960s, however, 80% of the blood used in Kaiser Permanente’s Northern California hospitals came from community blood banks, costing $25 a pint. Kaiser Permanente offered a Permanente Medical Group Blood Transfusion Insurance Program, which credited the donation of a single pint against unlimited blood needed by that member for two years, or one year if applied to a family. [i].

Text reads 'The Permanente Medical Group... Blood Transfusion Insurance Plan on an orange and white checkered background.
Graphic used on cover of the Permanente Medical Group Blood Program brochure, October 1967

The math worked out — Permanente Medical Group Executive Director Cecil Cutting, MD, noted: “... Participants are a relatively healthy lot of members whose transfusion requirements account for fewer than 3% of total Health Plan transfusions, while their contributions are running equivalent to 30% of the total blood used.” [ii]

In the past 4 decades, blood bank operators have been faced with the reality that the use of donated blood — its drawing, storing and administering — poses risks for transmission of disease, such as HIV/AIDS and Hepatitis B and C. In 1971, blood banks began to test donated blood for Hepatitis B.

Keeping blood supply safe

In 1983, U.S. blood banking groups issued their first warnings about AIDS. This action was taken after researchers learned HIV/AIDS was a blood-borne disease that could be transmitted by blood transfusion, as well as by sexual contact and shared hypodermic needles.

Black and white illustration of a blood bag sitting on top of a newspaper.

This blood donation illustration appeared in the "AIDS update" published in the Kaiser Permanente member publication "Planning for Health" in the Fall 1988 edition.

In 1985, immediately after the U.S. Food and Drug Administration licensed the first test to detect the antibody to HIV, Red Cross Blood Services regions began testing all newly donated blood for HIV. Since then, there have been an estimated 10,000 cases of HIV in the United States resulting from contaminated whole blood administered to patients between 1978 and 1985. (A heat treatment developed in 1985 renders blood plasma safe.) [iii]

In 1988, the federal Centers for Disease Control notified Kaiser Permanente that community blood banks in Kaiser Permanente’s Bay Area service areas had not screened blood donations properly to prevent contamination in the supply.

Kaiser Permanente, not responsible for independent blood bank procedures, contacted Health Plan members who had received blood from local banks between 1978 and 1985. Affected members were told that the risk of transmission of HIV might be higher than the nationwide average due to the blood banks’ improper and inadequate blood screening.

Kaiser Permanente encouraged these members to obtain free HIV screening tests. [iv] The 1985 cutoff date reflected the increased blood screening that virtually eliminated transfusion transmission.

Kaiser Permanente has also aggressively reduced other HIV blood transmission risks, such as hospital staff needle sticks, but addressing member risk through contaminated blood was a major first step. The task of addressing the epidemic was huge, but Kaiser Permanente took the challenge seriously.

By 2000, a Kaiser Permanente Northern California spokesperson could safely affirm: "Our efforts make a difference. Kaiser Permanente is making profound efforts to stop the spread of AIDS." [v]

[i] Permanente Medical Group Blood Program brochure, 1967.

[ii] Newsletter from the Desk of the PMG (Permanente Medical Group) Executive Director (Cecil Cutting, MD), October, 1967.

[iii] “Prevention of AIDS transmission through screening of the blood supply,” Annual Review of Immunology. 1995; 13:201-27. Galel SALifson JDEngleman EG.

[iv] “AIDS Update,” Planning for Health, Fall 1988

[v]  California Wire, November 20, 2000