Hot-blooded

FIVE QUARTS: A Personal and Natural History of Blood, by Bill Hayes, Ballantine, 2005, 304 pages, $23.95 (ISBN: 0-345-45687-4)

The story of blood and its meaning to the human race intrigues the historian, the scientist, and indeed, all of us, as we all have blood. The German philosopher Wolfgang Johann von Goethe put it well when he wrote that blood is "a very exceptional juice."

Throughout the centuries on to present day, writers have described the natural and scientific history of blood in scientific and romantic works. Some, like the Dracula vampire legend of the 15th century, are tired old stories, first produced by a Europe that could not then differentiate between religion and magic and medicine. But each new version of these tales adds a little more factual standing. Hayes, who mixed scientific and personal interests in his previous book "Sleep Demons: An Insomniac's Memoir," retells some of these intriguing stories in a style both readable and factually correct. For example, Hayes points out that transfusions in the 17th century were intended to magically calm agitated recipients with blood from a peaceful animal.

But there is a big problem with this book. "Five Quarts" focuses on and promotes, albeit indirectly, the "great fear" about AIDS and blood: that blood transfusions are deadly, major spreaders of HIV. Twenty-five years ago, before the disease had been named acquired immune deficiency syndrome, before it was accepted as being caused by a virus, and certainly before the possibility of diagnostic tests, it was a uniformly fatal condition observed only in a few male homosexuals. But soon it was also identified in childhood recipients of transfusions from blood donors, presumably from that gay population.

Almost immediately, clergymen, politicians, entertainment celebrities, and pillars of the community who had the disease began claiming that their exposures must have been from blood transfusions. The national panic and finger-pointing began. Television networks introduced their news stories about AIDS by showing blood being donated and blood in storage. Presumably that was a more publicly acceptable angle than that of gay men in San Francisco, but the subliminal message was delivered. In fact, some health authorities believe this misplaced fear has led to lax safe-sex practices, causing the disease to spread among young people.

There is no question that HIV is transmissible by blood, as is any other infection in which a person who is apparently asymptomatic harbors viruses, bacteria, parasites--or even prions, as evidenced by several probable recent cases of mad cow disease in England. Transmission by blood can happen not only during therapeutic transfusion of blood and blood products, but during licit or illicit injection of drugs, intimate contact, or even childbirth. Of the 1 million U.S. AIDS cases that the Centers for Disease Control & Prevention has accepted over the past 20 years, at least 12,000 cases have been attributed to the medical use of blood or blood products. But that number plummets to fewer than 1,000 AIDS patients when you subtract the patients with hemophilia who were uniformly infected while taking Factor VIII, a blood-clotting glycoprotein derived from blood plasma, before it became possible to provide them with a recombinant version. Of course, this was still a tragic and highly regretted event in the history of medical care.

Today, with blood tests that are sensitive enough to detect the DNA of HIV, the risk of contracting the virus is less than one in 2 million transfusions. Yet the great fear persists. The public avoids what it cannot control more than what it thinks it can control. That same thinking leads people to travel by automobile rather than by statistically much safer airplanes.

Hospitals still offer a form during the admission process that allows people to refuse to accept transfusion, but does not mention all the other things in a hospital that can kill. Patients want transfusions from relatives and friends about whose personal lives they know little, rather than from altruistic volunteers with nothing to gain by donating blood. Surgeons are offered educational seminars on "bloodless surgery" (a valid concept in the face of the extravagant overuse of blood 30 years ago), sponsored by Jehovah's Witnesses who oppose transfusions, and at which a church elder may allude suggestively to "the recent dangers."

To his credit, Hayes does not directly foment any fear of blood transfusion as a proximate cause of AIDS. But the great fear comes through from the very first chapter. He describes how Steve suffers a scalp wound from an accident in their home. Steve comes to him needing assistance in stanching the bleeding and cleaning up. Hayes describes his revulsion at touching that blood and thereby potentially exposing himself to HIV. He overcomes that courageously, and then writes: "I was used to seeing Steve's semen when we had sex; that didn't scare me. But his HIV-positive blood was altogether different." He then embarks on the "personal and natural history of blood" with never a mention again of semen, or of rectal and vaginal secretions, the body fluids that continue to contribute to almost 40% of AIDS infections.

The great fear persists as a fallacy that interferes with good medical practice worldwide and detracts from the much more pressing danger of sexual HIV transmission. Public health surveys in the U.S. show that those young gay men who did not experience the AIDS epidemic of the 1980s do not fear the risk of disease from homosexual contact, even unprotected. They assume that AIDS is a controllable disease on antiviral drugs, and that if they become infected, they can still live long and happy lives. That is why this reviewer says, Enjoy the book, but read it and weep.

Paul Schmidt is professor of pathology and laboratory medicine at the University of South Florida and historian of the International Society of Blood Transfusion.