In an article written by Paul J. Schmidt, entitled "Syphilis, a disease of direct transfusion," which appeared in the August 2001 edition (Volume 14) of Transfusion, Dr. Schmidt makes the argument that syphilis testing for the purpose of blood transfusions has become obsolete and solely exists on a physiological and emotional basis. A summary of the article appears here.
Syphilis is caused by the spirochete Treponema pallidum. If an infected person does not receive treatment, the disease progresses through three lifelong stages, which ultimately leads to cardiac failure and deterioration of the nervous system.
In 1937, the Surgeon General of the U.S. Public Health System reported that there were half a million new cases of syphilis in the U.S. every year. At that time, penicillin, the treatment for syphilis, was not yet discovered.
Transfusion therapy was being introduced to the medical world around the 1930's. Direct transfusion, where blood is pumped directly from the donor to the patient, was the only method available. The Wassermann Test was used to screen for syphilis in donors at the time, but a study showed that it was not reliable. Almost fifty percent of positive individuals were testing negative.
In 1945, the first federal licensing requirements for blood transfusions were published. The serological tests available to detect donors with syphilis were by no means dependable. During WWII, doctors even advocated for the physical examination of the genitalia of male donors for chancres, which appear in the primary phase of syphilis. Syphilis was at the time the most widely recognized disease transmitted by transfusion.
After WWII, the innovation of collecting blood and mixing it with an anticoagulant-preservative solution allowed for indirect blood transfusions. In an indirect transfusion, the donor and the patient are not connected by any means during the transfusion. The addition of a preservative allowed for the blood to be refrigerated for days. Cold temperatures are lethal to Treponema pallidum, the syphilis-causing organism. Syphilis as a result of blood transfusions basically ended at this point in time. Platelets, which are not refrigerated, are believed to be safe because they are stored in special bags that allow for the diffusion of oxygen. Oxygen kills the anaerobic T. pallidum. The last reported case of a patient developing syphilis in the U.S. because of a blood transfusion occurred in 1966.
In 1978, the Standards Committee of the American Association of Blood Banks (AABB), ceased making the testing of donors for syphilis a requirement. The FDA, which regulates blood products, was in the process of changing its regulations when the AIDS epidemic arose. The decision was made to continue all venereal disease testing as an anti-AIDS measure. The AABB put back syphilis testing into its standards in 1991.
Dr. Schmidt believes that syphilis testing is no longer necessary based on the national decline in syphilis cases, the availability of penicillin, and the fact that no direct transfusions are carried out, but believes this testing still occurs to put the public at ease phycologicaly and emotionally.
Marissa is a senior majoring in medical laboratory sciences and expects to graduate in May 2002.
