SPECIAL COLLECTIONS

PRE-OPERATIVE AUTOLOGOUS DONATION (PAD)

Introduction

Your own blood is the safest for you. Patients planning elective surgery requiring blood transfusion may be able to donate blood for themselves prior to surgery. This is called autologous donation or pre-donation. Patient’s health status and red blood count (hemoglobin or hematocrit) determine whether they can donate; final approval rests with the medical director of the local United Blood Services center. The patient’s doctor decides how much blood is needed. United Blood Services collects, processes and tests the blood and delivers it to the transfusing facility. Blood may be collected up to 42 days before the date of use, but no later than three working days prior to date of anticipated use. A special processing fee is charged for this service because additional recordkeeping and handling are required, even if the blood is not used by the donor. Autologous blood cannot be used for other patients.

Advantages of Autologous Blood Donation

1. Prevents transfusion-transmitted disease.
2. Prevent red cell alloimmunization.
3. Decreases the number of banked allogeneic units needed.
4. Provides compatible blood for patients with alloantibodies.
5. Prevents some adverse transfusion reactions.
6. Provides reassurance to patients concerned about blood risks.

Disadvantages of Autologous Blood Donation

1. Does not eliminate risk of bacterial contamination.
2. Does not eliminate risk of ABO incompatibility error.
3. Is more costly than allogeneic blood.
4. Results in wastage of blood that is not transfused.
5. Increased incidence of adverse reactions by the donor to autologous donation.
6. May subject patients to perioperative anemia, increased likelihood of transfusion, and delayed recovery.

Candidates for Pre-Operative Autologous Donation (PAD)

Candidates for pre-operative collection are stable patients scheduled for procedures in which blood transfusion is likely. PAD collections should be considered for patients likely to undergo:

• Major orthopedic procedures, most commonly total joint replacement.
• Vascular surgery
• Cardiac or thoracic surgery.

Autologous blood should not be collected for procedures that seldom require transfusion such as:

• Cholecystectomy
• Herniorrhaphy
• Vaginal hysterectomy
• Uncomplicated obstetric delivery

Donor-Patients Who Are Not Good Candidates for PAD

There some contraindications to participation in autologous blood donation program. Donor-patients considered not to be candidates are those with:

• Evidence of infection and risk of bacteremia
• Scheduled surgery to correct aortic stenosis
• Unstable angina
• Uncontrolled seizure disorder
• Myocardial infarction or cerebrovascular accident within 6 months of donation
• Significant cardiac or pulmonary disease who have not yet been cleared for surgery by their treating physician
• High-grade left main coronary artery disease
• Cyanotic heart disease
• Uncontrolled hypertension.

Requirements

Because of the special circumstances related to autologous blood transfusion, rigid criteria for donor selection are not required. However, the following requirements do apply:

• An order from the donor-patient’s physician.
• The hemoglobin concentration of the donor-patient’s blood shall be >11 g/dL or the hematocrit, if used, shall be >33%.
• Both the transfusion service and the requesting physician will be notified of abnormal test results. The transfusion service should have a written policy identifying how autologous units with abnormal test results will be handled.

Donation Frequency

Typically, a donor-patient should donate one unit per week and no more than one unit every three days. For orders of four units or less, donation should start three to four weeks prior to surgery. If more than four units are requested, donation should occur over several months. It is suggested that physicians or donor-patients contact the blood center to determine if freezing red blood cells is available. The donor-patient should also consider using banked allogeneic blood in cases where large volume transfusion is a possibility.

Other Considerations

There are times when surgery is cancelled or postponed. This may require freezing and storing the autologous units. Since freezing of red cells is not routine at most United Blood Services centers, the hospital must contact the United Blood Services center to discuss if these special handling options are available and the fees for this service.

To Schedule

The patient’s physician:

• Identifies candidate for autologous donation
• Requests autologous donation and determines number and types of components to be collected
• Completes applicable section of the Special Collections Form (BS 365).

The donor-patient/physicians office:

• Contacts the blood center to schedule the appointment(s)
• Faxes or mails the Special Collections Form (BS 365) to the blood center.

United Blood Services:

• Reviews the order for completeness
• Contacts donor-patient for any additional information
• Collects, processes and tests the donor-patient’s blood
• Ships units to hospital blood bank before surgery
• Notifies hospital when units will not be available
• Notifies hospital of special labeling in cases of abnormal test results. In these situations United Blood Services will notify the requesting physician. The physician and the transfusing facility policy will determine if the unit will be used for transfusion or be discarded.

Fees

Fees for autologous blood donation vary. Some hospitals require that the patient-donor pay for all donations while other hospitals accept the charges from the blood center. Contact the United Blood Services center in your area to find out how fees will be charged.

To Order

See the Special Collections Contact information for your area. To find the center nearest you click here.

DIRECTED DONATION

General Information

United Blood Services offers a comprehensive directed donation program. A directed (or designated) blood donation is one by which a patient selects his/her own blood donor(s) for an anticipated, non-emergency transfusion. The donor is typically a friend or relative to the patient but can be a donor unknown to the patient who has attributes that benefit the patient.

• Directed and designated donations are tagged specifically for the recipient.
• Although the data does not support it, the patient may feel that the blood they receive from people they know is safer than the community blood supply. In some cases, it may be less safe because donors known to the patient may be hesitant to reveal information about their personal or medical history.
• Directed donors are qualified in the same manner as community blood donors. This allows transfusing facilities to release directed blood to other patients if the intended patient does not receive it. Units with abnormal test results will not be distributed for transfusion.
• Male spouses do not usually make the most appropriate directed donors. Previously pregnant women can become sensitized against red cell antigens from their children’s father(s), causing adverse reactions in the transfusion recipient.
• Optimal time of 5-7 days should be given from time of donation to time of anticipated need.
• Units that are ABO/Rh incompatible with the recipient will not be distributed for the intended recipient or charged to the transfusion facility.

How to Schedule a Directed Donation

Advance notice to the blood center is always required prior to making a directed donation. The patient and physician:

• Identifies candidate for directed donation
• Requests directed donation and determines number and types of components to be collected
• Completes applicable section of the Special Collections Form (BS 365)
• Faxes or mails the Special Collections Form (BS 365) to the blood center.

The donor or patient or physicians office can contact the blood center to schedule the appointment(s).

United Blood Services:

• Reviews the order for completeness
• Contacts donor-patient for any additional information
• Collects, processes, tests and stores the blood
• Ships units to hospital blood bank before transfusion
• Notifies hospital of units that will not be shipped due to unexpected test results.

Fees

Fees for directed blood donation vary. Due to special handling requirements for directed units, it is typical the special handling fees are usually charged to the donor at the time of donation. Some hospitals require that the patient or donor pay for all donations while other hospitals accept the charges from the blood center. Contact the United Blood Services center in your area to find out how fees will be charged.

To Order

See the Special Collections Contact information for your area. To find the center nearest you click here.