Preoperative Autologous Blood Collection for Bone Marrow Harvests: Is It Justified?

Introduction

Preoperative autologous donation prior to bone marrow harvest is commonly performed at our hospital. We usually collect 2 units of autologous blood from the bone marrow donors prior to the harvest procedure. In order to save an additional trip to the donor center, we sometimes collect double red cell by apheresis procedure. The decision for doing double red cell collection is based on the donor's hemoglobin and willingness to undergo the procedure. We reviewed all the autologous collections performed at our hospital based blood bank over a period of 2 ½ years. The utilization rate of autologous units, cost effectiveness and donor adverse events were evaluated.

Methods:

A computerized search was performed for all the autologous donations performed between January 2013 and July 2015. The charts of only the donors undergoing bone marrow harvest were reviewed. All other indications for preoperative autologous blood donation were excluded. The pre-donation hemoglobin (HB), time from donation to day of surgery, and any adverse events during autologous donation were recorded. The preoperative HB values (usually 1- 3 days before surgery) and the amount of marrow harvested were also noted. The utilization of the collected units was evaluated by reviewing all the units that were transfused and those that expired on shelf. The cost effectiveness of all the autologous collections was evaluated.

Results:

A total of 262 autologous units were collected from 137 donors in age range 9-72 years (M:F = 1.3:1). Double red cell collection by apheresis was performed on 49 of 137 (36 %) donors in one visit. The remaining 88 donors underwent autologous collection of 1 to 2 units of whole blood. Five donors donated more than 2 autologous units throughout this time period. Among the 49 double red cell donors, only 3 were females and remaining 46 were males. Among the whole blood donors, 56 were females and 32 were male. The mean baseline HB prior to autologous donations was 12.9 g/dL (range 11 to 15) in female donors and 15.2 (range 12.5 -17.8) in male donors. The average amount of marrow harvested was 1232 cc (range 480 - 2000 cc). The average fall in HB (measured as the difference between the baseline HB and the HB prior to surgery) was 2.07 (range 0 to 4.6). The HB loss resulting from the procedure was not available since most of the donors undergoing marrow harvest were transfused in the operating room at the end of the procedure. Out of the 102 units collected by double red cell apheresis, 39 units (38 %) expired on shelf. Among the 160 whole blood autologous units, 25 units (16 %) expired on shelf. The overall utilization rate of all the autologous units was 75.5%. The marrow harvest was either cancelled or rescheduled in 15 donors. Three donors received allogeneic blood post operatively in addition to the autologous unit. The pre harvest HB was 10 or above in 93% of the donors. All the donors tolerated the marrow harvest procedure well. No severe adverse events were noted during any of the autologous donations.

Conclusion:

The instituitional trigger for transfusing blood is 9.0 g/dL and 93% of our donors had a pre-operative HB above 10 g/dL. Hence we conclude that these healthy donors can easily undergo the marrow harvest procedure without requiring any transfusion. The pre-operative autologous donations are unnecessary, time and resource consuming, costly for the donor and can be detrimental to donor's health by potentially exposing them overall to any type of blood.