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Autologous & Designated Donation

From an article in MEDI-CLINIC GESUNDHEIT April - June 2002 issue. Bar ===============

Western Province Blood Transfusion Service (WPBTS) has been offering an
autologous blood donation service since the early 1980s. The autologous service
allows patients to donate a number of units of blood during a pre-surgery period.
should a blood transfusion then become necessary during surgery, the
patient's own blood is re-administered to him or her

In the early days of the autologous service, the majority of requests for this service came from Jehovah Witnesses and people with rare blood groups. However, with the advent of HIV and recognition of its blood-borne transmission, came an increased public concern about the transfusion services' ability to ensure the safety of blood transfusion products. In the late 1980s the transfusion services noticed a steady increase in the number of requests for both autologous and designated donation (where a patient can select their own donors and ensure that blood is kept exclusively for the patient). The rise in demand for these services is often directly related to articles in the media about HIV. .

Today, when faced with the possibility of transfusion, patients expect warranties about the quality of blood and often request alternatives. In response to this public demand, the transfusion services have developed very sophisticated autologous and designated services.

In a previous article Gesundheit has discussed designated donation. In this article we specifically look at autologous donation.

How does autologous donation work?

Firstly, blood should only be ordered if there is an anticipated need (in other words, if it is likely that blood will be needed).

Patients can donate a maximum of 5 units and donations should be 4 to 7 days apart. The exact scheduling of the donations (in other words, when exactly the patient must donate blood) will depend on the number of units required. As red blood cells only expire after 35 days, it is possible to take 4 to 5 units over a five-week period.

The last donation should occur not less than 3 to 7 days prior to surgery or 7 days before the expected date of delivery.

What are the benefits of autologous donations?

There are many obvious benefits of a patient pre-depositing their own blood -the greatest one being a patient who approaches surgery with peace of mind. Other benefits include:

Are there any problems or risks associated with autologous donation?

Although autologous transfusion is often considered the safest

possible option by some patients, it is not completely problem or risk free.

Some of the problems include:

Who is eligible for autologous donation?

In general, most patients who are well enough to undergo elective surgery.

The transfusion services receive many requests for autologous donation. Unfortunately not all of them are accommodated. The general rule that is applied in this decision is that the benefits of donating blood are not outweighed by risks. Safety of the autologous patient is always the highest priority and these donors must meet certain health and medical criteria. Generally the donor or patient must be in good enough health to tolerate the withdrawal of 500 ml of blood in a short period of time. Criteria for autologous donation include:

What type of surgery is suited to autologous donation?

Surgery where a cross match is usually requested. A cross match is an investigation performed when it is envisaged that blood transfusion may be required. Requests come mainly from patients having urological, gynaecological, plastic or orthopaedic surgery.

Who may not make use of this autologous donation service?

There are certain contra-indications (reasons why a patient may not perform this procedure), including:

All of the above contra-indications will be reviewed individually by the medical staff of WPBTS. In some instances, persons may be able to donate for themselves under the supervision of the transfusion staff and their doctor. Hospitalisation may be necessary.

What happens during the procedure?

At the WPBTS all the autologous donations follow a routine screening process and are tested for haemoglobal levels, HIV antibody, p24 antigen, hepatitis Band C, and syphilis. This testing is performed at each donation, so that the processing of the units does not deviate from routine to avoid the risk of clerical errors. Autologous donors who test positive for HIV or hepatitis will not be accepted on the programme, as the transfusion services are concerned about the risk of storing positive units of blood in their blood bank. This theoretically increases the risk to other patients if the units are accidentally "crossed over" or "mis-administered" in the blood bank or hospital setting.

In order to facilitate the smooth running of these programmes, the WPBTS requires informed consent from the patient and a request for the required units of blood from the surgeon or anaesthetist.

Bar
au·tol·o·gous Pronunciation Key (ô-tl-gs) adj.
Derived or transferred from the same individual's body:
autologous blood donation; an autologous bone marrow transplant.
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