Revisiting old practices: More restricted indication of preoperative autologous blood donation in healthy bone marrow donors according to baseline hemoglobin levels

Gilli, Isadora Olenscki; Vigorito, Afonso Celso; Benites, Bruno Deltreggia

doi:10.1016/j.transci.2019.04.001

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…If we use even a lower cut-off, the percentage of donors able to undergo bone marrow collection without autotransfusion will grow. The hemoglobin cut-off <145 g/L as a predictor of the need for transfusion after BM harvest was also identified by Gilli et al [ 11 ].…”

Section: Discussionmentioning

confidence: 87%

“…Surveys conducted by U.S. transplant centers revealed that about 23 to 50% of centers do not routinely collect any autologous blood [ 1 , 9 ], while other centers, including ours, prepare PAD for most donors [ 4 , 10 , 11 ]. The number of autotransfusions that are not administered and disposed of can reach 25% or even 50% in some cases [ 3 , 5 , 7 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Autologous blood use is not completely without risk. PAD collection reduces preoperative hemoglobin level by up to 20 g/L (median in our cohort 8 g/L) depending on the number of units and time to BM harvest [ 3 , 4 , 11 ]. PAD can expose marrow donors to a risk of preoperative anemia and hence a greater risk of transfusion.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Should We Stop Collecting the Preoperative Autologous Blood before Bone Marrow Harvest?

Lysák

Hejretová

Hrabětová³

et al. 2021

JCM

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Preoperative autologous blood donation (PAD) in bone marrow (BM) donors is performed to meet potential post-harvest transfusion needs and to avoid the risk of allogeneic transfusions. We reviewed retrospectively bone marrow harvests in 216 healthy donors during a ten-year period to determine the use of autologous blood. All donors except four had undergone PAD. The initial hemoglobin level of 153 g/L (male donors) and 135 g/L (female donors), respectively, decreased by about 8 g/L after preoperative blood donation and by 23 g/L after bone marrow harvest (medians). Autologous blood was administered to 70% of donors, 30% of the units remained unused. The evaluation of the risk of reaching transfusion threshold (<115 g/L males, <105 g/L females) revealed that donors with initial hemoglobin above 145 g/L and those weighing above 75 kg have minimal risk of requiring blood substitution (about 10%). A larger volume of bone marrow was obtained from male compared to female donors (1300 vs. 1100 mL) because of their higher body weight, which resulted in a higher number of procured nucleated cells (362 vs. 307 × 106/kg TNC, ns). The donor-recipient weight difference predicted the probability of sufficient collection. Only 1.5% of donors weighing ≥ 20 kg more than recipients failed to reach ≥3 × 108/kg TNC recipient. Our findings affirm previous data that PAD is unnecessary for healthy marrow donors and may be indicated individually after considering the pre-collection hemoglobin level, donor and recipient weight, and expected blood loss. Reasonable substitution cut-offs have to be set together with clinical symptom evaluation. The effective use of PAD also requires an adequate time interval between PAD and BM harvest.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Should We Stop Collecting the Preoperative Autologous Blood before Bone Marrow Harvest?

Lysák

Hejretová

Hrabětová³

et al. 2021

JCM

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“…The use of preoperative autologous blood donation has since been discontinued at the MGUH-BMCP, in line with recommendations from elsewhere. [26][27][28][29] Recommendations for supportive care during the preprocedure preparation phase should include careful preparation of PBSC donors to anticipate complications related to G-CSF, and the management of pain, nausea, discomfort, and allergic manifestations of Filgrastim applications. For bone marrow donors, a careful determination of maximal donation volume should be established, and iron deficiency anemia should be corrected prior to the donation.…”

Section: Pre-procedures Preparationmentioning

confidence: 99%

Supportive Care of Hematopoietic Stem Cell Donors

Rennert,

Smith M,

Cormier

et al. 2024

Clinical Hematology International

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Supportive care needs for hematopoietic stem cell recipients have been studied. Less is known about the care needs of stem cell donors. Care challenges arise at donor selection, preparation for the donation, the donation procedure and the immediate and long-term after-care. Care needs were analyzed for 1,831 consecutive bone marrow and peripheral stem cell donors at MedStar Georgetown University Hospital between January 2018 and August 2023 in support of a review of the current literature. During the selection, related donors may experience psychological pressures affecting their motivation, while donation centers may be willing to accept co-morbidities in these donors which might preclude donation in unrelated peers. For bone marrow donations, it is important to select donors not only according to optimal genetic matching criteria but also according to suitable donor/recipient weight ratios, to facilitate sufficient stem cell yields. During the donation preparation phase, side effects and complications related to stem cell stimulation must be anticipated and managed for peripheral cell donors, while the pros and cons of autologous blood donation should be evaluated carefully for bone marrow donors. The stem cell donation procedure itself carries potential side effects and complications as well. Peripheral cell donors may require a central line and may encounter hypocalcemia, thrombocytopenia, and anemia. Bone marrow donors face risks associated with anesthesia, blood loss and pain. Post-procedure care focusses on pain management, blood cell recovery and the psychological support necessary to regain a high quality-of-life existence. Hematopoietic stem donors are giving part of themselves to save another’s life. They deserve comprehensive supportive care to accompany them throughout the donation process.

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“…Some authors reported pre-harvest Hb drop in donors referred for autotransfusion as statistically significant for all donors, not only for women [ 3 , 9 ]. However, comparison of results obtained in other hospitals may be difficult due to different routines.…”

Section: To the Editormentioning

confidence: 99%