Autologous Whole Blood Donation in Allogeneic Marrow Harvest – Is It Truly Needed?

Abstract

Authors Harvey, E, Abhyankar, S., Merkel, D., Shune, L. Background The collection of autologous units in allogeneic marrow donors, while no longer required by the National Marrow Donor Program, is still practiced by some collection centers. Collection centers have the option to request collection of autologous unit(s), however, this practice can cause a delay in time to transplant as well as the possibility of putting donors through procedures that are not needed. If a marrow collection is delayed or cancelled, autologous units may expire. Donors may also experience anemia prior to the harvest due to donation of autologous units. Method Our Center analyzed our marrow harvests collected between 2010 and July 2018. We checked a complete blood count (CBC) on the day of the harvest, both prior to and following completion of the marrow collection. Results Of the 227 marrow harvests that were reviewed, there were no donors that required transfusion support post-harvest. The average drop in the hemoglobin was 2.67 g/dL. (N=227 with a range of +1.3 g/dL to -6.8 g/dL). Of the donors whose hemoglobin dropped greater than 5 grams (N=6), 1 received 1 liter of IVF, one 1.3 L, 2 received 3 L and one received 5.5 L of IVF, possibly leading to hemodilution of these samples. Additionally, 2 of these were drawn from the IV line, which could also contribute to dilution of the sample. Average percentage of total blood volume taken from these 6 donors was 25%, which was consistent with the 21% average among all harvests, therefor the lower hemoglobin was felt to be dilutional and not an accurate portrayal of the actual hemoglobin. Conclusion Collection of autologous units is not needed in healthy allogeneic marrow donors. The practice of autologous unit collections can delay time to transplant for the recipient. It can also put the donors through additional and unnecessary procedures. Lastly, the units may be wasted if the harvest is delayed or cancelled.