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A blood drive enlisting past autologous donors.

Many who give blood for their own use recognize the need for an adequate blood supply and become good candidates for homologous donation.

As the types of transfusion-associated viral infections grow, blood transfusion safety depends on a widening amount of donor screening and blood testing.' Unfortunately, the necessary screening process, accomplished both through questionnaires and faceto-face interviews, increases the number of donors who are deferred and thus reduces the blood supply.

In our region, 7 to 9 per cent of donors are deferred, either on a temporary basis or permanently. Common reasons for temporary deferral include abnormal blood pressure, anemia, and use of certain medications. Another 4 per cent of homologous donor blood is rejected because of positive laboratory tests for ALT, RPR, antiHBc, and other infectious disease markers.

With able donors becoming harder to find, the blood bank at 360-bed St. Cloud Hospital decided to tap a new source of blood for general transfusion use-autologous donors. The hospital and the Central Minnesota Chapter of the American Red Cross jointly sponsored a blood drive to recruit individuals who had previously donated blood designated for their own use. (Dr. Yomtovian described St. Cloud's autologous donation program in a January 1985 MLD article.)

Autologous and homologous transfusion programs complement each other. Patients receiving their own blood place fewer demands on the homologous supply. Currently, predeposited autologous blood accounts for 13 per cent of St. Cloud Hospital's transfusion volume.

These self-donors can further enhance the homologous supply by donating their blood to it. As a consequence of giving blood to benefit themselves, autologous donors may come to recognize and appreciate the need for an adequate supply of homologous blood.

A survey conducted by the hospital found that about half of all its autologous donors had at some time donated homologously, but that almost none were active homologous donors at the time of the survey. The goal was to recruit autologous donors who had never given blood before for general use as well as those who had not been homologous donors for some time.

In general, autologous donors are older and more infirm than the typical homologous donor. Nearly half the patients who donate autologously at St. Cloud Hospital are in their seventh decade or beyond. The upper age limit for homologous donation, currently through 72 years, prohibits many from donating homologously. (There is no age limit on autologous donations, however.)

Often the medical history of autologous patients also prevents them from giving blood for general use. Typically they are taking one or more medications, most often aspirin-containing anti-inflammatory drugs for degenerative arthritis.

We undertook this project in part to see whether or not blood from these donors is comparable to blood from other donors. Although deferrals are more common within this group, we wanted to determine to what extent their blood would pass the pretransfusion lab tests.

Because the autologous units collected by St. Cloud Hospital are used only for autologous transfusions, the medical history taken for such transfusions is designed to detect potential bacteremia and to determine which patients may be at risk from phlebotomy (because of unstable cardiac status or anemia, for example). Autologous blood units are tested only for ABO and Rh compatibility. Given the simplicity of these protocols, it is possible that many individuals would not pass the more rigorous homologous screening and testing procedures.

Some observers also maintain that the medical histories given by autologous donors may not be as reliable as those of homologous donors. Since the former are primarily motivated to donate for themselves, they may not feel an obligation to be completely open when recounting their personal medical histories.

To learn more, we took the first step toward organizing an "autologous" blood drive in August 1986-defining the target donor population and determining if the numbers were sufficient to justify a drive. We knew from an attitudinal survey conducted among autologous donors that more than 90 per cent said they would be equally or more likely to donate homologously after giving blood for their own use. Of this group, 52 per cent had donated homologously in the past.

A longtime interest in the possible positive effect of autologous donation on the general blood supply had led us to keep records containing an assessment of each patient who has given autologously as a candidate for homologous donation.

According to computerized hospital files, of 580 patients who had donated autologously between May 1983 and August 1986, 223 or 38 per cent were potential homologous donors. The screening took into account medical eligibility and a time interval of at least six months since surgery . The medical directors of the hospital blood bank and the regional American Red Cross blood center reviewed these data at a planning meeting.

We decided to base the drive at the hospital, although many of our potential patient-donors lived some distance away-15 per cent would have to travel more than 36 miles, and 9 per cent more than 48 miles. By having them come to the hospital, we could use technologists who worked in the autologous program and were known to the donors.

In addition, a single location would make it easier to keep track of which autologous donors became homologous donors. We would use appointment sheets to identify former autologous donors and could check these sheets against the hospital's autologous donor files. In order to publish information about their participation in the drive, we felt we should obtain written consent, even though none of the donors would be identified by name.

The alternative to a hospitalbased drive was recruitment of former autologous donors through bloodmobiles in their communities. That might have been more convenient for many donors, but the logistics and planning would have been more complex and data gathering more difficult.

This generally elderly group of donors requires more time to evaluate and process, which could bog down the regular donation routine of a bloodmobile. Besides, the beneficial psychological effect of returning to the scene of a positive previous donation (the hospital) would have been lost.

We hold one or two blood drives in the hospital every year, so we decided to open this special campaign to hospital employees as well as former autologous donors. Some employees are very dedicated blood donors, and excluding them would have hurt their feelings.

Dealing with a novel donor population made it hard to calculate in advance how many staff members we would need for the bloodmobile. In light of the potential pool of 223 autologous donors and employee participation, we decided to follow American Red Cross guidelines for a drive of 130 to 150 anticipated donors, excluding deferrals.

The first formal contact with potential donors was a letter from the hospital blood bank's medical director explaining what we were trying to accomplish and inviting them to take part (Figure 1). Some letters were returned as undeliverable, and follow-up phone calls failed to reach some persons, reducing the number of potential donors to 136. Of this group, 34 individuals made appointments, and 26 came in to donate.

Because of the special needs of our older donor population, we were glad we chose the guidelines for a group of up to 150 productive donors rather than the 80 to 100 expected for a normal hospital drive. This allowed an additional hour of registration and screening time, two extra donors per 15-minute period, three additional donor beds, and an extra registered nurse.

Altogether, 82 units of blood were collected; 107 persons came in to donate, but 25 were deferred . Of the 26 former autologous donors, 11 of them were to donate homologously for the first time. The same number, 11, were deferred, one permanently because of a malignancy that was overlooked during the initial review of medical records. The other deferrals stemmed from use of medications, mostly anti-inflammatory drugs.

All of the units drawn from the 15 remaining former autologous donors passed the pretransfusion lab tests, which pleased us. The medical director of the hospital blood bank sent a follow-up letter thanking these and the deferred donors for their interest.

Some additional statistics may be of interest to those planning similar drives. The 11 per cent response rate (26 of 223 former autologous donors) is at least as good as the response to recruitment efforts among the general population. The mean donor age of 55 was significantly higher than the mean age in a routine blood drive.

Unfortunately, our 42 per cent deferral rate among former autologous donors was also high. Part of the difficulty was that we used hospital volunteers and laboratory staff members to recruit for the drive, and they did not foresee that patient medications would be a problem. For similar drives in the future, we plan to use experienced recruiters, who could determine which patients should hold off on their medications before donating.

Nine of the previous autologous donors traveled between 20 and 50 miles to donate, demonstrating the high level of motivation in this group. In the future, however, we will limit recruitment for hospital-based bloodmobiles to those residing within a 20 mile radius.

Participation in an autologous program reminds patients and their families of the value of blood in general. Many patients acting under the incentive of their own potential need find donation more convenient and less painful than they anticipated. Our special blood drive showed that active recruitment of former autologous donors can expand the homologous donor pool.
COPYRIGHT 1988 Nelson Publishing
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Author:Yomtovian, Roslyn; Schrank, Yvonne; Bowman, Robert
Publication:Medical Laboratory Observer
Date:Aug 1, 1988
Words:1566
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