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. 2023 Jul;21(4):337-344.
doi: 10.2450/2022.0134-22. Epub 2022 Dec 5.

A survey on preoperative autologous blood donation policy in bone marrow stem cell donors in Italy

Claudia Del Fante  1 , Francesca Masiello  2 , Stefania Vaglio  2   3 , Letizia Lombardini  4 , Serelina Coluzzi  5 , Maria B Rondinelli  6 , Fabio Ciceri  7 , Simonetta Pupella  2 , Vincenzo De Angelis  2
Affiliations

A survey on preoperative autologous blood donation policy in bone marrow stem cell donors in Italy

Claudia Del Fante et al. Blood Transfus. 2023 Jul.

Abstract

Background: The high safety of homologous blood components, together with the introduction of the Patient Blood Management strategy, has led to the progressive abandonment of preoperative autologous blood donation (PAD) in surgery. Furthermore, recent scientific publications provide evidence about the non-usefulness of PAD in the collection of hematopoietic stem cells (HSC) from bone marrow (BM), also in consideration of harvest procedure safety. Nevertheless, no conclusive studies have been published yet.

Materials and methods: Blood Establishments (BE) and Bone Marrow Collection Centers (BMCC) participated in a specific qualitative survey proposed by Italian National Blood and Transplant centers with the support of the relevant Italian Scientific Societies. The survey aimed at evaluating the policy adopted for PAD in related and unrelated adult HSC donors in Italy during the period 2018-2020.

Results: Forty-one BE corresponding to 37 BMCC filled in the questionnaire. Of 830 BM donors, 661 (80%) underwent 1063 PAD (mean 1.6 PAD/donor). The remaining 169 donors (20%) underwent BM harvest without PAD. No serious adverse events were reported for either donor group. In the case of ineligibility of donors for the PAD program, due to low hemoglobin values, 7/10 centers shifted donors to peripheral blood stem cell collection and three centers chose a different donor. Remarkably, only 51% of the PAD units requested were eventually transfused during the BM harvest process. Finally, the iron support policy among centers was heterogeneous.

Discussion: The results of this survey show that PAD is heterogeneously applied in Italian BMCC, as in other countries. However, all BMCC except two are willing to adopt a Patient Blood Management strategy as an alternative approach to adult related and unrelated BM donor harvests.

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Conflict of interest statement

The Authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Data sample from 3-year period (2018–2021) BE: Blood Establishments; BMCC: Bone Marrow Collection Centers; PAD: preoperative autologous blood donation.
Figure 2
Figure 2
(A) Volume of preoperatively donated autologous blood units (% of participants) collected. (B) Donors’ characteristics that led to a reduction in the volume of blood collected (% of participants) Hb: hemoglobin.
Figure 3
Figure 3
(A) PAD units actually required for bone marrow harvest (% of participants). (B) Place where the PAD units were requested for re-infusion (% of participants) PAD: preoperative autologous blood donation.
Figure 4
Figure 4
PAD units actually transfused during and after harvest (percentage of participants) PAD: preoperative autologous blood donation.
Figure 5
Figure 5
(A, B) Donors with hemoglobin values below the normal limits at the time of harvest (A) and after harvest, 24 hours later (B)
Figure 6
Figure 6
(A) Iron supplementation policy in anticipation of bone marrow harvest in donors not undergoing PAD (percentage of participants) (B) Iron supplementation policy in anticipation of bone marrow harvest in donors undergoing PAD, from the first donation to the bone marrow harvest (percentage of participants). PAD: preoperative autologous blood donation.
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