Contemporary use and safety of prepartum autologous blood donation: A retrospective cohort study in Quebec, Canada

Abstract

Background: Autologous blood donation (ABD) can be indicated in pregnant individuals with rare blood groups. Yet, unlike hospitals, some blood establishments are reluctant to collect ABDs in this population. Therefore, we evaluated the safety and use of prepartum ABD conducted by a blood establishment.

Study design and methods: This retrospective, descriptive cohort study used data from the ABD program in Québec, Canada, and patient medical data reported by treating physicians. Patients were included if they were pregnant, enrolled in Québec's ABD program between January 2010 and January 2021 (i.e., study period) and had a rare blood group.

Results: Twenty-four individuals met the inclusion criteria (mean age at first referral = 31.7 years; 21 [87.5%] first-time donors) and initiated 52 ABDs. Three mild vasovagal reactions (VVRs) were recorded, while no moderate or severe vasovagal reactions (VVRs) were observed. Of the 41 units distributed to the hospitals' blood banks, none were transfused to the mother; 3 were transfused to the fetus or newborn. Most fresh unused units were salvaged and cryopreserved post-delivery (75.0%). Twenty-seven (51.9%) ABDs were made <3 weeks of the expected date of delivery. All seven individuals with available data on iron supplementation had iron deficiency, but only two (28.6%) received intravenous iron.

Discussion: ABDs may be safely carried out by a blood establishment among pregnant individuals. Transfusion rate is low; however, the majority of donated units are successfully recovered. Improvements will be made to the program by developing specific guidance to target iron deficiency management and timing of donation.

Keywords: blood management; donors; transfusion practices (OB GYN).

FIGURE 1

Processing, trajectory and final disposition of collected autologous blood units. Trajectories of fresh blood units are indicated by solid red arrows, whereas trajectories of frozen blood units are denoted by dashed blue arrows. IUT, intrauterine transfusion; V, volume. [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Changes in the hemoglobin levels of pregnant individuals who made at least two autologous blood donations. Color‐coded lines indicate the magnitude of the change in Hb levels between two ABDs. ABD, autologous blood donation; Hb, hemoglobin. [Color figure can be viewed at wileyonlinelibrary.com]