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Blood Bank

Special Donations

While the standard allogeneic donation (giving blood for the general population) is the backbone of the blood supply, there are specific situations where different types of donations are needed or preferred. These “special” donations cater to unique circumstances, often involving specific donors or recipients, and might have slightly different criteria or procedures

Autologous Donation

  • Concept: This is when a person donates blood for their own use later on. Think of it as self-storage for blood!
  • Purpose/Indications: Primarily done before a scheduled surgery where blood loss is anticipated. The goal is to eliminate risks associated with allogeneic transfusion, such as:
    • Transfusion-transmitted diseases (viral, bacterial)
    • Alloimmunization (developing antibodies against foreign red cell, platelet, or HLA antigens)
    • Allergic or febrile transfusion reactions
  • Donor Criteria
    • Requires a prescription or order from the patient’s physician
    • Donor must be healthy enough to undergo both the donation and the planned surgery
    • Hemoglobin/Hematocrit: Requirements might be slightly lower than for allogeneic donation (e.g., Hgb ≥ 11.0 g/dL or Hct ≥ 33%), as determined by the blood center’s medical director and the prescribing physician. The key is ensuring the donation doesn’t make the patient dangerously anemic before surgery
    • Frequency: Can donate more frequently than allogeneic donors, often every few days up to 72 hours before the surgery, allowing collection of multiple units if needed. Iron supplementation is usually recommended
    • Age/Weight: Standard minimum weight usually applies (≥110 lbs). There’s often no upper age limit if the patient is otherwise fit
    • Infectious Disease Markers: Testing is still performed. If a unit tests positive (e.g., for Hepatitis B), specific labeling and handling procedures apply, and its use requires careful consideration and notification
  • Collection Process: Usually collected as standard Whole Blood units
  • Labeling & Handling: CRITICAL! Autologous units must be clearly labeled “For Autologous Use Only” and segregated from the general inventory. Rigorous identification checks are needed at collection and before transfusion to ensure the unit goes back to the correct patient-donor
  • Advantages: The safest option for the donor-recipient regarding disease transmission and alloimmunization
  • Disadvantages
    • Risk of pre-operative anemia in the donor-patient
    • Higher administrative and logistical effort
    • Units are often discarded if the surgery is cancelled or less blood is needed than collected (wastage)
    • Cannot: typically be “crossed over” into the general inventory if unused, due to potentially different donor criteria and testing implications
    • Does not eliminate the risk of bacterial contamination during collection or storage errors

Directed (or Designated) Donation

  • Concept: A donor gives blood specifically for transfusion to a named, intended recipient (who is not the donor themselves)
  • Purpose/Indications: Often requested by the patient or their family, usually for emotional reasons or a belief (often medically unsupported) that blood from family/friends is safer. In rare cases, it might be medically indicated to find antigen-negative blood from family members for patients with complex antibodies. It’s also necessary for transfusion between first-degree relatives to prevent Graft-versus-Host Disease (GVHD) by requiring irradiation of cellular components
  • Donor Criteria: The directed donor must meet all standard allogeneic donor eligibility criteria. There are no exceptions or relaxed standards allowed. They undergo the same screening and testing as regular volunteer donors
  • Collection Process: Standard Whole Blood or Apheresis collection
  • Labeling & Handling: Units must be labeled to clearly identify the intended recipient. They are held specifically for that patient
  • Advantages: Provides psychological comfort to the patient and family. Can sometimes be useful in finding rare compatible blood within a family. Ensures necessary irradiation for related donors
  • Disadvantages
    • No proven safety advantage: over standard allogeneic donations from volunteer donors (who are screened identically). Some studies suggest potential disadvantages (e.g., donors feeling pressured to donate despite risk factors)
    • Logistical complexity in coordinating the donation and ensuring it’s available when needed
    • If not used by the intended recipient, the unit is typically discarded or requires specific procedures/consent to be moved to general inventory (if it meets all criteria)
    • Irradiation is mandatory: for cellular products from blood relatives to prevent TA-GVHD (Transfusion-Associated Graft-versus-Host Disease)

Apheresis Donation

  • Concept: Collecting specific blood components (platelets, plasma, red cells, granulocytes, stem cells) using an apheresis machine, returning the remaining components to the donor
  • Purpose/Indications: Allows collection of a larger dose of a specific component from a single donor, reducing recipient exposure. Essential for collecting components like granulocytes or double units of red cells
  • Donor Criteria: Generally must meet allogeneic criteria, but specific requirements may apply:
    • Plateletpheresis: May have specific platelet count requirements. Can donate more frequently (e.g., every 7 days, up to 24 times/year)
    • Double Red Cell Apheresis: Requires higher Hgb/Hct levels and meeting specific height/weight criteria to ensure adequate blood volume. Donation interval is longer (e.g., 112 days/16 weeks)
    • Granulocyte Apheresis: Often requires donor pre-treatment with medications (G-CSF, corticosteroids) to increase granulocyte count. Specific consent regarding these medications is needed
  • Collection Process: Involves the apheresis machine, often requires venous access in both arms, takes longer (1-2 hours), uses citrate anticoagulant (potential for citrate reaction). Covered in more detail under Collection Methods
  • Labeling & Handling: Labeled according to the specific component collected (e.g., Platelets Pheresis, RBC Pheresis)
  • Advantages: High yield of specific component, reduced donor exposure for recipient, allows frequent donation of certain components
  • Disadvantages: Longer procedure time, potential for citrate reactions, requires specialized equipment and trained staff

Hematopoietic Progenitor Cell (HPC) Donation

  • Concept: Collection of stem cells, which can differentiate into various blood cells, for transplantation
  • Purpose/Indications: Used to treat cancers (leukemia, lymphoma, myeloma), bone marrow failure syndromes, and certain genetic disorders
  • Sources
    • Bone Marrow (HPC-M): Collected surgically from the donor’s hip bones under anesthesia
    • Peripheral Blood Stem Cells (PBSC / HPC-A): Collected via apheresis after the donor receives injections of mobilizing agents (like G-CSF) for several days to push stem cells from the marrow into the bloodstream. This is the most common method now
    • Cord Blood (HPC-C): Collected from the umbilical cord and placenta after birth
  • Donor Criteria: Involves extensive medical screening, infectious disease testing (often more extensive than standard donation), and crucial HLA (Human Leukocyte Antigen) matching between donor and recipient (unless it’s an autologous HPC transplant). Donor registries (like NMDP/Be The Match) facilitate finding unrelated donors. Separate regulatory standards apply (e.g., FACT)
  • Collection Process: Either surgery (marrow) or apheresis (PBSC)
  • Labeling & Handling: Extremely strict labeling (ISBT 128 format), handling, and cryopreservation protocols
  • Advantages: Can be curative for life-threatening diseases
  • Disadvantages: Complex process, potential side effects for donor (bone pain from G-CSF, risks of anesthesia for marrow harvest), requires specialized collection and transplant centers

Therapeutic Phlebotomy

  • Concept: Blood is withdrawn from an individual for medical reasons related to their own health, not primarily for transfusion into others
  • Purpose/Indications: To treat conditions characterized by an excess of red blood cells or iron, such as:
    • Polycythemia Vera (excess RBC production)
    • Hereditary Hemochromatosis (iron overload)
    • Porphyria Cutanea Tarda
  • Donor Criteria: Requires a physician’s order specifying the diagnosis, amount of blood to be removed, and frequency. The primary reason is treatment, not donation
  • Collection Process: Similar to standard whole blood donation, but the volume removed is based on the prescription
  • Labeling & Handling
    • If the patient-donor also meets all allogeneic donor eligibility criteria (which is sometimes the case, e.g., for hemochromatosis donors), the blood may be eligible for transfusion use (“qualified therapeutic collection”). It must be labeled accordingly
    • If the patient-donor does not meet allogeneic criteria (e.g., due to their underlying condition like polycythemia vera, or other standard deferrals), the unit must be labeled as Therapeutic Phlebotomy and discarded (not used for transfusion)
  • Advantages: Effectively treats the patient’s medical condition. Potential to contribute to the blood supply if all criteria are met
  • Disadvantages: The blood is often discarded. Requires careful coordination between the blood center and the treating physician

Key Takeaway

Special donations address specific clinical needs beyond the scope of standard allogeneic donation. They require careful attention to unique donor criteria, collection procedures, and especially labeling and handling protocols to ensure safety and efficacy for either the donor-patient (autologous, therapeutic) or the intended recipient (directed, HPC). Medical director oversight is often crucial in managing these special cases

Key Terms

  • Autologous Donation: Donation of blood by an individual for their own future use
  • Directed (Designated) Donation: Donation of blood by an individual for a specific, named recipient other than themselves
  • Apheresis: Procedure to collect specific blood components using automated equipment
  • Hematopoietic Progenitor Cells (HPCs): Stem cells capable of developing into blood cells, collected for transplantation (bone marrow, peripheral blood, or cord blood)
  • Therapeutic Phlebotomy: Removal of blood as a medical treatment for the person undergoing phlebotomy
  • Alloimmunization: The development of antibodies in response to foreign antigens (e.g., from a blood transfusion or pregnancy)
  • Graft-versus-Host Disease (GVHD): A complication where immune cells from donated tissue (graft, e.g., blood transfusion, HPC transplant) attack the recipient’s tissues (host). Prevented in relevant transfusions by irradiation
  • Irradiation: Treatment of cellular blood components with gamma rays or X-rays to inactivate donor lymphocytes and prevent TA-GVHD. Mandatory for directed donations between blood relatives
  • HLA (Human Leukocyte Antigen): Proteins on the surface of cells that are key to immune system recognition; critical for matching in HPC transplantation and sometimes relevant in platelet transfusion
  • G-CSF (Granulocyte Colony-Stimulating Factor): A medication used to increase the production and release of granulocytes and stem cells from the bone marrow into the bloodstream, often used before PBSC or granulocyte apheresis donation