TYPICAL PROCEDURES for
AUTOLOGOUS and DIRECTED
BLOOD DONATIONS

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THIS PAGE PRESENTS A MUCH MORE DETAILED AND CLINICAL VIEW OF AUTOLOGOUS BLOOD DONATION FROM A TECHNICAL PERSPECTIVE.

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Autologous RBCs/ Whole Blood for Transfusion
Autologous Cryoprecipitate for Transfusion
Obtaining Autologous Blood or Components Collected Out of the Area
Collection of Autologous Blood
Directed Donations for Transfusion
Collection of a Directed Donation
Example Autologous Blood Consent Form
Example of Directed Donation Program Physician's Order Form
Example of Directed Donation Program Patient Consent 
Other Very Important Factors to Consider


Autologous Red Blood Cells/Whole Blood for Transfusion

Autologous Blood is Blood that a patient has ordered drawn (donated) and stored, for his or her own use, most often in preparation for an upcoming surgery. (see information on Blood collection of autologous Blood.) Autologous Blood, by definition, can not be used for anyone other than the person who donated it.

At the time an autologous Blood unit is collected the donor/patient is given a receipt, which sometimes is in the form of a card, which they are instructed to present to the hospital where the Blood will be needed, upon admission. This receipt/card contains the donor’s name, date of birth and social security number as well as the Blood unit number, date it was drawn, and other information. We suggest that this information be recorded and kept in a secure place. Presentation of a copy of this receipt will ensure that patients register the same way at the hospital as they have at the Blood center. This entering of the exact same name on both records will help to ensure that you get your own Blood. Human error us a top cause of Blood related problems.

When you get to the Blood donor center and the hospital, procedures are in place to ensure positive identification of every patient at the time of the Blood draw and then again at the time of Blood transfusion. Blood drawn for the pre-transfusion testing of autologous units can be drawn up to 14 days in advance of planned surgery. Pre-transfusion testing of autologous Blood serves as a backup mechanism for checking patient identity. The ABO/Rh Blood type of the patient samples taken and the ABO/Rh of the autologous Blood unit(s) drawn are compared to be sure they match. The compatibility testing performed on an autologous Blood unit is valid until the unit expires. Autologous Blood is not cross-matched unless there is a discrepancy in patient identification.

It is up to the patient to be absolutely certain of the match of names and unit numbers. Again, human error causes more serious Blood problems than any other cause.

A certain and permanent identifying device indicating the patient’s name is affixed to each unit of autologous Blood. Your autologous Blood unit(s) will be accompanied by a Transfusion Report. The word "Autologous" appears as part of the component description. The expiration date/time of the unit will also appear.


Autologous Cryoprecipitate for Transfusion

When ordering Autologous Cryoprecipitate (Cryo), there is a noticeably less formal atmosphere, since there is no compatibility sample required to place the order, since this Blood product is essentially red cell free. When a patient stores autologous Cryoprecipitate, a unit of Red Blood Cells is also stored. If this unit is needed for transfusion, a sample is required for ABO compatibility testing. The Blood center follows essentially the same procedure as for ordering autologous Blood.

The preparation time for 'cryo' is short, however transportation time from the Blood center, where the Blood is stored, to the transfusing facility, where the Blood will be used by the patient, is critical when using the ordered Blood.


Obtaining Autologous Blood or Components Collected Out of the Area

If it is known that autologous Blood components are being collected and prepared outside of the area of the Blood center providing stored Blood or Blood products, hospital personnel, where the surgery/procedure is to be done, should verify that the Blood components have arrived at the point of use before surgery, as planned. Further, the Blood must be in a state of readiness. We recommend that this be done in person, and in writing, by the supervising physician, and verified to the patient, two or three days in advance of the operation. This simple safeguard will save needless anxiety on the day of your surgery/procedure. If the Blood that you need has not arrived in correct and useable order before you need it, then that Blood is of no use to you, whatever. If your physician has done this, it will be a recorded part of your medical record that is compiled on that visit to the hospital.


Collection of Autologous Blood

Many patients with planned surgeries may store their own Blood in advance to meet their operative transfusion needs. Although not completely risk free, autologous Blood is the safest transfusion component. Exclusive use of a patient’s own Blood eliminates reactions due to donor-recipient incompatibility and precludes exposure to transfusion-transmitted diseases.

Preoperative autologous Blood donation is appropriate for patients who:

Are likely to need a Blood transfusion,
Are likely to be able to provide a substantial portion of their Blood transfusion needs by using autologous Blood,
Have a hematocrit of 33% or greater,
Have two or more weeks before surgery to donate the needed Blood,
Are able to tolerate an acute 10% to 15% reduction in total Blood volume and,
Are able to tolerate a possible reaction (bradycardia, hypotension, seizures.)

An autologous Blood Program, which is in place at most Blood centers normally provides the resource for patients to store, short term, preoperative autologous Blood. Preoperative autologous Blood storage will normally be ordered by a physician. There is often an extra cost to the patient for this service.

The effectiveness of autologous Blood collection is largely dependent on the patient’s bone marrow being able to replace the red Blood cells that have been removed. It takes from seven to ten days to achieve an effective bone marrow response to a reduced hematocrit. If the patient is unable to replace some of the red cells removed for autologous Blood storage, all that is accomplished is hemodilution, which is minimally effective unless done in large volumes.

A patient storing autologous Blood is best served when the Blood is collected as far in advance of surgery as is practical. Since Blood can be stored for 42 days (under normal storage conditions), the first unit should optimally be stored about 35 days before surgery to avoid expiration of the Blood should a short postponement of surgery be necessary. In a donor of average weight and age, one unit (pint) of Blood is drawn and stored on each visit. Blood collections are scheduled at least 72 hours apart to allow the patient’s intravascular volume to return to normal.


Directed Donations for Transfusion

Directed Donation is Blood for transfusion that has been donated by a person specified by the patient. A Request for Blood form and a cross-match sample from the patient, drawn within three days of transfusion, must be sent to the Blood center’s compatibility testing laboratory in order to receive directed donations which have been collected and stored for the patient. For additional information concerning arranging collection of directed donations for a patient click here.

If a combination of autologous, directed donations and allogeneic units are to transfused, autologous units should be transfused first, directed donations second and allogeneic last.

Directed Donations require full compatibility testing. All cellular Directed Donation components will be irradiated. These charges will be billed to the hospital at the time the transfusion is ordered. The Transfusion Report will indicate "irradiation." A blue Directed Donation sticker and a blue tie-on-tag indicating the patient’s name should be affixed to each Directed Donation unit.

The component information listed on the Transfusion Report should be checked against the chart to be sure it matches the physician order for that patient. A blue "Directed Donation" sticker is applied to the Transfusion Report. Costs associated with collection, testing and processing are paid at the time of collection, therefore these cost are not billed to the hospital.


Collection of a Directed Donation

Under certain circumstances a patient anticipating a transfusion may request Blood from a friend or family member. This is called a Directed Donation. Many people elect to have friends or family donate for them because they feel that Blood from individuals they designate will be safer than Blood donated by unknown volunteers.

It is very important to remember that you almost certainly do not know everything about each of your friends and family members. Many of the very things that may well put you and them at mortal risk are among the most closely guarded secrets!

Your doctor can order collection Blood products for pediatric use, through any directed donation program.


OTHER VERY IMPORTANT FACTORS

Physician Order

Directed donations must be ordered by a physician on an approved Order Form.


Patient Consent

The patient must understand and sign some forms. Be prepared with information.

 Link - BloodBook.com Directed Blood Donation Order Form Link - BloodBook.com 
Link - BloodBook.com Directed Blood Donation Consent Form Link - BloodBook.com 
Link - BloodBook.com Sample Blood Donor Declaration Form Link - BloodBook.com 
Link - BloodBook.com Sample Blood Donor Consent Form Link - BloodBook.com 
Link - BloodBook.com Sample Informed Consent Form Link - BloodBook.com


Cost

Each directed donation may cost from $65.00 to $250.00. This processing fee must be paid by the donor or recipient prior to Blood collection. Your insurance policy may or may not cover these fees. There is no reimbursement for directed donations that are unsuitable for any reason, or for Blood or Blood products that are not used by the patient. If out of area shipping is required, normally an additional fee will be collected from the donor for each unit of Blood to be shipped.


Timing

As a rule of thumb, directed donations can occur no later than four work days (week days) before a planned transfusion, when the use is to be local, and no later than six work days (week days) for a regional transfusion. Directed Blood donations which are to be shipped out of the area normally must be collected no sooner than seven to ten week days (work days) before the planned transfusion. Donations should occur no sooner than five weeks before the planned transfusion.


Compatibility

Donors must be compatible with the patient in terms of ABO/Rh. Donors will not be scheduled without documentation of their Blood type (such as a Blood donor card or lab certification documents).

The donor ABO/Rh can be determined by the MD’s office prior to placing an order or by the Blood center after the physician’s order and patient’s consent have been received. In this case, donors must come into the Blood center and have a small sample of Blood drawn 24 hours or more before the day they plan to donate. There will be a charge for this service.

The ABO/Rh of the patient must be recorded on the Directed Donation Physician’s Order Form. Even when ABO/Rh compatible with the patient, the Blood center cannot guarantee that directed donor Blood will be compatible until the final compatibility testing is performed at the time of transfusion. Because directed donations will be accepted from ABO/Rh compatible but not necessarily ABO/Rh identical donors, the units provided for transfusion may not be identical to the recipient’s Blood type.

Link - BloodBook.com Blood Types and Compatibility Chart Link - BloodBook.com


Eligibility Criteria

Directed donors must meet all eligibility criteria required of any other donor.

Link - BloodBook.com Blood Donor Requirements Link - BloodBook.com


Unused Directed Donations

Directed Blood donations that are not used by the patient will be destroyed.


 

 

 

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   last updated 11/10/2004   bloodbook.com