Autologous Introduction

Blood

Transfusion

Autologous blood transfusion is the collection and reinfusion of the patient's own blood or blood components. Allogeneic blood, on the other hand, is collected from someone other than the patient. Over the last several years, an increased awareness of diseases transmitted by allogeneic blood has resulted in a dramatic increase in autologous blood transfusion. Clinical research and practice in autologous blood use have also grown in recent years, providing new insights into the issues involved. These new ins ights are provided into this complete revision of the National Heart, Lung, and Blood Institute's 1989 recommendations on the use of autologous blood.
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Despite reduction of the risk of transmitting viruses such as the human immunodeficiency virus (HIV) or hepatitis B or C

(HCV),2,3 autologous blood transfusion remains safer than allogeneic blood transfusion and appropriate for p roperly selected patients. Exclusive or supplemental use of autologous blood can eliminate or reduce many adverse effects of transfusion. Directed donations -- blood donated by a friend or family member for a designated patient -- are not as safe as the patient's own blood and must not be considered equivalent to autologous donations. Since most planned surgical procedures are not associated with sufficient blood loss to result in transfusion, autologous blood techniques are not appropriate for all patien ts. The transfusion experience of patients who have undergone similar procedures can serve as a guide. If transfusion is likely for a planned surgical procedure, several types of autologous transfusion can be used either alone or in combination:

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preoperat ive autologous blood donation (PABD), intraoperative blood salvage, postoperative blood salvage, and acute normovolemic hemodilution (ANH).

Standards, guidelines, and regulations exist for patient selection as well as processing and transfusion of blo od collected using autologous transfusion techniques. These should be used by each hospital's transfusion committee in establishing and monitoring autologous transfusion programs. The following table summarizes the proper use of autologous transfusion tech niques for selected surgical procedures.

Autologous techniques are considered inappropriate for many surgical procedures because the expected blood loss is small and it is unlikely the patient will receive a transfusion. The best approach depends, in par t, upon the surgical procedure planned. For example, for a PABD and postoperative undergoing that blood salvage of total are hip appropriate replacement, patients revisions frequently

procedure

necessitates

transfusions. However, intraoperative blood loss for total knee replacement is minimal because tourniquets are used. Thus intraoperative blood salvage would not be effective.

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Table: Surgical Procedure and Autologous Techniques

Table I

Selected Surgical Procedure

Coronary artery bypass Major vascular surgery Primary hip replacement Revision, hip replacement Total knee replacement Major spine surgery with instrumentation Selected neurological procedures (e.g., resection of arteriovenous formation) Hepatic resections Radical prostatectomy Cervical spine fusion Intervertebral discectomy Mastectomy Hysterectomy Reduction Mammoplasty Cholecystectomy Tonsillectomy Vaginal and cesarean deliveries Transurethral resection of the prostate

Autologous Technique
PABD + + + + + + + + + IBS + + + + + + +* +* PBS ANH + + + + + + + + + + + + + -

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+Appropriate; - Inappropriate; * See section on cancer surgery in IBS section on selection of patients; PABD = preoperative autologous blood donation; IBS = intraoperative blood salvage; PBS = postoperative blood salvage; ANH = acute normovolemic

Preoperative Autologous Blood Donation

In general, autologous blood donations are indicated for patients having surgical procedures Tables for for the which amount blood of is usually to be crossmatched. blood

crossmatched for specific procedures are widely available in hospitals and may serve as guides for the amount of autologous blood that should be collected. The less likely the transfusion, the more likely donated blood will not be used. Therefore, patients should not be encouraged to donate autologous blood for surgery unless there is a re alistic possibility of transfusion, for example, the likelihood of transfusion is greater than 10

percent.

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Surgical

Procedures

For surgical procedures where transfusion is likely, autologous donations can provide some or all of the blood components needed by the patient (see Table I Table: Surgical Procedure

and Autologous Techniques ). Nevertheless, PABD does not

completely eliminate the possibility that the patient might receive allogeneic blood. If the need for transfusion is greater than anticipated, or insufficient autologous blood has been collected, the patient may need blood from the allogeneic supply. Thus, during the discussion with the patient of the surgical risks and benefits, autologous donations cannot be presented as a guarantee against allogeneic transfusions.

The indications for PABD may be broadened and the number of units to be collected increased under unusual circumstances (e.g., patients with coagulation disorders that increase the risk of bleeding, or patients with alloantibodies for whom locating compatible blood may be difficult).

Selection

of

Patients

Most patients who are healthy enough to u ndergo elective surgery will be able to donate blood preoperatively. Determination of suitability for PABD is the responsibility of the physicians caring for the patient and the physician responsible for the blood collections. In deciding to collect autolo gous blood from a patient, the benefit of decreased exposure to allogeneic blood must be weighed against the risk of making the donation and of delaying surgery for the time needed for adequate regeneration of red blood cells (RBCs). Appropriate patients a re those having:

elective surgery that can be scheduled at least several weeks in the future, a surgical procedure for which blood is usually crossmatched, a hemoglobin > 110 g/L (hematocrit 0.33), and no medical contraindications to the donation or st orage

of blood. Patients with conditions predisposing to bacteremia, such as those with an indwelling urinary catheter or a device penetrating the skin, are not eligible for PABD because bacteria collected with the blood may proliferate during its storage .

Vasovagal reactions occur in about 2 to 5 percent of all blood donors--either reactions hypotension autologous of and or allogeneic. and are Most to vasovagal transient Severe consist lightheadedness due

bradycardia

self -limited.

reactions with loss of consciousness or seizure activity are uncommon. According to information from the American Red Cross, autologous blood collections result in hospitalization of approximately 1 donor in 16,000 autologous collections per year (written communication, N. Rebe cca Haley, M.D., May 1994).

Special

Considerations

Special consideration should be given to the following situations:

Patients with coexisting medical conditions. Autologous donations can be safely obtained from patients with stable coronary artery disease, stable valvular disease, and congenital heart disease. One inadequately controlled recent report indicated that bloo d donation may be associated with increased risks in patients with unstable severe angina, aortic cyanotic stenosis, congenital and heart disease, occlusive severe

cerebrovascular disease. None of these studies involved large numbers of subjects.

Elderly patients. Age alone should not exclude a patient from autologous blood donation. As with all patients, underlying even those diseases who and and the never patient's donated in physiologic blood, can condition are the determining factors. Elderly patients, have safely successfully participate preoperative

autologous blood donation.

Pediatric patients. Autologous blood has been collected from children as young as 8 years old. Children (and adults) weighing less than 110 pounds can safely donate, although th e volume drawn at each donation is reduced

in

proportion

to

the

body

weight.

Most

individuals

tolerate well a phlebotomy of up to 10 percent of their blood volume. Other factors, such as venous access and emotional tolerance of venipuncture, occasionally l imit the collection of autologous blood from children.

Obstetric patients. Several studies, each reporting a small blood number donation. of patients, so have few not detected need complications for either mother or baby from autologous However, mothers transfusions during or after delivery that autologous donations should be discouraged for pregnant women. An exception may be the presence of a placenta previa as an indication for autologous donations because of the greater likelihood of transfusion.

Technique The decision to collect PABD should be based on a discussion between doctor and patient regarding the procedure's risks and benefits, after which the patient can be referred to a blood collection facility. Here, the patient is evaluated for eligib ility of autologous donation. Patients distant from the hospital where surgery is planned often can donate at a local blood collection facility and have the blood sent to the hospital.

Many patients can give blood as frequently as every 3 days, although once a week is more common. Patients donating autologous blood may benefit from oral iron supplementation; for example, ferrous sulfate 325 mg P.O. T.I.D. or ferrous gluconate 325 mg five times a day. The optimal donation period begins 4 to 6 weeks before surgery in order for a sufficient number of units to be donated and to enable more complete RBC regeneration. In any case, the last blood donation should not be collected later than 72 hours before surgery to allow for restoration of intravascular volume. A single unit donation a few days before surgery will not be beneficial because minimal RBC regeneration will occur.

Handling and Storage

Autologous blood components require special handling and

segregated processing and storage compared with allogeneic units. In addition, increased personnel time is associated with collecting blood from patients with complex medical histories as opposed to healthy donors. Therefore, autologous blood often costs more than allogeneic blood and may result in billing surcharges. If a unit of autologous blood is confirmed to be anti -HIV or HBsAg-positive, the Food and Drug Administration (FDA) recommends that it be discarded. However, the donor may be transfused with these autologous components if permitted by the hospital and collecting facility and if appropriate documentation is provided by the patient's physician. The patient's physician should be informed if tests on a unit are positive for anti -HCV, anti-HBc, or syphilis.

Number of Units Donated between one -third and one-half of collected autologous blood components are not used by their donors.23 -25 Collections in excess of transfusions are considered inevitable in order to provide sufficient blood to meet the needs of most patients,10 although this complicates the lo gistics and adds to the costs of an autologous blood program. However, those unused units of autologous blood have given rise to the controversy regarding the appropriate transfusion of autologous collections.

Release of Unused Autologous Units

Unused autologous blood is stored for the patient's perioperative needs for a variable period of time after the operation (in accordance with local policies and procedures). Typically, this blood is stored until the patient's discharge or the unit's outdate. If a second surgical procedure is anticipated or if the scheduled procedure is delayed, the transfusion service may be able to arrange for extended frozen storage of the autologous blood. Unused autologous blood is usually destroyed rather than being added to the allogeneic blood inventory. Only a relatively small number of autologous units are suitable for transfusion to other patients because autologous donors often do not meet the health criteria required for allogeneic blood donors. Furthermore, the suitable unit, when no longer needed by the donor, often has a

very short shelf life. Thus, the adding of unused autologous blood to the inventory would have little impact on the overall blood supply and should not be considered a justification for requesting autologous donations from patients who are not likely to require transfusion.

Additional Autologous Components

Plasma: autologous Autologous plasma should be prepared with the

RBCs.

Fibrin glue: Fibrin glue mixed with thrombin is a biologic adhesive used during surgery. It is prepared from plasma or cryoprecipitate. If the use of fibrin glue is anticipated and if preoperative donation is feasible, it should be prepared from autologous Autologous rather platelet -rich than plasma: allogeneic Autologous blood. platelet-rich

plasma can be collected from patients in the operating room using apheresis equipment. For cardiac surgery patients, this plasma is removed before cardiopulmonary bypass and re turned after heparin reversal. do Although not the procedure its has been use. advocated as a technique to improve hemostasis and limit blood loss,other data support routine

Risks
Despite the use of special systems to avoid administering the wrong unit of allo-geneic or autologous blood to patients, such errors happen. The dependency of preoperative blood donation and transfusion on clerical accuracy has resulted in increased vigilance. Nevertheless, the likelihood that autologous blood is given to the wrong patient is not zero but can be estimated to be 1:30,000 to 1:50,000.

The Role of Recombinant Erythropoietin in PABD

Several studies have demonstrated that administering

recombinant erythropoietin (rEPO) can increase the amount of

autologous blood tha t can be collected over a given period of time. Although rEPO increases erythropoiesis, its role in PABD is limited to a few situations, such as when a patient is already anemic or needs to donate an unusually large amount of blood in a short time. The FDA has not approved the use of rEPO for autologous donation.

Perioperative Blood Salvage

Perioperative blood salvage is the collection and reinfusion of blood lost during and immediately after surgery. Once used almost exclusively during cardiac procedures , perioperative blood salvage is now commonly used for vascular and orthopedic surgical operations, some solid organ transplants, and some trauma where cases. See Table I for selected is procedures where perioperative salvage may be appropriate, as well as examples intraoperative salvage usually unnecessary.

Intraoperative Blood Salvage

The amount of RBCs recovered during surgery varies with the procedure but may amount to 50 percent or more of that lost. Even though the amount recovered may be equivalent to only one or two units of blood for some patients, this may be of significant benefit, especially when combined with other autologous transfusion techniques. The posttransfusion survival of intraoperatively recovered RBCs is comparable to that of allogeneic RBCs.

Surgical

Procedures

In general, intraoperative blood salvage is appropriate for the following surgical procedures:

Cardiac and vascular surgery : Intraoperative blood salvage is valuable in most major vascular operations and during cardiac surgery. In addition to salvaging blood lost during cardiac surgery, blood remaining in the cardiopulmonary bypass circuit should be recovered.

Orthopedic Surgery: Intraoperative blood salvage has been shown to substantially reduce the need for allogene ic transfusions in such procedures as spinal surgery39 and hip replacement. Other surgical procedures : Intraoperative blood salvage can be used for other surgical procedures involving major blood loss, such as trauma, liver transplantation, splenectomy, and ruptured ectopic pregnancy. Concerns remain about the safety of cause disseminated intravascular coagulation (DIC); washing the salvaged bl blood salvaged during cesarean deliveries because the infusion of amniotic fluid may ood may not eliminate this risk.

Selection Many surgical patients who

of undergo procedures

Patients in which

transfusions are likely can benefit from intraoperative blood salvage, especially in cases where preoperative donation is impossible or inadequate.42 If the shed blood is collected by sterile methods and properly reinfused, the procedure has few risks. Relative contraindications to the use of intraoperative blood salvage include:

Infection: No existing system of blood filtering or washing can completely eliminate bac teria. As a result, intraoperative blood salvage is not routinely used if the field is contaminated with bacteria. abscesses, Contamination or of salvaged blood for can occur in with procedures with spilled intestinal contents, bacterial peritonitis, osteomyelitis. Nevertheless, patients massive life-threatening blood loss, immediate reinfusion of blood recovered from a contaminated field may be appropriate when adequate amounts of allogeneic blood are not available. The safety of using potentially contamin ated recovered blood has been evaluated in only a small number of patients. Recovered blood should not be stored since the bacteria may grow and multiply. Cancer: Malignant cells are not completely removed from

salvaged blood by washing or filtration, an d there is a theoretical

risk

that

transfusion may salvage The

of in

blood in

salvaged metastases.

during The has that

surgery safety not is

for of

malignancy intraoperative cancer

result

cancer of

patients blood

been grossly

established, although the technique has been performed in some patients. reinfusion malignant contaminated with cells should be avoided.

Technique Blood salvaged intraoperatively may be transfused directly after collection or processed (washed) prior to infusion. Controversy exists regarding the relative merits of washed versus unwashed salvaged blood. Washed blood has the theoretical advantage of reducing infusion of free hemoglobin, tissue procoagulants, and debris. Although data regarding the safety of unwashed salvaged blood ar e limited, this form of autologous blood is usually infused in relatively small amounts (less than 2 L) without significant adverse effects. When collecting blood for infusion without processing, care should be taken to avoid hemolysis (due to high aspirat ion pressure and surface suctioning) and contamination with tissue debris. Because of the presence of debris and the high incidence of hemolysis, washing salvaged blood during orthopedic procedures is indicated.

Commercially available equipment with disp osable software exist for Semiautomated systems each wash the collected blood option: before

reinfusion. The washed RBCs do not contain significant amounts of clotting factors or platelets. A trained, dedicated operator is essential automated to operate the equipm ent, even with the newer models.

Suction systems that collect blood for reinfusion without washing are modifications of disposable suction systems. These machines are relatively inexpensive and technically easy to set up and use. To ensure a quality blood product for reinfusion, a well designed program and appropriately trained staff are necessary. The American Association of Blood Banks has developed guidelines and standards that are valuable program in designing an effective quality intraoperative recovery and maintaining

assurance.53

Postoperative Blood Salvage

Surgical Procedures

Postoperative blood salvage is used most frequently for cardiac and orthopedic surgical patients.

Cardiac surgery: The reinfusion without washing of salvaged blood obtained from mediastinal drainage after cardiac surgery is widespread and appears to be safe and effective. However, reinfusion of unwashed blood may affect laboratory tests. For example, the blood may co ntain cardiac enzymes, such as creatine kinase, so its reinfusion may complicate the diagnosis of perioperative Orthopedic surgery: may myocardial Blood be safe salvaged and and infarction. reinfused the after of

orthopedic surgery (e.g., hip arthroplasty and spinal fusion wit h instrumentation) reduce amount allogeneic blood given. Others, however, have not demonstrated the same efficacy. Small amounts have been reinfused with no apparent side effects, but fever, hypotension, and upper airway edema have been reported.

Technique Blood salvaged postoperatively generally is collected from mediastinal, chest, and joint drains and transfused without washing. Because it is defibrinogenated, it does not require anticoagulation prior to transfusion. Although dil uted, the blood is sterile and has viable RBCs.

Traumatic Hemothorax: Blood that collects in the thoracic cavity following blunt or penetrating trauma is analogous to blood shed following cardiac or orthopedic surgery. It is defibrinogenated and may be collected and transfused. Typically, this process is accomplished using chest drainage devices that have been adapted for blood salvage.

Risks Of Perioperative Blood Salvage

Dilutional coagulopathy : Because salvaged blood is deficient in coagulation may factors and platelets, patients receiving transfusions of large volumes of salvaged blood (> 1 blood volume) develop hypofibrinogenemia, thrombocytopenia, and prolonged prothrombin (PT) and partial thromboplastin times (PTT). However, plasma and platelet t ransfusions generally are not required and should be given only when indicated by the clinical situation and laboratory tests. Although coagulation test abnormalities following infusion of salvaged blood have been interpreted as evidence of DIC, these chan ges likely are the result of infusion of fibrin degradation products and do not represent a consumptive coagulopathy.

Reinfusion of anticoagulant : When heparin is used as the anticoagulant, infusion of unwashed blood may cause systemic anticoagulation. In some cases, this anticoagulant effect may be undesirable. However, proper cell washing virtually eliminates the heparin.

Renal insufficiency: Infusion of large quantities of unwashed blood that contain hemolyzed RBCs may contribute to renal failure, particularly in patients with already compromised renal function. Hemolysis can be reduced by decreasing aspiration pressures and avoiding surface suctioning.

Air embolism: As with all intravenous infusions, improper technique, such as applying pressure to air -containing systems, may lead to air embolism.

Acute Normovolemic Hemodilution

Acute normovolemic hemodilution (ANH) is the removal of blo od with the simultaneous intravascular is a infusion volume of cell -free to for solution(s) blood who to will maintain prior option surgical loss.

Hemodilution

transfusion

patients

tolerate a large, acute decrease in hemoglobin concentration. ANH reduces R BC loss because the blood lost during surgery has a lower hematocrit. The removed blood is reinfused during or after surgery, as needed, to maintain the desired post -ANH hemoglobin expertise, concentration. and an ANH requires of vigilance, the clinical understan ding physiological

consequences.

Efficacy Mathematical analysis predicts that the efficacy of ANH increases with greater surgical blood loss, higher initial patient hematocrit, and lower post-ANH that to hematocrit. extreme 0.20), In may addition, result mathematical (for in example, substantial analysis reduction predicts hemodilution

hematocrit

reduction of allogeneic blood transfusions if surgical blood loss is > 50 percent of blood volume. Removal of several units of blood in patients with b lood loss of < 50 percent of blood volume may have little or no effect on the requirement for allo -geneic transfusion. Randomized studies show conflicting results regarding the efficacy of ANH, perhaps due to the varying conditions of each study. Further c linical studies are needed to test the models and determine the extent of efficacy.

Surgical

Procedures

Table I lists examples of surgical procedures in which expected blood loss may be substantial and ANH may be appropriate, as well as examples of surg ical procedures in which expected blood loss usually is not sufficient of to warrant ANH.

Selection

Patients

ANH may be employed alone or in conjunction with other forms of autologous transfusion. Although PABD may be inadvisable for some patients with serious cardiac disease, withdrawing blood in the operating room under carefully controlled and monitored conditions offers an alternative for many of these patients. When PABD is undesirable or impossible (e.g., there is a potential for bacteremia or too little time for donation), ANH may be an appropriate solution. ANH can also be considered when malignancy or infection at the operative site precludes the use of intraoperative blood salvage.

Since ANH probably is efficacious only when the hematocrit is reduced to <0.30, additional caution is necessary in patients with hepatic dysfunction or cardiovascular, cerebrovascular, or pulmonary Technique The amount of blood removed depends on the patient's blood disease.

volume and the initial and post -ANH hematocrits. The blood must be collected into properly labeled blood bags containing an anticoagulant. It may be stored at room temperature (to preserve platelet function) for up to 8 hours and up to 24 hours if appropriately refrigerated. The hematocrits of the units will vary between the initial hematocrit and the post -ANH hematocrit. Risks Hemodilution decreases hemoglobin concentration and oxygen carrying capacity and content, thereby increasing the potential for critical organ ischemia to the same ext ent as does surgical blood loss and replacement with non -oxygen-carrying fluid. The lowest safe hemoglobin concentration in humans, with or without disease of critical organs, is not known.

ANH dilutes circulating coagulation factors, as well as RBCs; platelet count decreases to a lesser extent. If abnormal bleeding is observed, laboratory tests of coagulation should be monitored.

Transfusion Components
When should

Of

Autologous

Blood

blood

(autologous

or

allogeneic)

be

transfused? Blood components should be transfused only when they are needed. However, objective indications for the transfusion of blood components are difficult to establish. The decision to transfuse RBC's is ideally based on the prevention of tissue hypoxia due to an oxygen transport deficit. No specific method to measure or anticipate a clinically significant deficit exists. In awake patients, symptoms of oxygen deficiency and such as are headache, lightheadedness, tinnitus, faintness

nonspecific and do not lend themselves to the avo idance of symptomatic hypoxia. If available, base excess, the oxygen extraction ratio, serum lactate, and cardiac index can be used as surrogate markers. The hemoglobin and hematocrit are easily obtained laboratory values, but are far less likely to reflec t the degree of oxygen deficiency in a patient because many other factors affect oxygen transport, such as underlying cardiac or pulmonary disease, cardiac output, and hemoglobin's affinity for

oxygen. Practice guidelines have been based on hemoglobin le vels,

although the inadequacy of this approach is widely recognized. In general, transfusions at or below hemoglobin levels of 70 g/L (hematocrit 0.21) are appropriate, whereas transfusions at hemoglobin levels above 100 g/L (hematocrit 0.30) rarely are indicated. Between these two levels, clinical circumstances such as the potential for further blood loss and the patient's underlying condition will determine the decision to transfuse.

Should the indications for autologous blood transfusion differ The from those for allogeneic for the blood use of transfusion? autologous or comparative indications

allogeneic blood are controversial. If precise indications for a blood transfusion could be defined, autologous blood could be used only in situations where al logeneic blood would be given. On the other hand, the benefits of allogeneic and autologous RBC transfusions are similar, but the risks of autologous blood are less. Hence, the risk -benefit ratio supports the more liberal use of autologous blood.

Although some physicians may choose to use autologous blood components more liberally than allogeneic components for a given indication, autologous blood should not be transfused merely because it has been collected. For example, the transfusion of autologous RBC s to the slightly or non -anemic patient or the use of autologous fresh frozen plasma in the absence of coagulopathy is inappropriate.

In what order should autologous RBC's be transfused when a variety of autologous components are available? When multi ple autologous RBC components are available, the decision to transfuse should be based on a variety of factors, such as the component's quality, safety, efficacy, and shelf life. Table II lists the shelf life of autologous RBCs.

Table: Shelf life of auto logous RBCs

Table II Source of Red Blood Cells Shelf Life

Units collected during perioperative blood salvage Units collected during hemodilution Thawed, previously frozen autologous red blood cells Liquid-stored PABD units

6 hours 8 hours 24 hours 35-42 days

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What Is An Autologous Blood Donation? What you need to know.

By Carol Eustice, About.com Guide Updated May 25, 2006
About.com Health's Disease and Condition content is reviewed by the Medical Review Board

Filed In:
1. Arthritis Basics / Q&A What is an autologous blood donation? An autologous blood donation is when a person donates blood for their own use, prior to a scheduled elective surgery. There are actually at least three kinds of autologous procedures: Pre-operative autologous donation - patient donates his/her own blood prior to surgery. The pre-operative autologous donation is the most common of the three procedures.

 Intra-operative salvage - a way of saving blood lost during surgery so it can be returned to the patient. Utilizes a machine called a cell saver. Postoperative cell salvage - Done usually after the patient leaves the operating room. During some surgical procedures, there can be an accumulation of blood in the body, which can be collected and returned to the patient via transfusion. What is an autologous blood transfusion? The blood which a patient donates prior to their scheduled elective surgery is stored and saved for their use. When the blood is given back to the patient, it is called an autologous blood transfusion. Who decides if you should be an autologous blood donor prior to your surgery? If there is a possibility that you will need a blood transfusion during your surgery, your surgeon may recommend an autologous blood donation. The type of surgery determines the need for autologous donation and the health of the patient determines their ability to donate. You will need an appointment at the local blood bank if you will be scheduling an autologous blood donation. Can you donate an autologous blood unit if you were previously turned down as a blood donor? Being turned down before does not necessarily preclude you from donating an autologous unit. You will be screened once you arrive at your blood bank appointment. A brief medical history is taken from you, as well as your pulse, blood pressure, temperature, and a fingerstick blood sample to determine your hematocrit (checking to see if you are anemic). Your medications are discussed, so be sure you arrive at your appointment with a list of your medications. (I was told at my appointment that having rheumatoid arthritis (RA) does not preclude a person from being a general blood donor. However, an RA patient must be off of methotrexate for 30 days before they can donate for the general population.) The requirement about methotrexate is waived since your own blood will be given back to you with autologous blood donation. Why should you go through the hassle of donating autologous units? How do you benefit from autologous blood donation? By donating an autologous blood unit, you: Eliminate the risk of acquiring infectious diseases from blood tranfusions. Though blood from strangers, family, and friends are all screened and tested to minimize any risk of transmitting infectious disease, autologous donation remains the only way to eliminate the risks. Also, by using your own blood you don't reduce the community blood supply and you leave it for people who may need it. Is there any cost involved with autologous blood donation?

Yes, there are fees associated with autologous blood donation. Check with your blood bank on processing and administrative fees and check with your insurance to see if they cover autologous blood donation.