The Autologous (Self) Donation Program allows patients to donate their own blood to meet the anticipated transfusion needs for planned surgeries. However, the use of autologous blood has decreased dramatically over the years due to the fact that donor screening protocols and sensitive blood tests were developed to reduce the risk of transmission of hepatitis and HIV. Collection of autologous units is no longer a standard practice.

It is the responsibility of the patient’s physician and the medical staff at Versiti to determine whether the patient’s health will permit them to donate safely.

As soon as possible after the decision for surgery is made, please review the information with the patient and complete the Autologous Donation Prescription Form. Autologous donations are drawn at the following sites:

• Illinois: Aurora, Tinley Park, Crystal Lake, DeKalb, Joliet, Winfield, Naperville and Highland
• Indiana: all donor centers
• Michigan: Grand Rapids, Kalamazoo, Saginaw, Traverse City, Livonia and Midland Dow Diamond
• Ohio: Mill Run Center
• Wisconsin: all donor centers

Nearly anyone who is scheduled to undergo a planned surgical procedure that may require the transfusion of blood is eligible to participate in the Autologous Donor Program. However, for the safety of autologous donors, certain guidelines must be followed.

There are several contraindications to autologous donation:

• Unmanaged aortic stenosis
• Heart attack (myocardial infarction) within the last six months
• Hemoglobin less than 12.5 g/dL for females and 13.0 g/dL for males
• High blood pressure greater than 180/100 mm Hg
• Active infection with or without ongoing antibiotic treatment
• Seizures within the last two months
• Patient’s weight less than 110 lbs.

Note: In the event the autologous patient is not able to understand the donation procedure or reliably answer the medical history questionnaire given before donation, a legal representative of the patient must be available to provide medical information and/or donation authorization in case of need.

The patient may donate in an interval of three days between donations prior to surgery, as long as allogeneic hemoglobin level is met. The donation must be made at least seven days prior to the date of surgery. On the day of donation, the patient will be given a mini-physical, including a medical history, blood pressure, pulse, temperature, and a small sample of blood to test hemoglobin. If the patient passes this mini-physical and meets the eligibility criteria, a unit of blood will be drawn. This process takes approximately one hour.

Although rare, a donor may experience an adverse reaction during blood collection or within a few hours after blood is drawn. These reactions include but are not limited to: discomfort, swelling and bruising at the needle site; fainting and convulsions; injury to blood vessels or nerves; infection; and local blood clot. Some reactions may preclude any further autologous donations. IN this and other instances, blood from the community blood supply may be needed for the patient’s surgery. To prevent reactions, it is recommended that the donor has something to eat within two hours preceding donation.

A special autologous label with information linking the unit to the patient is affixed to the blood bag. Components requested by the physician retain the special autologous labeling information, and upon meeting testing and processing requirements, are delivered to the hospital where the surgery is scheduled.

As the Autologous Donor Program requires the services of many trained professionals, special handling of the blood, and additional paperwork, the processing charges for each autologous unit are higher than for other donated blood. Since the blood components requested by the patient’s physician are held for the exclusive use of the patient, these charges are assessed even if the blood is never transfused. There are additional charges for shipping the units out of Versiti’s service area. Health insurance (including Medicare) may not cover processing fees for autologous blood and/or additional processing, as needed.

Drawing of autologous units to be transfused to hospitals outside of Versiti’s service area must be approved by Versiti Hospital Services. Whenever autologous blood needs to be shipped to other blood centers, patients are responsible for making arrangements in advance with these centers to ensure they will accept the shipments.

Note: Autologous units testing reactive for infectious disease markers will be shipped depending on acceptance by the physician and transfusing facility. If not accepted, these units will be discarded.

Before choosing to participate in this program, the patient and physician should consider the community blood supply, which is exceptionally safe. Blood banking authorities have found that the transfusion of blood from directed donors does not reduce the risks associated with transfusions. The safety of the blood relies, in part, on the truthfulness of each donor. Should family members and friends feel undue pressure to donate, they may fail to be truthful about their eligibility as blood donors.

The request must be made by the patient’s physician. As soon as possible after the decision for surgery is made, the Directed Donation Order Form should be completed with the patient’s information and sent to Versiti. Once the patient’s order is received, donors may call Special Patient Services at 800-525-1388 to make an appointment. It is advisable to recruit more donors than the number recommended by the physician, as some donated units may not be suitable for the patient’s use.

It is NOT recommended that a female patient of childbearing age receive blood from a husband or male partner, as their blood may cause immunization of the patient and therefore compromise future pregnancies. It is NOT recommended that a female donate blood to her biological child, as antibodies that may have been produced during pregnancy could cause a reaction during transfusion. Also, it is NOT recommended to have directed units if the patient has red cell antibodies in their blood.

Directed donors must meet the same blood donor eligibility criteria as any person donating for the general blood supply.

After collection, these units are subjected to the same tests as other donated blood. If, for any reason, a unit is not suitable for transfusion, it is discarded. Donors are informed of abnormal test results only when all tests are completed, which may be later than the patient’s transfusion date. (Note: To protect the confidentiality rights of the donor, neither the patient nor the patient’s physician is notified of non-suitable units.) All ABO-compatible units matching the order are tagged, reserving them for the patient’s use.

Hospitals will be notified only of drawn units not available for the patient’s transfusion. At the hospital, the donated blood will be crossmatched with a sample of the patient’s blood. Only crossmatch-compatible units will be held for the patient’s surgery.

Other reasons for which the blood may not be available for the patient’s surgery include but are not limited to: breakage of the plastic container, inadvertent contamination of the blood, or the need for repeat or additional testing. For these and other reasons beyond its control, Versiti cannot ensure that directed donor units will be available. In such circumstances, the physician may decide to supplement with transfusion of blood from the community blood supply.

Because this program is very involved and requires special handling, a surcharge is added to the blood processing fee charged to the hospital for each unit sent. Also, to standardize directed units and improve safety of the blood (such as prevention of a rare transfusion complication known as graft vs. host disease), all directed products from blood relatives will be irradiated. All products are leukoreduced.

Prospective donors must schedule appointments for directed donations at one of the following donor centers:

• Illinois: Aurora, Tinley Park, Crystal Lake, DeKalb, Joliet, Winfield, Naperville and Highland
• Indiana: all donor centers
• Michigan: Grand Rapids, Kalamazoo, Saginaw, Traverse City, Livonia and Midland Dow Diamond
• Ohio: Mill Run Center
• Wisconsin: all donor centers

To allow ample time for collection, testing, processing and delivery to the hospital, donors must donate at least three, but not more than 12, working days (excluding Sundays and holidays) before the date of the patient’s surgery. For example, donations made on a Friday should be available for a surgery scheduled the following Tuesday.

Patients with hereditary hemochromatosis (HH) or undergoing testosterone replacement therapy (TRT) may donate at Versiti Blood Center of Wisconsin without a prescription, so long as they meet all allogeneic donation criteria. This includes an Hgb of 12.5-20.0 g/dL for females and an Hgb of 13.0-20.0 g/dL for males who are prescribed whole blood draws no sooner than every eight weeks. All other diagnoses and timeframes require a prescription.

It is the ordering physician’s responsibility to evaluate whether the patient’s health will permit them to donate safely. Versiti Blood Center of Illinois and Versiti Blood Center of Wisconsin ask for a limited medical history and perform a mini physical, including blood pressure, pulse, temperature and hemoglobin. Patients with significant cardiac, pulmonary or other donor safety health history issues may not be able to donate.

All therapeutic patients may donate as often as ordered (no more than once a week) as long as their Hgb remains ≥ 11.0 g/dL and no new patient safety issues arise.

Prior to the first donation (and annually), a prescription is required for more frequent donations than every 56 days for whole blood. This prescription must include the patient’s name, date of birth, diagnosis, frequency of phlebotomy, and lowest allowable Hgb to perform the procedure. If the prescription is incomplete, the missing order information must be obtained prior to phlebotomy being performed.

Other than Hgb level, no testing will be performed on the donation unless the patient meets all allogeneic donation criteria (other than donation frequency). If all allogeneic criteria are met, routine donor panel testing will be performed. Arrangements for other blood tests, such as ferritin levels, need to be coordinated with the patient using another laboratory service.

Patients will be given a Therapeutic Blood Loss Tracker card for monitoring the dates and volumes of serial phlebotomies. Physicians should encourage patients to bring their card to their appointments so that copies can be added to their charts.

There is no charge for therapeutic phlebotomy procedures.