return of autologous blood donors as homologous blood donors

Return of autologous blood donors as homologous blood donors

P.A. MCVAY, H.C. FUNG, AND P.T.C.Y. TOY

Autologous blood donors (ABDs) have been reported to have favorable attitudes toward returning as homologous blood donors (HBDs), but the frequency of return has not been well documented. ABDs eligible by history to be HBDs were followed at one blood center: 255 donating for elective surgery and 234 donating during pregnancy were followed for an average of 18 months and 20 months, respectively, from time of eligibility after surgery or postpartum. Male ABDs had a higher rate of return as HBDs, as 34 percent (21/62) returned to donate an average of 3 units, whereas 13 percent (56/427) of female ABDs returned as HBDs to donate an average of 2 units. Although a history of donation was associated with a hi her rate of return

donate homologous units, despite having been recruited less frequently than prior HBDs. Overall, all male ABDs and female ABDs with an HBD history returned most frequently. The extra effort required for an autolo ous donor pro ram may result in the recruitment of new donors into the HBD pool. ~RANSFUSIO~1991;31:119-121.

(30%, 34/113), 11 percent (43/376) of ABDs with no history as a BDs returned to

Abbrevlatlons: ABD = autologous blood donor; HBD = homologous blood donor.

SOME BLOOD CENTERS DO NOT charge more for autologous blood units despite the extra time (and therefore cost) involved in autologous donations.' By not charging more, centers hope not to deter eligible patients from becoming autologous blood donors (ABDs). Secondar- ily, it is hoped that ABDs will return to donate blood for others and become new homologous blood donors (HBDs).

That ABDs will return as HBDs was suggested by a survey of ABDs, 94 percent (116/123) of whom reported that their experience would make them equally or more likely to return as HBDs.~ However, only 11 percent (15/136) of specially recruited ABDs eligible for homologous donation actually returned and successfully donated for other^.^ The return rate for ABDs who are not specially recruited is unknown. We therefore determined the frequency of homologous donation after autologous donation and determined the factors associated with a higher return rate.

Materials and Methods We retrospectively reviewed records at Irwin Memorial Blood

Centers, located in a large metropolitan area and serving both community and tertiary referral hospitals, to identify all ABDs

From the Blood Bank, San Francisco General Hospital Medical Center. and the Department of Laboratory Medicine. University of California, San Francisco, California.

Supported by Public Health Service grant R01 HL 36715 from the National Heart, Lung, and Blood Institute, National Institutes of Health.

Received for publication March 9. 1990; revision received and ac- cepted June 29. 1990.

between 16.5 and 64 years of age and not pregnant who donated for elective surgery scheduled from June 1 through July 31, 1987. The donors were restricted to that age group so that they would be at least 17 years old by 6 months after surgery and would not be more than 65 during the follow-up period, which averaged 18 months (546 ? 18 days). At the same blood center, all consecutive pregnant ABDs with an estimated date of confinement from January 1, 1987 through June 30, 1988 were identified retrospectively. We followed them from 6 weeks after their estimated date of confinement for an average of 20 months (623 f 146 days). All ABDs answered the complete standard HBD questionnaire and could therefore be evaluated by history for HBD eligibility.

ABDs were recruited for homologous blood donation by the same methods as HBDs. Donors were recruited by telephone according to needed blood types, but donors who had a history as HBDs may have been called preferentially. Donors with no blood type on record were rarely called. All prior HBDs had a recorded blood type, but, during part of the study period, blood types were not recorded for ABDs when autologous units were not tested for infectious markers. Therefore, ABDs with no history as HBDs were recruited less often, not only because of their lack of prior homologous blood donation, but also because the blood type may not have been known to the blood center.

We used the two-tailed chi-square test to test differences in proportions. We used the two-tailed I test to test differences between means.

Results The average age for male donors was 46 5 13 years

(n = 113) and that for nonpregnant female donors was 41 k 11 years (n = 285). Pregnant donors had an average age of 33 k 4.5 years (n = 272). Among the 398 donors for elective surgery (men and nonpregnant women), the majority (72%, 285/398) of ABDs were women.

119

120 McVAY, FUNG, AND TOY TRANSFUSION Vol. 31. No. 2-1991

Table 1 shows the proportion of ABDs eligible by history for homologous blood donation and the proportion who returned as HBDs. The pregnant donor group had the highest proportion of eligible donors (86%), and the male donor group had the lowest proportion of eligible donors (55%). However, in terms of actual homologous blood donation, male ABDs had a higher proportion of HBDs (19%) than female ABDs (lo%), whether the latter had recently been pregnant or not. Among ABDs eligible by history for homologous blood donation, the most common categories of elective surgery were gynecologic surgery for nonpregnant females (55%, 106/193), with most of these operations being hysterectomies and uterine myomectomies (58%, 62/106), and orthopedic surgery for males (55%, 34/62), with most of these operations being for degen- erative spinal disease (SO%, 17/34).

Table 2 shows the reasons for deferral of patients ineligible by history. Most (80%) ineligible patients had reasons for permanent deferral, the most common of which for pregnant donors was hepatitis, which included a history of hepatitis or prior HBD deferral for a positive hepatitis B surface antigen test or a surrogate hepatitis test. For nonpregnant donors, the most common reason for deferral was a history of cancer.

Table 1. Autologous blood donors (ABDs) (aged 16.5-64 years) and subsequent homologous donations: eligible and

actual homologous donors*

Number eligible to

Autologous Total be H B D s t Number of donor group number (46) HBDs (%)

Pregnant 272 234 (86) 28 (10)

Nonpregnant 285 193 (68) 28 (10)

Men 113 62 (55) 21 (19) Total 670 489 (73) 77 (11)

women

women

’p<O.OOl for two-by-three chi-square comparison of all three ABD groups for eligibility: p = 0.034 for two-by-three chi-square comparison of all three ABD groups for homologous blood donation. tHomologous blood donors.

Table 2. Reasons for donor ineligibility

Pregnant A B D ~ ’ Nonpregnant ABDs (“h) Female (%) Male (%) Total (“A)

Permanent deferrals Cancer 0 26 (28) Hepatitis 12 (32) 14 (15) Medical problems 8 (21) 18 (20) AIDS risk group 5 (13) 2 (2) Small veins 0 6 (7) IVDAt 0 0 Other 0 5 (5)

Total 25 (66) 71 (77)

Low weight 2 (5) 14 (15) Travel 2 (5) 5 (5) Acupuncture* 3 (8) 1 (1) HSVQ 3 (8) 0 Other 3 (8) 1 (1)

Temporary deferrals

Total 13 (34) 21 (23) All deferrals 38 (100) 92 (100)

23 (45) 11 (21) 10 (20)

1 (2) 0 3 (6) 0

48 (94)

0

49 (27)

36 (20) 37 (20)

8 (4) 6 (3) 3 (2) 5 (3)

144 (80)

‘Autologous blood donors. tlntravenous drug abusers. +Includes electrolysis and ear piercing. §Herpes simplex virus (active genital).

Table 3 presents return rates among ABDs eligible by history. Male ABDs had a higher rate of return as HBDs, as 34 percent (21/62) returned to donate, whereas 13 percent (56/ 427) of female ABDs returned as HBDs to donate. The average ( 2 SD) number of homologous blood units donated by the 21 male donors was 3.0 f 1.6 and that by the 56 female donors was 2.0 f 1.4 (p = 0.012). Overall, 23 percent (113/489) of ABDs eligible by history had previously been HBDs. A higher return rate, 30 percent, was seen among ABDs who were prior HBDs, and there was no significant difference among the subgroups. This 30 percent is significantly higher than the 11 percent return rate among donors who had not previously been HBDs, but no blood type was available from computer-stored donor recruitment lists for 49 percent (162/333) of those ABDs who did not return. It is noteworthy that, of the donors with HBD experience, 29 percent (10/34) had not been HBDs within the last 5 years. Among ABDs without HBD experience, the three groups were different, with the male group having the highest percentage of donors returning as HBDs (30%).

Discussion This study shows that, of ABDs eligible by history,

34 percent of men and 13 percent of women (even those who were recently pregnant) return to donate homologous units within an average of 1.5 years. A history of homologous blood donation was associated with a higher return rate, with no difference among men, pregnant women, or nonpregnant women. However, 43 new donors (11% of 376 ABDs with no history of homologous blood donation) became HBDs during the follow-up period. This is especially remarkable not only because ABDs with no history as HBDs were not specially recruited, but also because they appeared less frequently on donor recruitment lists than ABDs with a history as HBDs. That is, one-half of the ABDs with no HBD history who did not return had no computer record of blood type and would have only rarely appeared on donor lists used by telephone recruiters. Moreover, recruiters preferred to call donors who had a history of one or more homologous blood donations even when ABDs with known blood types but no history as HBDs appeared on recruitment lists.

Those most likely to return were all male donors and female donors with a history of homologous blood donation. These factors associated with return among ABDs are similar to those found in HBDs. Men outnumber women among homologous d o n o r ~ . ~ It is generally rec- ognized that most homologous donors are repeat donor^.^.^

Whether the return rate among ABDs is different from that among HBDs cannot be determined from this study, as HBDs were not studied. However, in this study, the combined rate of homologous donation by eligible and ineligible ABDs (12% for men, 7% for women, when adjusted to a 1-year period) appears to be higher than that by the general population. A national health survey in 19736 showed that, during a 1-year period, 7.2 percent of men aged 45 to 54 years and 2.8 percent of women

TRANSFUSION 1991-Vol. 31. No. 2 RETURN OF AUTOLOGOUS DONORS 121

Table 3. Homologous blood donations among autologous blood donors (ABDs) eligible by history for homologous blood donation

NonDreanant ABDs Pregnant ABDs Female Male Total

ABDs who were prior HBDst (%) 14/50 (28) 12/45 (27) 8/18 (44) 34/113 (30) Average number of units 1.9 (1 -5) 2.0 (1-5) 3.5 (1-7) 2.3 (1-7)

(range)

(range)

franae)

ABDs not prior HBDs (%) 14/184 (7.6) 161148 (11) 13/44 (30) 43/376 (1 1) Average number of units 1.9 (1 -5) 2.3 (1-8) 2.7 (1-6) 2.3 (1-7)

All eligible ABDs (%) 28/234 (1 2) 28/193 (14) 21/62 (34) 77/489 (16) Average number of units 1.9 (1 -5) 2.1 (1-8) 3.0 (1-7) 2.3 (1-7)

*p<O.O01 for comparison of those ABDs who were (34/113) and those who were not prior HBDs (43/376); p<O.OOl for comparison of male ABDs who were not prior HBDs (13/44) and all female donors not prior HBDs (30/332); p = 0.35 for two-by-three chi-square comparison of all prior HBDs; and p>0.40 for all two-by-two comparisons of pregnant and nonpregnant women. tHomologous blood donors.

aged 35 to 44 years (i.e., ranges closest to the average ages of ABDs in this study) donated blood. In a 1989 national health suwey,’ 8 percent of men and 5 percent of women in the general population claimed to have given blood in the previous year (although the distribu- tion of donation by age or gender was not available). No firm conclusion can be made, however, as our study was local, whereas the other two studies were national surveys.

A difficult question is whether previous ABDs should be recruited as HBDs, with a point of controversy being whether their blood is as safe as that of regular volunteer donors, even after regular donor screening and laboratory te~t ing .~**,~ At this blood center, autologous blood units are not crossed over, primarily for logistical reasons that include maintenance of the quarantine of usable and nonissuable autologous units, as determined by both autologous donor history and laboratory results. More- over, most autologous units not transfused to their donors are released so near the time of outdate that they can only rarely be used. Finally, the controversial issue of safety has not been settled. This blood center currently recruits ABDs with a history as HBDs in the same man- ner as i t recruits other prior HBDs and less frequently recruits ABDs with no history.

This study shows that 19 percent of male and 10 percent of female ABDs return to donate within 1.5 years. Among ABDs eligible by history to be HBDs, 34 percent of men and 13 percent of women donate an average of 3 and 2 units, respectively, in 1.5 years. Therefore, for every 100 male ABDs eligible by history, 102 homologous units will be donated in a 1.5-year period, and for every 100 female ABDs, 26 homologous units will be donated. Whether this benefit to the blood supply completely offsets the extra cost of ABDs should be studied further. If special recruitment efforts are used, all male ABDs, but only those female ABDs who have a history as HBDs, should be targeted.

Acknowledgments The authors thank Herbert Perkins, MD, Sandra Skcttino, MD. and

Dolores Godfrcy of the lnvin Mcmorial Blood Ccntcrs, San Francisco, California, for their assistance.

1.

2.

3.

4.

5.

6.

7.

8.

9.

References Toy PTCY, Strauss RG, Stchling LC, et al. Prcdcpositcd autologous blood for elective surgery. A national multiccntcr study. N Engl J Mcd 1987;316:517-20. Yomtovian R, Ceynar J, Kcpncr JL, Buhl M. Prcdeposit autologous blood transfusion: an analysis of donor attitudes and attri-

Yomtovian R, Schrank Y, Casselton B, Bowman R. Rccruiting former autologous blood donors as future homologous blood donors (abstract). Transfusion 1987;27(suppl):571. Drakc AW, Finkelstein SN. Sapolsky HM. The Amcrican blood supply. Cambridge, MA: The MIT Press, 1982:76-113. Sfarkey JM, MacPhcrson JL, Bolgiano DC, Simon ER, Zuck TF, Sayers MH. Markers for transfusion-transmittcd disease in different groups of blood donors. JAMA 1989;262:3452-4. Blood donor characteristics and types of blood donations. United States-1973. US Dept of Health, Education, and Welfare publication No. (HRA) 76-1533. Series 10, No. 106:l-71. Rockville, MD: 1976. Dawson DA. AIDS knowledge and attitudes for January-March 1989: provisional data from the National Health Interview Survey. Nafional Ccnter for Health Statistics, Advance Data No. 176. US Dcpt of Health and Human Services publication No. (PHS) 89- 1250. Hyatfsville, MD: Public Health Scrvicc, 1989. Grossman BJ, Stewart NC. Grindon AJ. Incrcascd risk of a positive test for antibody to hepafifis B core antigcn (anti-HBC) in autologous blood donors. Transfusion 1988;28:283-5. Kruskall MS, Popovsky MA, Pacini DG, Donovan LM, Ransil BJ. Autologous versus homologous donors: cvaluation of markers for infectious disease. Transfusion 1988;28:286-8.

butes. ORB 1987;13:45-50.

Patricia A. McVay, MD, Fellow. Dcpartmcnt of Laboratory Med- icine, Univcrsity of California, San Francisco.

Hau Chong Fung. Undergraduate student, San Francisco Statc Uni- versity, San Francisco.

Pearl T.C.Y. Toy, MD, Associate Professor, Dcpartmcnt of Lab- oratory Medicine, University of California, San Francisco; and Chief, Blood Bank, 2M6, Bldg. NH, San Francisco Gcncral Hospital, 1001 Pofrcro Avenue, San Francisco, CA 941 10. [Rcprint rcquests]

return of autologous blood donors as homologous blood donors

Documents