The safety of preoperative autologous blood donation in the nonhospital setting

The increasing use of preoperative autologous donation (PAD) of blood has led to more frequent donation in settings outside of hospitals, despite concerns that persons making PADs may face increased risks of postdonation reaction. Analysis was conducted of 5660 PADs made at 25 different blood centers, to determine the risks of PAD in nonhospital settings and to search for predictors of severe reactions. Sixteen percent (886) of the donations studied were by persons who did not meet all usual homologous donor criteria. The most common variances were for cardiovascular disease, including the use of cardiac drugs (416 donors, 41% of those not meeting criteria), history of angina (204, 23%), and history of myocardial infarction (192, 22%). Donation by persons not meeting routine criteria was followed by a higher reaction rate than that by donors without any variance (4.3 vs. 2.7%; p less than 0.0001). An increased likelihood of reaction was associated with donor age less than 17 years, female gender, weight less than 110 pounds, and a history of reaction. Four reactions were graded as severe (transient ischemic attack, 1; angina, 3), and all occurred in donors not meeting all criteria (0.4% of 886 donations). A review of these donors' histories failed to identify distinguishing features from which their severe reactions could have been predicted. This study documents the infrequency of severe reactions after PADs by persons referred to a blood center for donation, even those not meeting routine homologous donor criteria, and quantitates the risk to these donors of a severe reaction.