Autologous Donation

If you are scheduled for surgery that has a high likelihood of requiring a blood transfusion, your doctor may suggest that you donate blood for your own use during the surgery (autologous blood donation), if you meet specific indications and are likely to benefit from it.

Who it is for

Autologous blood donations are recommended only for patients with rare blood groups or multiple red cell antibodies who have a high likelihood of requiring transfusion with red cells of rare blood types, during elective surgeries. It may also be considered in children and adults ≤ 30 years old requiring spinal surgery.

Autologous blood donation (ABD) is not recommended for all patients. Current evidence does not support the routine use of ABD for most surgical procedures. This is mainly because patients undergoing ABD may still need to be transfused with donated (allogeneic blood). ABD is also not recommended in surgeries with a low likelihood of needing blood, as more than half of all autologous blood donations may never be used and are wasted. It is less likely to be wasted when there is at least a 50 percent chance that the surgery or procedure you are having will require a blood transfusion.

Even for surgeries with high likelihood of needing transfusion, ABD only reduces the chances but does not always prevent the need to transfuse allogeneic blood from donors.

Patients who underwent pre-surgical ABD also have a higher risk of anaemia and iron deficiency on the day of their surgeries, both of which may be associated with a higher risk of needing transfusion and poorer clinical outcomes during and after surgery.

Autologous blood is also not significantly safer than allogeneic blood from donors, as there are stringent donor selection criteria and highly sensitive blood donation testing for HIV, Hepatitis C virus and Hepatitis B virus, rendering allogeneic blood equally safe with low risks of transfusion transmitted infections. ABD also does not prevent severe transfusion reaction, such as fluid overload in the lungs and transfusion associated bacterial infection.

Hence, it is not recommended to subject you to ABD if there is no indication as this will expose you unnecessarily to the risks of blood donation and anaemia on the day of your surgery.

How it works

• If you are found to be suitable, your doctor will take your written consent and make the necessary arrangements with us. Note that there is a fee for this service.

• Your doctor will give you oral iron supplements to take before the first donation. These should be continued for (at least) 2 weeks after the donation.

• At the appointed dates, your blood will be collected at the Bloodbank@HSA located in the Health Sciences Authority Building at 11 Outram Road. Your blood can be stored for up to 42 days.

• Donation should not be earlier than 5 weeks prior to the scheduled surgery and not later than 2 weeks prior to surgery, as ABD performed in the 2 weeks before surgery increases the risk of anaemia at the time of the surgery. Depending on how much blood you will need, your blood can be collected once every 5 to 7 days provided you continue to meet the criteria.

• For obstetric patients, autologous donation should be performed between the 35^th and 37^th week of pregnancy with close monitoring of fetal well-being during the procedure. This would usually be carried out in the labour suite of a hospital. Your obstetrician will liaise with the KKH/NUH/SGH Labour Ward (Public hospital patients) or SGH Labour Ward (Private hospital patients) for the blood collection appointment schedule and inform HSA once it is confirmed.

• If you need more information, please call our medical screeners at the Bloodbank@HSA at Tel: 6213 0626 or email us at HSA_BSG_clinicalservices@hsa.gov.sg .

Other criteria that need to be met

In addition to our restricted indications for ABD, you will need to meet the following criteria:

• You are less than 60 years of age

• Your haemoglobin is at least 12.5 g/dl (women) or at least 13 g/dl (men) before each donation (The minimum haemoglobin for obstetric patients who opt for autologous donation should be at least 11 g/dl)

• Your weight is at least 35 kg

• You do not have any medical conditions like heart and lung diseases or epilepsy

• You are well without fever or infections.

How the need for a blood transfusion can be decreased

It is not always possible to avoid having a blood transfusion. However, there are some safe and effective options that can be considered before surgery to (i) improve your own blood supply and (ii) to decrease the amount of blood loss during surgery:

• Have a full blood count taken 14 to 45 days before your operation to check for anaemia. This allows your doctor or nurse to optimise your health status well ahead of your treatment.

• Ensuring sufficient iron intake (iron supplements may be required if you are deficient in iron)

• Reviewing your regular medications with your surgeon or anaesthetists to see if those that affect clotting can be safely stopped before surgery.

• Informing your surgeon or anaesthetist of any personal or family history of abnormal bleeding, so that investigations and treatment to prevent bleeding can be arranged prior to surgery.

• During your operation, your doctor may suggest having your blood collected and returned to you, during some types of major surgery. This is called intra-operative cell salvage.

• Advanced blood monitoring tools and certain medications can be used in the operating theatre to reduce bleeding.

• Certain surgical techniques and instruments can prevent or minimise blood loss.