Limitations of the erythropoietic response to serial phlebotomy: implications for autologous blood donor programs.

Autologous blood (AB) deposit before elective surgery is a widely endorsed and rapidly expanding transfusion practice that reduces homologous blood (HB) needs but does not minimize HB transfusion in donors who are unsuccessful in predonating the amount of AB requested by their surgeon. To study limitations of the erythropoietic response in AB donors we have conducted a prospective analysis of 72 consecutive adult AB donors scheduled for orthopedic surgery. The data in this report indicate that endogenous erythropoietin response is inadequate in at least 58% of AB donors who are successful in predonating the requested amount of AB and that AB donors with lower initial body iron reserves relative to the amount of blood requested have a greater risk of deferral; 15 of 45 female patients (33%) were unable to predonate the requested amount of AB. Lower circulating red cell volumes (reflecting anemia at first blood donation, smaller body size, or both) and/or lower storage iron pools are contributing factors in this population. This report also indicates that a significant number of AB units have red cell volumes below minimum standards for blood donation, which has important implications in a risk/benefit analysis of whether nontransfused AB units should be "crossed-over" for HB transfusion, and that future studies designed to maximize AB procurement should include an evaluation of recombinant erythropoietin therapy in AB programs and therapeutic alternatives to ferrous sulfate as iron supplementation in AB donors.