Fante Claudia Del, Masiello Francesca, Zecca Marco, La Rocca Ursula, Pupella Simonetta, De Angelis Vincenzo
Immunohematology and Transfusion Service, Fondazione IRCCS Policlinico "San Matteo", Pavia, Italy.
National Blood Center, Italian National Institute of Health, Rome, Italy.
Blood Transfus. 2025 Jul-Aug;23(4):295-303. doi: 10.2450/BloodTransfus.847. Epub 2024 Nov 28.
The present study highlights the highly heterogeneous criteria for the use of PAD (including calculating of the volume of whole blood collected) and the lack of a specific policy in preparation for BM HSC donation, either from non-trait carrier donors or those with sickle cell or thalassemia trait, both pediatric and adolescent.
Current national and international guidelines (Italian Bone Marrow Donor Registry [IBMDR], World Marrow Donor Association [WMDA] standards) provide an indication for preoperative autologous blood donation (PAD) only in adult family and volunteer non-family donors in anticipation of bone marrow (BM) hematopoietic stem cell (HSC) donation to avoid the use of homologous transfusions. In addition, there is no clear guidance from the relevant scientific societies regarding pediatric and adolescent donors.
To assess the actual use of PAD in pediatric (up to 14 years) and adolescent (aged 15-18 years) family donors in relation to BM HSC donation in the five years 2017-2021, a specific online questionnaire was administered to blood establishments and clinical units of pediatric transplantation programs responsible for BM HSC collection.
Adherence to the project was 100% (18/18 centers). During the five-year period considered, 273 BM HSC donors (205 pediatric and 68 adolescent) were registered. Forty percent of the non-trait carrier donors who underwent PAD received iron therapy in preparation for BM HSC donation; only 4.8% of the pediatric and none of the adolescents had hemoglobin values below the age limit at donation. Finally, 66.4% of pediatric donors and 15.4% of non-trait carrier adolescent donors who did not undergo PAD received homologous transfusions during BM harvest.
本研究强调了使用术前自体血采集（PAD，包括计算采集的全血量）的标准高度异质性，以及在准备骨髓造血干细胞捐赠时缺乏具体政策，无论是来自非特征携带者供者还是患有镰状细胞或地中海贫血特征的供者，包括儿童和青少年。
当前的国家和国际指南（意大利骨髓捐赠者登记处[IBMDR]、世界骨髓捐赠者协会[WMDA]标准）仅针对成年家庭和志愿非家庭供者在预期进行骨髓（BM）造血干细胞（HSC）捐赠时进行术前自体血捐赠（PAD）提供了指导，以避免使用异体输血。此外，相关科学协会对于儿童和青少年供者没有明确的指导意见。
为评估2017 - 2021年这五年间儿童（14岁及以下）和青少年（15 - 18岁）家庭供者在骨髓造血干细胞捐赠方面对PAD的实际使用情况，向负责骨髓造血干细胞采集的儿童移植项目的血液机构和临床单位发放了一份特定的在线问卷。
项目依从率为100%（18/18个中心）。在研究的五年期间，登记了273名骨髓造血干细胞供者（205名儿童和68名青少年）。接受PAD的非特征携带者供者中有40%在准备骨髓造血干细胞捐赠时接受了铁剂治疗；只有4.8%的儿童供者在捐赠时血红蛋白值低于年龄限制，青少年供者中无一例低于该限制。最后，未接受PAD的儿童供者中有66.4%以及非特征携带者青少年供者中有15.4%在骨髓采集期间接受了异体输血。
