Autologous Donation for Fusion Surgery

[John Bowers]

I would appreciate comments on the following practice:

Automatic scheduling of patients to donate autologous units prior to spinal fusion surgery for the purpose of "stimulating" the bone marrow seamingly to enhance the grafting process. Would this be considered an acceptable protocol? Most of these patients are provided no information regarding their options for transfusion and most would not be adverse to allogeneic transfusion. Many would have preferred not to have had to come in (sometimes from quite a distance) to donate.

[Deny Morlino]

Nice theory, but are there any studies to support this practice? Very doubtful your facility would be able to obtain reimbursement for the auto unit. Sounds like an inconvience for the patients to go through the auto donation with the distance they are traveling. Not sure the pathologist here would go for this process given the reason presented.

[adiescast]

I have not heard of this practice. I don't think the bone marrow is necessarily the most important part of grafting bone. If the bone marrow is busy throwing out blood cells, will the osteoplasts (spelling?) be affected? You want bone growth for the fusion, not blood cells, right?

[Tonyd]

Sounds pretty theoretical.

I'd rather make sure they got into theatre with a good haemoglobin, then perform Acute Normovolaemic Haemodilution coupled with a cell-saver.

Our experience with pre-deposit autologous donation in these patients is that they get to theatre fairly anaemic and feeling pretty ropey - nobody does it any more in the UK unless it's an exceptional case with mulitple antibodies, when the Blood Service will perform it rather than the hospital.