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Transfusion practices for bone marrow harvests: a survey analysis from the AABB Bone Marrow Quality Improvement Initiative Working Group

Bone Marrow Transplantation volume 52, pages 1199–1200 (2017)Cite this article

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The collection and transfusion of autologous blood in the management of healthy donors undergoing a bone marrow harvest has historically been an accepted standard of care. Given that the number of harvests may be increasing based on BMT-CTN 0201 data showing more chronic GvHD with peripheral blood as compared to bone marrow as the source of stem cells for unrelated donor transplantation, this practice is particularly relevant.1 Autologous blood donation was recommended during the era of heightened concern over transfusion-transmitted infectious disease, and has been justified by the potentially large volume of blood loss associated with bone marrow harvesting. The World Marrow Donor Association (WMDA) and the National Marrow Donor Program (NMDP) have provided guidelines in the past for the collection of autologous blood based, in part, on the estimated blood loss or product total nucleated cell count anticipated for the collection procedure.2, 3, 4

This practice, however, has recently become more controversial given that the risk:benefit ratio of pre-storage of autologous blood and indications for transfusion during or after the harvest have become less clear. Both the WMDA and NMDP have called this practice in to question,4, 5 and the NMDP has recently left the decision about collection and transfusion of autologous blood to the discretion of the collection centers. In order to address this issue, the Product Collection and Clinical Practices Subsection of the AABB Cellular Therapies Section Coordinating Committee (CTSCC) formed an interorganizational working group, called the Bone Marrow Quality Improvement Initiative Working Group, that includes representatives from the Center for International Blood and Marrow Transplant Research (CIBMTR) Donor Health and Safety Committee, the American Society for Blood and Marrow Transplantation (ASBMT) and the NMDP. The initial charge to this group was to develop, distribute and analyze data from a survey regarding institutional policies and practices guiding autologous blood collection, storage and transfusion around bone marrow harvesting. This survey was developed and reviewed by the Working Group and validated in SurveyMonkey (San Mateo, CA, USA) (Supplementary Appendix 1 lists the survey questions). Characteristics of the survey respondents are described in Table 1. Among the 120 US transplant centers contacted for this survey, 68 (57%) initiated the survey, including institutions that harvest marrow from pediatric and/or adult-related donors and centers that collect unrelated donor marrow for the NMDP. Interestingly, of the responding centers, 72% (39/54) and 64% (30/47) perform 10 or fewer bone marrow harvests per year from related adult and unrelated adults, respectively. Notable findings were that only half of the responding centers have a written policy guiding the collection and storage of autologous blood from related marrow donors. Most of these centers (70%, 33/47) follow NMDP guidelines regarding the number of autologous units collected and 59% (27/46) collect the maximum marrow volume per NMDP standards (20 mL/donor kg) from adult donors. Other questions addressed clinical practices such as the timing of autologous blood collection, when the donor’s hemoglobin and/or hematocrit are assessed in relation to the harvest procedure, transfusion triggers, if and when iron supplementation is used and post-donation follow-up (Supplementary Appendix 2 provides additional responses). Three response domains are worthy of further mention:

Table 1 Survey respondent characteristics
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Authors and Affiliations

  1. Massachusetts General Hospital, Boston, MA, USA

    T R Spitzer & P O'Donnell

  2. University of Florida, Gainesville, FL, USA

    M W Sugrue

  3. Georgetown University Medical Center, Washington, DC, USA

    C Gonzalez

  4. National Marrow Donor Program, Minneapolis, MN, USA

    D Confer

  5. Johns Hopkins University, Baltimore, MD, USA

    E Fuchs

  6. Children’s Hospital Los Angeles, Los Angeles, CA, USA

    M A Pulsipher

  7. Columbia University Medical Center, New York, NY, USA

    J Schwartz

  8. University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    M Linenberger

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  1. T R Spitzer
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Correspondence to T R Spitzer.

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Spitzer, T., Sugrue, M., Gonzalez, C. et al. Transfusion practices for bone marrow harvests: a survey analysis from the AABB Bone Marrow Quality Improvement Initiative Working Group. Bone Marrow Transplant 52, 1199–1200 (2017). https://doi.org/10.1038/bmt.2017.92

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