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Recipient-Specific Blood Donation


Recipient-specific blood components are typically donated in three circumstances: exceptional medical need, directed donation, and autologous donations. Aside from specific donor qualifications, evaluating need and appropriate use of these specific components requires balanced medical oversight and optimal communication between ordering physician, transfusion service medical director, and collection facility medical director.

Exceptional medical need exists when blood or appropriate components are collected for a specific patient who requires a rare product. Directed donors donate to a specific patient, who is often a family member. Autologous donors donate for themselves, usually for a specific procedure that will require blood (typically RBCs).

Exceptional Medical Need

There are patient-specific situations for which the blood center medical director may accept a blood donor and override typical criteria, such as allowing for shorter interdonation time interval. For RBC donation, this can be as frequent as every 3 days, provided the predonation hemoglobin and hematocrit are ≥12.5 g/dL and 38%, respectively, for females and ≥13.0 g/dL and 39%, respectively, for males. Donors who give multiple units to a specific patient/recipient are sometimes called designated donors. The donor must fulfill all other allogeneic blood donation criteria. Circumstances for which blood products are collected for this reason include the following:

  • RBC products for a patient with multiple alloantibodies or alloantibodies to high-frequency RBC antigens, when rare RBC products are needed.

  • Platelet products for a neonate with NAIT who requires platelet antigen-negative products. NAIT is associated with alloantibodies to platelet-specific antigens. In the white population, this antibody is most commonly toward HPA-1a, which has an antigen frequency of 98% in this population. Collection of a plateletpheresis product from a donor with this rare alloantigen negative type may be an exceptional medical need. In addition, use of maternal (washed) platelets, which are alloantigen-negative, classifies as exceptional medical need due to waiver of the postpartum restriction of blood donation.

  • IgA-deficient plasma or platelet products for a patient with anaphylactic transfusion reactions secondary to antibodies to IgA. Anaphylactic reactions occur in 1 in 20,000 to 50,000 transfused blood components. Reactions related to antibodies to IgA occur less frequently but are the most common cause of transfusion-associated anaphylaxis in the United States. The management of patients with antibodies to IgA requires IgA-deficient products, such as washed RBCs and platelets, and platelets and plasma products from IgA-deficient donors. Of note, anaphylactic reactions can also occur in patients who are deficient in haptoglobin and have developed antihaptoglobin antibodies. These patients require washed products or products from haptoglobin-deficient donors.

  • Granulocytes for infected, immune-suppressed recipient with neutropenia. Indications for granulocytes are limited and include neonatal sepsis, neutrophil function defects, and neutropenic patients with fungal infections. Granulocyte donors are typically stimulated with G-CSF and/or steroids and may be recruited to give more than one donation (see Chapter 37 ).

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