The following question was recently asked of the network: "Does anyone use a shortened version of the questions for autologous donors? If so, which questions do you leave out?"

To which the following replies were received:

1. We use an abbreviated questionnaire for autologous donors and a consent form that is different from the consent form used for allogeneic donors.  Here are the questions that we ask autologous donors:

1. Do you currently have a cold, sore throat, or flu?  Are you being treated for an infection? (each autologous donation)
2. In the last 6 months have you had chest pain, a heart attack or other heart problems? (first autologous donation only)
3. In the last 6 months have you had a stoke, mini-stroke/transient ischemic attack (TIA) or seizure? (first autologous donation only)
4. Do you have any other serious illness? (first autologous donation only)
5. Have you ever had any problems donating blood? (each autologous donation)
6. Has there been a change in your medical condition since your last visit(blood donation)? (each autologous visit except the first one)

2. The autologous donor question is just too big an issue for me to handle with a simple answer. What I believe is key in the autologous questionnaire is that you include questions regarding donor and recipient safety. Therefore, general health questions are important for donor safety. For recipient safety, one does not have to worry about HIV/Hepatitis/etc, but you do have to worry about possible bacterial contamination. So questions that focus on this would be pertinent. I think it would also be wise to make sure you address what is required by the AABB Standards.

3. We do not require our autologous donors to answer the allogeneic donor questions. We have a four-question autologous screening procedure which inquires about 1) current infections, colds or flu, 2) history of hepatitis, lung/kidney disease or chronic illnesses, 3) history of heart conditions, MIs, CVAs, surgery, 4) medications.

4. We use a shortened form for autologous donors at our blood center in Texas. We ask questions that focus on donor risk. In addition, directed donors use the regular donor card and are treated as a regular donor.

5. As far the autologous donor questions, we only ask 8 out of 32 questions that are asked of routine donors. Here is what we ask:

Q1 - Have you donated or attempted to donate under a different name?
Q2 - Have you been deferred as a blood donor?
Q3 - Are you feeling well and healthy today?
Q4 - In the past 3 day have you had infection, cold, flu, fever, etc?
Q5 - Have you taken any pills or medications in the last 4 weeks?
Q6 - Have you had stroke, chest pain, heart or lung disease?
Q7 - Have you had a flu shot in the past 6 months?
Q8 - Have you been diagnosed as a hepatitis B carrier or are you HIV-positive?

6. At our center autologous donors answer only a few questions about their health, since we are not going to crossover their blood, and all we are interested in is whether or not they can tolerate the procedure. Our questions are: Do you have any infection, cold or flu today? Have you ever had hepatitis, lung or kidney disease, or other chronic illness? Have you ever had a heart condition, heart attack, heart surgery or a stroke? Are you taking any medications?

7. We use a shortened history for autologous donors and only ask 11 questions, which are the ones that refer to donor safety i.e. heart disease, medications, infection.

8. We only ask autologous donors about their health history, medications and if they have seen a physician recently.

9. We use an abbreviated questionnaire for autologous donations which asks:

• Have you ever donated under another name?
• Are you feeling well and healthy?
• Are you under a doctor's care for any reason other than your scheduled surgery?
• Are you taking any medications?
• Have you had any shots or vaccinations in 3 months?
• Do you have any history of chest pain, heart disease, heart attack, mini-stroke, or stroke?
• Do you have any history of fainting or convulsions?
• Have you ever had a problem donating or have you been told not to give blood?
• Are you pregnant?
• Do you have a history of hepatitis or jaundice?
• Is there anything else we should know about your medical history before you give blood?

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator