Policies on Directed Donations from Mother to Neonate and from Husband to Wife of Childbearing Age

The following question was circulated amongst the e-Network members, and the answers that resulted are shown below. The answers to this question do not necessarily reflect CBBS policy.

"Our facility is questioning the scientific basis of two related policies currently in place regarding directed donations. We would like to know of any reported cases and what the community is doing as far as accepting these donors."

1. A mother donating for her own newborn child: We currently do not accept the mother unless there are specific circumstances that make her the optimal donor. The theory has been that the mother could have antibodies with specificity for the child's antigens, formed during the pregnancy, that would cause harm to the child.
2. A spouse or sexual partner donating for his partner who is a woman of childbearing age: The theory is that the woman could become sensitized to her husband's antigens, affecting future pregnancies. (Responses on Page 2)

Question #1 Responses

1. One blood collecting organization reported that their SOPs do not specifically address this issue. However, since women are deferred for 6 weeks after termination of pregnancy, a Medical Affairs physician would need to approve the mother's directed donation to her newborn baby. As a collection (not transfusion) facility, a Medical Affairs physician would discuss such a situation with the ordering physician and the intended transfusion facility for the same scientific reasons stated in the question. This blood collecting organization reports that they see more requests for platelet donations for the baby with alloimmune neonatal thrombocytopenia than they see for red cell donations. This organization also points out that washing the RBCs and/or the platelets will remove the maternal plasma with any antibodies it may contain.
   
   
2. Another blood center stated that if a child requires surgery and the child's mother desires to provide a directed donation for the surgery, and if maternal antibodies are present, the antibodies could be washed away from the red cells or platelets. The washed cells could be resuspended in an electrolyte solution or Plasmalyte (pH 7.4) solution. In fact, this blood center has had so many recent requests that their procedure manuals now have a procedure to wash platelets.
   
   
3. A third blood center pointed out that with additive red cell units, there is now little plasma left in the red cell unit, which has been diluted with saline and additive. The nominal residual antibody could be removed by washing the unit.
   
   
4. A fourth blood center stated that they do not restrict taking a unit of blood from a mother who is donating to her child. The only criterion is that written authorization has been obtained from the mother's OB/GYN physician and the approval of the Blood Bank MD.
   
   
5. A blood banker reported that if the mother has antibodies to the child's antigens, this situation could be easily managed by washing the unit.
   
   
6. Another blood banker stated that he was aware of a case of TRALI from a mother to child transfusion. This was reported at the1991 AABB annual meeting. This blood banker pointed out that the recipient was not a neonate, but a child. However, TRALI in a sick neonate might be very difficult to appreciate, and may well be underreported. This blood banker believes there is at least one other case in the TRALI literature, but in an adult who got a donor-specific transfusion from his mother prior to planned kidney transplant. The reference is as follows: Ramsey G, Clay M, Stroncek D. Leukoagglutinin transfusion reaction from a mother-to-child directed donor transfusion. Transfusion 31:(suppl) 50S, 1991.
   
   
7. A third blood banker was concerned that if the mother will be donating blood for her newborn child, that the blood MUST be irradiated. In this blood bankers opinion, the real risk is GVHD, not hemolytic transfusion reaction, if the blood is not irradiated. The risk of antibodies to the newborn's antigens does not concern him as long as a classic compatibility test (not an electronic crossmatch) has been done. In any event, as long as the risk is quantitated and explained to the mother in writing, and the mother signs off as accepting that risk, he would go along with her wishes. (It might be a good idea to get the father of the newborn to sign off as well.)
   
   
8. A fourth blood banker stated that a woman who has given birth cannot donate for 6 weeks, therefore, any exception would pass through the MD. This blood banker would only approve for a medical reason and, of course, plasma would be washed off (as in platelet donation for neonatal alloimmune thrombocytopenia) to remove the offending antibody. Also, since the mother is missing the antigen, she is sometimes the best donor, minus her plasma.
   
   
9. A hospital transfusion service representative said they would not encourage this type of donation. If the mother's antibody screen is negative, they would not strenuously discourage the scenario in question one, as the risk seems very small. If the mother and father are ABO compatible, they might ask for a paternal sample to do a crossmatch with the mother's serum -- this hasn't come up and isn't in their SOP.
   
   
10. Someone from a second hospital transfusion service said they would not routinely accept the mother of a newborn child unless there are specific circumstances that would make her the optimal donor (ie, neonatal thrombocytopenia due to anti-PL-A1). There are other maternal factors following delivery that would impact donation...C/section vs vaginal birth, and Hb/Hct level.
    
    
11. Another person from a third hospital transfusion service said if a mother's blood is medically indicated for her neonate, the blood should be irradiated.
    
    
12. Finally, a person from a fourth hospital transfusion service said that as long as the mother meets all other criteria, they would allow her to donate. But if she proved to have a red cell antibody, her plasma/platelet concentrate would not be used, and her red cells would be washed prior to transfusion to the baby.

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