Should preoperative autologous donation be discouraged or postponed in patients receiving agents that modify the immune system?

A colleague in Alberta, Canada wonders if autologous blood donations should be deferred in pre-operative patients who are taking immune modifying agents, when the immune modifying agents are known to increase the risk of bacterial infections in the peri-operative period. The main concern is that even if a patient is instructed to discontinue taking immune modifying agents in advance of their scheduled surgery, autologous blood, if collected, might contain sufficient levels of immune modifying agents to increase the risk of perioperative infection, following transfusion of the autologous blood. Is this a hypothetical or a real risk? Does anyone have actual experience with this type of situation? If so, what has been your experience, and what advice should patients receive regarding the timing of autologous blood collection in relationship to receiving (or discontinuing) immune modifying agents?

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