CORRESPONDENCE AND CORRECTIONS
650 Correction
The authors discovered an error in the article by Hiroshi Kamesaki and associates entitled 'Angiocentric Lymphoma with Histologic Features of Neoplastic AnAutologous Blood
Journal of Clinical Pathology. The term "angiocentric lymphoma" should have been "angiotropic lymphoma."
ments of the American Association of Blood Banks and the Food and Drug Administration (FDA) for homologous transfusion, why are autologous units not routinely transfused to other patients?
These are only a few of the issues raised by this stimulating editorial. This author also notes that the driving forces in patient blood transfusion are an anxious public and acquired immune deficiency syndrome. I would strongly recommend that as pathologists responsible for transfusion safety in our hospitals, we must strive to be included on that list. We should concern ourselves more with the quality of blood we receive from our blood suppliers acting not as recipients but more as physician and patient advocates.
Transfusion
Questions that should be addressed as a result of these paternalistic statements include the following. 1. Why: If autologous blood donors and their blood meet the require-
2. What: What is "increasingly uncommon," quantitatively? 3. Why: Why is this noncrossover "increasingly uncommon"? 4. What: What proportion of autologous blood units have plasma removed for sale to blood fractionators? 5. Why: If blood donor centers do not routinely transfuse FDA acceptable autologous units, why are directed blood donor units routinely being transfused to unwitting recipients other than the designated recipient?
KENNETH FAWCETT, M.D.
St. Joseph Hosital Flint, Michigan REFERENCE 1. Popovsky MA. Autologous blood transfusion in the 1990s. Am J Clin Pathol 1992:97:297-300.
Reply
To the Editor.—Dr. Fawcett has raised several interesting points to which I shall respond in the order in which they were presented. Surgeons are often unfamiliar with the fact that autologous donors/patients may have units collected with hemoglobin values or medical histories that preclude untransfused units from being used for others because of failure to meet Federal Drug Administration regulations and/or American Association of Blood Banks standards for homologous blood donation. The fact remains that when the pertinent regulations and standards are met, most units are discarded because of unproven concerns that autologous donations are not as safe as those collected from volunteer, homologous donors. This issue arose after several, relatively uncontrolled studies1,2 demonstrated higher rates of infectious disease markers, namely anti-HBc in autologous donors, when compared to homologous donors. This author as well as others has conducted studies that suggest that the data do not support that position.3 In my view, the results of these studies are insufficient for making a judgment regarding crossover. In my editorial
I was not advocating a position as much as noting an observation of transfusion practice. In a 1987 survey of the American Association of Blood Banks, institutional members Anderson and Tomasulo4 noted that 65% of institutions practiced crossover of autologous units for homologous use. Since that publication, this practice has diminished greatly. I am not aware of publications that address this particular point, but from empiric observation of hospitals in New England, it is clear that crossover is practiced less often. In reference to Dr. Fawcett's question about the use of plasma collected from autologous donors for fractionation, I can only draw on the practice of my center. Such plasma is not shipped to fractionators. Dr. Fawcett suggests that regional blood centers are independently determining the transfusion fate of autologous units. Most autologous units are collected by hospital blood banks and it is transfusion services, as well as blood centers, that have moved away from the practice of crossover. As my editorial only addressed the issue of autologous transfusion, it would be inA.J.C.P. • December 1992
appropriate for me to discuss directed donations. MARK A. POPOVSKY, M.D.
Medical Director American Red Cross Blood Services—Northeast Region Dedham, Massachusetts, and Assistant Professor of Pathology Harvard Medical School Boston, Massachusetts REFERENCES 1. Grossman BJ, Steward NC, Grindon AJ. Increased risk of positive test for antiHBc in autologous donors. Transfusion 1987;27:523. 2. Nicely 1, Lugo J, Glackin K, et al. Infectious disease markers in autologous donors compared to the random population. Transfusion 1987;27:517. 3. Kruskall MS, Popovsky, MA, Pacini DG, et al. Autologous versus homologous donors: Evaluation of markers for infectious disease. Transfusion 1988;28: 286-288. 4. Anderson BV, Tomasulo PA. Current autologous transfusion practices. Implications for the future. Transfusion 1988;28:394-396.
Downloaded from http://ajcp.oxfordjournals.org/ by guest on June 7, 2016
To the Editor.—The recent editorial on "Autologous Blood Transfusion in the 1990s"1 raises questions that should be answered. The author's statements that incite these questions are as follows: "As an additional point, many surgeons incorrectly assume that untransfused units are routinely used for another patient, a practice that, in fact, is increasingly uncommon. The consequences of this degree of overcollection (of autologous units) are obvious; patients are subjected to low but measurable risks of autologous blood donation, and the healthcare systems incurs the costs of unnecessary collections and discarding of unused blood."
The Author's
gioendotheliomatosis Presenting with Predominant Respiratory and Hematologic Manifestations,' which appeared in the December 1990 issue of the American
650 Correction
The authors discovered an error in the article by Hiroshi Kamesaki and associates entitled 'Angiocentric Lymphoma with Histologic Features of Neoplastic AnAutologous Blood
Journal of Clinical Pathology. The term "angiocentric lymphoma" should have been "angiotropic lymphoma."
ments of the American Association of Blood Banks and the Food and Drug Administration (FDA) for homologous transfusion, why are autologous units not routinely transfused to other patients?
These are only a few of the issues raised by this stimulating editorial. This author also notes that the driving forces in patient blood transfusion are an anxious public and acquired immune deficiency syndrome. I would strongly recommend that as pathologists responsible for transfusion safety in our hospitals, we must strive to be included on that list. We should concern ourselves more with the quality of blood we receive from our blood suppliers acting not as recipients but more as physician and patient advocates.
Transfusion
Questions that should be addressed as a result of these paternalistic statements include the following. 1. Why: If autologous blood donors and their blood meet the require-
2. What: What is "increasingly uncommon," quantitatively? 3. Why: Why is this noncrossover "increasingly uncommon"? 4. What: What proportion of autologous blood units have plasma removed for sale to blood fractionators? 5. Why: If blood donor centers do not routinely transfuse FDA acceptable autologous units, why are directed blood donor units routinely being transfused to unwitting recipients other than the designated recipient?
KENNETH FAWCETT, M.D.
St. Joseph Hosital Flint, Michigan REFERENCE 1. Popovsky MA. Autologous blood transfusion in the 1990s. Am J Clin Pathol 1992:97:297-300.
Reply
To the Editor.—Dr. Fawcett has raised several interesting points to which I shall respond in the order in which they were presented. Surgeons are often unfamiliar with the fact that autologous donors/patients may have units collected with hemoglobin values or medical histories that preclude untransfused units from being used for others because of failure to meet Federal Drug Administration regulations and/or American Association of Blood Banks standards for homologous blood donation. The fact remains that when the pertinent regulations and standards are met, most units are discarded because of unproven concerns that autologous donations are not as safe as those collected from volunteer, homologous donors. This issue arose after several, relatively uncontrolled studies1,2 demonstrated higher rates of infectious disease markers, namely anti-HBc in autologous donors, when compared to homologous donors. This author as well as others has conducted studies that suggest that the data do not support that position.3 In my view, the results of these studies are insufficient for making a judgment regarding crossover. In my editorial
I was not advocating a position as much as noting an observation of transfusion practice. In a 1987 survey of the American Association of Blood Banks, institutional members Anderson and Tomasulo4 noted that 65% of institutions practiced crossover of autologous units for homologous use. Since that publication, this practice has diminished greatly. I am not aware of publications that address this particular point, but from empiric observation of hospitals in New England, it is clear that crossover is practiced less often. In reference to Dr. Fawcett's question about the use of plasma collected from autologous donors for fractionation, I can only draw on the practice of my center. Such plasma is not shipped to fractionators. Dr. Fawcett suggests that regional blood centers are independently determining the transfusion fate of autologous units. Most autologous units are collected by hospital blood banks and it is transfusion services, as well as blood centers, that have moved away from the practice of crossover. As my editorial only addressed the issue of autologous transfusion, it would be inA.J.C.P. • December 1992
appropriate for me to discuss directed donations. MARK A. POPOVSKY, M.D.
Medical Director American Red Cross Blood Services—Northeast Region Dedham, Massachusetts, and Assistant Professor of Pathology Harvard Medical School Boston, Massachusetts REFERENCES 1. Grossman BJ, Steward NC, Grindon AJ. Increased risk of positive test for antiHBc in autologous donors. Transfusion 1987;27:523. 2. Nicely 1, Lugo J, Glackin K, et al. Infectious disease markers in autologous donors compared to the random population. Transfusion 1987;27:517. 3. Kruskall MS, Popovsky, MA, Pacini DG, et al. Autologous versus homologous donors: Evaluation of markers for infectious disease. Transfusion 1988;28: 286-288. 4. Anderson BV, Tomasulo PA. Current autologous transfusion practices. Implications for the future. Transfusion 1988;28:394-396.
Downloaded from http://ajcp.oxfordjournals.org/ by guest on June 7, 2016
To the Editor.—The recent editorial on "Autologous Blood Transfusion in the 1990s"1 raises questions that should be answered. The author's statements that incite these questions are as follows: "As an additional point, many surgeons incorrectly assume that untransfused units are routinely used for another patient, a practice that, in fact, is increasingly uncommon. The consequences of this degree of overcollection (of autologous units) are obvious; patients are subjected to low but measurable risks of autologous blood donation, and the healthcare systems incurs the costs of unnecessary collections and discarding of unused blood."
The Author's
gioendotheliomatosis Presenting with Predominant Respiratory and Hematologic Manifestations,' which appeared in the December 1990 issue of the American
