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To avoid risk for allogeneic transfusions in healthy bone marrow (BM) donors, 1-2 preoperative autologous blood donations (PAD) are usually collected before the BM harvest. We analysed the haematological parameters in BM donors before and after the harvest, to assess the efficacy of this practice in limiting the postharvest anaemia. Overall, 102 consecutive donors underwent BM harvest preceded by one (26 cases) or two PAD (76 cases), which were infused during BM collection. We analysed the parameters related to donors, PAD timing and BM graft characteristics. PAD induced a significant decrease in Hb (from 14·6 g/dl, IQ range 13·3-15·5 to12·9 g/dl, IQ range 11·8-13·9; P

Background Bone marrow harvest (BMH) for haematopoietic stem cell transplantation is a well-established procedure. The guidelines of World Marrow Donor Association provide information on donor selection. However, some of the guidelines regarding donors with anaemia prior to harvest lack in supporting data from clinical studies. With this study, we aimed to provide such data. Material and methods In this retrospective, single-centre study, we analysed the interplay between haemoglobin levels and BMH and BMH impact on haemoglobin levels in a cohort of 149 unrelated BM donors, including 13 subjects with mild anaemia. Results The BMH led to significantly lower decrease in haemoglobin levels in donors with anaemia than in control group (1·79 g/dl vs. 2·56 g/dl, P 0·05). Median BM volume harvested from anaemic donors was 16·34 ml/kg; none of them required blood transfusion after BMH. Conclusion Mild anaemia prior to BMH does not significantly impact the collection results. The BMH is safe and feasible in donors with mild anaemia.

By comparison with many other procedures in medicine, apheresis for collection of haematopoietic progenitor cells (HPC) is a relatively innocuous process. The procedure itself is straightforward, serious adverse effects are rare and many donors experience real benefits. But the apparent simplicity of HPC harvest is misleading as apheresis raises substantial issues of consent, risk assessment and conflict of interest. G-CSF primed apheresis is associated with a number of predictable shortterm risks and unpredictable long-term risks, particularly in those who submit to a second or third donation. Donors are often coerced by the very nature of their relationship to the recipient and by expectations of altruism and are infrequently offered a true choice between bone marrow harvest and peripheral HPC harvest. And, as is the case in solid organ donation, HPC donors may consent to HPC collection for a number of different reasons, some of which may negatively impact upon their experience of apheresis and may give rise to concerns regarding late withdrawal from donation. While these issues are complex enough where competent adults are the donors, they are more difficult again where the ‘donor’ in not competent, is mentally ill or is a child. In this paper I will review the ethics of apheresis, critique the concept of informed consent and the disproportionate concern with unrelated donors, and consider whether current practices are ethically justifiable.

The anaesthetic management of 217 donors undergoing 236 operative procedures to donate bone marrow for allogeneic transplantation or for autologous grafting is described. The procedures were those performed between November 1979 and the end of October 1982.