Background. High-volume harvest of bone marrow (BM) poses donors at risk of anemia. To prevent allogeneic transfusions and improve post-donation recovery, BM donors usually undergo perioperative autologous donation (PAD), which, however, is a practice not supported by strong clinical evidence.
Materials and methods. To expand knowledge on the BM harvesting procedure in the absence of previous PAD, we started a prospective study enrolling familial BM donors recruited at Fondazione Policlinico A. Gemelli IRCCS (The ATREMA Study, NCT04355130). Donors received subcutaneous B12 vitamin and i.v. iron supplementation one week before donation, and started folic acid 5 mg/day per os until day 15 post-harvest. Study outcomes were the proportion of donors needing allogeneic transfusion and hematological recovery in comparison with a sex-matched retrospective series of donors undergoing BM donation with one or two PADs.
Results. From April 2020 to December 2022, seven total BM donors were included in the study. The under-recruitment was imputable to changes occurring after the COVID-19 pandemic, with preferential use of mobilized stem cell collections. All included donors were male, with a mean age of 36 ±4.8 years and a mean body weight of 78±9.9 kg. The harvested BM volume was 20.8±2.0 ml/Kg of the donor body weight. No allogeneic transfusions were administered; after BM collection, there was a significantly lower Hb level in ATREMA donors than in controls. Nevertheless, hematological recovery was similar in both groups, with no difference in Hb values at one-week outpatient control.
Discussion. Performing PAD in BM donors is a controversial issue. This study is affected by a significant under-recruitment, which does not allow for drawing definite conclusions. Nevertheless, our data suggest that discontinuing PAD in healthy BM donors receiving iron and vitamin supplementation is a safe and feasible approach. A PBM program dedicated to BM donors is worth it.
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