DOES A PATIENT WITH HEREDITARY SPHEROCYTOSIS QUALIFY FOR PREOPERATIVEAUTOLOGOUS BLOOD DONATION

BACKGROUND: Hereditary spherocytosis (HS) is characterized by osmotica lly fragile spherocytic red cells (RBCs), mild to moderate hemolysis, and splenomegaly. Little is known about the safety of blood bank stora ge of HS RBCs. CASE REPORT: A 50-year-old man with mild autosomally do minant HS asked to make an autologous RBC deposit before his scheduled surgery. His RBCs were serially tested for osmotic fragility during 4 weeks of blood bank storage in CPD with adenine-saline. Aliquots of h is fresh and 4-week-old RBCs were also labeled with Cr-51 for measurem ent of in vivo survival. The osmotic fragility of the patient's fresh RBCs was normal, with 50-percent hemolysis at approximately 0.43-perce nt NaCl and a sigmoid lysis curve. Incubated osmotic fragility (24 hou rs at 37 degrees C) was abnormal, with 50-percent hemolysis at 0.64-pe rcent NaCl. Median survival of his fresh Cr-51-labeled RBCs was modera tely shortened at 17.5 days. Osmotic fragility increased during storag e, with 50-percent lysis occurring at 0.58-percent and 0.62-percent Na Cl after 2 and 4 weeks, respectively. Volunteer normal donor RBCs exhi bited 50-percent lysis in 0.48-percent NaCl after 4 weeks. Median surv ival of the patient's 4-week-old Cr-51-labeled RBCs was severely short ened, at 3.5 days. At surgery, intraoperatively salvaged RBCs demonstr ated osmotic fragility identical to that of the patient's RBCs freshly obtained by venipuncture. CONCLUSION: HS RBCs may lose membrane under optimum storage conditions, becoming unsuitable for transfusion at su rgery. Intraoperative autologous transfusion may be preferable to preo perative deposit for avoidance of allogeneic RBC transfusion in patien ts with HS.