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Autologous RBC Collection

Mnemonic:    [AUTO COLL]
Name:    Autologous RBC Collection
Note:    Outpatients: Donations are scheduled in advance with the American Red Cross. Refer to the link below for complete ordering information and patient guidelines.


Guidelines for completing American Red Cross Special Collections Order:

Section A: Patient Information Record
--Information submitted must be legible.
--List the patientís full name, exactly as the patient is registered at the hospital.
--Include the patientís home phone number and an alternative number, if available.
--List the patientís mailing address.

Section B: Physicianís Order
--Specify the Donation Type: Autologous, Directed or Both.
--Indicate the Unit Type and the Number of Units to be collected.
--Indicate test for CMV*, Leuko-reduce, or irradiate, as necessary.
* CMV (cytomegalovirus) testing may be requested for directed donations, if desired. CM V testing is not requested for Autologous donors unless the patient is a bone marrow donor.

Section C: Physicianís Pre-assessment of the Autologous Donor:
--Check all past or present medical conditions of the donor.
--The Special Collections Staff will contact the patientís cardiologist of primary care physician if your patient has a history of Cardiac/Cardiovascular Disease. The cardiologist or primary care physician would then be asked to complete Section E of the Special Collection Order.
--Indicate if your patient has any restriction of physical activity.
--List the patientís current medications.

Section D: Ordering Physicianís Information
--The Transfusion Date is the Scheduled Surgery Date.
--The Transfusion Service/Hospital is the facility in which the surgery is scheduled
--The Ordering Surgeon must sign and date the order.
--The Special Collections Department must be notified of any changes.

Please contact the Special Collection Staff, by phone, at 1-888-808-4918, if you have any questions regarding Special Collections Donations

For more information about autologous and directed donations:
http://www.redcrossblood.org/donating-blood/types-donations/autologous-and-directed

American Red Cross Special Collections Order Form