Blood donor deferral is a critical safeguard to protect both donor health and transfusion safety. However, deferral practices can adversely affect blood availability and donor retention. The aim of this study is to evaluate deferral patterns among voluntary blood donors and to identify opportunities to optimize deferral strategies.

Deferral data were retrospectively collected from the blood transfusion management system of a single center between January 2019 and December 2023. Statistical analyses were performed using SPSS version 25, with p < 0.001 considered statistically significant.

A total of 148,282 blood donors were included, of whom 18,343 (12.37%) were deferred. Temporary deferrals accounted for 10.95% (16,240/148,282) and permanent deferrals for 1.42% (2103/148,282). The leading causes of temporary deferral were abnormal alanine aminotransferase (ALT) levels, representing 51.33% (9415/18,343) of all deferrals, followed by low hemoglobin levels at 12.20% (2237/18,343), lipemic blood at 7.12% (1306/18,343), non‐medical reasons including time constraints, procedural complexity, and psychological concerns at 6.90% (1265/18,343), hypertension at 4.08% (749/18,343), and medication use at 2.26% (414/18,343). Permanent deferrals were most frequently attributed to hepatitis B surface antigen (HBsAg) positivity at 4.12% (755/18,343) and syphilis antibody positivity at 2.89% (530/18,343), while nucleic acid reactivity accounted for 0.26% (48/18,343).

Targeted donor education, optimization of pre‐donation screening, and refinement of deferral criteria may improve donor recruitment and retention while maintaining transfusion safety.

Pre‐operative autologous blood donation (PAD) is increasingly used in spinal surgery because of the risk of substantial intraoperative blood loss. However, evidence on the effectiveness and safety of apheresis autologous red blood cell (RBC) technology remains limited. This study was conducted to evaluate whether this technology can reduce allogeneic transfusion in spinal surgery without adverse effects.

In this randomized, two‐group, unblinded clinical trial, participants undergoing spinal surgery between November 2018 and September 2023 were randomized 1:1 to receive apheresis autologous RBCs (auto‐RBC group, n = 30) or standard allogeneic transfusion (allo‐RBC group, n = 30). The two primary outcomes were allogeneic RBC transfusion and postoperative length of hospitalization. Twenty‐eight secondary outcomes and 12 safety indicators were also assessed.

Of the 60 randomized patients, 47 completed the trial. The allogeneic RBC transfusion rate was significantly lower in the auto‐RBC group than in the allo‐RBC group (39.1% vs. 70.8%, p = 0.041). Intraoperative allogeneic RBC transfusion volume was also significantly reduced (0.50 ± 1.16 vs. 1.50 ± 1.69 U, p = 0.023). No significant difference was found in postoperative hospitalization (7.48 ± 0.80 vs. 9.21 ± 2.41 d, p = 0.461). Of the 28 prespecified secondary outcomes, 25 showed no significant between‐group differences. Hemoglobin on postoperative day 3 was lower in the auto‐RBC group (91.09 ± 2.99 vs. 100.00 ± 2.91 g/L, p = 0.039). Hemoglobin in the auto‐RBC group also declined from pre‐apheresis to preoperative levels (144.65 ± 10.86 vs. 122.56 ± 14.60 g/L, p < 0.001).

Apheresis autologous RBC technology reduces the rate of allogeneic RBC transfusion in major spinal surgeries without increasing hospitalization or complications. These findings support its use in adult patients undergoing major spinal procedures.