Clinical Services

Autologous Blood Donation

Patients should be advised of their transfusion options including potential risks.
All requests for autologous donation must be submitted on the Blood Center's Physician's Order Form For Autologous Blood Collection. This must be received by the Special Donor Services Department before the patient arrives for his/her appointment. It can be faxed or mailed to the address below.
Autologous blood donations may be made every three days, but not less than 72 hours before surgery. Ideally appointments should be scheduled a week apart and not less than a week before surgery.
The Blood Center requires a minimum of five (5) to seven (7) business days to complete testing of Autologous blood..
The following conditions would exclude a patient from Autologous donation:
  • Severe aortic stenosis
  • Active infection with or without antibiotic
  • Left main coronary artery disease
  • Hemoglobin less than 11.0 gm/dl

Certain medical conditions may require written approval for Autologous donation from the patient's primary care physician or cardiologist. Final approval is obtained from the Blood Center's Medical Director/Designee.

If a patient will be doing an Autologous donation and having directed donors, two (2) separate Pysician's Order Forms will be required. Click on Directed Donation for information about the Directed Donor Program.

Autologous donations may be made at the Blood Center's main facility in Paramus or our satellite sites at Englewood Hospital and St Joseph's/Wayne Hospital. Patients should call the Blood Center's Special Donor Services Department at (201) 444-3900 to schedule an appointment.
The FDA and the State of New Jersey require a written request for an Autologous donation.
Instructions:  To get a copy of the Blood Center's Physician's Order Form For Autologous Blood Collection click on the link below. The form is not valid unless there is a physician's signature on it, a stamped signature will NOT be accepted. Please print the form, complete all information and sign it.
Fax it to: (201) 444-1885 
Or you can mail it to:
Community Blood Services
Bergen Community Regional Blood Center 
P.O. Box 39 
Paramus, NJ 07653-0039


Attention: SDS 

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