The following paraphrased question was posed by an air force veteran of Desert Storm:

'Although I was not in service on the front line, when I got back to the United States following Operation Desert Storm, I was debriefed about being a blood donor. I remember being told that I was not to donate blood upon returning to the United States. I never heard if this ban on blood donation was lifted. What is the status of this donation ban as of today?'

In order to provide this veteran with an accurate answer, an expert opinion was solicited from a member of the CBBS e-Network panel. Here is that opinion:

There was an indefinite deferral from blood donation in place for veterans returning from Desert Shield/Desert Storm since it was unclear what type of infectious diseases they may have encountered during the conflict. The Armed Forces Blood Program was the first group to suggest a deferral, and other blood donation organizations quickly followed their recommendation. Of particular concern was the possible spread of Leishmaniasis parasites to veterans due to exposure to the flies that act as vectors of this parasite. The indefinite deferral period was lifted after enough evidence had accumulated to be sure that Leishmaniasis was not a concern among returning veterans. Veterans of Desert Storm who were in good health were once again encouraged to give blood. The deferral criteria were put in place during 1991 and retracted during 1993.

In addition to the above opinion, listed below are some references to the risk of transfusion transmitted Leishmaniasis:

Visceral leishmaniosis (VL) due to Leishmania infantum (L. chagasi) is a lethal sease if untreated, but asymptomatic L.infantum infections have been reported previously. A better understanding of parasite transmission, dissemination, and survival in the human host is needed. The purpose of this study was to assess whether L. infantum circulated in peripheral blood of subjects with no history of VL. Sera from 565 blood donors were screened by Western blotting to detect Leishmania-specific antibodies and identify individuals with probable past exposure to Leishmania. Seropositivity was found in 76 donors whose buffy coats were examined by PCR and direct culture. The parasite minicircle kinetoplast DNA was amplified from blood samples of nine donors. Promastigotes were detected by culture in blood samples from nine donors. Only two donors were PCR and culture positive. These results indicate that L. infantum circulates intermittently and at low density in the blood of healthy seropositive individuals, who thus appear to be asymptomatic carriers. Implications for the safety of blood transfusion are discussed.

An English child developed visceral leishmaniasis (kala-azar) after cardiac surgery. Neither he nor his mother had ever been out of the UK, and his disease was probably transmitted by blood transfusion. Kala-azar should be considered in patients with unexplained fever and hepatosplenomegaly, even if there is no history of foreign travel.

The case of a 13 month-old-boy with visceral leishmaniasis acquired in Brittany, a region of France where leishmaniasis is not endemic, is presented. The mode of contamination remains unclear, although a transfusional origin through blood transfusions during the neonatal period appears the most likely.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator