A transfusion medicine physician in Missouri wants to know how other centers handle prospective donors with rheumatoid arthritis, multiple sclerosis, ulcerative colitis, Crohn's disease, a history of Guillian-Barre' syndrome, and other immunologic or probably/partly immunologic diseases. The Missouri blood banker reports that her center currently defers donors with Guillian-Barre' syndrome since the inquiring blood banker has read reports that the disease can be transmitted via T-cells in mouse models. Here are some of those reports:

• Linington C, Lassmann H, Ozawa K, Kosin S, Mongan L. Cell adhesion molecules of the immunoglobulin supergene family as tissue-specific autoantigens induction of experimental allergic neuritis (EAN) by P0 protein-specific T cell lines. Eur J Immunol. 1992 Jul;22(7)1813-7.
• Harvey GK, Pollard JD Peripheral nervous system demyelination from systemic transfer of experimental allergic neuritis serum. J Neuroimmunol 1992 Dec;41(2)159-66.
• Hahn AF, Feasby TE, Lovgren D, Wilkie L. Adoptive transfer of experimental allergic neuritis in the immune-suppressed host. Acta Neuropathol 1993;86(6)596-601.

However, for prospective donors with ulcerative colitis, Crohn's Disease, Multiple Sclerosis, and Rheumatoid Arthritis, if the prospective donor is symptom-free and not on any medications for the condition, the inquiring blood banker would accept them as a donor. A previous director of the center where the inquiring blood banker works had a policy to defer anyone with an immunologic disease. The previous director's reasoning was that we don't know enough about the cause of these immunologic conditions and whether these conditions can be transferred by immunocompetent cells to a transfusion recipient. The inquiring blood banker would be interested in what others do and in any references that address the safety or lack of safety of qualifying donors with the above conditions.

The following replies were submitted in response to the above.

1. A blood banker from Minnesota wrote that at a time when it is so important for us to continue to restore public confidence in the safety of the blood supply, it is very important that we not "muddy the waters" by accepting as donors people who are not "healthy and normal". If we were to actually take blood donations from unhealthy individuals and the public learned that we were accepting blood from donors with a variety of "diseases", we would have an enormous public relations problem to deal with. Even if one might argue that there is a dearth of published data on the transmissability of the conditions mentioned, the public would be instantly suspicious that our need for blood was, once again blinding us to potential dangers! Witness the FDA mandates relative to vCJD in the absence of a single case of transmission and the lack of even a hint of such from extensive epidemiological evaluations of huge numbers of donations. The Minnesotan adds that our patients should not have to worry that they might be getting blood from donors with "diseases" and certainly should not have to be concerned that blood bankers who were publicly excoriated only 20 years ago for "laxity" in the face of AIDS, should again be debating whether to take blood from patients with a variety of disorders, some of which might even be autoimmune in nature. He concludes by saying "We are all aware of blood shortages but the way to address that problem cannot be to jeopardize the reputation for safety of the blood supply".

2. A blood banker in Northern California reports their current policies pertaining to donors with histories of those disorders: 

• Rheumatoid Arthritis--Acceptable if inactive/asymptomatic (e.g., not on corticosteroids; off gold therapy > 1 year); Defer indefinitely if symptoms of fever or acute inflammation, or if taking corticosteroids; Evaluate by blood center physician if status of donor's RA is questionable/borderline.
• Multiple Sclerosis--Defer indefinitely.
• Ulcerative Colitis--Acceptable if controlled by medication and asymptomatic 72 hours.
• Crohn's Disease--Acceptable if controlled by medication and asymptomatic 72 hours.
• Guillain-Barre Disease--OK to donate, one year after recovery.

ADDENDA June 11, 2002

3. A blood bank physician in Texas wrote that at his blood center they allow donation by individuals with rheumatoid arthritis if they have no symptoms and are taking no medications except for non-steroidal anti-inflammatory medications (nothing stronger). They will accept donors with inflammatory bowel disease in remission (i.e., no symptoms, no meds). They defer anyone with a diagnosis of multiple sclerosis. They will accept individuals recovered from Guillain-Barre syndrome (6 months or more after recovery).

ADDENDA January 8, 2004

4. The medical director of blood donor services at a moderate-sized collection facility in Indiana submits the medical criteria currently in use for determining donor eligibility for the following conditions:

• Crohn's Disease and Ulcerative Colitis: If these conditions have been confirmed medically, consider them reason for permanent deferral.
• Multiple sclerosis: Permanent deferral.
• Guillain-Barre: Accept these donors if they have recovered from the disease and are currently well and asymptomatic.
• Rheumatoid arthritis: If the disease is active and severe enough to require systemic steroid therapy, defer the donor.

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