A blood banker from Florida wrote that her institution has been debating whether or not to notify donors who are discovered to have sickle cell trait. Donors with sickle cell trait are discovered upon investigating filtration failures when preparing leukocyte-reduced red cell units. The Floridian's blood donor center performs a screening test for sickle hemoglobin on donors whose units fail to filter properly. Currently their donation consent form does not specify that a specific test for sickle cell trait may be performed (in the event of a filter failure). However, the consent does state that "testing will be done for disease indicators" to ensure the safety and quality of the blood. The consent also states that the donor will be notified of "any" abnormal result. Since sickle cell trait can be interpreted as a 'disease indicator', the inquiring blood banker's institution has decided to notify donors who are discovered to have sickle cell trait. The inquiring blood banker would like to know if other institutions notify sickle trait individuals of their sickle hemoglobin status.

In response to the above, the following replies were received.

1. A Chief of Hematology and Director of a Comprehensive Sickle Cell Center at a prestigious university in the Carolinas wrote that if the donor center tests for Hgb S with a sickledex or similar test (rather than hemoglobin electrophoresis), they had better not tell the patient they have sickle trait! The donor might have Hgb SC or another compound heterozygous hemoglobinopathy (e.g. S-beta thal+). This makes a real difference when genetic counseling is done re having children. So the donor center will have to be careful to say only that the presence of Hb S was detected and then refer the donor to a physician for diagnosis of the actual hemoglobin status.

2. A blood bank physician who works at a university in Northern California that is equally as prestigious as the center where respondent #1 works, agrees with the Carolina physician saying 'Yes, we do notify donors who have positive results on the sickle screening test. Note that Hb S is not the only abnormality that can cause a positive result on the screen. We recommend that donors with positive screening tests obtain further evaluation".

3. A blood bank physician who runs a large Southern California donor center says that "there is no question in our minds that a donor determined to carry the sickle cell trait detected in the course of evaluating a filter failure should be informed."

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