Should persons with thrombophilia be accepted as blood donors?
A transfusion medicine physician in Ohio just deferred a donor who reported having tested positive for Factor V Leiden. The Ohio physician was leaning towards allowing the donation as he feels there is no significant decrease in donor safety, and the potency of the product concerning coagulation should not be decreased. However, he works in (verbatim) "a conservative region here", and the possibility exists that this could be the only unit transfused to a neonate or other small volume person with this same defect, and could lead to a hypercoagulative state. Interestingly, they admit to currently accepting donors with 'history of DVT', if they are currently symptom-free, have no restrictions on physical activity, and are not on any cardiovascular medications. Arterial thrombosis cases would be evaluated on a case by case basis, but most likely deferred. He asks colleagues "How do you handle donors who give a history of being heterozygous Factor V Leiden mutation? What about other genetic conditions that predispose to thrombosis? What are people's thoughts in terms of donor safety and product efficacy?"
Editor's Note: The review article on thrombophilia by William Check, PhD from the Jan. 2002 issue of CAP Today might be of interest to this discussion.
The following responses were received.
ADDENDA Mar. 21, 2003
- A blood center in Texas has made a policy to accept donors with a history of Factor V Leiden for either whole blood or apheresis donation unless the prospective donor is currently symptomatic or receiving treatment for thrombosis. The responding colleague reports that with anywhere from 2 to 10% of the population carrying the factor V Leiden gene as heterozygotes, it seemed impractical to defer these individuals if they were currently asymptomatic, not on treatment and not at increased risk of donating blood. A similar argument could be made form other thrombophilic conditions like prothrombin mutation G20210 (2% of the population) or elevated homocysteine (12%).
ADDENDA Mar. 29, 2003
- A colleague in Texas is of the opinion (without providing peer journal citations) that patients with thrombophilia should be allowed to donate without any problems because:
In summary, the Texan believes that the transfusion of a unit of FFP from a thrombophilic donor should not be of concern, even for neonates and others with relatively small blood volumes, provided the transfusion is being given to correct bleeding due to coagulopathy.
- When transfusing FFP for correction of coagulopathy, the product is being given to correct a bleeding tendency, and hence a unit of FFP from a thrombophilic donor would not be expected to be detrimental. Whether such a unit would be of any additional benefit is uncertain!
- For large volume use (e.g. plasma exchange for TTP), a unit of FFP from a thrombophilic donor would be diluted.
ADDENDA Mar. 31, 2003
- According to the Chair of the UK Standing Advisory Committee on the Care and Selection of Blood Donors, they were faced with a donor in England who developed a superificial venous thrombosis from the phlebotomy site in his arm after his sixth donation, and was subsequently found to be a carrier of FV Leiden. In their opinion, this was almost certainly a coincidence. They decided that mere carriage of the FV Leiden gene by a person who was otherwise healthy and passed all other health criteria regarding the selection of donors was NOT a reason for deferral. They also take the view that babies requiring treatment with plasma-rich blood products usually require them to treat a hemorrhagic state, and that the provision of plasma from a donor with one, or even two, FV Leiden genes would not be contraindicated. The responding colleague adds that there are many genetic variants in healthy humans (e.g; hemochromatosis, hemoglobin variants, enzyme variants, HLA B27, etc), and if we were to defer merely on the basis of potential for pathology, such a policy would undoubtedly impact on the availability of the supply of blood.
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Ira A. Shulman, MD
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