Should taking selective serotonin reuptake inhibitors (SSRIs) be a factor in donor selection and/or the products manufactured from such a donation?

A colleague in Queensland, Australia is curious to know how blood collection centers handle prospective blood donors who are taking selective serotonin reuptake inhibitors (SSRIs), especially regarding apheresis platelet collections. His concern stems from an article by Meijer et al. entitled: "Association of Risk of Abnormal Bleeding With Degree of Serotonin Reuptake Inhibition by Antidepressants" which appeared in Arch Intern Med 2004; 164:2367-2370. Briefly, the authors of the aforementioned article report that serotonin plays a role in platelet aggregation, and that based on their study of a large population of new antidepressant users, there was a significant association between degree of serotonin reuptake inhibition by antidepressants and risk of hospital admission for abnormal bleeding as the primary diagnosis. The Australian colleague is aware that many donors take antidepressant medications, and wonders if taking an SSRI should be a factor in donor selection and/or the products that are manufactured from such a donation. He hopes to learn how other centers manage prospective donors (and donated products) when the donors take SSRIs.

The following comments have been received.

ADDENDA Mar 4, 2005

1. A group of experienced transfusion medicine colleagues recently discussed the issue of SSRIs and blood donation. The consensus of their group was as follows:
   • As part of the routine health history, each prospective donor is asked about the medications that s/he takes, as well as about any tendency toward abnormal bleeding. If a donor acknowledges taking an SSRI and also acknowledges a tendency toward abnormal bleeding, that kind of donor is more likely to be deferred.
   • There are currently insufficient data to be sure that the SSRI effect on hemostasis is clinically significant for apheresis platelet donors/products.
   • The issue of a possible bleeding disorder associated with the administration of SSRIs should be monitored by MDs involved in transfusion medicine. They should specifically look for studies that assess the dose relationship of any potential bleeding disorder, the degree of abnormality and the clinical picture that can be associated with these drugs over multiple studies.
   • In addition, it would be good to try to assess whether any potential bleeding disorder is more or less significant than that associated with aspirin.
   • MDs may want to consider a research project to assess whether taking these drugs is associated with reports of abnormal bleeding in blood donors.
   • In a recent AABB audio conference devoted to the new AABB standards led by Dr. Tom Price, an important distinction was drawn between reversible and irreversible platelet inhibitors. Medications that irreversibly inhibit platelet function should defer platelet donors. Of these, ASA leads to a 36-hour deferral. While other irreversible inhibitors such as Plavix and Ticlid are not specifically mentioned, the centers might have a policy deferring such donors as defined by the medical director. Treatment with reversible platelet inhibitors, such as NSAIDS, in contrast, need not lead to platelet donor deferral.
   In summary, the group felt that there had been a lot of experience with donors taking these drugs and not much evidence that the drugs create a significant problem. The publications about a possible relationship between SSRIs and abnormal bleeding have put these colleagues on guard, but not enough to justify deferring donors without more information.

Submit comments to the e-Network Forum at enetworkforum@cbbsweb.org

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

W. Tait Stevens, MD
CBBS e-Network Forum Editor & Moderator

Elizabeth M. St. Lezin, MD
CBBS e-Network Forum Associate Editor & Moderator