According to AABB Standards a prospective donor shall appear to be in good health and shall be free of major organ disease (e.g., heart, liver, lungs), cancer, or abnormal bleeding tendency, unless determined eligible by the medical director. Consequently, many institutions defer prospective blood donors who have had a diagnosis of cancer. A colleague in Southern California would like to know how collection centers or hospital blood banks manage post donation information events involving a diagnosis of cancer when the cancer diagnosis is made AFTER one or more previous blood donations. Do donor centers and hospital blood banks attempt to 'retrieve' such units and/or notify the recipients of such products? If so, what criteria are used to determine how far back the retrieval and/or notification should extend? What is the message given to the recipient, if a recipient is notified? Do collection centers and hospital blood banks differentiate between solid tissue cancers/tumors and blood cancers (leukemia/myeloma, etc) in determining the extend of the retrieval/notification?

The following comments have been received.

ADDENDA June 16, 2006

1. Dr. Susan Rossmann, Chief Medical Officer of Gulf Coast Regional Blood Center (attribution used with permission) reports that when her center receives information about a previous donor who now has cancer, they take an individualized approach, considering the type of cancer and the time elapsed since the most recent donation. In general, if the patient did not have symptoms at the time of donation, they do not do any notification unless the interval is extremely short (maybe a month or two). Dr. Rossmann acknowledges that she has notified hospitals when the donor received a diagnosis of leukemia within a few months of donation. For visceral cancers, however, such notification would seem to have little utility. It is now known from molecular and other studies that many cancers can grow slowly for years and/or have circulating tumor cells in very low numbers. The donor population, like the general population it is drawn from, undoubtedly includes persons with undiagnosed cancers. Experience suggests that cancer is very rarely (if ever) transmitted by transfusion. What would be the utility of notification? This is uncertain. What would be the downside of notification? Presumably anxiety on the part of the transfusing physician and, if the recipient is notified, on his or her part as well. Would any additional screening measures be justified for the recipient? It is hard to imagine that they would be. However, they might well be suggested. Dr. Rossmann acknowledges that to notify physicians and recipients of a donor's cancer diagnosis would cause increased costs and the risks of additional screening without a clear benefit, and could generate confusion and anxiety. Mandated notifications for infectious disease test results already cause considerable anxiety in the recipients of that information.

2. In the experience of Dr. Kathleen Sazama at MD Anderson Cancer Center, (attribution used with permission), in the 60+ years of US blood banking, she is unaware of there being any report (or even a suspicion raised) of cancer transmission by transfusion - hematologic or solid tumor. In her donor center (they collect about 45,000 units/year), when they learn of a cancer diagnosis in a donor, they defer the donor from future donations but do nothing about prior donations. It is their belief that this policy represents the appropriate balance between safeguarding the blood supply and respecting patient rights. In a concern for protecting patients and giving them correct and current information, she suggests that we think carefully about the harm we do by raising unfounded concerns. There is harm done by alarming patients unnecessarily. In her opinion, if ever there is an example of a time when no further action is indicated, a donor with a cancer diagnosis is it. Also, it is common practice in other blood centers in their area to defer donors with a cancer diagnosis for 5 years (not indefinitely), then automatically reinstate them. In the MD Anderson donor center, donors with a history of cancer are deferred indefinitely (except for cervical CIS and basal cell carcinoma), but donors whose cancer diagnosis and treatment occurred more than 5 years ago can be re-evaluated upon donor request, and they occasionally reinstate a donor whose cancer was local and whose only treatment was surgical resection. This decision relies upon a signed statement from the treating physician in which he/she verifies the diagnosis, the treatment and the disease-free interval. In summary, Dr Sazama strongly urges a conservative approach.

ADDENDA May 21, 2007

3. The Editors think that colleagues may find the following articles to be germane to the present discussion:

• Edgren G, et al. Risk of cancer after blood transfusion from donors with subclinical cancer: a retrospective cohort study. Lancet 2007; 369:1724-1730.
• Edgren G, et al. A population-based binational register for monitoring long-term outcome and possible disease concordance among blood donors and recipients. Vox Sang 91(4), 316–323.

Please submit comments to the e-Network Forum.

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

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