How do you handle Hemoglobin S positive donors?

Erik Scott, Sr. Research Coordinator at the BloodCenter of Wisconsin, (attribution used with permission) writes to ask donor centers:

"When are donors tested for Hemoglobin S (HbS)?" He asks how HbS positive donors are handled: "Do you steer them towards automated collections, defer them, decline to actively recruit them, or something else entirely?" (The editors would also be interested in knowing if counseling is offered).

Erik adds: "Thank you for any information you can share!"

The following comments have been received.

ADDENDA Mar. 12, 2009

1. A Medical Director of a community blood donation collection organization located in the Southern region of the US reports that they do not defer HbS positive donors. At their facility such individuals may make any type of donation. However, they have wondered about the cost-effectiveness of this approach since the red cell units collected from these donors frequently have problems when they undergo leukocyte reduction filtration ( see previous e-Network Forum discussion "Implications of Sickle Trait Blood for Leukocyte Reduction and Transfusion". The donors are notified of their HbS status by certified letter and are told that a screening test for hemoglobin S was positive and that one condition that can cause this is sickle trait. The letter recommends that the donor visit their physician for follow-up.

2. The medical director of a large hospital based blood collection center in the Northern USA that collects the majority of the blood products transfused at their facility reports that all of the blood used at his hospital is pre-storage leukocyte reduced and that it is their practice to perform hemoglobin solubility testing on the donors of RBC units in two circumstances: 1) Whenever an RBC unit is intended for transfusion to a neonate or a patient with sickle cell anemia; 2) If a donor has on more than one occasion had their donated whole blood unit not properly filter through a leukocyte reduction filter (i.e., clog the filter). In these instances, a screening solubility test is performed. If positive, the donor is notified by mail that they may be a carrier for HbS or some other abnormal hemoglobin. They are provided contact information where they can call with questions. They are also provided a contact number where they can schedule an appointment to be evaluated by a hematologist. The responding colleague's blood bank does not perform confirmatory testing (e.g. hemoglobin electrophoresis) for the donors, leaving such testing up to the discretion of each donor's personal physician. Of note, the responding colleague has seen only one donor who was unaware that they were a HbS carrier upon being notified of that information. All the others already knew. If a donor tests positive for a sickling hemoglobin, the donor is deferred from whole blood and automated red cell donation. They are still eligible for apheresis platelet and apheresis plasma donation.

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