Deferral for biologics such as TNF-alpha receptor blockers?

A physician at a prominently named clinic is interested in finding out deferral practices for biologics such as TNF-alpha receptor blockers (e.g. adalimumab, etanercept, and infliximab). He is concerned about the immunosuppressive effects of these drugs in recipients, especially kids. Would you defer eligible donors on these medications, (assuming they wouldn't be deferred for the underlying disease or low hemoglobin)?

The following comments have been submitted in response to the above.

ADDENDA July 1, 2009

1. The Senior Medical Technologist for a hospital-based donor center writes, "We have recently added immunosuppressive agents to our Medication Deferral list in lieu of asking for a general medication history. Our reasoning was the risk of a subclinical infectious process as well as risk of not seroconverting if exposed to an infectious agent. At present we have only listed immunosuppresives as a general category to the medication deferral list."

ADDENDA July 2, 2009

2. A Southern California based consultant reports: "After having audited several thousand charts for donor eligibility in the past couple of years, I am concerned about listing immunosuppressive agents as a general category. Will screening staff and donors be aware of what even is an immunosuppressive drug if they are not listed? Initial screening staff are usually of limited clinical expertise, and should not be expected to know what drugs are without a detailed reference guide of what medications would qualify as an immunosuppressive agent." She adds "It is amazing what donors 'forget', then 'remember' later at a subsequent donation, resulting in having to perform market withdrawals on previously collected products (not to mention the headache of having to do BPDs)."

ADDENDA July 26, 2009

3. A Medical Director at a blood bank in Pennsylvania reports that they currently address the need for donor deferral of individuals taking certain drugs that might have immunosuppressive effects on recipients, especially kids, by deferring individuals who are taking medications that are disclosed when questioned about what drugs they take and the "route of administration" of those drug. Since drugs likely to have immunosuppressive effects on recipients are largely injectables, the responding colleague's center is developing an abbreviated list of injectables that are either acceptable or not. While donors may not know exactly why they take a drug or what the category of drug is, they do know how they take an injectable drug.

Submit Comments to the e-Network Forum below:

Items marked with an asterisk (*) are required entries. Please note that there is a 60 minute time-out on this form. if one anticipates taking more than 30 minutes or so to compose the submission, we recommend composing your comments in a word processing application, and performing a copy and paste of your text into the comments field.
* Name
Title
Affiliation
* email address
* Enter email address again to verify
* Do you wish to have attribution for your comments?	Yes No
* Your Comments
*Please indicate if this is a new question, or if you are commenting on an existing discussion:	New Question Existing, Name:
File Attachments (2MB limit)
To help us prevent SPAM, you must enter the the validation code EXACTLY AS IT IS DISPLAYED in the image directly to the right of the text entry field below in order to submit this form. Please note that the validation code is CASE SENSITIVE.

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

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