open access

Vol 12, No 2 (2019)
Review paper
Published online: 2019-09-06
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Hereditary hemochromatosis — therapeutic phlebotomy as additional source of blood

Aleksandra Rosiek
DOI: 10.5603/JTM.2019.0003
·
Journal of Transfusion Medicine 2019;12(2):65-71.

open access

Vol 12, No 2 (2019)
REVIEWS
Published online: 2019-09-06

Abstract

Many countries currently witness a decline in the number of blood donors and, consequently, a decrease in supply of blood and blood components dedicated for clinical use. To improve the situation one of the measures taken is to qualify for blood donation people with diagnosed hereditary hemochromatosis (HH) — a genetic disorder that leads to iron overload, most effectively treated by frequent bloodletting to eliminate the excess of iron. Blood from therapeutic phlebotomy is often discarded. Reservations and doubts related to the clinical use of this blood are primarily related to additional factors that affect its safety. However, there is currently no convincing evidence that blood from HH donors exposes recipients to higher risk. Reservations are also raised regarding organizational challenge and costs as well as ethical concerns regarding the voluntary nature of donations. In Poland — according to current regulations — HH individuals are deferred from donating blood during the onset of disease symptoms or in the course of treatment other than phlebotomy. The decision regarding blood donation as well as frequency of subsequent donations is made by the physician in the unit of the public health service in cooperation with the doctor responsible for therapy of hemochromatosis. Guidelines regarding this group of potential blood donors markedly differ from country to country therefore numerous publications emphasize the need to develop a set of uniform, optimal regulations based on the outcome of available research.

Abstract

Many countries currently witness a decline in the number of blood donors and, consequently, a decrease in supply of blood and blood components dedicated for clinical use. To improve the situation one of the measures taken is to qualify for blood donation people with diagnosed hereditary hemochromatosis (HH) — a genetic disorder that leads to iron overload, most effectively treated by frequent bloodletting to eliminate the excess of iron. Blood from therapeutic phlebotomy is often discarded. Reservations and doubts related to the clinical use of this blood are primarily related to additional factors that affect its safety. However, there is currently no convincing evidence that blood from HH donors exposes recipients to higher risk. Reservations are also raised regarding organizational challenge and costs as well as ethical concerns regarding the voluntary nature of donations. In Poland — according to current regulations — HH individuals are deferred from donating blood during the onset of disease symptoms or in the course of treatment other than phlebotomy. The decision regarding blood donation as well as frequency of subsequent donations is made by the physician in the unit of the public health service in cooperation with the doctor responsible for therapy of hemochromatosis. Guidelines regarding this group of potential blood donors markedly differ from country to country therefore numerous publications emphasize the need to develop a set of uniform, optimal regulations based on the outcome of available research.
Get Citation

Keywords

blood donation; blood donors; hemochromatosis

About this article
Title

Hereditary hemochromatosis — therapeutic phlebotomy as additional source of blood

Journal

Journal of Transfusion Medicine

Issue

Vol 12, No 2 (2019)

Article type

Review paper

Pages

65-71

Published online

2019-09-06

DOI

10.5603/JTM.2019.0003

Bibliographic record

Journal of Transfusion Medicine 2019;12(2):65-71.

Keywords

blood donation
blood donors
hemochromatosis

Authors

Aleksandra Rosiek

References (24)
  1. Pogłód R, Rosiek A, Grabarczyk P, et al. Charakterystyka podstawowych wskaźników dotyczących krwiodawstwa i krwiolecznictwa w Europie - aktualne wyzwania i działania. Journal of Transfusion Medicine. 2015; 8(2): 60–77.
  2. Rosiek A, Tomaszewska A, Lachert E, et al. Działalność jednostek organizacyjnych służby krwi w Polsce w 2017 roku. Journal of Transfusion Medicine, 2018. ; 4(11): 113-130.
  3. Barton JC, Grindon AJ, Barton NH, et al. Hemochromatosis probands as blood donors. Transfusion. 1999; 39(6): 578–585.
  4. Trousseau A. Glycosurie, diabète sucré. Clinique médicale de l’Hôtel-Dieu de Paris, Vol. 2, 2nd edn. Paris: Balliere, 1865:663.
  5. von Re. Über Hamochromatose. Tagebl Versamml Natur Ärzte Heidelberg. 1889; 62: 324.
  6. Sheldon JH. Haemochromatosis. London: Oxford University Press. ; 1935.
  7. Feder JN, Gnirke A, Thomas W, et al. A novel MHC class I-like gene is mutated in patients with hereditary haemochromatosis. Nat Genet. 1996; 13(4): 399–408.
  8. Weiss G. Genetic mechanisms and modifying factors in hereditary hemochromatosis. Nat Rev Gastroenterol Hepatol. 2010; 7(1): 50–58.
  9. Mach T. Hemochromatoza. [aut. książki] Gajewski P. i wsp. (red.). Interna Szczeklika. Kraków : Medycyna Praktyczna, 2018, strony 1185-1189.
  10. DAVIS WD, ARROWSMITH WR. The effect of repeated bleeding in Hemochromatosis. J Lab Clin Med. 1950; 36(5): 814–815.
  11. Winters AC, Tremblay D, Arinsburg S, et al. Reassessing the safety concerns of utilizing blood donations from patients with hemochromatosis. Hepatology. 2018; 67(3): 1150–1157.
  12. Pauwels NS, De Buck E, Compernolle V, et al. Worldwide policies on haemochromatosis and blood donation: a survey among blood services. Vox Sang. 2013; 105(2): 121–128.
  13. De Buck E, Pauwels NS, Dieltjens T, et al. Is blood of uncomplicated hemochromatosis patients safe and effective for blood transfusion? A systematic review. J Hepatol. 2012; 57(5): 1126–1134.
  14. Pennings G. Demanding pure motives for donation: the moral acceptability of blood donations by haemochromatosis patients. J Med Ethics. 2005; 31(2): 69–72.
  15. U.S. Department of Health and Human Services, Food and Drug Administration, Center for Biologics Evaluation and Research (CBER). Guidance for Industry: Variances for Blood Collection from Individuals with Hereditary Hemochromatosis. http://academy.gmp-compliance.org/guidemgr/files/HEMCHROM.PDF. [Online] [Zacytowano: 18 04. ; 2019.
  16. World Health Organization. Blood donor selection: guidelines on assessing donor suitability for blood donation. ; 2012.
  17. Rozporządzenie Ministra Zdrowia z dnia 11 września 2017 r. w sprawie warunków pobierania krwi od kandydatów na dawców krwi i dawców krwi. (Dz. U. z 2017 r. poz. 1741).
  18. West KA, Eder AF. Accepting hereditary hemochromatosis blood donors: ask not why, ask why not. Transfusion. 2016; 56(12): 2907–2909.
  19. Leitman SF, Browning JN, Yau YuY, et al. Hemochromatosis subjects as allogeneic blood donors: a prospective study. Transfusion. 2003; 43(11): 1538–1544.
  20. Zou S, Dorsey KA, Notari EP, et al. Prevalence, incidence, and residual risk of human immunodeficiency virus and hepatitis C virus infections among United States blood donors since the introduction of nucleic acid testing. Transfusion. 2010; 50(7): 1495–1504.
  21. Hoad V, Bentley P, Bell B, et al. The infectious disease blood safety risk of Australian hemochromatosis donations. Transfusion. 2016; 56(12): 2934–2940.
  22. Røsvik AS, Ulvik RJ, Wentzel-Larsen T, et al. Blood donors with hereditary hemochromatosis. Transfusion. 2010; 50(8): 1787–1793.
  23. Marrow B, Clarkson J, Chapman CE, et al. Facilitation of blood donation amongst haemochromatosis patients. Transfus Med. 2015; 25(4): 239–242.
  24. Sanchez AM, Schreiber GB, Bethel J, et al. Retrovirus Epidemiology Donor Study (REDS). Prevalence, donation practices, and risk assessment of blood donors with hemochromatosis. JAMA. 2001; 286(12): 1475–1481.

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