RECRUITMENT OF PATIENTS WITH HEREDITARY HAEMOCHROMATOSIS AS BLOOD DONORS
Background. Hereditary haemochromatosis is the most common inherited disorder in white persons with prevalence of about 1 in 200. Therapeutic phlebotomy is an effective treatment for the disease and prevents its sequele. In addition to their altruism, patients with hereditary haemochromatosis have also medical and monetary incentives for blood donation. Current guidelines do not allow haemochromatosis patients to donate blood. About two thirds of patients are eligible as blood donors and about two thirds of therapeutically drawn blood is suitable for transfusion. Therapeutically drawn blood could increase the blood supply by 1.5 to 30%.
Conclusions. The number of states that already accept patients with hereditary haemochromatosis as blood donors is increasing. To avoid monetary incentives they offer free phlebotomies for all patients with hereditary haemochromatosis. There have been no reports about higher incidence of transfusion reactions. In Slovenia the number of therapeutic phlebotomy is increasing. We should evaluate the possibilities for recruitment of haemochromatosis patients as blood donors also in our country. It is necessary to modify regulatory restrictions and to ensure that there is no other incentives than altruism for blood donation.
Merryweather-Clarke A, Pointon J, Shearman J, Robson K. Global prevalence of putative haemochromatosis mutations. J Mol Genet 1997; 34: 275–8.
McCullen MA, Crawford DHG, Hickman PE. Screening for hemochromatosis. Clin Chim Acta 2002; 315: 169–86.
Barton JC, McDonnell SM, Adams PC et al. Management of hemochromatosis. Ann Intern Med 1998; 129: 932–9.
McDonnell SM, Grindon AJ, Preston BL, Barton JC, Edwards CQ, Adams PC. A survey of phlebotomy among persons with hemochromatosis. Transfusion 1999; 39: 651–6.
Lucotte G. Celtic origin of the C282Y mutation of hemochromatosis. Blood Cells Mol Dis 1998: 24: 433–8.
Hanson EH, Imperatore G, Burke W. HFE gene and hereditary hemochromatosis. Am J Epidemiol 2001; 154: 193–206.
Markovič S. Hemokromatoza. Med Razgl 2000; 39: Suppl 5: 69–73.
Wilson JMG, Jugner G. Principles and practice of screening for disease. Public Health Papers 1968; 34: 26–39.
McDonnell SM, Phatak PD, Felitti V, Hover A, McLaren GD. Screening for hemochromatosis in primary care settings. Ann Intern Med 1998; 129: 962– 70.
Adams PC. Screening for hemochromatosis – Should we do the last test first? BC Medical Journal 2002; 44: 83–5.
Allen K, Williamson R. Screening for hereditary haemochromatosis should be implemented now. BMJ 2000; 320: 183–4.
Bradley LA, Haddow JE, Palomaki GE. Population screening for hemochromatosis: a unifying analysis of published intervention trials. J Med Screen 1996; 3: 178–84.
Olynyk JK, Cullen DJ, Aquilia S, Rossi E, Summerville L, Powell LW. A population-based study of the clinical expression of the hemochromatosis gene. N Engl J Med 1999; 341: 718–24.
Brittenham GM, Klein HG, Kushner JP, Ajioka RS. Preserving the national blood supply. Hematology 2001; 422–32.
Zakon o preskrbi s krvjo. Uradni list RS, 13. 6. 2000, št. 52; 6943–8.
Tan L, Khan MK, Hawk III JC. Use of blood therapeutically drawn from hemochromatosis patients. Transfusion 1999: 39; 1018–25.
Barton JC, Grindon AJ, Barton NH, Bertoli LF. Hemochromatosis probands as blood donors. Transfusion 1999; 39: 578–85
Blacklock HA, Dewse M, Bollard C, Hudson P, Barnhill D, Jackson S. Blood donations by healthy individuals with haemochromatosis. NZ Med J 2000; 113: 77–8.
Jackson HA, Carter K, Darke C, Guttridge MG, Ravine D et al. HFE mutations, iron deficiency and overload in 10,500 blood donors. Br J Haematol. 2001; 114: 474–84.
Anon. Priporočilo o pripravi, uporabi in zagotavljanju kakovosti komponent krvi. Prevod. Ljubljana: Zavod RS za transfuzijo krvi: Informacijsko dokumentacijski center Sveta Evrope pri Narodni in univerzitetni knjižnici, 2000.
Aach RD, Kahn RA. Post-transfusion hepatitis: current perspectives. Ann Intern Med 1980; 92: 539–46.
Sanchez AM, Schreiber GB, Bethel J et al. Prevalence, donation pracitices, and risk assesment of blood donors with hemochromatosis. JAMA 2001; 286; 1475–81.
Vengelen-Tyler V et al. Technical manual. 13th ed. Bethesda: American Association of Blood Banks, 1999: 563–75.
Leitman SF, Browning JN, Ying Yau Y et al. Hemochromatosis subjects as allogeneic blood donors: a prospective study. Transfusion 2003; 43: 1538– 44.
Nusbacher J. Blood transfusion is mononuclear cell transplantation. Transfusion 1994; 34: 1002–5.
Grompe M. The role of bone marrow stem cells in liver regeneration. Semin Liver Dis 2003; 23: 363–72.
Jeffrey G, Adams PC. Blood from patients with hereditary hemochromatosis – a wasted resource? Transfusion 1999; 39: 549–56.
Bullen JJ, Spalding PB, Ward CG, Gutteridge JM. Hemochromatosis, iron and septicemia caused by Vibrio vulnificus. Arch Intern Med 1991; 151: 1606–9.
Vadillo M, Corbella X, Pac V, Fernandez-Viladrich P, Pujol R. Multiple liver abscesses due to Yersinia enterocolitica discloses primary hemochromatosis: three case reports and review. Clin Infect Dis 1994; 18: 938–41.
Emerit J, Beaumont C, Trivin F. Iron metabolism, free radicals, and oxidative injury. Biomed Pharmacother 2001; 55: 333–9.
Conry-Cantilena C. Phlebotomy, blood donation, and hereditary hemochromatosis. Transfus Med Rev 2001; 15: 136–43.
Wordwood M, Darke C, Trenchard P. Hereditary haemochromatosis and blood donation. BMJ 1991; 302: 593–3.
Domanovič D. Hemokromatoza v transfuzijski praksi. Med Razgl 2000; 39: Suppl 5: 75–80.
Food and drug administration. Guidance for industry: Variances for blood collection from individuals with hereditary hemochromatosis, August 2001. http://www.fda.gov/cber/guidelines.htm
UKBTS. Guidelines for the blood transfusion services in the United Kingdom. 6th ed. London: TSO, 2002: 21–1.
Levstik M, Adams PC. Eliglibility and exclusion of hemochromatosis patients as voluntary blood donors. Can J Gastroenterol 1998; 12: 61–3.
Center for biologics evaluation and research. Guidance for industry variances for blood collection from individuals with hereditary hemochromatosis (draft), December 2000. http://www.fda.gov/cber/gdlns/hemchrom.htm.
Barton JC, Preston BL, McDonnell SM, Rotthenberg BE. Severity of iron overload in hemochromatosis: effect of volunteer blood donation before diagnosis. Transfusion 2001; 41: 123–9.
Edvards CQ, Griffen LM, Goldgar D et al. Prevalence of hemochromatosis among11,065 presumably healthy blood donors. N Engl J Med 1988; 318: 1355–62.
Beutler E. The HFE Cys282Tyr mutation as a necessary but not sufficient cause of clinical hereditary hemochromatosis. Blood 2003; 101: 3347–50.
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