Is blood of uncomplicated hemochromatosis patients safe and effective for blood transfusion? A systematic review

Abstract

Hemochromatosis is a disorder of the iron metabolism, characterized by high body iron content, necessitating frequent phlebotomies to remove excess iron. In some countries, this blood is discarded and not used for blood transfusion because of the non-voluntary character of this donation, and because a potential risk of microbial contamination of the donor blood is assumed. A systematic review was performed in order to collect and critically examine solid evidence with regard to the effectiveness and safety of blood for transfusion when derived from hemochromatosis patients who do not suffer from complications or organ damage. Using three databases (The Cochrane Library, MEDLINE, and Embase) we searched for studies from date of inception until January 2012. Out of 3470 articles, 80 references that were relevant to our question were selected, including many opinion pieces, comments, letters, and narrative reviews. Based on our selection criteria, we finally retained only six observational studies, so evidence on this subject is scarce and furthermore, the strength of the available evidence is low to very low, due to poor study designs. We found no evidence that red blood cell concentrates from hemochromatosis patients without complications of iron overload do not comply with the physiological quality requirements for transfusion, nor that their blood would present a greater risk to recipient safety than blood from non-hemochromatosis donors. However, in vitro findings from two studies suggest that iron-overloaded patients would be more susceptible to bacterial growth, but future in vivo studies are warranted to confirm this. Based on this, we call for harmonization of the blood donor selection policy among countries allowing hemochromatosis patients who do not suffer from complications of iron overload to donate blood, once iron levels are normalized.

Pattern of care of blood donors with early‐uncomplicated hereditary haemochromatosis in a Swiss blood donation centre

“…In a systematic review of the literature on haemochromatosis and blood donation, De Buck et al . came to the conclusion that blood products should be released for transfusion once iron levels are normalized. Our approach is to clear blood when the ferritin level falls below 300 ng/ml, future research on which we can safely base our practice is needed.…”

“…Further, in the absence of definite in vivo data excluding an association between HH and a higher risk of bacterial and viral contamination of derived blood, ruling out hyperferritinemia might increase blood transfusion safety. In a systematic review of the literature on haemochromatosis and blood donation, De Buck et al [25] came to the conclusion that blood products should be released for transfusion once iron levels are normalized. Our approach is to clear blood when the ferritin level falls below 300 ng/ml, future research on which we can safely base our practice is needed.…”

The deferred donor

“…A web‐based questionnaire revealed that in 24 of 33 countries, individuals with a genetic susceptibility to hemochromatosis are accepted as blood donors, with some of them accepting asymptomatic or even symptomatic patients as blood donor . In other countries, individuals with a genetic susceptibility are entirely excluded although the few available (low quality) studies suggest that blood products from donors with hemochromatosis without iron overload can safely be used in patients . In addition, in male‐to‐male sex policies, there is a lack of hard evidence supporting a certain deferral policy , which explains the heterogeneity in deferral policies among countries.…”

Blood donor deferral: time for change? An evidence-based analysis

“…Also, harmonization of the blood donor selection policy among countries allowing hemochromatosis patients to donate blood once iron levels are normalized is needed. 18 In 2015, a systematic review was performed to investigate whether to investigate whether male blood donors, having sex with men, present a risk of TTIs in Western countries. Fifteen low-quality observational studies suggested a link between blood donors who were MSM and HIV-1 infection, but the evidence is too limited to recommend a precise deferral period.…”