[Donor deferrals....or not for Cancer]

I forgot to add that there are many approaches to this and it really boils down to what your medical director is comfortable with. Some institutions have a 1 year deferral for cancers. Oh, I also treat in-situ cancers as non-cancer. That is no deferral.

[Donor deferrals....or not for Cancer]

The policy at my community blood center is to defer for 5 years donors with any malignancy other than leukemia or lymphoma. Those with leukemia or lymphoma are indefinitely deferred. If a person calls us and tells us that they have just been diagnosed, we do not notify consignees receiving any products donated prior to the diagnosis. We do consignee notification for products donated after the diagnosis.

[Age of blood]

With regard to making requests for products and changing policy, this NEJM study has been used to "confirm" what we intuitively believe about older blood. Older blood must be bad. Only red wine gets better with age (and perhaps some people).

We do know about the "storage lesion" and the RBCs look worse the longer they are stored. However at a recent conference, shortcomings to the study were discussed.

1) It is a retrospective study. There are 2 studies being started (one called the ABLE study) to address this issue, however it is believed that they do not have the statistical power to answer the question .... Stay tuned.

2)The two groups are not the same:

<14 d blood >14 d blood

Grp O xfusn 53 31

Grp O pt 51 30

WBC Red Prod 55 35

LVF 58 63

Valve Dz 4 7

PVD 54 58

In the <14 d study group, more group O units were transfused and there were fewer group O patients. Group O rbcs are slipperier and group o individuals make less vWF, making that group less prone to getting clots.

The <14 d study group has more LR blood suggesting that the >14 d study group was subjected to older surgical techniques.

The cases were not matched for heart function either the < 14 day group had better cardiac function (LVF, Valve disease, PVD).

3) Survival numbers were not adjusted. In the fine print there was a disclaimer that the survival numbers were unadjusted.

4) The blood age was treated as a dichotomous variable. How was the cut off of 14 days determined? Shouldn't the mortality increase as the units transfused age?

5) There is no plausible mechanism to explain the divergence of the survival curves seen after the transfused RBC should have been gone from the circulation...

So, while the study raises questions that should be answered, the study does not prove anything. Consequently there is really no information on which to base a policy change.

[Icteric Components]

With findings such as yours, it is important to speak with the donor and obtain a clinical history. Perhaps there is a medication your donors are taking. Some BCPs will change the color of donor plasma, for example. The donor may benefit from seeing a hepatologist or hematologist to have an bili evaluated.