Sickle + donors

[DFields]

Unresolved issue, how are others handling + sickle donors?

1. do you send notification letter, if so what do you say?

2. do you allow them to continue to donate?

3. if unit goes through filter and leukoreduces how can we be sure the wbcs are effectively removed (per literature) without counting each product?

4. do you put the donor on some sort of flag or surveillance in case they come back?

THANK YOU!

[heathervaught]

We do track our HgbS trait donors, usually because we don't filter.

1. We only started notifying them when we brought up our BioArray DNA testing. Our MD and our Donor Counselor do the notification.

2. YES, we allow them to continue to donate.

3. We do not count each unit. If the sickle condition causes any problems, they just don't filter. Our WBC QC is random, so we test sickle positive donors.

[OPUS104]

We are 100% leuko-reduced...... if a unit does not filter and there is no visible clot or there is an extended filter time for no apparent reason we perform a sickle test. All donors destroyed for clot are coded and anyone that codes numerous times are also tested. These donors are contacted by letter from our Dr. and ENCOURAGED to please call for more info. They are made perm. def. as we are a 100% leuko-red. facility and they almost never filter completely/correctly. We have caught two donors that filter but had high WBC counts during our routine QC.

[rcurrie]

We are 100% leuko-reduced...... if a unit does not filter and there is no visible clot or there is an extended filter time for no apparent reason we perform a sickle test. All donors destroyed for clot are coded and anyone that codes numerous times are also tested. These donors are contacted by letter from our Dr. and ENCOURAGED to please call for more info. They are made perm. def. as we are a 100% leuko-red. facility and they almost never filter completely/correctly. We have caught two donors that filter but had high WBC counts during our routine QC.

Back when I was a bloodbanker, we did the same thing. We created a deferral code in our computer system (SafeTrace), sent the donor a letter explaining why they can't donate, and deferred them permanently.

I was the lab director of a lab that (I have been told) was the first lab in the Great State of Texas to become 100% leukoreduced. I noticed way back in the early 90's that many filtration problems were associated with donors who were positive with the hemoglobin solubility test. I mentioned that to the filter manufacturer, Pall, and was blown off. Oh, there couldn't possibly be a link between sickle cell trait donors and filtration problems.

BC

Workin' on the railroad, all the live-long day

[geekay]

Unresolved issue, how are others handling + sickle donors?

1. do you send notification letter, if so what do you say?

2. do you allow them to continue to donate?

3. if unit goes through filter and leukoreduces how can we be sure the wbcs are effectively removed (per literature) without counting each product?

4. do you put the donor on some sort of flag or surveillance in case they come back?

THANK YOU!

Hi there !

Connection between "sickle cell trait" and "WBC filtration" ?

any reference given somewhere ?

we dont defer the donors for this reson !

with wishes !

[OPUS104]

Hey BC! We had two more units tagged "did not filter, no clot visible" today....... both were Hgbs +. Hope your enjoying the RR!!!!!!!!

[sshel55]

Quarterly I run a query that identifies donors who are filter failures (donor comment triggers an attribute for subsequent donations). If they fail x 2 then they are contacted by an MD and either enouraged to switch to apheresis platelet donations or deferred. Some sickle trait donors may eventually filter but in our experience they almost always fail the WBC count if tested. We are also a 100% LR facility. This is actually difficult because we support a large group of sickle cell patients and perform RBC exchanges. If a pt develops a blood group antibody we provide complete antigen matched RBC so losing black donors to filter failures is impacting our ability to provide antigen matched units in some cases. Also, one of our U- donors has sickle trait so there goes a rare unit.

[MJDrew]

We inform our sickle positive donors by letter and tell them that although we currently can't use their RBCs for transfusion, we encourage them to become apheresis donors. We are also 100% LR.

An article in the Dec 2007 Transfusion, discussing a metered device to dispense citrate to WB units throughout the collection, mentions that collection of RBCs via apheresis may mitigate the polymerization effect of the AS RBCs hitting a concentrated bolus of citrate in the collection bag. High osmolarity and low pH contribute to polymerization of S hemoglobin, and this in turn contributes to inability to filter these units. Both of these issues are lessened with apheresis collections due to citrate being added throughout the procedure. The article referenced reported more success (but not 100% success) with filtering AS units collected by apheresis (Transfusion 2002;42:1466-72).

I sure would like to capture these donors as some have valuable "rare" phenotypes we're always searching for!

MJ :cool:

[OPUS104]

MJ, By chance do you work at the ARC at 313 mack?