venesection instructions

[sona]

hi all,

as we work in a hospital we sometimes come in contact with patients suffering from polycythemia

we generally know about the disease and its causes but usually the patients ask a very common questions that "can their blood be used ?" we try to explain about their disease but we dont know what exactly to say

please answer why cannot we use their blood and other instructions to give a patient undergoing venesection

thnx w8ng for ur answers:)

[Malcolm Needs ☆]

hi all,

as we work in a hospital we sometimes come in contact with patients suffering from polycythemia

we generally know about the disease and its causes but usually the patients ask a very common questions that "can their blood be used ?" we try to explain about their disease but we dont know what exactly to say

please answer why cannot we use their blood and other instructions to give a patient undergoing venesection

thnx w8ng for ur answers:)

Actually, you can use such blood for transfusion, but it is best if it is irradiated prior to use, just to be on the safe side.

:):)

[David Saikin]

In the US blood from pts with hemochomatosis may only be used for transfusion if the bleed is done at a donor center WHERE IT WOULD BE DONE FOR FREE FOR THERAPEUTIC PURPOSES, ie, the patient would not be charged for their therapeutic bleed if they were not going to donate. Does this sound right? If you would bleed them for free, then they can donate. The feds worry that patients will not be truthful in order to donate (get a free bleed). We used to use this blood all the time, but the rules changed that the patient would have to say they will accept hemochromatosis blood - in the late 1980's.

Edited March 29, 2010 by David Saikin
poor grammar

[KKidd]

I tell them that they may check with the Red Cross to see if they qualify as a donor. One of my patients recently gave it a shot and they wouldn't accept him. Many patients do not meet criteria established for donors.

:rolleyes:

[SMW]

The reason for the polycythemia is also important. Units can be used if the individuals meet all the donor qualification requirments and the unit is labled with the donor's disease state [and generally the prescribing/transfusing physician agrees to use unit (which usually never occurs so most don't even attempt)]. The FDA has guidelines and a variance approval process for using blood from individuals with hemochromatosis without special labeling as to disease status (provided individuals meet all other donor qualification and testing criteria). As previosuly mentioned, all procedures most be performed without charge regardless if individual meets donation criteria. On the other hand, blood from an individual having phlebotomies performed due to porphyria cutanea tarda would not be used for transfusion nor from an individual with polycythemia due to p. vera since this is considered a pre-malignant state. I am not aware of situations in the US that would advocate the use of blood from individuals with p.vera even if the unit was irradiated.

[ar_confederate]

Actually if I'm not mistaken, the FDA changed the rules slightly a couple of years ago about HH donors. You no longer have to have a variance from them to use their blood, IF they meet all other blood donor requirements and the testing is all negative. This only applies to HH patients and as stated earlier, all other therapuetic phlebotomies have to be done at no charge.

I don't remember exactly when this came out but look at the FDA website under approved variances and there is a statement attached to a HH variance that says it's no longer required.

[sona]

thanx everybody 4 ur answers but please specify what risks [if any ]can be faced if this unit is used without irradiating?

[Malcolm Needs ☆]

thanx everybody 4 ur answers but please specify what risks [if any ]can be faced if this unit is used without irradiating?

I will quote from page 14 of Klein HG and Anstee DJ. Mollison's Blood Transfusion in Clinical Medicine. 11th edition, Blackwell Publishing, 2005.

"Phlebotomy remains the overwhelming choice for the initial therapy of polycythaemia vera. Although red cells from such patients survive normally, polycythaemia vera is a clonal, progressive, myeloproliferative disorder and patients are at increased risk for developing leukaemia. As a rule, this blood is not used for transfusion, although the risk of acquiring a graft of malignant cells from the donor seems to be neg;igible, even in recipients whose immune mechanisms are supressed by disease or drugs."

It is for the reasons of this low risk, and bearing in mind that, one day, I may require a transfusion from such a donor, that I suggest irradiation.

:):)

[SMW]

Actually if I'm not mistaken, the FDA changed the rules slightly a couple of years ago about HH donors. You no longer have to have a variance from them to use their blood, IF they meet all other blood donor requirements and the testing is all negative. This only applies to HH patients and as stated earlier, all other therapuetic phlebotomies have to be done at no charge.

I don't remember exactly when this came out but look at the FDA website under approved variances and there is a statement attached to a HH variance that says it's no longer required.

The FDA still has a current guidance document outlining the process and requirements to obtain this variance and also lists the facilities that have been approved for this variance, so I believe the variance is still required.........The variance is to use the blood without additional labeling as to the disease state and also addresses the frequency of donation.

Remember that the exceptions and alternative procedures listed by FDA apply only to the individual manufacturer submitting the specific request (until regulations change, e.g., electronic crossmatch). As stated on the FDA page listing these exceptions "Publication of these approvals for a specific exception or alternative procedure does not necessarily mean that they can be generally applied to other manufacturers." There may be multiple manufacturers that have been approved for the same exception but you will not be able to tell that from the list, e.g., many facilities have requested and received a variance to use FFP for up to 24 hours rather than the 6 hours stated in CFR but this "exception" only appears once on the list.

[ar_confederate]

I have to apologize. I went back and reread the variances and you are absolutely correct. I'm sorry to have given the wrong information here.