high hemoglobin as a cause of deferral

[lyla_n]

what is the upper limit of cut off for hemoglobin levels in donors? Is it ok for donors with hb >17g/dl to donate?what should be the policy in such cases?

[David Saikin]

If you have reason to believe it is pathological you should defer, otherwise . . . I know of no reason not to draw at that hgb.

[lyla_n]

If you have reason to believe it is pathological you should defer, otherwise . . . I know of no reason not to draw at that hgb.

what is the upper limit for hb levels for blood donation??

is it acceptable to go to 19g/dl or 20g/dl in accepting donors?

[David Saikin]

There is no defined upper limit.

[Cliff]

As David has said, there isn't an upper limit; however, you may want to talk to your medical director about this. I'd be concerned about the health of a donor whose Hg was 19 or 20 as you said. At a minimum they are possibly too dehydrated to safely donate.

At our center we have an upper limit of 18, but again, it's one selected by our medical director, there isn't a mandated upper limit.

[khalidm3]

At our center, upper Hg level is 18, to avoid risk of a Polycythemia rubra ver transfusion and dehydration risk for donor. It is the decision of our medical director.

[Kip Kuttner]

I talk with donors having a hematocrit over 50. The issue with high hematocrit/hemoglobin levels include dehydration, living at a high altitude, hemochromatosis, erythroblastic leukemia (rare) and multiple causes of polycythemia. In the US a blood center can obtain an FDA variance to distribute blood drawn for therapeutic reasons, from donors with hemochromatosis but not polycythemia. In addition, the platelet collection equipment software (®Trima) begins to have difficulty establishing an interface if the hematocrit is higher than 51. However there is no upper limit established by regulatory agencies. Be sure to discuss this issue with your medical director.

[clmergen]

Having drawn donors for years in CO at elevation, we would have had problems with an upper limit. In fact, physicians would sometimes recommend donation for those people who may have a high H/H due to the elevation and no other reason. If donors mentioned this to us, we very clearly asked if they were diagnosed with polycythemia or hemochromatosis. If the answer was no, we accepted them for donation.

BTW, we had a noncompliant polycythemia patient that would occasionally come in with a hematocrit of 70%.

Edited July 27, 2011 by clmergen
Added afterthought.

[OldBloodBanker]

There is nothing more I would want to add except to reiterate: anything out of the ordinary, as in these examples, should be referred to the medical director. It may not be within our purview to be diagnosticians, but we do serve as the eyes and ears of the director. We tend to forget that this individual is a donor/patient, and that the medical director is his/her physician. During my active career we discovered several donors suffering from polycythemia or hemochromatosis who, ironically, (that word is NOT a pun) became our patients, as therapeutic "donors."

It was good to see the FDA's change of stance on the issue of some of these donors. For years we drew an R2R2 donor whose RBCs went into frozen stock. His Hemoglobin was only tested via the old-fashioned copper sulfate method. When modern technology became available, it became obvious that his hemoglobin level was perilously high, and he became a patient. And of course he went from donating for free to paying for therapeutic phlebotomy. He was not a happy man.