Eligibility and exclusion of hemochromatosis patients as voluntary blood donors

Because hemochromatosis patients are treated by periodic venesection to remove iron they have the potential to become regular blood donors (1). The number of patients who have successfully donated blood since the guidelines of the Canadian Red Cross were expanded in 1991 to include healthy hemochromatosis patients is unknown. Exclusion criteria of the Canadian Red Cross are diabetes, hypertension on medication, cirrhosis, skin discolouration and positive testing for hepatitis B (hepatitis B surface antigen), hepatitis C (antihepatitis C virus) and human immunodeficiency virus. In this study, we review the potential eligibility of hemochromatosis patients and determine by survey the actual success of hemochromatosis patients in donating blood.

B ecause hemochromatosis patients are treated by periodic venesection to remove iron they have the potential to become regular blood donors (1). The number of patients who have successfully donated blood since the guidelines of the Canadian Red Cross were expanded in 1991 to include healthy hemochromatosis patients is unknown. Exclusion criteria of the Canadian Red Cross are diabetes, hyperten-sion on medication, cirrhosis, skin discolouration and positive testing for hepatitis B (hepatitis B surface antigen), hepatitis C (antihepatitis C virus) and human immunodeficiency virus.
In this study, we review the potential eligibility of hemochromatosis patients and determine by survey the actual success of hemochromatosis patients in donating blood.

PATIENTS AND METHODS
A database comprising 208 hemochromatosis homozygous patients diagnosed at this centre since 1960 was reviewed to assess potential eligibility of patients to donate blood. This represents all known living hemochromatosis patients in the database. This database includes information on signs and symptoms of hemochromatosis, biochemical and liver biopsy data, and concomitant illness.
A survey was sent to available homozygous patients in 1996 to determine their success in donating blood. This study was approved by the Human Ethics Committee of the University of Western Ontario, London, Ontario. The information on blood donation was part of an American survey on hemochromatosis sponsored by the Centers for Disease Control and Prevention, Atlanta, Georgia. Because American patients are ineligible to be voluntary blood donors, this study was conducted on hemochromatosis patients diagnosed at this medical centre. If patients provided more than one explanation for exclusion, the reason that was a valid contraindication by Canadian Red Cross criteria was considered the reason for ineligibility. Information on the use of the donated blood was not available.

RESULTS
Sixty-seven per cent (140 of 208) of hemochromatosis patients were potential donors. Sixty-four per cent of patients were classified as ineligible because of diabetes, 18% because they were older than 71 years of age, 9% because of chronic medication use, 2% because of cirrhosis and 2% because of malignancy. Of this population 6% (13 of 208) had been voluntary blood donors before the diagnosis of hemochromatosis.
In the initial mailing, the survey was sent to 164 patients who were thought to be alive at the time of the survey. Follow-up telephone calls determined that many patients were no longer at their original address. Eighty-one homozygous patients responded to the survey. This may have resulted in a bias in favour of patients who have participated in voluntary blood donation. This is suggested by the high percentage of patients who attempted to donate blood (51%) compared with the percentage of the general population that donates blood (estimated at 5% by Canadian Red Cross). Of these 81 patients, 51% (41 of 81) were potentially eligible donors. Fifty-one per cent (41 of 81) had attempted to donate blood, but only 7% (3 of 41) were successful. Of the patients who attempted to donate and were excluded, 44% (18 of 41) would have been eligible according to the above criteria ( Figure 1). A diagnosis of hemochromatosis was the reason for exclusion in 67% (12 of 18) (Figure 1).

DISCUSSION
Hereditary hemochromatosis is a genetic disease with no evidence of transmission by blood transfusion. Despite changes in Canadian Red Cross policy in 1991, it is still uncommon for a hemochromatosis patient to donate blood successfully, possibly for the following reasons: 1. lack of awareness at blood donor clinics of the eligibility of hemochromatosis patients; 2. lack of awareness of hemochromatosis patients about the possibility of being a voluntary blood donor; and 3. existence of appropriate reasons for exclusion in hemochromatosis patients, including diabetes, cirrhosis and concomitant use of medications.
It is not feasible for weekly therapeutic venesections to be done at voluntary blood donor clinics in Canada because a patient can only donate once every 56 days. However, it is possible for iron depleted hemochromatosis patients to donate every three months as maintenance therapy on a long term basis. The historical reasons for the exclusion of hemochromatosis patients as voluntary blood donors are that therapeutic venesections cannot be used for voluntary blood donation and the unproven concern that the donated blood may have deleterious effects in the donor. In some countries patients incur significant costs for therapeutic venesections and may seek to avoid these costs. There is concern that donors motivated by reasons other than altruistic ones might misrepresent important historical data (2,3). Healthy hemochromatosis patients have been accepted as donors in Can-