People who are required to donate blood for the management of medical conditions, like erythrocytosis or iron overload, are known as therapeutic donors. The decision whether to use their blood depends on the indication for donation and whether they meet the standard donor criteria. The blood of donors with polycythaemia vera or high affinity haemoglobin is not used for transfusion purposes seeing as the haemoglobin is inherently abnormal. We use the majority of blood from donors with iron overload conditions, like hereditary haemochromatosis, provided the donor’s liver functions are not significantly deranged as coagulation factor production could be impaired. If a donor’s blood cannot be used they are charged for the donation to cover the cost of phlebotomy and safe disposal of the blood. Therapeutic donors who do not meet standard donor criteria (eg. use teratogenic drugs or have engaged in any type of high-risk behaviour) are permitted to donate, but their blood is discarded and they are charged for the donation.
Referral forms for therapeutic donors are carefully scrutinised to establish the indication for phlebotomy. If this is not clear, the referring clinician is asked for additional information or tests. Where donors have elevated ferritin levels and PCR testing for hereditary haemochromatosis cannot be afforded, inflammatory marker testing (eg. ESR or CRP) will suffice to exclude underlying infection or inflammation.
For more information about the WCBS therapeutic phlebotomy programme, please contact Sister Tania Paarman, Manager – Specialised Donations (tania@wcbs.org.za) or Dr Caroline Hilton, Head – Medical Division (caroline@wcbs.org.za).