Condition
Low number of red blood cells (RBCs) or the amount of haemoglobin (the oxygen carrier to tissues in the blood); multiple causes; iron deficiency is a common cause; symptoms can range from fatigue or light-headedness for mild-moderate anaemia to exhaustion, syncope, or problems with ADLs (Activities of Daily Living) or severe anaemia
Individual at risk
Donor / Recipient
Recommendation at RECRUITMENT
Establish cause and degree of anaemia. May be acceptable if benign cause and haemoglobin (Hb) level is acceptable. Registries and donor centres should establish a lower limit for an acceptable haemoglobin level based on local reference ranges.
Iron deficiency is acceptable if haemoglobin is within the limit set by the registry/donor centre, and with appropriate follow-up referral and treatment.
It is not recommended to accept donors with G6PD deficiency at recruitment, but due to high allele frequencies in many non-Caucasian populations, it is likely that many male donors will have asymptomatic and undiagnosed G6PD deficiency.
Unacceptable if cause of anaemia is unknown, or due to autoimmunity or malignancy. Recommend to Donor to consult with health professional / practitioner.
Aplastic Anaemia - Defer if inherited disorder. Accept if drug or viral induced and fully recovered.
Recommendation at CT/WORK-UP
Establish cause and degree of anaemia. May be acceptable if benign cause and haemoglobin level is acceptable. Registries and donor centres should establish a lower limit for an acceptable haemoglobin level based on local reference ranges, and these levels should be taken into account in the context of whether the donation is a bone marrow or PBSC harvest. The local blood transfusion donor Hb guidelines for deferral and follow up are recommended as a minimum.
Iron deficiency is acceptable if haemoglobin is within the limit set by the registry/donor centre, but advice on iron replacement and treatment and even referral if appropriate are advised.
Donors with mild or asymptomatic G6PD deficiency may be acceptable at CT/work-up stage at the discretion of the transplant centre.
Unacceptable if cause of anaemia is unknown, or due to autoimmunity or malignancy. Defer and refer to appropriate medical care/facility.
For Sickle Cell Disease or Thalassaemia Major / Intermedia: see page on Thalassaemia and haemoglobin disorder.
Justification
Anaemia most commonly reflects iron deficiency, may be easily remediable and is not necessarily a barrier to donation. If the red cell indices (MCV, MCH & MCHC) & Hb suggest an iron or nutritional deficiency then ferritin, red cell folate and Vitamin B12 levels should be checked and appropriate treatment and referral for follow up recommended. Depending on results, a HB electrophoresis may be requested if a haemoglobinopathy is suspected. However, other causes, such as other inherited diseases or acquired bone marrow disorders may prohibit donation.
A lower threshold of Hb concentration should be set because of the risk of a fall in haemoglobin as a consequence of donation, particularly when donating by bone marrow harvest.
References
Mijovic A, Britten C, Regan F, Harrison J. Preoperative autologous blood donation for bone marrow harvests: are we wasting donors’ time and blood? Transfus. Med.16(1),57–62 (2006)
Parkkali T, Juvonen E, Volin L, Partanen J, Ruutu T. Collection of autologous blood for bone marrow donation: how useful is it? Bone Marrow Transplant.35(11),1035–1039 (2005).
Zachary C et al. Donor Iron Deficiency Study (DIDS): protocol of a study to test whether iron deficiency in blood donors affects red blood cell recovery after transfusion. Blood Transfus. 2019 Jul; 17(4): 274–280.
Moore C. The INTERVAL trial to determine whether intervals between blood donations can be safely and acceptably decreased to optimise blood supply: study protocol for a randomised controlled trial. PMID: 25230735 PMCID: PMC4177700 DOI: 10.1186/1745-6215-15-363