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Donor
ACCEPT if body mass index (BMI) is no greater than 40 kg/m2 and weight i= s no less than 50 kg.
Registries may consider having no weight criteria at recruitment on the ba=
sis that the weight of the donor is likely to change between recruitment an=
d donation, and due to the relative lack of evidence supporting the deferra=
l of over- or underweight donors.
QUALIFIED, see below.
Qualified guidance
ACCEPTABLE for PBSC if weight is at least 50 kg and BMI is no greater th= an 40.0 kg/m2 (but see below)
ACCEPTABLE for BM if weight is at least 50 kg and BMI is no greater than 3=
5.0 kg/m2 (but see below).
Donors outside these limits at work-up should be discussed with the medica=
l officer who may allow them to proceed after discussion with the responsib=
le physician. Consider the following factors when evaluating donors outside=
the usual limits:
=E2=80=A2 With underweight donors, the difference between donor and recipi=
ent weight should be considered when assessing realistic harvest targets
=E2=80=A2 Muscle mass =E2=80=93 some individuals with high BMI may not be =
obese; however, other issues such as anabolic steroid abuse and cardiovascu=
lar abnormalities may be relevant.
=E2=80=A2 General anaesthetic risk =E2=80=93 the presence of co-morbiditie=
s associated with obesity may increase the risk of general anaesthetic if B=
M collection is requested or considered as a fallback option. In general, c=
o-morbidities should discourage acceptance of donors above the usual BMI li=
mit for bone marrow collection.
=E2=80=A2 Venous access =E2=80=93 peripheral venous access can be poor in =
obese donors, and is difficult to assess at confirmatory typing stage unles=
s the registry has an amenable protocol in place or access to relevant reco=
rds such as blood donation history.
o At CT stage, therefore, the possibility of poor venous access should a= utomatically be flagged for any donor accepted above the usual BMI limit fo= r PBSC collection =E2=80=93 with or without any qualifying data such as blo= od donation history. Depending on registry policy for central venous line i= nsertion, a known history of poor venous access might discourage acceptance= of donors above the usual BMI limit for PBSC.
o At Work-up stage, venous access must be carefully assessed by the coll= ection centre. If difficulty in gaining peripheral venous access for PBSC c= ollection is anticipated, and therefore central venous access is considered= , additional resources should be applied wherever possible, such as anaesth= etic consultation or ultrasound guidance. Registries should have in place a= policy for central venous line insertion. Otherwise, it may be more approp= riate to reject a donor with BMI above 40 kg/m2 with poor peripheral venous= access than to rely on central line placement as an unplanned contingency.=
The evidence to support this practice is limited. Pulsipher et al. found= a slightly increased risk of adverse events in those with a BMI >30. Ho= wever, much of the rationale for excluding overweight donors lies with two = key points: first, BM harvest is technically a considerably more difficult = procedure in overweight donors; and, second, there is much evidence to supp= ort the concept that the morbidly obese in general (i.e., with a BMI >35= ) have a higher risk of premature death, anesthetic complications and occul= t cardiovascular disease.
For the lower weight limit, those donors less than 50 kg stand a higher ch=
ance of not achieving the cell dose requested by the harvest centre.
Pulsipher MA, Chitphakdithai P, Logan BR, Shaw BE, Wingard JR, Lazarus H= M et al. Acute toxicities of unrelated bone marrow versus peripheral blood = stem cell donation: results of a prospective trial from the NMDP. Blood 201= 2. [1]
Adams JP, Murphy PG. Obesity in anaesthesia and intensive care. Br. J. Ana=
esth.85(1),91=E2=80=93108 (2000) [2]