Condition
An abnormality of cardiac electrical activity, most commonly diagnosed by electrocardiography.
Guidance at RECRUITMENT for adult volunteer donor and maternal donor (cord blood donation)
QUALIFIED, SEE BELOW
Guidance at CT/WORK-UP
QUALIFIED, SEE BELOW
Individual at Risk
Donor
Qualified Guidance
Where possible, particularly at CT-stage and work-up, advice from a cardiologist should be sought.
Acceptable
- Benign atrial or ventricular ectopics (extrasystoles).
- Sinus tachycardia/bradycardia acceptable, but inform anaesthetist at work-up if for bone marrow harvest.
- Beta-blockers prescribed for benign ectopics or sinus tachycardia are acceptable.
- Supraventricular tachycardias (SVT), including atrial fibrillation/flutter, may be acceptable if successfully treated with catheter ablation and off rate/rhythm-control medications (such as beta-blockers) for at least one year.
- Right bundle branch block in the absence of any other abnormality.
- First degree heart block may be acceptable at work-up at the discretion of the assessing physician.
- Wolff-Parkinson-White (WPW)a: Donors successfully treated are fully qualified. Donors with very mild or symptoms more than 12 months ago should be evaluated on an individual basis. If symptomatic: defer.
- Note: While this guidance offers recommendations based on current evidence, individual donor registries may take a more conservative approach due to concerns about the theoretical risk for the donor. Clinical judgment should always guide decision-making. A cardiac consultation might be considered.
Unacceptable
- Uncorrected atrial fibrillation/flutter.
- Any history of ventricular tachycardia/fibrillation.
- Lown-Ganong-Levine syndromes unacceptable unless successfully treated with catheter ablation and no ECG evidence of accessory pathways.
- Second (Mobitz type 1, 2 or Wenkebach) or third degree heart block.
- All pacemakers and implantable cardiac defibrillators (ICD).
- Left bundle branch block.
- Long-QT syndrome, Brugada syndrome or any other known cause of sudden cardiac death.
Justification
a WPW syndrome is a congenital heart defect present in approx 0.25-0.30% of a westerly population and in many cases asymptomatic. Patients with symptoms are most often treated with ablation that is usually very successful. Donors successfully treated are fully qualified and donors with very mild or symptoms more than 12 months ago should be evaluated on an individual basis. If symptomatic: defer.
References
Halter J, Kodera Y, Ispizua AU, Greinix HT, Schmitz N, Favre G et al. Severe events in donors after allogeneic hematopoietic stem cell donation. Haematologica 2009; 94(1): 94-101.
Komatsu F, Shikata M. Abnormal electrocardiographic findings in apheresis donors. Transfusion 1988; 28(4): 371-4.
Laspina SJ, Browne MA, McSweeney EN, Lawlor J, Whelan DM, Kinsella AL et al. QTc prolongation in apheresis platelet donors. Transfusion 2002; 42(7): 899-903.
Povsic TJ, Losordo DW, Story K, Junge CE, Schatz RA, Harrington RA et al. Incidence and clinical significance of cardiac biomarker elevation during stem cell mobilization, apheresis, and intramyocardial delivery: an analysis from ACT34-CMI. Am Heart J 2012; 164(5): 689-697 e3.
Yuan S, Ziman A, Smeltzer B, Lu Q, Goldfinger D. Moderate and severe adverse events associated with apheresis donations: incidences and risk factors. Transfusion 2010; 50(2): 478-86.
Notes
One member of the review committee the acceptability of donors with a history of supraventricular tachycardia treated with catheter ablation and off rate-control medication for one year.