Condition
Bipolar affective disorder. Also known as manic depression.
Individual at Risk
Donor / recipient
Guidance at RECRUITMENT for adult volunteer donor and maternal donor (cord blood donation)
MAY BE ACCEPTABLE if not currently manic, or if condition adequately treated with medication or counselling. The condition should have been stable for at least one year.
In addition, if donor is taking neuroleptics, valproate or carbemazepine, it should be established that medication is well tolerated, with no significant effect on blood counts and liver function. Ask the following questions:
Can the donor work and travel?
Could the donor cope with a hospital stay if required to donate?
Could the donor cope with pressures involved with donating, as donation may be a stressful procedure for some individuals?
If the answer to these questions are yes, than accept.
Donors taking lithium
Donors taking lithium may donate by BM only.
Guidance at CT/WORK-UP
MAY BE ACCEPTABLE if not currently manic, or if condition adequately treated with medication or counselling. The condition should have been stable for at least one year.
In addition, if donor is taking neuroleptics, valproate or carbemazepine, it should be established that medication is well tolerated, with no significant effect on blood counts and liver function. Ask the following questions:
Can the donor work and travel?
Could the donor cope with a hospital stay if required to donate?
Could the donor cope with pressures involved with donating, as donation may be a stressful procedure for some individuals?
If the answer to these questions are yes, than accept.
Donors taking lithium
Donors taking lithium may be able to donate by BM only.
Justification for guidance
The majority of donors with bipolar affective disorder will be able to donate. There is anecdotal evidence of donors with mental illness withdrawing from donation at the last minute, but this behaviour has also been seen in non-depressed donors and forms no basis for deferral.
There is some evidence than those who are in a manic phase may have an impaired capacity to undergo informed consent, and as such these donors should be deferred until the mania has resolved.
Lithium may enhance the effect of G-CSF, thus its use is a protocol exclusion for PBSC.
References
Misra S, Ganzini L. Capacity to consent to research among patients with bipolar disorder. J Affect Disord 2004; 80(2-3): 115-23.
Focosi, D., Azzara, A., Kast, R. E., Carulli, G. & Petrini, M. 2009. Lithium and hematology: established and proposed uses. J Leukoc Biol, 85, 20-8.