Hemochromatosis subjects as allogeneic blood donors: A prospective study

BACKGROUND: Persons with hemochromatosis constitute a plentiful and willing source of blood for transfusion. A program was established and evaluated for treating persons with hemochromatosis in a donor center and making their blood available for transfusion. STUDY DESIGN AND METHODS: Phlebotomy therapy was performed free of charge regardless of whether subjects met criteria for allogeneic donation. A Hb level of 12.5 g per dL was used as the threshold for performing phlebotomy, and decreases in the MCV were used to guide the endpoints of therapy. RESULTS: A total of 130 subjects were consecutively enrolled: 74 percent were homozygous for the C282Y mutation in the HFE gene, 76 percent met eligibility criteria for allogeneic donation, and 55 percent were previous blood donors. A median of 20 weekly or biweekly phlebotomies (range, 7-99) were performed before the MCV reached the targeted endpoint of 3 percent below baseline, at which time the ferritin level was less than 30 μg per L and the transferrin saturation was less than 30 percent. The median phlebotomy interval necessary to keep the MCV at this level during maintenance therapy was 10 weeks. No incident seroconversions for agents of transfusion-transmissible disease occurred during 1402 donations. All subjects testing positive for viral agents gave a prior history of deferrable risk. Twenty-seven months after starting the program, hemochromatosis donors were contributing 14 percent of the RBC units collected for allogeneic use. CONCLUSIONS: Hemochromatosis subjects can safely and significantly augment the allogeneic blood supply. Provision of phlebotomy therapy unrestricted by considerations of cost or suitability for donation can improve access to care and remove incentives for incomplete risk disclosure.