It is not allowed in Switzerland, because of the clonal origin of the disease, because of frequent iron deficiency that is associated, and because most of the patients are treated with hydroxyurea.

Regards

Thanks very much for your answer.

It was a relatively common practice in the States about 30 years ago, but it

fell out of favor during the HIV epidemic, as Blood Bankers became more

risk averse. The issues were the potential transmission of disease, and,

as Dr. Tissot , the potential transfer of a clonal cell population. The units

had to be tested for all the known markers of Transfusion Transmitted

Diseases, as well as irradiated. It also presumed that a sufficient number

of patients requiring Therapeutic phlebotomy were available, and that

the resources for processing the blood units were available.

I'm pretty sure in the UK (and the rest of Europe) the answer is no, due to the (probably negligible) chance of passing on malignant cells. Haemochromatosis RBCs are considered suitable.

According to AABB Standards for Blood Banks and Transfusion Services (28th Edition): 5.6.7.1 Units drawn as therapeutic phlebotomies shall not be used for allogeneic transfusions UNLESS:

1. The individual underging the therapeutic phlebotomy meets all allogeneic donor criteria and the unit is labeled with the disease/condition of the donor that makes the phlebotomy necessary, or

2. The indication for therapeutic phlebotomy is hereditary hemochromatosis and the program has received variance approval from the FDA.

Thanks. Your answers are very helpful for me.

In Europe: NOT

Allogeneic blood donation must be:

1) From a healthy donor

2) Voluntary; and

3) Altruistric

I am terrible sorry, but these three conditions required are not present in PV patients.

In belgium it is not allowed by law

best regards

This issue was reviewed recently by Yang et al in Transfusion medicine reviews 2010, 24(3) 235-43.

The consensus and evidence appears to be pretty clear. There is no increased risk to recipients if a donor has one of the forms of leukaemia.

Indeed not allowed in Belgium:

PV patients are not healthy donors: they come to get treatment, not for altruistic donation.

Dear Fred Reyers,

I have read the conclusion of the important paper that you have mentioned (Transfusion Medicine Reviews Volume 24, Issue 3, July 2010, Pages 235–243). In this review, the authors said "Despite the many millions of units transfused since the advent of allogeneic blood transfusion, there is no evidence to support the theoretical concern that cancer could be transmitted via blood." ... "Even with such restrictions, blood donors with a history of cancer make a useful contribution to the Australian blood supply. Evidence confirms that this is a safe practice that could also benefit the blood supply in other countries."

If so, the answer may be "Yes"?

Best regards

Qi

Given that the blood from patients with polycythemia vera is tested negative for all infection and parasitic diseases, the red blood cells may be transfused. Different countries may have different rules and regulations.

As you can see by the responses, the answer is very dependent on the geographical location of the phlebotomy and the accompanying standards or regulations in that locale. For more specifics, determine the standard setting or regulatory agency which is responsible for a given location.

In strictest sense, a patient cannot be an allogenic donor. Having said that if donated blood tests negative for infectious disease and is labeled with blood from polycythemia patient and the recipient consented for this transfusion, then can be used.

In the US, FDA discourages the use of donors with Polycythemia Vera but allows self-transfusions of polycythemic blood. However, the position of the Polycythemia Vera Study Group, to which I was a long-term member, opined that there should be no restrictions to transfusions of polycythemic blood to patients with malignancies. I support that view.

I believe that this answer is more an ethical discussion than a medical problem to solve. I live in a veterinary world where the altruistic and voluntary position came from the owner and not from the donor. Starting by this point of view, any kind of no harmful donation is welcome (our blood supply usually is closely of zero). I just want to clear that, although not voluntary, animal donors not cooperatives, nervous, agressive or frightened are excluded of the donation, and we start a behavior training for the association of donation with good prices (yeah, we bought ours blood donors with food, play and affection). And with my simple point of view I believe that receive blood from a donor with a detailed and periodical medical historical is more secure than a blood from a eventual donor, specially in countries were hepatite virus are prevalent and the detection form still is by sorology (HBsAg and anti-HBC), as Brazil. I'll start this topic in a veterinary group and I thank all for this discussion. PV is relatively commom in veterinary medicine but we usualy end the discuss without a clear position. Maybe with this different point of view we could find a answer to our reality.

The blood drawn from polycytemia vera (PV) is not allowed in many countries to use for a transfusion, because such patients are not healthy but a kind of cancer. Even with such negative conditions, blood from PV has no evidence of cancer transfer to the recipients. I think blood from PV can contribute for transfusion in a situation of blood shortage.

No, because we do not know the true origin of the disease and risk of transmitting diseases to the recipient.

In Spain that kind of donor would be rejected, other different scenario will be a benign polycytemia although it is difficult to be sure it is really a benign one and not to have any concomitant conditions. Cancer patients are admitted in certain countries (eg. Australia) after totally recovered but not (as far as I know) during cancer, even though the risk is anecdotal or unproven.

in India also,blood from these donors(like polycythemia vera, hemochromatosis etc) is not used for transfusion purposes as there are theoretical chances of spreading a disease.

Thank you for your question. In Indonesia we say No. Any blood component from polycythemia vera patient (by phlebotomy) is drawn not for transfusion purpose and should be discarded even without any infectious diseases screened in BTS. It is acknowledged that blood for transfusion purpose is screened for only a few blood transfusion transmitted diseases employing currently available tests. The number and types of test vary from country to country despite at least 4 tests are conducted universally for HIV, HBV, HCV and Syphilis. In fact, many potential blood transfusion transmitted disease are around including probable potential Viruse(s)? underlying pathogenesis of polycythemia vera. Unless we are certain about its safety, the safest thing is not to use it.

At Europe in 2004, march 22nd, it was aproved by the European Commision the Directive number 33 related about technical requirements for blood donation and its components.

(DIRECTIVA 2004/33/CE DE LA COMISIÓN de 22 de marzo de 2004 por la que se aplica la Directiva 2002/98/CE del Parlamento Europeo y del Consejo en lo que se refiere a determinados requisitos técnicos de la sangre y los componentes sanguíneos)

At the anexum III, point 2.1. Permanent exclusion criteria (2.1. Criterios de exclusión permanente para donantes homólogos) is included: "malign tumors or cancer" with one exception: localized tumor after complete resolution (and several countries like Spain add "after 5 years of total remmision").

Please, if restrictive transfusion criteria will be applied and safe and cost-effective alternatives will be used (for example, if all anenic patients scheluded for an elective surgery will be treated and anemia corrected), we really need less than half of actual blood supplies. Please use blood carefuly and we do not need to "bleed cancer patient".

Hereditarya Hemochromatosis is condition considered as an illness. But if a normal citizen has an isolate HFE mutation without iron overload, without organic damage and it has none exclussion criteria, why exclude him or her?

There are no ethical neither medical condition to exclude sane population, if this potential donor respect the three ethical conditions: healthy, altruistic and voluntary.

PV is included in the permanent exclusion criteria for blood donation in Europe

In medicine as we all know you apply the same standard for all of your patients, thus if you are given the choice to recieve blood transfusion unit coming from a healthy volunteer donor or a unit that comes from polycythemia patient which one do you prefer?

Obviously the unit that comes from the healthy donor is your choice; whether you are the recipient or your patient.

The ethical as well as the pathological nature of the polycythemic blood deters us from using it.

Polycythemia vera is a clonal progressive myeloproliferative disorder with risk of progression to leukemia. Hence, blood from such patients should not be used for transfusion purposes to avoid any potential risk to the recipient. It is included in the permanent deferral criteria for blood donation.

I am agree!

No here too as it is a myeloproliferative disease

can 'a neoplastic disease transmitted through blood transfusion from one individual to another individual? no I do not think so '. however, would use the red blood cells of hemochromatosis.

Polycythemia vera comes under myeloproliferative disorders which is a neoplastic condition.Therefore it is not used for transfusion but may probably used to make blood agar in microbiology department.

I think it is possible eritroaferesi.it are mature red blood cells have no nucleus.

Dear Antonini

Actually, erythrocytapheresis could obtain red cell concentrate withan high hematocrit (around 80%), low plasma contain, low figure of leukocytes, but not zero. In spite the use of leukofilter of fourth generation (lower 40 micras), white cells will be present. In quality controls < 0,5x10 6/L cells.

The solution to innative this residual cells is to radiate this blood with 25-30 Gy.

But we must use optimely the blood donation, avoid unnecesary transfusion

[please, do no transfuse couple of units, do it, one by one, if the second is needed), reduce the bleeding and,fourth, but not the last, treat the anemia.

Best regards

Unfortunately in Italy it is not possible to use blood if the person is a patient who use the donation as therapeutic strategy (venesection).

I do not completely agree because if there are not other complications, including organ damage, and the patient is eligible as donor (checking viral status, hepatic and renal function, iron assessment,...physical examination, instrumental evaluation), the blood could be safely used.

100 years from now you will solve 'the problem is not

Priceless

Sane

Altruistic and

Voluntary!

the polycythemia vera begins with somatic mutation of the gene or JAK2 Janus Kinase 2 (JAK2 V617F) mutation that results in an increased activity of the protein tyrosine kinase JAK2, which is involved in the mechanisms of regulation of cell proliferation. The red blood cell (DOES NOT HAVE THE CORE) can 'transmit the disease in question if transfused into a healthy individual? I do not believe it! same for hemochromatosis and all poliglobulie primitives and non-primitive

in Germany, P vera is an exclusion criterion for blood donation because it is part of the chronic myeloproliferative syndromes. Patients are not allowed to donate allogeneic blood. However, a sole genetic abnormality/difference is not considered a contraindication as long as there are no disease symptoms. This allows asymptomatic hemochromatosis carriers to donate allogeneic blood, while patients with P. vera or patients suffering from hemochromatosis complications are deferred.

A donor with an isolated mutation, without ironoverload neither organ damage, is a sane person. His or her donation is altruistic and voluntary. These are the three pilars of the safest donation

Dear José,

Your answer perfectly summarizes the strategy.

Best,

Markus

 Blood Donation from the Polycythemia vera patient is therapeutically advised for there treatment . I am fully agree with the statement of Purnima S Rao and  we are doing the same practice

Polycythemia vera comes under myeloproliferative disorders which is a neoplastic condition.Therefore it is not used for transfusion but may probably used to make blood agar in microbiology department.

Would not irradiating well the phlebotomy obtained blood make it safe for transfusion?

Blood removed from polycythemia patient can not be used for transfusion in other to avoid the possibility of cancer of the blood in the recipient.

yes it is possible

la polyglobulie vraie fait partie des syndromes myéloprolifératifs chroniques. Il n'a pas été démontré que la mutation rapportée plus haut peut être transmise du donneur (atteint) au receveur avec induction de maladie chez ce dernier. Toutefois et, dans l'impossibilité de démontrer le contraire, c'est à dire l'absence de tous risque chez le receveur, les responsables de la sélection des donneurs de sang ont préféré exclure ce type de donneurs pour des raisons d'éthique essentiellement. Ce choix a été celui de plusieurs pays dont certains en ont fait des choix réglementaires.

Conclusion: dans le doute, il y'a lieu de favoriser le choix de la sécurité.