An autoimmune disease (AID) occurs when the body’s immune system mistakenly attacks healthy tissues. With over 80 recognized AIDs, eligibility to donate blood is highly conditional and requires an individualized assessment. Having an AID does not automatically disqualify a person, but specific guidelines exist to protect both the donor and the potential blood recipient.
General Eligibility Rules Based on Disease Status
The primary consideration for any chronic condition, including an AID, is the donor’s current state of health. Blood centers require that the condition must be stable, well-controlled, and not cause the donor to feel ill. This ensures that the stress of blood donation does not trigger a flare-up or worsen the donor’s condition.
A person must be in remission, or disease inactivity, for a specified period, which ranges from weeks to months depending on the condition. Donating blood during an active flare-up is always a reason for temporary deferral. Since the immune system is stressed during active disease, volume loss from donation could be detrimental to the donor’s recovery.
The goal is to prevent a donation that could compromise the donor’s health or introduce problematic components into the blood supply. For instance, the presence of certain autoantibodies or inflammatory cytokines, which are elevated during active disease, is a concern for the recipient. Therefore, the blood bank focuses on ensuring the disease is quiescent and the person is in good general health, meeting all other standard eligibility requirements like hemoglobin level and blood pressure.
Specific Autoimmune Conditions and Donation Guidelines
Guidelines for specific AIDs vary widely, often resulting in permanent versus conditional deferral. Conditions affecting multiple organ systems or having an uncertain etiology, such as Multiple Sclerosis (MS) and Systemic Lupus Erythematosus (Lupus), often result in permanent deferral. This decision protects the recipient from potential risks associated with transfusing blood components containing unknown disease factors.
Severe or debilitating Rheumatoid Arthritis (RA) is typically a cause for permanent exclusion due to the systemic nature of the disease and the high likelihood of organ damage. However, individuals with mild, non-systemic autoimmune conditions may be eligible if they are asymptomatic and in sustained remission. Stable Hashimoto’s Thyroiditis, for example, is often acceptable if the person is euthyroid—meaning their thyroid hormone levels are regulated—and they are symptom-free.
Other localized conditions like Celiac Disease are usually acceptable for donation, provided the donor is adhering to a gluten-free diet and is otherwise healthy. This distinction between systemic, multi-organ AIDs and more localized or well-managed conditions highlights the individualized nature of the assessment. The more aggressive the condition and the greater its impact on overall health, the more likely the deferral.
How Medications Affect Donor Eligibility
Even when an AID is in remission, the medications used to maintain that stability are a major factor in determining eligibility. Deferral periods related to medication are necessary because some drugs can pose a risk to the blood recipient, particularly if the recipient is a pregnant woman or an immunocompromised patient. The drug, not the disease, becomes the reason for temporary exclusion.
Immunosuppressants used to treat AIDs, such as methotrexate and azathioprine, require a specific deferral time, which can vary depending on the dose and the blood center’s policy. For example, Mycophenolate Mofetil (CellCept) often requires a six-week waiting period after the last dose because it is a teratogen that could cause birth defects if transfused to a pregnant patient.
Biologic agents, including TNF alpha inhibitors like adalimumab (Humira) and etanercept (Enbrel), typically require a multi-month deferral period, often three months, after the last injection. Blood centers defer donation to prevent the accidental transfer of these powerful agents, which can remain in the donor’s system for extended periods, to a recipient. Standard anti-inflammatory drugs (NSAIDs) do not usually cause a deferral for whole blood donation. However, aspirin and similar anti-platelet medications require a waiting period, often two full days, before a platelet donation can be made, as they interfere with platelet function.
The Screening Process and Donor Safety
The screening process for all potential blood donors, particularly those with a history of AID, begins with a detailed health history questionnaire. Potential donors must answer questions about their diagnosis, disease activity, and all current and recent medications. This is followed by a private interview with a trained blood bank screener, who uses the provided information to determine eligibility based on current regulatory guidelines.
During the screening, a mini-physical is conducted, which includes checking the donor’s temperature, pulse, blood pressure, and hemoglobin level. Honesty during this interview is paramount, as the screener needs a complete picture of the donor’s health status. The guidelines are designed for two purposes: to ensure the safety of the blood product for the recipient and to protect the donor from complications.
Donating blood removes a significant volume of fluid, and for a person with an underlying chronic condition, this could potentially lead to adverse effects or trigger a symptom flare. Therefore, the final determination is always made by the blood donation center staff, who are guided by FDA regulations and institutional protocols. If there is any uncertainty about eligibility, a potential donor should contact the blood bank directly before arrival to discuss their specific circumstances.