People with hemochromatosis, a genetic disorder causing iron overload, often ask if they can still contribute to the blood supply. Generally, the answer is yes, but the process is typically managed through a medical procedure called therapeutic phlebotomy. While primarily a treatment for their condition, federal guidelines now permit this collected blood to enter the general supply if it meets all standard safety criteria.
Understanding Hemochromatosis and Iron Overload
Hemochromatosis is a genetic condition where the body absorbs an excessive amount of iron from the diet. The disorder is linked to gene mutations that disrupt the body’s iron regulation system. Normally, the hormone hepcidin controls iron absorption and release from storage sites, but in hemochromatosis, hepcidin production is inadequate.
This failure to regulate iron leads to a gradual buildup of iron in the body’s tissues and organs, known as iron overload. The excess iron is toxic and can damage the liver, heart, and pancreas, potentially causing conditions like cirrhosis, heart failure, and diabetes. Since the body cannot efficiently excrete large amounts of iron, removing iron-rich red blood cells is the most effective way to prevent organ damage.
Therapeutic Phlebotomy: The Medical Procedure
The primary treatment for iron overload is therapeutic phlebotomy, which is the medical removal of blood. The procedure is nearly identical to a standard blood donation, involving the withdrawal of a unit of whole blood (450 to 500 milliliters). Each unit removed reduces the body’s iron content by approximately 200 to 250 milligrams.
The treatment occurs in two phases: induction and maintenance. During the induction phase, when iron stores are high, phlebotomies may be performed frequently (sometimes weekly or biweekly) until the excess iron is depleted. The goal during this initial stage is to reduce the serum ferritin level, a measure of iron storage, to below 50 micrograms per liter (µg/L).
Once iron stores are depleted, the patient enters the maintenance phase, requiring less frequent blood removal to prevent reaccumulation. Maintenance phlebotomies are typically performed every one to four months, aiming to keep serum ferritin levels between 50 and 100 µg/L. A doctor’s prescription is required for this treatment, as the frequency often exceeds the regulatory limits for voluntary blood donation.
Navigating Donation Eligibility and Regulatory Guidelines
A distinction exists between therapeutic phlebotomy as a medical treatment and voluntary blood donation. Historically, blood removed from hemochromatosis patients was often discarded. This was partly due to concerns that the patient’s financial incentive to avoid paying for the procedure compromised their volunteer status. Regulatory bodies are now working to facilitate the use of this blood.
The U.S. Food and Drug Administration (FDA) now allows blood establishments to distribute blood collected from individuals with hereditary hemochromatosis. For the blood to be used, the patient must meet all standard donor eligibility criteria and pass the same rigorous testing for infectious diseases as any other donation. Since hemochromatosis is a non-infectious, hereditary condition, the blood is medically safe for transfusion.
Blood centers can apply for an FDA variance to collect blood from these patients more frequently than the standard eight-week interval, which is necessary for managing the condition. To ensure the donation remains voluntary and not financially motivated, the blood establishment must eliminate any financial incentive for the donor, such as waiving the fee for a therapeutic draw. If the phlebotomy is performed in a medical setting that does not meet the strict quality and screening requirements of a blood bank, or if the patient has secondary conditions, the blood will be drawn for the patient’s health but will be discarded.