A transfusion medicine physician in Ohio wishes to share the following case with the e-network forum. A 75 year-old gentleman who is a regular whole blood donor at a neighboring facility recently came to the inquiring physician's facility to donate platelets. According to the inquiring colleague, the prospective donor is in "tip-top health", daily running two miles and swimming a half mile. When the man came to donate platelets his pulse was regular but only 35 beats per minute. The Ohio physician wants to know how other colleagues would handle such a donor? Accept? Defer? Refer?

The following responses were received.

1. A transfusion medicine physician who operates both a transfusion service and a donor center in a hospital in Southern California is of the opinion that unless there is absolutely no doubt that the Ohio donor's bradycardia is due to his exceptional athletic condition, it would be prudent for the donor to present a letter from a cardiologist clearing him of some type of A-V block or other cardiac conduction defect.

ADDENDA Feb. 10, 2003

2.A very experienced physician blood banker in New York commented that he would defer and refer the donor.

ADDENDA June 3, 2003

3. A transfusion medicine physician in South Bend, Indiana who oversees donor collection at a moderate-sized blood center reports that he would ask for evaluation by the donor's physician of record, preferably a cardiologist, followed by a letter of authorization from this clinician indicating that it is safe for this gentleman to donate his blood. Particularly for a donor in this age group, the responding physician is concerned about the possibility of underlying cardiac disease.

ADDENDA June 4, 2003

4. A transfusion medicine physician in Riyadh, Saudi Arabia, agrees with the comments that this particular donor should be deferred until his private doctor/specialist has cleared him from being in a higher risk group due to underlying cardiopulmonary disease. In general he asks donors who want to continue past the official age limit to bring a document from his/her physician attesting to his/her good health and lack of risk factors relating to donation. This procedure repeats itself once a year as long as the aging donor wants to continue as active. He comments that? It is easy to imagine the possible legal consequences of not having this documentation in a worst case scenario?

ADDENDA June 5, 2003

5. A military blood banker in Maryland reports that their policy is to have the donor present with a letter from his cardiologist prior to donation documenting an appropriate evaluation of his bradycardia. They keep this letter filed with the donor records.

ADDENDA June 7, 2003

6. A colleague in Minnesota reports that he advises against accepting any elderly autologous donors with significant bradycardia (below normal cutoff for allogeneic donors), regardless of presentation of a letter from another physician such as a cardiologist. He had an experience with an elderly autologous donor presenting with mild bradycardia. During the donation he experienced a prolonged vasovagal hypotensive reaction, accompanied by severe bradycardia, and the donor's heart rate did not normalize. As the donation was being performed at a hospital, he was sent to the ER. The donor was subsequently admitted to the hospital with persistent severe bradycardia, eventually undergoing insertion of a permanent pacemaker. The donor's scheduled orthopedic surgery was postponed until a later date. His physician was thankful that this happened prior to elective surgery, not during surgery.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator