HH Blood NYT

July 25, 2000

Letters to the Editor

To the Editor:

RE: Forever Ending Blood Shortages

The entire country, and particularly the New York Metropolitan area, is suffering from a worse-than-usual annual July-August severe donor blood shortage, made worse this year partly because the Food and Drug Administration now stipulates that anyone who spent six months or more from 1980 to 1996 in Great Britain is not allowed to donate blood, because of the rare possibility that the infectious agent of mad cow disease may be in some of the beef eaten in Great Britain during that period.

The solution to the problem is simple. About 12% of all Americans (including about 20% of Irish-Americans and about 30% of Afro-Americans), for genetic reasons, are walking blood banks. They have blood iron so high that they should be making one or two blood donations per year to lower their high iron, so that it does not gradually build up in their body tissues and, in their 40ís and 50ís, gradually produce diabetes, heart disease, liver disease, and arthritis. Most do not know they have this condition, called heterozygous hemochromatosis (genetic iron overload), because they have never had their blood iron measured. Unfortunately, measuring blood iron, which should be part of any routine blood testing because it is so often high, is rarely done, except by hematologists.

Worse, about 1 in 12 of these folks have 2 of these genes (homozygous hemochromatosis). They develop toxic tissue iron levels more than twice as fast, and start getting severe organ damage in their 20ís and 30ís. Every adult should insist that their blood iron be checked on any routine blood sample drawn for routine tests as part of a routine health exam, doctor visit, or clinic visit and, if it is high, donate blood to get it down to normal.

Blood drawn to prevent or correct disease is called ìtherapeutic phlebotomyî, and the FDA has a blanket prohibition against using therapeutic phlebotomy blood as donor blood. However, any blood bank which wishes to use this perfectly good blood as donor blood can do so by getting a variance to do so from the FDA, simply by writing the FDA and promising not to charge the donor for phlebotomy, to test the blood for safety like any other donor blood, and to follow the recipient to be sure he/she gets no adverse effects from the donor blood (which good blood banking practice requires blood banks to do anyway, on any donated blood).

Working with me, our Mount Sinai Blood Bank Director, Dr. Morton Spivack, has obtained such a variance from the FDA and from New York State. Anyone with hemochromatosis can get his/her therapeutic phlebotomies free of charge, and with our thanks, at our Blood Bank. All they need do is come in with a note from their physician stating that they have hemochromatosis and need therapeutic phlebotomy.

Our friends and colleagues at the New York Blood Center are currently in process of getting the same variances we have, so they too can do these therapeutic phlebotomies free of charge, and use this excellent high-iron blood as donor blood. The majority of patients who need blood have lost blood and become iron-deficient, so high-iron blood is particularly good for them.

The total need of the entire U.S. for donor blood as of now is about 13 million units per year. If the 12% of our population of about 180 million adults who are ìwalking blood banksî and need to give blood at least once a year to maintain their health did so, that would be almost 22 million units per year. Ideally, blood banks would no longer need to store blood. They would just keep a computerized register of their ìwalking blood banksî, and, when a patient needs blood, they would punch into the computer the patientís blood type and cross match, print out the names of the compatible donors, and ask them to come in for their therapeutic phlebotomy.

Sincerely,

Victor Herbert, M.D., J.D., M.A.C.P., F.R.S.M.(London)