Donating blood while on coumadin

[Guest]

This is an interesting thread, my questions are how can we be donors after death? I had always thought about donating my organs, scratch the heart, no one could use it, but I have other healthy organs that give the gift of life. I am asking my cardio about this at my February appointment!

 

[TheGymGuy]

LucyLou, a very interesting point. I am a donor on my driver's license as well, I am curious what your cardio says.

 

[dtread]

I donated through American Red Cross and National Institute of Health (NIH) Blood Banks for years before going on Warfarin. I also donated through American Red Cross Research Donor program, where the blood is used for research and the requirements for donation are not as stringent. From my inquiries post op it appears that none of these are interested in your blood as long as you're on Warfarin. I also inquired with the Armed Services Blood Program as they had a blood drive where I work, and they are also not interested as long as you're on Warfarin. What I have been told is that you have to be off Warfarin for 30 days before they'll take your blood.

 

[triff]

I registered as a bone marrow donor around 18 months ago and had to remove myself from that and the blood donor register after my MMVR in June '12.

I'm hopeful, being young and generally fit and healthy, that at some point in the future maybe medications or criteria will change and I'll be able to donate. It's extremely frustrating that the same life event that underlined mortality and made me more determined to help others is the exact same reason I can no longer do that.

 

[Protimenow]

The issue, as I understand it, is not that you will bleed out when you are giving blood, but that there may be management problems with the blood recipient. (For example, consider a patient with impaired liver function who normally has a high INR; or a patient who received heparin during surgery -- adding blood with a high INR/residual warfarin could cause an uncontrollable bleed. The risk of using blood from a person who is receiving warfarin may be too high to administer to patients requiring donated blood).

If you want to give to help people (and blood is one of the things that should be fairly easy to donate - if we could), perhaps you can give some volunteer time at a clinic or shelter, where your time will do a lot of good?

 

[dtread]

According to info I found on the Internet, the average male has about 10 - 12 pints of blood and the average female about 8 - 10 pints of blood. So, even if somebody was transfused with a pint of blood that was at a high level of anticoagulation (e.g., 3.5 INR or higher) it would still only account for roughly 8% - 12% of their blood supply. Unless whoever received the transfusion was also on Coumadin, the infusion of one pint of anticoagulated blood should not affect their INR level hardly at all. I think most of the objection to accepting Coumadin patients as blood donors is simply based on long-standing historical misconceptions about Coumadin. When the drug first came out over 50 years ago it was probably put on the deferral list of drugs for the Red Cross and other Blood Banks, and subsequently no one has ever really thought about whether it makes sense or not.

 

[RobThatsMe]

The issue, as I understand it, is not that you will bleed out when you are giving blood, but that there may be management problems with the blood recipient. (For example, consider a patient with impaired liver function who normally has a high INR; or a patient who received heparin during surgery -- adding blood with a high INR/residual warfarin could cause an uncontrollable bleed. The risk of using blood from a person who is receiving warfarin may be too high to administer to patients requiring donated blood).

If you want to give to help people (and blood is one of the things that should be fairly easy to donate - if we could), perhaps you can give some volunteer time at a clinic or shelter, where your time will do a lot of good?

I totally agree with you P-time.

I can understand why folks who always donated would like to continue doing so, BUT, that could be deadly to the recipient, and selfish of the donor, just to feel good about helping others in need. Life changing events happen to us all, so if someone who used to donate, but due to warfarin, can no longer, then find another way to "feel good about helping out". Think of it this way, if you had a family member, that was facing surgery, or was in an auto accident, would you want blood that could not clot, or clotted at a reduced rate given to them?

Rob

 

[Protimenow]

Dtread -- you make an interesting point, but in a lot of trauma cases - and for some surgeries - the patient may receive many units of blood. Although they won't come from just one person, if enough of us on anticoagulants gave blood, it's possible that there may be enough anticoagulated blood used that a real problem can occur. Also, even if 8-10% of a patient's blood is replaced with anticoagulated blood, this may cause a management problem. (If a patient is not adequately clotting, how do you assess the effects from a patient's own system, versus those from donated blood?). Also - during surgery, they can also test the blood for prothrombin time, as well as many other factors -- if the prothrombin time of a patient is elevated, can treating it as if the PATIENT's INR is high because of liver problems bring the patient's INR TOO LOW?

I think that, with the possible wrong signals that anticoagulated blood inserted into the donor supply can create, that the Red Cross (and others) have wisely decided NOT to use such blood. (OTOH -- if I was planning to have surgery, I may bank my OWN anticoagulated blood in case I needed a transfusion -- it will at least be a known quantity and may actually make it easier for the doctors to manage my INR).

 

[dtread]

As long as there are enough blood donors to keep supplies at adequate levels they're not going to allow folks on Coumadin to donate. Why should they? If there was a severe shortage of blood, or if the (potential) donor that was on Coumadin had a really rare blood type they might change their tune. I personally would not have any qualms about donating for any of my family members (none are on Coumadin), but the blood bank and the doctors probably wouldn't allow it, so its a moot point. One thing that hasn't been mentioned much in this discussion so far is possible interaction between Coumadin and some other drug(s) that the recipient might be on. That is another point to be considered. Lastly, one thing that could be done if they were to allow Coumadin donors to donate blood would be to note that right on the blood bag. That way the concerns that were expressed previously in this thread that someone might get several pints of anticoagulated blood could be avoided.

 

[Protimenow]

Right.

If your blood type was extremely hard to match (perhaps it had some factors that only others in your close family could use), donating your blood shouldn't be a problem -- but THEN the medical team would be aware of the donor and of the anticoagulant in the blood.

Your suggestion about marking bags of blood from anticoagulated patients makes sense -- perhaps even marking the INR of the collected blood would make it possible for the blood to be used. Good idea.

 

[RobThatsMe]

As long as there are enough blood donors to keep supplies at adequate levels they're not going to allow folks on Coumadin to donate. Why should they? If there was a severe shortage of blood, or if the (potential) donor that was on Coumadin had a really rare blood type they might change their tune. I personally would not have any qualms about donating for any of my family members (none are on Coumadin), but the blood bank and the doctors probably wouldn't allow it, so its a moot point. One thing that hasn't been mentioned much in this discussion so far is possible interaction between Coumadin and some other drug(s) that the recipient might be on. That is another point to be considered. Lastly, one thing that could be done if they were to allow Coumadin donors to donate blood would be to note that right on the blood bag. That way the concerns that were expressed previously in this thread that someone might get several pints of anticoagulated blood could be avoided.

I would be leary of that. Each person that would donate blood while on Coumadin would have different INR levels!
Can you imagine trying to regulate and stablize that mix!

 

[ElectLive]

There is a very very long list of Red Cross eligibility criteria, with more than a few disputably arcane rules. But rules are rules all the same. I'm a tissue valver, not on Coumadin, but I'm ineligible. Why? I used animal sourced insulin as a kid many many years ago. Any use after 1980 is deemed a potential threat due to concerns of Mad Cow / CJD. Now, technically I could get a waver if I could prove the cows used for my insulin weren't from the UK...but hmm...as much as I love research, that's just a bit too much of an undertaking for my taste.

But should otherwise be ok, right? Nope, folks with pacemakers have stipulations too. Your pulse must be between 50 and 100 with only a "small" number of irregular beats. Now, as the first rule disqualifies me, I haven't taken the steps to inquire for more specifics on this one, what constitutes "small" etc. Then, as if that weren't enough, what else... Oh yeah, aspirin. Have to withhold 2 days when donating platelets, ok by the rules for whole blood but have heard of holds for that too.

Anyway, I don't mean to steer this discussion too far of course, just wanted to point out that there are actually quite a few rules and restrictions on blood donation, and I'm sure a number of frustrated folks out there with and without mechanical valves. So a big +1 to the point above about "donating" in other ways if we must...

 

[Protimenow]

There's a problem with all these rules -- and with documents, in general: People Don't Read.

I suspect that, if there's a multipage questionnaire that must be filled out before donating blood, many (most?) people will skip the boxes (or just absent-mindedly check them off), and proceed to the end, where they may have to sign the thing. Their goal is to get through the paperwork, and get the needle in their arms. Plus, I suspect that the questions may be confusing -- if they're asked 'do you take coumadin?' they may answer NO because they weren't asked if they take Warfarin. If they're asked 'do you take an anticoagulant' they may answer no because they take a 'blood thinner.'

For some obscure reason, I read everything that I sign -- and I often find mistakes in forms that have been in use for years (decades?) and nobody apparently caught before. (Perhaps it's the result of an undetected TIA that rewired my brain to actually READ and try to UNDERSTAND everything before I sign it)

My point isn't that there's a lot of crummy writing out there - and people are conditioned to sign things without reading them first -- it's that, with a lot of rules for qualifying or disqualifying donated blood, I wouldn't be surprised if a lot of blood that SHOULDN'T have been donated is always in the pipeline. (To help allay concerns about the safety of our blood supply, I'm sure that tests are run on it - either at the time of donation or while it's being processed - to detect a lot of things (like, for example, INR, HEP-C, and other stuff)

 

[metronome]

What I find intriguing is no blood components are acceptable. I understand they don't want our platelets, perhaps even red cells. But what about plasma ? Do we have any hematologists on board....

 

[ski girl]

I think I might have a chat with our bone marrow registry again and this time not tell them that I'm on warfarin.

 

[Protimenow]

Perhaps they don't actually know where the warfarin is actually producing the anticoagulant effect -- it may not be with the platelets; it may perhaps in the serum, which is in intimate contact with the platelets, thrombin, and other blood components. Perhaps they don't know if ANY of the components would have an adverse impact on the clotting capacity of the blood recipient. Because everything in contact with the blood is probably awash with warfarin or secondary metabolites, I suspect that they may not feel safe using ANY of it.