Young blood donors contribute substantially to the US blood supply, yet these are the donors at greatest risk of immediate reactions and other adverse health effects related to their blood donations. Sixteen and 17-year-old adolescents constitute only 2.8% of the US population, but they contribute an estimated 10% of the blood supply, with more than 1 million donations per year.1 Mass recruitment and blood collection are scheduled at high schools despite the consistent demonstration that teenage blood donors are at significantly increased risk of phlebotomy-related reactions and injuries after blood donation as compared with adults.2 Approximately one-third of all donor reactions and more than half of all syncope-related injuries occur in adolescents and young adults.2 In addition to the immediate hazards of the donation process, iron deficiency has become well recognized as a complication of frequent blood donation, and high school–age students are particularly vulnerable. How did...
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April 2017
Pediatrics Perspectives|
April 01 2017
Teenage Blood Donors: Are We Asking Too Little and Taking Too Much?
Evan M. Bloch, MD;
aDepartment of Pathology, Johns Hopkins University, School of Medicine, Baltimore, Maryland;
Address correspondence to Evan M Bloch, MD, MS, Department of Pathology, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 446 D1, Baltimore, MD 21287. E-mail: ebloch2@jhmi.edu
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Alan E. Mast, MD;
Alan E. Mast, MD
bBloodCenter of Wisconsin, Milwaukee, Wisconsin;
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Cassandra D. Josephson, MD;
Cassandra D. Josephson, MD
cPathology and Pediatrics Center for Transfusion and Cellular Therapies, Aflac Cancer Center and Blood Disorders Service, School of Medicine, Emory University, Atlanta, Georgia; and
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Harvey G. Klein, MD;
Harvey G. Klein, MD
dNational Institutes of Health Clinical Center, Bethesda, Maryland
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Anne F. Eder, MD
Anne F. Eder, MD
dNational Institutes of Health Clinical Center, Bethesda, Maryland
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Address correspondence to Evan M Bloch, MD, MS, Department of Pathology, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 446 D1, Baltimore, MD 21287. E-mail: ebloch2@jhmi.edu
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2017) 139 (4): e20162955.
Article history
Accepted:
November 28 2016
Citation
Evan M. Bloch, Alan E. Mast, Cassandra D. Josephson, Harvey G. Klein, Anne F. Eder; Teenage Blood Donors: Are We Asking Too Little and Taking Too Much?. Pediatrics April 2017; 139 (4): e20162955. 10.1542/peds.2016-2955
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We thank Mr. Berger for his considered comments. However we respectfully disagree. First, we would argue that one size does indeed fit all, at least in regards to protection of teenage blood donors. Anything but, assumes that there is an inherent difference in risk, by state, and concomitant need for protection. There is no scientific or medical foundation for such a distinction. Second, the reluctance to assume federal protection, given concerns regarding the inability to alter restrictive policy should new data come to light, references the example of permanent deferral of those who have engaged in MSM (sex between two males). The MSM deferral was adopted in the wake of HIV as a means to mitigate infectious risk; it has been subject to extensive criticism for not aligning with comparable risk factors. Outside of prompting an emotionally charged debate, it is completely tangential to the recruitment of teenage blood donors. Third, uncertainty as to whether “favorable circumstances will indefinitely continue” is not –in itself- a reason to sustain a policy that is medically unfounded. Contrary to evidence based practice, such an approach suggests that one should maintain the status quo, independent of available evidence, on the off chance that there will be a change in the future. Furthermore, while shortages are a concern, blood collection agencies have already shown to be able to sustain the blood supply without weighting the donor pool toward those at highest risk (i.e. minors).
Fourth, contact sports and the military have only superficial overlap with blood donation. Teenagers are not recruited to play sport for the benefit of others. Those in the military are compensated and provided with a career and skillset. This is hardly in keeping with blood donation. As for comparison with medical decision-making and reproductive health, those decisions are often borne out of necessity; importantly, the informed consent process is comprehensive whereby the risks are explicit and individualized.
Finally, to Mr. Berger’s last point about “voluntary screening and other efforts to benefit altruistic teenage donors”, this runs contrary to the blood center’s mandate. The latter is confined to ensuring a safe and adequate blood supply. While blood donation does provide a public health service, it is somewhat nuanced as blood collection cannot be incentivized. Incentivizing individuals to donate has been shown repeatedly to incur risk of transfusion-transmitted infections, whereby high-risk individuals are drawn to collection for unintended reasons e.g. free testing. Furthermore, when screening young, healthy populations, there are associated risks of false positive test results that require unnecessary investigation. Collectively, this would incur additional cost to blood centers for little gain to recipients, further straining the blood industry and its ability to contend with real safety concerns.
Again, we thank Mr. Berger for continuing this important dialogue. We hope that our paper will motivate the appropriate professional societies such as the American Academy of Pediatrics to consider developing and publicizing a position to protect the adolescent blood donor.
To the editor:
In their commentary about teenage blood donors, the authors provide important recommendations such as steps to reduce donor risk and enhance parental participation in teenage blood donation.(1) Adverse reactions for teenage blood donors were discussed during a November 2016 meeting of the Food and Drug Administration’s Blood Products Advisory Committee (BPAC) (in which some of the authors participated).(2)
Many of the authors’ points are well-taken, but some recommendations may warrant scrutiny and skepticism.
First, the authors should consider whether a one-size-fits-all approach, particularly federal regulations or subregulatory guidance, is the ideal way to address inconsistent state laws or blood center practices. Once established, more restrictive federal policies and regulations may be difficult to alter even as scientific evidence, blood supply needs and social realities change.(3) Even in areas, for instance, that would not currently experience shortages without adolescent blood donors, there is no guarantee that such favorable circumstances will indefinitely continue.
Second, both the authors and BPAC materials fail to place the benefits and risks of teen blood donation in the context of societal willingness to tolerate other, arguably much more severe risks to teens because of perceived individual and community benefits. Both 16- and 17-year olds routinely participate in injury-prone sports such as football, soccer, cheerleading and martial arts (as discussed in this journal). Labor laws for teenagers vary among states (https://www.dol.gov/whd/state/state.htm). With parental consent, 17-year olds may enlist in the military (http://todaysmilitary.com/joining/entrance-requirements). These discussions also ignore debates about parental involvement and adolescent decision-making in health care outside of blood donation. State laws regarding minor consent to medical treatment and parental involvement vary for such conditions as behavioral and reproductive health.(4) State blood donation laws and local blood establishment practices, in short, do not exist in a policy and cultural vacuum.
Lastly, in addition to improvements discussed by the authors and BPAC, blood establishments can, consistent with applicable ethical and legal requirements, consider voluntary screening and other efforts to benefit altruistic teenage donors.(5)
The authors make a good case for avoiding complacency about teenage blood donations. The risk of policy interventions that carry unintended consequences also should not be understated.
1. Bloch EM, Mast AE, Josephson CD et al. Teenage Blood Donors: Are We Asking Too Little and Taking Too Much? Pediatrics. 2017;139(4):e20162955
2. Food and Drug Administration. Blood Products Advisory Committee. November 17-18, 2016. Available at: https://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/BloodV.... Accessed May 27, 2017.
3. Sacks CA, Goldstein RH and Walensky RP. Rethinking the ban: the U.S. blood supply and men who have sex with men. N Engl J Med. 2017;376:174-177
4. Hill JB. Medical Decision Making by and on Behalf of Adolescents: Reconsidering First Principles, J. Health Care L. & Pol'y. 2012; 15(4). Available at: http://digitalcommons.law.umaryland.edu/jhclp/vol15/iss1/4/. Accessed May 27, 2017.
5. Gore MO, Eason SJ, Ayers CR et. al. High prevalence of elevated haemoglobin A1C among adolescent blood donors: Results from a voluntary screening programme including 31,546 adolescents. Diab Vasc Dis Res. 2015;12(4):272-8.