g6pd deficient blood

G6PD-Deficient Blood

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Can G6PD-Deficient Individuals Donate Blood? Risks and Considerations

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic red cell disorder worldwide. While individuals with this condition are often healthy outside of oxidative stress exposure, their red cells have reduced ability to handle oxidative injury. This unique vulnerability has implications for blood donation and transfusion practices.

1. Is G6PD Deficiency a Disqualification for Blood Donation?

Globally, G6PD deficiency is not an automatic exclusion for blood donors. Standard donor screening by organizations such as the World Health Organization (WHO) and the American Association of Blood Banks (AABB) does not include routine testing for G6PD status. Instead, eligibility is determined by:

  • General health of the donor

  • Hemoglobin level

  • Freedom from transmissible infections

Thus, a G6PD-deficient individual may donate blood if they meet these requirements.

Reference:

  • WHO. Screening Donated Blood for Transfusion-Transmissible Infections. 2010.

  • AABB Standards for Blood Banks and Transfusion Services, 32nd edition.

2. Why G6PD-Deficient Blood May Be Risky in Certain Recipients

While donation is permitted, the use of G6PD-deficient blood in transfusion carries risks under specific clinical circumstances.

a) Neonates and Infants

  • Risk: Neonatal red cells are already vulnerable to oxidative stress. When transfused with G6PD-deficient donor cells, the risk of hemolysis rises.

  • Evidence: Case reports document hemolysis after neonatal exchange transfusions using G6PD-deficient donor blood.

Reference:

  • Arndt PA, Garratty G. The Significance of Red Cell G6PD Deficiency in Blood Transfusion. Transfusion Medicine Reviews. 2004;18(4):245-256.

b) Patients Receiving Massive Transfusions

  • Risk: In emergencies requiring rapid, large-volume transfusion, stored G6PD-deficient red cells may have reduced survival and be prone to oxidative injury.

  • Consequence: This can worsen anemia or cause unexpected hemolysis post-transfusion.

Reference:

  • Rinalducci S, et al. Red Blood Cell Storage and Oxidative Stress: G6PD Deficiency as a Risk Factor. Blood Transfusion. 2015;13(4):575–581.

c) Patients Undergoing Oxidative Stress (Sepsis, Certain Medications, Chemotherapy)

  • Risk: Infections, certain drugs (like sulfa medications), or chemotherapy already increase oxidative load. Adding G6PD-deficient blood amplifies this risk.

  • Consequence: Transfused red cells may hemolyze prematurely, complicating treatment.

Reference:

  • Kaplan M, et al. Hemolysis After G6PD-Deficient Blood Transfusion: Clinical Observations and Mechanistic Insights. Journal of Pediatrics. 2001;138(5):731–734.

d) Patients Requiring Irradiated Blood

  • Risk: Irradiation, used to prevent transfusion-associated graft-versus-host disease (TA-GVHD), increases oxidative stress on red cells. G6PD-deficient donor cells tolerate this poorly.

  • Consequence: Reduced post-transfusion red cell survival.

Reference:

  • Arndt PA, Garratty G. Significance of G6PD Deficiency in Irradiated Blood Components. Transfusion. 2004;44(3): 437–444.

3. When G6PD-Deficient Blood May Be Acceptable

  • Healthy Adult Recipients: Adults without oxidative stress, not critically ill, and not requiring massive or exchange transfusions usually tolerate G6PD-deficient blood well.

  • Routine Transfusions in Stable Patients: If no oxidative challenges are present, there is little evidence of adverse outcomes.

  • Resource-Limited Settings: In emergencies where no alternative blood is available, transfusing G6PD-deficient blood may still be life-saving.

Reference:

  • Luzzatto L, Arese P. Favism and Glucose-6-Phosphate Dehydrogenase Deficiency. New England Journal of Medicine. 2018;378:60–71.

✅ Conclusion

  • Donation: G6PD deficiency does not disqualify individuals from donating blood.

  • Transfusion Use: The main concern lies not in collection but in selective use of such blood. For neonates, massive transfusion, patients under oxidative stress, or those needing irradiated blood, G6PD-deficient blood units pose real risks of hemolysis.

  • Best Practice: Blood services should consider screening or restricting the use of G6PD-deficient blood for high-risk groups, while still allowing its use for routine transfusion in stable adult patients.