What are the contraindications to donating plasma?

Contraindications to Plasma Donation

Plasma donation is contraindicated in individuals with HIV, hepatitis C, active bacterial infections, active malignancies, severe immunosuppression, and certain hematologic disorders, while relative contraindications include obesity (BMI >35 kg/m²), refusal of blood product transfusion, and certain medications.

Absolute Contraindications

Infectious Diseases

• HIV infection - complete exclusion from donation 1
• Hepatitis C - absolute contraindication 1
• Active syphilis - requires treatment before any further evaluation (positive RPR test) 1
• Active tuberculosis - evidence of renal or systemic TB precludes donation 1
• Active bacterial infections - particularly wound contamination or systemic infections 2

Important caveat: Hepatitis B surface antibody alone is NOT a contraindication - only active hepatitis B infection 1

Malignancies

• Active cancer - absolute contraindication due to risk of cancer transmission 1
• History of malignancy - may be acceptable only if:
  • Cancer is deemed cured
  • Oncology clearance obtained
  • Potential for transmission excluded 1

Hematologic Conditions

• Sickle cell disease and sickle cell trait - relative contraindications for certain collection methods 2
• Active hemopathies - stabilized or cured conditions may be acceptable with expert evaluation 3
• Severe cytopenia - contraindication 3

Metabolic/Endocrine

• Known diabetes mellitus - absolute contraindication 1
• Fasting plasma glucose ≥126 mg/dL on 2+ occasions 1
• 2-hour glucose ≥200 mg/dL after oral glucose tolerance test on 2+ occasions 1

Relative Contraindications

Metabolic Risk Factors

• Impaired fasting glucose (110-125 mg/dL) - particularly in high range 1
• Impaired glucose tolerance with additional risk factors:
  • First-degree relatives with type 2 diabetes
  • Obesity
  • Gestational diabetes history
  • Dyslipidemia 1

Body Habitus

• BMI >35 kg/m² - should not donate in presence of other comorbidities; weight loss advised before donation 1

Cardiovascular/Pulmonary

• Moderate to severe pulmonary disease:
  • FEV1 or FVC <70% predicted
  • FEV1:FVC ratio <65% 1
• Uncontrolled hypertension - blood pressure must be <140/90 mmHg on at least 2 measurements 1

Renal/Urologic

• Proteinuria - requires 24-hour urine confirmation and evaluation 1
• Microscopic hematuria - requires extensive workup to exclude:
  • Glomerular diseases (IgA nephropathy, Alport disease)
  • Urinary tract malignancy
  • Renal tuberculosis 1
• Kidney stones - current stones or recurrent history (donation acceptable only if single stone >10 years ago without recurrence) 1

Autoimmune/Familial Conditions

• Family history of systemic lupus erythematosus - positive ANA in family member precludes donation 1
• Familial glomerulonephritis - contraindication when multiple family members affected 1
• Polycystic kidney disease - age-specific criteria apply 1

Medications

• Genotoxic drugs - require deferral period of t(max) + 24 half-lives 4
• Retinoids, thalidomide, lenalidomide - require waiting periods for all blood products 4
• Dutasteride or finasteride - require waiting periods 4
• Irreversible platelet inhibitors - 10-day waiting period if platelet concentrates intended 4

Other Considerations

• Jehovah's Witness adherents or refusal of blood product transfusion - relative contraindication due to surgical risk 1
• Immunosuppressive therapy - requires careful evaluation 3

Common Pitfalls to Avoid

1. Don't confuse hepatitis B surface antibody with active infection - antibody presence is acceptable 1

2. Age considerations matter - donation may be acceptable up to age 70 with appropriate screening 5

3. Frequency limits exist - while some jurisdictions allow up to 104 donations/year, evidence for safety at this frequency is limited; twice-weekly donation may cause clinically relevant ferritin decrease and IgG depletion below 6 g/L 6, 7

4. Post-donation symptoms occur - approximately 12% of plasma donors report feeling ill after donation, with most managed in-center 8

5. Deferral on donation day creates significant psychological barrier - described as "walk of shame" by donors 8

The evidence base for these contraindications comes primarily from kidney donor evaluation guidelines [1-1-1], which provide the most comprehensive framework, supplemented by plasma-specific research [5-7]. While these guidelines are from 2007, they represent the most detailed systematic approach available and align with current transfusion medicine principles.