Blood Donation in Polycythemia Patients
Patients with polycythemia vera should not donate blood for transfusion to other patients, as this is a malignant hematological disorder that disqualifies them from standard blood donation. However, therapeutic phlebotomy (removing blood and discarding it) is a cornerstone treatment for these patients to reduce their elevated red blood cell mass and prevent thrombotic complications 1, 2.
Key Distinction: Therapeutic Phlebotomy vs. Blood Donation
- Therapeutic phlebotomy is mandatory treatment for all polycythemia vera patients to maintain hematocrit below 45%, which significantly reduces thrombosis risk 1, 2
- The removed blood is discarded, not used for transfusion, as polycythemia vera is a clonal myeloproliferative neoplasm—essentially a blood cancer 1, 3
- Blood donation programs exclude individuals with malignant hematological conditions from donating blood for transfusion to other patients 1
Why Polycythemia Vera Patients Cannot Donate Blood
- Polycythemia vera is a haematological malignancy characterized by clonal proliferation of hematopoietic stem cells, with more than 95% of patients carrying the JAK2V617F mutation 1, 3
- The disease carries risk of transformation to myelofibrosis (12.7% of patients) and acute myeloid leukemia (6.8% of patients) 1
- Blood from these patients is unsuitable for transfusion due to the underlying malignant process 3
Secondary Polycythemia Considerations
- Patients with secondary polycythemia (due to smoking, chronic lung disease, sleep apnea, or other hypoxic conditions) also should not donate blood 4, 5
- These patients have elevated red blood cell mass as a compensatory response to chronic hypoxia, and their blood parameters are abnormal 4, 5
- Smoker's polycythemia resolves with smoking cessation, with risk reduction beginning within 1 year 5
- Treatment of secondary polycythemia focuses on correcting the underlying cause rather than phlebotomy, unless the cause cannot be remedied 6
Clinical Pitfall to Avoid
- Do not confuse therapeutic phlebotomy with blood donation—while the procedure is similar, therapeutic phlebotomy for polycythemia vera is a medical treatment where blood is removed and discarded, not collected for transfusion 1, 2
- Phlebotomy is definitely contraindicated in relative (apparent) polycythemia, which results from plasma volume depletion rather than true increase in red cell mass 6