How should I proceed with a 17-year-old blood donor who has dyslipidemia and an elevated absolute eosinophil (eosinophil count) of 650, and works as a fisherman (occupation)?

Blood Donation Eligibility in a 17-Year-Old Fisherman with Dyslipidemia and Eosinophilia

This patient should be temporarily deferred from blood donation pending evaluation for helminth infection given the occupational exposure and mild eosinophilia, and dyslipidemia alone does not preclude donation but requires cardiovascular risk assessment. 1, 2

Immediate Assessment of Eosinophilia (650 cells/μL)

Classification and Risk Stratification

• This represents mild eosinophilia (500-1500 cells/μL), which in a fisherman with occupational water and raw fish exposure raises significant concern for parasitic infection. 1, 3
• Helminth infections account for 19-80% of eosinophilia cases in individuals with relevant exposures, making this the primary diagnostic consideration. 1, 4
• The fisherman occupation creates specific risk for Strongyloides stercoralis, schistosomiasis (if freshwater exposure), and fish-borne parasites like Anisakis or Diphyllobothrium. 1, 5

Critical Evaluation Required Before Blood Donation

• Obtain detailed occupational history focusing on freshwater versus saltwater exposure, raw/undercooked fish consumption, and any gastrointestinal or respiratory symptoms. 1, 4
• Perform stool microscopy for ova and parasites (3 separate concentrated specimens) as first-line testing. 1
• Order serology for Strongyloides and schistosomiasis based on exposure history. 1, 4
• Strongyloides is particularly critical to exclude because it can persist lifelong and cause fatal hyperinfection syndrome if the recipient becomes immunocompromised. 1

Blood Donation Decision Algorithm

• Defer donation until parasitic infection is excluded or adequately treated. 2, 1
• Living donor guidelines emphasize that occupational exposures must be assessed for transmissible infections, and this principle applies to blood donation. 2
• If initial testing is negative but suspicion remains high, consider empiric treatment with albendazole 400 mg single dose plus ivermectin 200 μg/kg single dose before clearing for donation. 4
• Recheck eosinophil count after treatment; persistent elevation warrants hematology referral if >3 months duration. 1, 6

Management of Dyslipidemia in a 17-Year-Old

Age-Specific Considerations

• At age 17, dyslipidemia does not automatically disqualify blood donation but requires assessment for familial hypercholesterolaemia and cardiovascular risk factors. 2
• Familial hypercholesterolaemia affects 1 in 500 people and is characterized by total cholesterol >8 mmol/L (320 mg/dL) and LDL >6 mmol/L (240 mg/dL). 2
• If dyslipidemia is mild and secondary to diet/lifestyle, this does not preclude donation. 2

Required Assessment

• Obtain fasting lipid panel to determine severity and pattern (elevated LDL, triglycerides, or both). 2
• Screen for secondary causes: diabetes/prediabetes, hypothyroidism, liver disease, and medication use. 2
• Assess family history of premature cardiovascular disease or familial hypercholesterolaemia. 2
• If total cholesterol >8 mmol/L or LDL >6 mmol/L, refer to specialist for evaluation of familial hypercholesterolaemia before donation. 2

Blood Donation Eligibility

• Dyslipidemia alone is not a contraindication to blood donation unless associated with active cardiovascular disease or severe metabolic syndrome. 2
• The recipient's risk from transfused lipids is negligible compared to infectious disease transmission. 2

Integrated Decision-Making Algorithm

Step 1: Immediate Actions

1. Defer blood donation pending parasitic workup. 2, 1
2. Order stool ova and parasites (×3), Strongyloides serology, and schistosomiasis serology if freshwater exposure. 1, 4
3. Obtain fasting lipid panel. 2

Step 2: Based on Parasitic Workup Results

• If positive for helminths: Treat appropriately, defer donation for 3 months post-treatment, recheck eosinophil count. 1, 4
• If negative but high suspicion: Consider empiric treatment, defer donation until 2 weeks post-treatment. 4
• If negative with low suspicion: May proceed to Step 3 after 4-week interval recheck shows eosinophil count <500. 1, 6

Step 3: Based on Lipid Results

• If mild dyslipidemia (LDL <4 mmol/L): Counsel on lifestyle modification, does not preclude donation. 2
• If severe dyslipidemia (total cholesterol >8 mmol/L or LDL >6 mmol/L): Refer to specialist, defer donation pending evaluation. 2

Critical Pitfalls to Avoid

• Do not assume normal eosinophil count excludes helminth infection—many infected patients have normal counts, but this patient has mild elevation requiring investigation. 1
• Do not allow blood donation from individuals with occupational parasitic exposure without adequate screening, as Strongyloides can cause fatal disease in immunocompromised recipients. 1, 2
• Do not delay cardiac evaluation if eosinophilia persists >3 months or increases to ≥1.5 × 10⁹/L, as subclinical endomyocardial damage can occur. 1, 4
• Do not assume dyslipidemia in a 17-year-old is purely dietary without screening for familial hypercholesterolaemia. 2