Can individuals with liver cirrhosis donate plasma?

From the Guidelines

Plasma donation is not recommended for individuals with liver cirrhosis due to the potential risks of worsening their health condition. People with cirrhosis often have compromised liver function, which can affect blood clotting factors, protein levels, and immune function, as noted in the EASL clinical practice guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis 1. Donating plasma could potentially further reduce important proteins and clotting factors that are already compromised due to liver disease. Some key points to consider include:

• Compromised liver function in cirrhosis patients can affect blood clotting factors and protein levels
• Plasma donation may exacerbate existing blood abnormalities, such as reduced platelet counts
• Blood donation centers typically screen out potential donors with liver disease, including cirrhosis, to protect both the donor's health and ensure the safety of the blood supply
• Cirrhosis patients should focus on managing their condition through regular medical care, medication adherence, abstaining from alcohol, maintaining proper nutrition, and following their hepatologist's recommendations, as suggested by the guidelines 1. The primary concern is that the liver's reduced ability to synthesize proteins and other essential blood components in cirrhosis makes plasma donation potentially harmful to the donor's health status, and therefore, it is not recommended.

From the Research

Plasma Donation and Liver Cirrhosis

• There is no direct evidence in the provided studies regarding plasma donation in patients with liver cirrhosis.
• However, the studies discuss the use of albumin infusions in the management of patients with decompensated cirrhosis 2, 3, 4.
• Albumin infusions have been used to reduce the formation of ascites, improve circulatory and renal function, and prevent hepatorenal syndrome in patients with cirrhosis 2, 3.
• The use of albumin infusions in patients with cirrhosis is still controversial, but it has been proven to be safe 2.
• Long-term albumin therapy in patients with cirrhosis and ascites may improve survival, prevent complications, and simplify ascites management 3, 4.

Management of Liver Cirrhosis

• The management of liver cirrhosis includes directed counseling, laboratory testing, and ultrasound monitoring 5.
• Treatment goals are preventing cirrhosis, decompensation, and death 5.
• Varices are monitored with endoscopy and often require prophylaxis with nonselective beta blockers 5.
• Ascites treatment includes diuresis, salt restriction, and antibiotic prophylaxis for spontaneous bacterial peritonitis, when indicated 5, 4.
• Hepatic encephalopathy is managed with lifestyle and nutritional modifications and, as needed, with lactulose and rifaximin 5, 4.

Role of Albumin in Liver Cirrhosis

• Albumin has been used primarily as a plasma expander, since it leads to an increase in the circulating blood volume 3.
• Current generally recommended indications for albumin therapy in cirrhotic patients are the prevention of circulatory dysfunction after large-volume paracentesis, the prevention of hepatorenal syndrome (HRS) in patients with spontaneous bacterial peritonitis (SBP), and the management of HRS in combination with vasoconstrictors 3, 4.
• New data show that albumin both supports the circulation and reduces systemic inflammation 3.
• Albumin therapy is effective in the indications already recommended by the guidelines, but the optimal dosage and administration intervals have not yet been finally defined 3, 4.