title: Should blood donors be routinely screened for glucose-6-phosphate dehydrogenase deficiency? A systematic review of clinical studies focusing on patients transfused with glucose-6-phosphate dehydrogenase-deficient red cells.
abstract: The risk factors associated with the use of glucose-6-phosphate dehydrogenase (G6PD)-deficient blood in transfusion have not yet been well established. Therefore, the aim of this review was to evaluate whether whole blood from healthy G6PD-deficient donors is safe to use for transfusion. The study undertook a systematic review of English articles indexed in COCHRANE, MEDLINE, EMBASE, and CINHAL, with no date restriction up to March 2013, as well as those included in articles' reference lists and those included in Google Scholar. Inclusion criteria required that studies be randomized controlled trials, case controls, case reports, or prospective clinical series. Data were extracted following the Preferred Reporting Items for Systematic Reviews using a previously piloted form, which included fields for study design, population under study, sample size, study results, limitations, conclusions, and recommendations. The initial search identified 663 potentially relevant articles, of which only 13 studies met the inclusion criteria. The reported effects of G6PD-deficient transfused blood on neonates and children appear to be more deleterious than effects reported on adult patients. In most cases, the rise of total serum bilirubin was abnormal in infants transfused with G6PD-deficient blood from 6 hours up to 60 hours after transfusion. All studies on neonates and children, except one, recommended a routine screening for G6PD deficiency for this at-risk subpopulation because their immature hepatic function potentially makes them less able to handle any excess bilirubin load. It is difficult to make firm clinical conclusions and recommendations given the equivocal results, the lack of standardized evaluation methods to categorize red blood cell units as G6PD deficient (some of which are questionable), and the limited methodological quality and low quality of evidence. Notwithstanding these limitations, based on our review of the available literature, there is little to suggest that G6PD-deficient individuals should be excluded from donating red blood cells, although transfusions of such blood may potentially have negative impacts on premature neonates or patients who need repeated transfusions, and thus, for this group, screening for G6PD deficiency may be appropriate.
authors.affiliation: Migration, Social Disadvantage, and Health Programs, Global Health and Society Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for International Health, Burnet Institute, Melbourne, Victoria, Australia. Electronic address: andre.renzaho@monash.edu.
authors.forename: Andre M N
authors.initials: AM
authors.lastname: Renzaho
authors.affiliation: Global Health and Society Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: eliette.husser@monash.edu.
authors.forename: Eliette
authors.initials: E
authors.lastname: Husser
authors.affiliation: School of Management and Marketing, Deakin University, Burwood, Victoria, Australia. Electronic address: michael.polonsky@deakin.edu.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Polonsky
mesh_terms: D000328:Adult; D000367:Age Factors; D000743:Anemia, Hemolytic / Q000209:etiology; D001782:Blood Donors; D058731:Blood Safety; D002648:Child; D046148:Donor Selection / Q000592:standards; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005078:Exchange Transfusion, Whole Blood / Q000009:adverse effects; D005260:Female; D014943:Global Health; D005954:Glucosephosphate Dehydrogenase / Q000097:blood; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology / Q000628:therapy; D007231:Infant, Newborn; D007234:Infant, Premature; D008099:Liver / Q000503:physiopathology; D008297:Male; D010789:Phototherapy; D011237:Predictive Value of Tests; D015995:Prevalence; D012107:Research Design; D065227:Transfusion Reaction
chemical_list: D005954:Glucosephosphate Dehydrogenase