National Blood Donor Month was in June; with that we chat to Dr Nolubabalo Makiwane, from the South African National Blood Services (SANBS) about whether people living with diabetes can donate blood.
Can diabetes patients using insulin (injection or pump) donate blood?
Yes, we accept donors who are using insulin to control their diabetes. Both those using injections or pumps. The most important factor is that their diabetes must be controlled and they must be well on the day they present to donate.
Insulin users should also not have any skin complications associated with using injections/pumps. We won’t allow a donor to donate blood, if they have a skin infection at the injection site, for example.
Can diabetes patients using oral diabetes medication donate blood?
Yes, persons using oral medications and diet to control their diabetes are welcome to donate. Again, their diabetes must be well-controlled and they must be well when presenting to donate blood.
Most medication used to treat diabetes are classed as category B drugs. Therefore, are considered safe if one should opt to become a blood donor.
Understanding the categories of medication
Medications are assigned to five letter categories based on their level of risk to foetal outcomes in pregnancy. It can give one a good idea on the level of safety of a drug at a glance. This is of importance in transfusion as a fair percentage of SANBS blood products are used by pregnant women, women in labour or who are post-partum, and, of course, we also supply blood products for use in babies and children.
So, category A is the safest category of drugs to take. Category B medications are medications that are used routinely and safely during pregnancy. The C and D category drugs have shown positive evidence of human foetal risk but potential benefits of the drug may warrant use in pregnant women. Category X is never to be used in pregnancy. This is a classification based on the safety of a drug in pregnancy and lactation.
|No risk in controlled human studies: Adequate and well-controlled human studies have failed to demonstrate a risk to the foetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
|No risk in other studies: Animal reproduction studies have failed to demonstrate a risk to the foetus and there are no adequate and well-controlled studies in pregnant women or animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the foetus in any trimester.
|Risk not ruled out: Animal reproduction studies have shown an adverse effect on the foetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
|Positive evidence of risk: There is positive evidence of human foetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
|Contraindicated in pregnancy: Studies in animals or humans have demonstrated foetal abnormalities and/or there is positive evidence of human foetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.
|FDA has not yet classified the drug into a specified pregnancy category.
What are the medications that if taken, a person can’t donate blood?
Generally, SANBS doesn’t accept donors who are using medication that is classified as teratogenic. These drugs would fall into category X. These medications are known to cause malformations in unborn babies, or miscarriages. These include a lot of dermatological agents, like Roaccutane, Neotigason and etretinate.
Some anticonvulsant medication has been found to have teratogenic effects, such as valproic acid, phenytoin and phenobarbitone.
Some antibiotics and male hormonal medications are also classed as teratogenic. The list of teratogenics is, of course, much longer than this. However, what is of note is that there are no hypoglycaemic agents listed as teratogenic.
Diabetes, unfortunately, has many side effects, such as heart problems, neuropathy, slow-healing, etc. Will any of these side effects stop people living with diabetes from donating blood?
Most definitely. If donors are people living with diabetes and they develop a complication due to their diabetes, we defer them until the complications are resolved, and until good control of the donors’ blood glucose level is re-established.
Persons who suffer from a hypoglycaemic coma (due to low blood glucose levels) are deferred for four months from the time of the episode. This is to ensure that their glucose control is adequate.
SANBS also doesn’t accept donors who develop diabetes as a complication of another disease process. For example, a donor who develops diabetes as a complication of acromegaly (a disorder caused by excessive production of growth hormone by the pituitary gland and marked especially by progressive enlargement of hands, feet, and face) would not be accepted for the procedure.
Does SANBS encourage people living with diabetes to donate blood?
We encourage people living with diabetes to donate blood only if they are well enough to tolerate the procedures. At SANBS, the health of our donors is of very high importance. We do not collect blood from a donor if it would be detrimental to the health of the donor at all. This applies to our diabetic donors, even more so as they are at a slightly increased risk of developing infections and other complications.
MEET OUR EXPERT
Dr Nolubabalo Makiwane is a registered medical practitioner working in the transfusion medicine field. She is part of the medical team at the SANBS where she works to ensure that donor care is at its best.