MEDICAL WORKING GROUP – DONOR SUITABILITY 30 May 2016 Spring meeting – Singapore Chair: H Yang

Committee business Co-chair: Continuity Clerical support Access to comprehensive national HPC donor suitability guidelines and/or related field Attends WMDA Fall meetings/EBMT

Zika & other arboviruses Zika, dengue, chikungunya and West Nile virus - while distinct and varied in clinical manifestation - share important similarities in risk assessment: Can we use a common framework in assessing “geographical” risk? What about local/ongoing risk vs past/travel risk? For Zika only – what about sexual contact with exposed males?  With symptoms  Without symptoms

Arbovirus commonalities

Zika + dengue/CHIKV/WNV/malaria

Arbovirus common framework At enrolment – accept At verification typing – notify TC of exposure type and timing: Past travel vs ongoing residence Sexual contact (Zika only) At work-up – test RNA outside 14 days where possible; notify TC

Zika virus sexual contact Sexual contact with a male who has been exposed to Zika virus risk: Male with symptoms – notify TC; use condoms; test for RNA outside 14 days where possible. Male without symptoms – as above? Duration of risk – 3 months to cover 66–70 day case reports, or 6 months to comply with FDA? Australian risk modelling – sexual contact question not warranted for blood donors, as risk is conservatively <1 in 9 million (Feb 2016).

Australian risk modelling Assumptions: 1 in 319 male partner infection rate % travel exposure + 100% sexual contact rate + 10% infection rate  1 in 180,000 female donor infection rate 780,000 WB collections/year + 50% female donors + 7- day viraemia + 0% effectiveness of general deferrals  1 in 9 million risk of collecting an infected WB donation 100% transfusion transmission + 0% immunity + 80% asymptomatic recipient infections  1 in 47 million risk of symptomatic recipient infections 1% obstetric use + 50% severe foetal outcomes  1 in 1,874 million risk of severe foetal outcomes

Splenomegaly How big is too big? Palpation Ultrasound Other? Underlying cause – what if unknown?

Diabetes mellitus Current guidance: Individual at risk – donor At recruitment – unacceptable At CT/WU – accept if type 2 controlled with diet or oral Rx + no complications Justification - “…more likely to be medically deferred if eventually called to donate several years later.”

Type 2 diabetes mellitus Is exclusion at enrolment stage warranted? Increasing type 2 diabetes in Australia, USA, etc Decreasing age of onset Highest risk among people with Asia/Pacific and African ethnicity Could this limit ethnic diversity?

Asthma Is specialist assessment necessary? Would an assessment protocol be useful? Recommendation of medical supervision of first-dose G-CSF – what is our actual experience?

Transgender donors HIV risk in transwomen (MTF)? HIV risk in transmen (FTM)? Pre-surgery vs post-surgery How to document donor sex? “Agender” individuals (non-binary sex paradigm)

Case studies 1.MVA 4 yrs ago  leg #s Rx IF; still in situ 2.Regular plasmapheresis blood donor for rabies Ig  rabies vaccine every 3 months 3.MBA 8 yrs ago  neurosurgery  visual deficit & “impending blindness” 4.MVA 18 yrs ago  # femur Rx IF  plate removed but now 7 cm diff leg length & minor back pain

More case studies 4.39F with 7/12 hx of ?asthma cough Rx Symbicort; Singulair  now well- controlled with normal CXR and PEF; PBSC requested 5.PHx asthma; MBA 7 yrs ago  skull # without LoC  12-month hx of recurrent headaches associated with torticollis & ?nerve entrapment. Episodes every 2/12 respond to paracetamol.

Other business