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 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 247-248

Advocating optimal abstinence period after smoking although before donating blood


1 Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
2 Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India

Date of Submission16-Oct-2021
Date of Acceptance19-Oct-2021
Date of Web Publication30-Nov-2021

Correspondence Address:
Dr. Manish Raturi
Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/gjtm.gjtm_93_21

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How to cite this article:
Raturi M, Dhawan V, Kediya A, Chandra S, Kusum A. Advocating optimal abstinence period after smoking although before donating blood. Glob J Transfus Med 2021;6:247-8

How to cite this URL:
Raturi M, Dhawan V, Kediya A, Chandra S, Kusum A. Advocating optimal abstinence period after smoking although before donating blood. Glob J Transfus Med [serial online] 2021 [cited 2022 Aug 10];6:247-8. Available from: https://www.gjtmonline.com/text.asp?2021/6/2/247/331630



Sir,

Smokers as blood donors (SBD) comprise approximately 10%–15% of the donor population; however, this could vary from one blood center to another. The concerns regarding the lack of abstinence period for smokers in the Indian Blood Donation (IBD) guidelines before donating blood merit justified attention.[1] A pilot study found smaller hemoglobin (Hb) increment in those who received packed red blood cells (PRBC) units that were, found to be cotinine (a metabolite obtained from nicotine use) positive. This pilot study hypothesized that using tobacco leads to inflammation and an increased rate of red blood cell hemolysis.[2] In another study conducted at Kaiser Permanente, Northern California, smaller Hb increments were observed, with the transfusion of PRBC units (obtained from SBD) when used as gamma-irradiated (GI), as against the effect observed with GI alone.[3] In addition, the recipients of GI units obtained from the SBD were more likely to receive another PRBC transfusion when compared to the recipients of non-SBD units. Furthermore, the scientific community is bound to ask the transfusion medicine community the following two queries:

Query 1: What are the effects of cigarette smoking on the PRBC units?

Answer 1: PRBC units obtained from chronic SBD have higher carboxy-Hb (COHb), cadmium and lead content when compared to the non-SBD. An increased level of the markers of oxidant stress in the stored blood from nicotine exposed SBD have been reported as well.[4]

Query 2: What are the effects of donor smoking on the components other than the PRBC units?

Answer 2: Smoking is associated with increased platelets (PLT) adhesiveness, aggregation, and thrombin generation.[5] Therefore, its detrimental effects on PLT and the recipient outcomes, such as cessation of bleeding, corrected count increments, including a chance of thrombosis' warrant further research.

At our blood center, amidst the 11,000 annual collections, the 6.1% SBD prevalence (n = 673/11,000) is comparable to the 5.9% prevalence of SBD seen by the study done by Boehm et al.[6] Furthermore, their study advocates a 12-h abstinence period from smoking and highlights that consuming <20 cigarettes in a day was associated with lower cotinine levels and COHb concentration in the donated units, respectively. In addition, we also observed that the mean predonation Hb (g/dL ± standard deviation) was higher in the SBD cohort (16.2 ± 0.87; n = 673/11,000) as against the non-SBD cohort (14.9 ± 1.41; n = 10327/11,000) (two-tailed P < 0.0001). Although statistically significant, whether this difference would also have some clinical impact on the efficacy of PRBC transfusion, in the form of Hb increment after transfusion, needs to be researched further. Although the authors believe that this certainly does not qualify to be called a trivial decision and bears the potential to affect the blood inventory. Nevertheless, given the known detrimental effects of smoking on the PRBC units and the absence of any stringent recommendations toward abstinence from smoking, the authors wish to advocate the inclusion of a minimum 12-h abstinence period before collecting blood in the IBD guidelines.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Central Drugs Standard Control Organization. Directorate General of Health Services. Ministry of Health and Family Welfare. Government of India, New Delhi. Available from: https://cdsco.gov.in/opencms/opencms/system/modules/CDSCO.WEB/elements/download_file_division.jsp?num_id=NTc2MQ. [Last accessed on 2021 Sept 25].  Back to cited text no. 1
    
2.
DeSimone RA, Hayden JA, Mazur CA, Vasovic LV, Sachais BS, Zhao Z, et al. Red blood cells donated by smokers: A pilot investigation of recipient transfusion outcomes. Transfusion 2019;59:2537-43.  Back to cited text no. 2
    
3.
DeSimone RA, Plimier C, Lee C, Kanias T, Cushing MM, Sachais BS, et al. Additive effects of blood donor smoking and gamma irradiation on outcome measures of red blood cell transfusion. Transfusion 2020;60:1175-82.  Back to cited text no. 3
    
4.
Stefanoni D, Fu X, Reisz JA, Kanias T, Nemkov T, Page GP, et al. Nicotine exposure increases markers of oxidant stress in stored red blood cells from healthy donor volunteers. Transfusion 2020;60:1160-74.  Back to cited text no. 4
    
5.
Hioki H, Aoki N, Kawano K, Homori M, Hasumura Y, Yasumura T, et al. Acute effects of cigarette smoking on platelet-dependent thrombin generation. Eur Heart J 2001;22:56-61.  Back to cited text no. 5
    
6.
Boehm RE, Arbo BD, Leal D, Hansen AW, Pulcinelli RR, Thiesen FV, et al. Smoking fewer than 20 cigarettes per day and remaining abstinent for more than 12 hours reduces carboxyhemoglobin levels in packed red blood cells for transfusion. PLoS One 2018;13:e0204102.  Back to cited text no. 6
    




 

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