Articulo Hypertrigyceridemia In Blood Donors En Boletin Asoc Med Pr


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Articulo Hypertrigyceridemia In Blood Donors En Boletin Asoc Med Pr

  1. 1. ABSTRACT SEVERE HYPERTRIGLYCERIDEMIAPuerto Rico blood donor issues hasbeen identified in cases of severe hy- IN PUERTO RICO BLOODpertriglyceridemia presenting as tur- DONORS:bid. Blood donations resulting in milkyserum must be discarded. They are A Population Studydiscarded because we cannot properly 2009-2011test the donation. This is the first reportwhere we correlate turbidity and cardio-vascular risk factors in the Puerto Rico Raúl H. Morales-Borges MDa*, Carmen Mercedpopulation as well as blood types O MT band A, Rh (+) with dyslipidemia. Blooddonors should be screened in moredetails regarding cardiovascular andmetabolic risks to avoid problems with a Medical Director, American Red Cross, Puerto Rico Region,recruitment and retention strategies. San Juan, Puerto Rico. b Manager, Donor Information, American Red Cross, Puerto Rico Region, San Juan, Puerto Rico.Index words: severe, hypertriglyceride- *Corresponding author: Raúl H. Morales-Borges MD - Medi-mia, Puerto Rico, blood, donors, popu- cal Director, American Red Cross, Puerto Rico Region, POlation Box 366046 San Juan, Puerto Rico 00936. E-mail: Raul.Mo- rales@redcross.orgINTRODUCTIONHyperlipidemia, defined as an abnormal elevation of plas- If a sample appears excessively turbid and fails visual exa-ma cholesterol and/or triglyceride levels, is one of the most mination for lipemia, the National Testing Laboratory (NTL)common clinical problems confronting the clinician in daily performs a quantitative triglyceride analysis. Samples withpractice (1). Although these disorders appear to be common triglycerides value less or equal than 3000 mg/dl are con-in the general population, it seems not a major issue in blood sidered acceptable for testing; but samples with a triglyce-donor’s population. A French study published by Terrier et al ride value more than 3000 mg/dl are unsuitable for testing.(2) with 1184 blood donors found a correlation between high Approximately 99% of samples pass the visual examina-blood pressure, obesity, blood group O, and type II-b Hyper- tion for turbidity and therefore do not require a quantitativelipoproteinemias in 32 cases. Another study from Brazil by triglyceride analysis. Of those samples that fail the visualMG Ferreira et al (3) evaluated the accuracy of anthropo- examination for turbidity, greater than half have a quantitati-metric fat location indices as predictors of dyslipidemia. One ve value less or equal than 3000 mg/dl and are determinedstudy from the Netherlands provided important knowledge acceptable for testing. Only a few samples a day fails theabout demographic distributions and cardiovascular risk visual examination for turbidity and have a triglyceride levelfactors within whole blood and plasma donors (4). Another > 3000 mg/ also from the Netherlands reported that donors whoprovided a turbid donation have a less favorable cardio- The NTL uses the result of the triglyceride testing to deter-vascular profile compared to other donors (5). One study mine sample suitability and is required to report the resultsabout fasting blood sugar in 1188 blood donors from Mexico to the region or to the donor. It should be noted that theshowed that the prevalence of impaired fasting glucose was triglyceride test performed by the Charlotte NTL is to be per-higher than expected and 70% of those subjects showed formed on non-fasting sample, which is usually the case forhypertriglyceridemia, comparing with other populations re- our donor samples. The expected value for a fasting sampleported in the literature (6). We wanted to demonstrate the is < 200 mg/dl. The package insert does not include anyneeds of further research on the role of blood donation in expected values for non-fasting samples. Because there iscardiovascular risk reduction, correlation between blood no expected value for a non-fasting sample, the testing istype and groups with dyslipidemia. We are presenting data performed to determine sample suitability for infectious di-from 50248 whole blood donors from March 1 to October 31 sease testing (8)of 2011 from which 5 were identified to have a triglyceridelevel above 3000 mg/dl. There is additional data from April of Once the donors are identified we pulled the blood donors2009 to December of 2010 with a total of 9 donors identified registry, known as BDR, of them and we reviewed to chartwith high triglyceride levels identified when the BHQ Medi- the data of age, gender, weight, blood type and group, towncal Office asked the National’s Testing Laboratory (NTL) to or city of living, collection date, and serum triglyceride level.systemically notify the regional physicians of donations thatcould not be tested because of high triglyceride levels. Puerto Rico has 78 municipalities and we colored the muni- cipalities or cities of the affected donors.METHODS RESULTSWe obtained the cases were a visual examination of allblood tubes is performed as part of the National’s Testing Five blood donors were identified to have turbid plasma withLaboratory sample suitability evaluation. Lipemia is one of triglycerides over 3000 mg/dl. Four were male and the avera-the variables assessed during this initial visual examination ge/median age was 46 years with a range of 41 to 50 years shown also in a study from K Peffer et al and commented The average weight was 184 pounds with a range of 140 to 240by RR Vassallo and FM Stearns with 272 donors (5, 7). pounds. Four of the blood donors were identified overweight. 15
  2. 2. Four were identified the blood type and group with three of One study determined 32% as the overall prevalence of thethem as A, Rh (+). Three of them are from the north area of metabolic syndrome (defined as diabetes, hypertension,the Island and one from the south and central area respec- obesity, dyslipidemia, glucose intolerance, and hyperinsu-tively. The lowest triglyceride level was 3038 mg/dl and the linemia) among a determined Puerto Rican population (9).highest was 5701 mg/dl with an average level of 3912 mg/ Cox stated that despite clear and consistent clinical-trialdl (See Table 1). evidence establishing a causal link between lipid disorders and coronary heart di- sease and that choles- terol-lowering therapy dramatically reduces the risk for that disease and its complications, many patients for whom such treatment is indicated re- main either unidentified or untreated (10). With that in mind we found that dyslipidemia might be a problem in this population, but our data is on isolated non- fasting triglyceride levels. This might be taken in consideration when we are doing blood drives and we need to educate more our people aboutFrom 2009 to 2010 we identified nine male donors with an good health habits and cardiovascular risks. Also discardingaverage age of 44 years and a range of 30 to 56 years old. donations may have a negative impact on donor satisfactionFive of them have blood type and group O, Rh (+). The geo- and retention, although the educational material informs allgraphic distribution varies with four from the Central region, donors that their donation may not be tested, but ARC doesthree from the North, and two from the Metropolitan region. not inform donors if their donations are discarded.The lowest triglyceride level was 2153 mg/dl, the highestwas 5396 mg/dl with an average 3545 mg/dl (See Table 2). Regarding turbid plasma donations, Peffer et al (5) mentio- ned that in the Netherlands, 3 to 4 per 1000 whole bloodIn general we are reporting 14 cases with an average age donations reveal turbid plasma. Familial hypertriglyceride-of 44.5 years and the majority were males from the North mia or chylomicronemia has been reported, but commonlyCentral Municipalities of the Island (See Figure 1). occurs among donors who ate a fatty meal before donation as well in obese diabetic donors with unfavorable cardiovascular profile. They found no difference between plasma or whole blood donors. The mean age of participating cases was 46.1 years as well as in our small num- ber of blood donors on 2011, although the average age of the 14 cases was 44.5 years. Men were more frequent in their study along with ours. One im- portant data from their study was the question of when was their last meal before donation and we missed this information. Without this information and without any follow-up on the do- nors, it is impossible to interpret the relevance of an isolated high triglyce- ride level. The main blood type and group of our groups was O, Rh (+) followed by A, Rh (+). This is the first report from our knowledge regarding a Puerto Rico population. There is one paper by J Hørby et al from Denmark (11) where they showed a small group study of a relation of serum lipids to the ABO blood groups in 66 patients with inter- mittent claudication. The concluded that the serum lipoprotein and lipid le- vels do not give an obvious explana- tion why patients with blood group ADISCUSSION seem more liable to develop atherosclerosis than those with blood group non-A. This data correlates with an Italian studyThis is the first publication were we identified turbid plasma from Clara Carpeggiani et al (12) where they demonstratedin Puerto Rico blood donors with a correlation of gender, that a significant association between group non-O and fa-age, regional area where they live, and blood type/group. mily history of ischemic heart disease, hypercholesterolemia 16
  3. 3. had a rate 10-times higher. Blood donors should be screened in more details regarding cardio- vascular and metabolic risks to avoid problems with recruitment and retention strategies. A future and larger study is recommended. REFERENCES 1. Witztum JL, Steinberg D: The Hyperlipoproteinemias (Chapter 206). In Goldman L, Bennett JC, eds. Cecil Textbook of Medicine. Philadelphia: W.B. Saunders Company, 2000: 1090-1100. 2. Terrier E, Baillet M, Jaulmes B: Detection of lipid abnormalities in blood donors. Rev Fr Transfus Immunohema- tol. 1979 Mar; 22(2): 147-158. 3. Ferreira MG, Valente JG, Gon- calves-Silva RM, Sichieri R: Accuand presence of coronary atheros- racy of waistclerosis. Their higher predictor group circumference and waist-to-hip ratio as predictors of dys-were patients aged < 65 years old and lipidemia in a cross-sectionalwomen. JL Cronenwett et al (13) with study among blood donors in Cuiaba, Mato Grosso State,73 women requiring aortoiliac recons- Brazil. Cad Saude Publicatruction for atherosclerotic occlusive 2006 Feb; 22(2): 307-314.disease demonstrated that women 4. Atsma F, Veldhuizen I, de Vegt F, Doggen C, de Kort W:with blood group A had increased fre- Cardiovascular andquency as comparable to published demographic characteristics in whole blood and plasmadata. The only study that does not co- donors: results from the Donor InSight study. Transfusionrrelate with this data is the one from 2011 Feb; 51(2): 412-420.North Carolina, USA with 1198 pa- 5. Peffer K, de Kort WL, Slot E, Doggen CJ: Turbid plasmatients who underwent percutaneous donations in whole bloodcoronary intervention and patients donors: fat chance? Transfusion 2011 Jun; 51(6): 1179-with O blood type were slightly older 1187.(62 years old), had a higher prevalen- 6. Munguia-Miranda C, Sánchez-Barrera RG, Tuz K, Alon-ce of hypercholesterolemia and had so-García AL, Cruz M:a higher burden of atherosclerosis Impaired casting glucose detection in blood donor’s popu-with more vascular disease (14). This lation. Rev Med Inst Mexfact is important regarding blood do- Seguro Soc. 2009 Jan-Feb; 47(1): 17-24.nations. A study must be performing 7. Vassallo RR, Stearns FM: Lipemic plasma: a renaissan-to correlate the blood type/group and ce. Transfusion 2011 Feb;dyslipidemia because it may be a 51(6): 1136-1139.coincidental finding. 8. Stearns FM, Stramer SL, Alvarez AW: Verification of Vi- sual Lipemia SampleAnother piece of information regarding Suitability by Quantitative Triglyceride Testing. Transfu-strategies for blood drives is that the sion 2005; 45, Supplement,majority of the small groups were from SP199, p89A.the north and central areas of PuertoRico. This is important, although, the 9. Gomez M, Ramirez M, Disdier O: Prevalence of the meta-finding of a few donors with isolated bolic syndrome among ahigh triglyceride levels does not have determined Puerto Rican population. PR Health Sci J.any implications for planning blood 2006 Jun; 25(2): 111-116.drives. 10. Cox RA: The hyperlipidemias. Bol Asoc Med PR. 2003 Sep-Oct; 95(5): 36-44.CONCLUSIONS 11. Hørby J, Gyrtrup HJ, Grande P, Vestergaard A: Relation of serum lipoproteins andThis data provided important lipids to the ABO blood groups in patients with intermit-knowledge about lipemic plasma and tent claudication.demographics of our blood donor’s J Cardiovasc Surg (Torino) 1989 Jul-Aug; 30(4):533-population. It was confirmed that the 537.main blood type and group O, Rh (+) 12. Carpeggiani C, Coceani M, Landi P, Michelassi C,is related with dyslipidemia as well as L’abbate A: ABO blood groupA, Rh (+) by our small sample and alleles: A risk factor for coronary artery disease. An an-they are mostly located in the north giographic study.central municipalities of Puerto Rico. Atherosclerosis 2010 Aug; 211(2): 461-466.What is most interesting is Figure 1 13. Cronenwett JL, Davis JT Jr, Garret HE: ABO blood groupper 130,000 of severe hypertriglyce- and serum lipids in femaleridemia in which Ralph R. Vassallo atherosclerosis. J Cardiovasc Surg (Torino) 1983 Nov-and Frank M. Stearns (7) reported for Dec; 24(6): 658-661.the Philadelphia NTL were our donors 14. Ketch TR, Turner SJ, Sacrinty MT, Lingle KC, Applegate 17
  4. 4. RJ, Kutcher MA, Sane RESUMEN DC: ABO blood types: Influence on infarct size, proceduralcharacteristics and Se ha identificado un asunto en cuanto a donantes de sangre prognosis. Thromb Res 2008; 123(2): 200-205. puertorriqueños con hipertrigliceridemia presentándose como plasma turbio en hombres con sobre peso y una edad prome- dio 44.5 años. Las donaciones de sangre resultantes en sueroACKNOWLEDEDGMENTS lechoso usualmente son descartadas. Se descartan porque no se pueden realizar las pruebas a las donaciones. Este esThe authors thank Dr. Anne F. Eder, Dr. Ralph R. Vassallo, and el primer reporte donde nosotros correlacionamos la turbiedadDr. Frank M. Stearns from the American Red Cross for their y los factores de riesgo cardiovasculares en la población deediting support and comments. Puerto Rico asi como los tipos y grupos sanguíneos O y A, Rh (+) con dislipidemia. Los donantes de sangre deben recibir un cernimiento mas detallado sobre los riesgos de padecer enfermedad cardiovascular o síndrome metabólico para evitar problemas con su reclutamiento. Every week, ... in your email address... Visit our website: and click on “Sign up Today” button, fill the form, and receive in your e-mail, each week, news and informa- tion about conferences, continued medical education, and all you need to be well informed about health. Information: 18