Should Transfusions of Donated G6PD-Deficient Donor Red Blood Cells Be Restricted to Improve Patient Safety? A Critical Review of the Current Literature

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzyme deficiency and can cause significant hemolysis and anemia in individuals exposed to oxidative stress. During refrigerated storage after donation, red blood cells (RBCs) accumulate oxidative damage which adversely affects transfusion efficacy, with more severe effects on RBCs collected from G6PD-defienct donors. Although there are international recommendations to assess blood donors for G6PD deficiency and to decide on transfusing G6PD-deficient RBCs based on recipient characteristics, in the United States this is not routinely done. This review critically evaluates relative strengths and weaknesses of recent studies examining the post-transfusion circulatory survival of G6PD-deficient RBCs in healthy volunteers, in general patient populations, and in chronically-transfused patients. Although these studies uniformly suggest that transfusions of G6PD-deficient RBCs lead to less optimal outcomes, they have not led to a change in clinical practice. Remaining unanswered questions are also considered in the context of how a change in transfusion practice could become feasible in the future.