Alsharif Mada H, Mansory Eman M, Alharazi Amjad A, Badawi Maha A
From the Department of Preventive Medicine (Alsharif, Alharazi), Directorate of Health Affairs; from the Hematology Department (Mansory, Badawi), Faculty of Medicine, King Abdulaziz University; and from the Hematology Research Unit (Mansory, Badawi), King Fahd Medical Research Center, King Abdulaziz University, and from the Blood Transfusion Services Unit (Badawi), King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia.
Saudi Med J. 2024 Dec;45(12):1289-1304. doi: 10.15537/smj.2024.45.12.20240594.
To systematically review evidence on the prevalence of the JAK2V617F (JAK2) mutation and polycythemia vera (PV) among all blood donors, focusing on those with elevated hematocrit. Although blood donors are generally healthy, considering a preclinical stage of myeloproliferative neoplasm, especially in those with polycythemia, is crucial. Evidence on managing these donors is limited.
We performed a literature search using EMBASE and MEDLINE from inception until August 2023, including studies on the prevalence of JAK2 mutation or PV among blood donors. Eligible studies examined blood donors in hospital or community settings, had a sample size of at least 20 donors, and reported the prevalence of the JAK2 mutation or PV. We assessed bias, extracted data, and used a random effects model meta-analysis to estimate pooled prevalence and 95% confidence intervals. Subgroup analysis differentiated donors with normal hematocrit from those with polycythemia. Heterogeneity was assessed using I2 statistics.
Our review included eleven studies in total. Of those, ten studies examined the presence of a JAK-2 mutation in 1,999 blood donors. The overall proportion of JAK2 mutations was 3% (95% CI 0.60 - 6.9, I2 90.21%). Subgroup analysis revealed a prevalence of 4.7% (95% CI 2.1 - 8.0, I2 0.00%) among repeat donors with polycythemia and 2.3% (95% CI 0.0 - 7.7, I2 0.00%) among healthy ones. Only 3 (309 donors) studies reported PV prevalence, precluding a meta-analysis.
The prevalence of the JAK2 mutation among blood donors is similar to the general population's but slightly higher among repeat donors with elevated hematocrit. Further research is necessary to establish definitive upper hemoglobin limits for donor deferral..
系统回顾所有献血者中JAK2V617F（JAK2）突变和真性红细胞增多症（PV）患病率的证据，重点关注血细胞比容升高的献血者。尽管献血者通常健康，但考虑到骨髓增殖性肿瘤的临床前期，尤其是在患有红细胞增多症的献血者中，这一点至关重要。关于管理这些献血者的证据有限。
我们使用EMBASE和MEDLINE进行文献检索，检索时间从数据库建立至2023年8月，包括关于献血者中JAK2突变或PV患病率的研究。符合条件的研究对医院或社区环境中的献血者进行了检查，样本量至少为20名献血者，并报告了JAK2突变或PV的患病率。我们评估了偏倚，提取了数据，并使用随机效应模型荟萃分析来估计合并患病率和95%置信区间。亚组分析区分了血细胞比容正常的献血者和患有红细胞增多症的献血者。使用I2统计量评估异质性。
我们的综述共纳入11项研究。其中，10项研究检测了1999名献血者中JAK-2突变的存在情况。JAK2突变的总体比例为3%（95%CI 0.60 - 6.9，I2 90.21%）。亚组分析显示，患有红细胞增多症的重复献血者中患病率为4.7%（95%CI 2.1 - 8.0，I2 0.00%），健康献血者中患病率为2.3%（95%CI 0.0 - 7.7，I2 0.00%）。只有3项研究（309名献血者）报告了PV患病率，无法进行荟萃分析。
献血者中JAK2突变的患病率与一般人群相似，但在血细胞比容升高的重复献血者中略高。有必要进行进一步研究以确定献血者延期的明确血红蛋白上限。
