AABB Updates DHQ v4.0 Medication Deferral List to Add B-Cell-Depleting Monoclonal Antibody Therapies

AABB has released Association Bulletin #26-05, “B-Cell-Depleting Monoclonal Antibody Therapy and Blood Safety,” along with an implementation toolkit outlining updates to the DHQ/aDHQ v4.0 Medication Deferral List (MDL).

The bulletin and toolkit add CD19-, CD20- and CD52-targeted B-cell-depleting monoclonal antibody therapies to the MDL under the “Immunosuppressants” category, with a six-month donor deferral. Therapies added to the updated list include Ocrevus, Kesimpta, Rituxan, Gazyva, Briumvi, Uplizna and Lemtrada.

The update follows a review by the AABB Transfusion Transmitted Diseases (TTD) Committee, Donor History Task Force (DHTF) and subject matter experts after CDC shared information regarding prolonged arboviral infections, including prolonged West Nile virus viremia, in individuals receiving these therapies. While no transfusion-transmitted infections have been linked to these medications, the review identified theoretical risks associated with prolonged asymptomatic infection, transfer of therapeutic monoclonal antibodies to recipients and depletion of circulating therapy in donors.

The review also considered international practices, including a survey of blood collectors in Europe, Australia, Canada and the United Kingdom, which found that most organizations already defer donors receiving B-cell-depleting monoclonal antibody therapies, often because of concerns related to immunomodulatory treatment or underlying disease severity.

With the release of the updated MDL v4.0, blood centers should now begin planning to implement the changes. Facilities should review the bulletin and toolkit, incorporate the newly added B-cell-depleting monoclonal antibody therapies into the “Immunosuppressants” section of the MDL, train staff on the new six-month deferral, and make any necessary software or process changes.

Because the change affects only the Medication Deferral List, a new version of the DHQ/aDHQ v4.0 is not required. AABB-accredited facilities are expected to implement the updated MDL v4.0 by March 31, 2027.

AABB thanks the members of the TTD Committee, DHTF, and contributing subject matter experts for their work in evaluating emerging data, assessing international practices and developing these materials to support blood safety and donor qualification practices.