standards and excellence of cancer treatment in this country. ' I have witnessed dramatic responses to interleukin 2 in patients with metastatic colorectal cancer. Unfortunately, we cannot predict which of the many eligible patients will respond to therapy. The hospital in which I work cannot afford interleukin 2, and this places me in an invidious position when faced with a patient whose life may be prolonged for a considerable time by expensive treatment. Mr Waldegrave's response to the problem was nothing less than parliamentary camouflage.' The lack of a product licence is irrelevant, the real issue being one of finance. The price of interleukin 2 and other drugs is easily identifiable and thus ripe for sanctions. This method of rationing health care is spurious and unfair as many forms of cancer treatment, including surgery, are often not cost effective in a business or medical sense. In the brave new world that begins on 1 April this problem will not remain hidden for long and hard decisions based on cost, not benefit, will be made for us by hospital managers and financiers. We have to accept that we can no longer offer patients the best available treatment and reluctantly accept our decline to a "Third World" medical service.
normally be rejected from the blood donor panel on a permanent basis, but a radical alternative warrants careful consideration. We propose that the transfusion service should monitor the iron stores of such donors and take blood from them at an appropriate frequency (monthly at first). The blood from such "superdonors" would be made fully available for clinical transfusion provided that all other safety requirements were met. We have made calculations based on the distribution of ferritin concentrations in our donor sample using the cut off values indicated above and assuming a donation frequency of four times a year for those with ferritin concentrations >50 tg/l. The proposed scheme would increase the potential number of donations for the donor panel by 22% compared with the number for the present maximum of two donations a year. This would be particularly valuable given the difficulties in enlarging blood donor panels in the United Kingdom. By such means the Blood Transfusion Service could prevent the consequences of hereditary haemochromatosis and also safely obtain more blood from those most able to give it. M WORWOOD
Department of Haematology, University of Wales College of Mledicine, Cardiff
GEORGE JACOB
C DARKE P TRENCHARD
Royal Hallamshire Hospital, Sheffield S10 2JF I Walker A. Interleukin 2 denied on grounds of cost. BAIJ 1991;302:372-3. (16 February.) 2 Waldegrave W. Parliamentary oral answer. House of Commons Ofjficial Report (Hansard) 1991 February 5;185:col 152. No 49.
Hereditary haemochromatosis and blood donation SIR, -Hereditary haemochromatosis is one of the most common inherited disorders in Britain.' The metabolic abnormality that causes iron overload is not known, but early detection (by measuring serum transferrin saturation and ferritin concentration) is highly beneficial. The treatment for the iron overload is venesection. Thus regular blood donation helps to delay the consequences of excess iron deposition in the tissues. We have recently completed a study of the incidence of hereditary haemochromatosis in 1600 blood donors in south Wales. Our findings agree with a generally quoted prevalence of 05% for the homozygous state in the general population. This means that blood (about 500 donations a year in our region) is being collected and transfused from donors with haemochromatosis. To detect haemochromatosis in its early stages requires measurement of transferrin saturation, but the percentage of false positive results is high.2 Measurements of serum ferritin concentration should identify most donors with haemochromatosis who have raised iron stores. By screening all donors it will also be possible to identify those without haemochromatosis whose iron stores will permit them to donate blood more often than twice a year. The best way to do this is to measure the serum ferritin concentration after each donation. The assay requires only 10 1tl of blood and is easily adaptable to the microtitre plate technology widely used in the Blood Transfusion Service. Non-anaemic donors with low iron stores (ferritin concentrations of, say,
normally be rejected from the blood donor panel on a permanent basis, but a radical alternative warrants careful consideration. We propose that the transfusion service should monitor the iron stores of such donors and take blood from them at an appropriate frequency (monthly at first). The blood from such "superdonors" would be made fully available for clinical transfusion provided that all other safety requirements were met. We have made calculations based on the distribution of ferritin concentrations in our donor sample using the cut off values indicated above and assuming a donation frequency of four times a year for those with ferritin concentrations >50 tg/l. The proposed scheme would increase the potential number of donations for the donor panel by 22% compared with the number for the present maximum of two donations a year. This would be particularly valuable given the difficulties in enlarging blood donor panels in the United Kingdom. By such means the Blood Transfusion Service could prevent the consequences of hereditary haemochromatosis and also safely obtain more blood from those most able to give it. M WORWOOD
Department of Haematology, University of Wales College of Mledicine, Cardiff
GEORGE JACOB
C DARKE P TRENCHARD
Royal Hallamshire Hospital, Sheffield S10 2JF I Walker A. Interleukin 2 denied on grounds of cost. BAIJ 1991;302:372-3. (16 February.) 2 Waldegrave W. Parliamentary oral answer. House of Commons Ofjficial Report (Hansard) 1991 February 5;185:col 152. No 49.
Hereditary haemochromatosis and blood donation SIR, -Hereditary haemochromatosis is one of the most common inherited disorders in Britain.' The metabolic abnormality that causes iron overload is not known, but early detection (by measuring serum transferrin saturation and ferritin concentration) is highly beneficial. The treatment for the iron overload is venesection. Thus regular blood donation helps to delay the consequences of excess iron deposition in the tissues. We have recently completed a study of the incidence of hereditary haemochromatosis in 1600 blood donors in south Wales. Our findings agree with a generally quoted prevalence of 05% for the homozygous state in the general population. This means that blood (about 500 donations a year in our region) is being collected and transfused from donors with haemochromatosis. To detect haemochromatosis in its early stages requires measurement of transferrin saturation, but the percentage of false positive results is high.2 Measurements of serum ferritin concentration should identify most donors with haemochromatosis who have raised iron stores. By screening all donors it will also be possible to identify those without haemochromatosis whose iron stores will permit them to donate blood more often than twice a year. The best way to do this is to measure the serum ferritin concentration after each donation. The assay requires only 10 1tl of blood and is easily adaptable to the microtitre plate technology widely used in the Blood Transfusion Service. Non-anaemic donors with low iron stores (ferritin concentrations of, say,
