Hereditary hemochromatosis (HH) is a genetic disorder of iron metabolism that 
may lead to iron overload. Clinical penetrance is low, however those afflicted 
may develop cirrhosis, hepatocellular carcinoma, diabetes mellitus, and 
cardiomyopathy. Treatment of HH involves regular phlebotomy to reduce the 
systemic iron burden. In many countries-including the United States-numerous 
blood centers do not accept donated blood obtained from HH patients during 
therapeutic phlebotomy and there are inconsistent positions regarding this 
globally. This refusal of blood is borne out of a few concerns. First, there is 
a theoretical increase in the infectious risk of these blood products, 
particularly by siderophilic organisms such as Yersinia enterocolitica. Second, 
given the increased incidence of hepatitis C infection from nonvoluntary donors 
in the 1970s, there is a concern that blood units from HH donors may harbor 
additional risk given the nonvoluntary nature of their presentation. In this 
review, we examine the existing biological and clinical data concerning 
infectious risk and summarize clinical experience from centers allowing HH 
donors, and demonstrate that blood from HH patients is safe and should be 
allowed into the donor pool. We conclude that there is no convincing evidence to 
exclude this population from serving as blood donors. (Hepatology 
2018;67:1150-1157).