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DEAR DR. ROACH: When my mother discovered she has a factor V mutation, everyone in the family decided to be tested as a precaution. This is a hereditary item, which I am sure you know. It was determined that I carry the gene. I am 65. I have had no issues, and it probably never would have been discovered if we did not go looking for it. This was discovered over 10 years ago and is listed on all my charts. I would like to donate plasma for extra money. I am not on any type of blood thinners except for a baby aspirin every morning. I take a statin for cholesterol control. Can I donate my plasma? – S.S.
ANSWER: Factor V is a blood clotting factor made in the liver. A common mutation in the gene, called factor V Leiden, confers a small increased risk to developing blood clots. People with factor V Leiden and who have never had a blood clot are generally not started on medication to prevent one; however, they may need more aggressive prophylactic treatment to prevent a clot at a time of surgery, for example. Although some experts use aspirin in this situation, there is not good evidence to support it.
People with factor V Leiden may donate blood, platelets or plasma safely, as long as they are not on an anticoagulant such as warfarin.
Only a very few medicines prevent people from donating blood. In addition to anticoagulants, these include medicines that can cause serious birth defects (such as Accutane, used for acne; finasteride and dutasteride, used for prostate enlargement and baldness; and Aubagio, a treatment for multiple sclerosis) and those which might cause infection risk (human-derived growth hormone).
DEAR DR. ROACH: I am 87 and take 10 mg of melatonin every night to help me sleep. I have heard it is perfectly safe. Are there any side effects to melatonin? I know a lot of people who take it, including a child who takes 3 mg. – B.D.
ANSWER: Melatonin is a hormone secreted in the pineal gland of the brain that affects sleep and circadian rhythms. At nighttime, melatonin blood levels are 10 times higher than in the day. Melatonin is used extensively as a sleep aid, as you can confirm.
There is no substance you can put in your body that is perfectly safe at all doses. To paraphrase a wise man, anyone who tells you differently is selling something. However, the risk of major side effects with even high doses of melatonin is low. The major adverse events reported were headache, fragmented sleep and seizures. Rare adverse events reported included confusion, psychosis, autoimmune hepatitis and rash.
Incidentally, the term “side effect” means an unintended effect that occurs from a drug when taken correctly. “Adverse event” refers to any undesired reaction that comes with taking a medication. Adverse events are more common at high doses. With very high doses of melatonin can come additional types of reactions, including poor memory and reduced physical exercise performance.
Ten mg is far more melatonin than I recommend starting with. For older people, I recommend 0.5 mg to 1 mg about an hour before bed. Higher doses are generally not more effective and have higher risk.
Dr. Roach regrets he is unable to answer individual questions, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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