A 39-year-old male was referred to our service for treatment of an asymptomatic mediastinal mass. The mass was detected on a routine pre-employment chest X-ray. CT scan showed a well-defined soft tissue mass measuring 7.5× 5.5×5.3 cm in close relation to the right border of the heart. A CT-guided biopsy proved to be inconclusive as necrotic tissue was obtained. At exploratory thoracotomy, a well-defined cyst was found attached to the right side of the pericardium. The cyst was totally excised and sent for histopathological examination which came back with a surprise diagnosis of epidermoid cyst.

A unit of apheresis PLTs was collected from a 35-year-old volunteer donor after a high-fat meal-a hamburger for lunch. The donor weighs 270 lbs. A follow-up call revealed that he has been diagnosed with elevated cholesterol in the past. Previous apheresis PLT donations were not lipemic. A complete blood count result was acceptable for PLT donation criteria. The apheresis procedure was completed successfully. On gross evaluation of the unit at the transfusion medicine service, the appearance of the PLT concentrate was yellowish white, commonly described as "milky." PLT concentrates from donors who recently have eaten a fatty meal are often observed to be milky. Chemistries obtained from a sample taken from the PLT concentrate concluded that the triglyceride level was elevated to 1303 mg per dL (normal range, 35-160 mg/dL) with a normal cholesterol level. Although PLT concentrates with this visual appearance are considered acceptable for transfusion, some of our clients such as nurses and patients often question their safety and verify their acceptability and quality before infusion by calling the transfusion service. This particular unit was discarded.We believe that it may be timely to reconsider and have a second look at our donation practices. Should we advise donors to refrain from eating fatty foods before donation? This is an important issue for donor health, selection, and recipient confidence. In the United Kingdom, such donations are not released for issue. The donor of a milky unit is advised not to eat fatty food before donation.

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