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treatment, primarily venesection, aspirin and cyto-reductive medication, selected cases may be
considered for restricted certification.
ACUTE LEUKAEMIA
Acute leukaemia of any type should be considered disqualifying. Depending on the specialist’s report,
cases in remission may be considered for restricted certification.
ICAO Preliminary Unedited Version — November 2009 III-5-3
However, treatment of leukaemia often involves use of very toxic medicines as well as high doses of
radiation or even bone marrow transplantation. Some antineoplastic medicines are known to be
cardiotoxic, especially antracyclines like doxorubicin and daunorubicin. Particular attention therefore
needs to be paid to applicants with a previous history of succesful leukaemia treatment to exclude the
long-term consequences of such treatment, which can include subtle cardiac abnormalities, pulmonary
fibrosis, cataracts, and endocrine dysfunction (including hypothyrodism).
CHRONIC LEUKAEMIA
Chronic myeloid leukaemia (CML), like other myeloproliferative diseases, is usually an aggressive
condition with very high white cell counts and systemic illness, associated with an enlarged spleen with
the risk of splenic infarction and spontaneous or traumatic rupture. The typical course of CML is
progression over three to five years with development of an acute blast crisis in the final stage.
An applicant with a confirmed diagnosis of CML should normally not be considered for certification. In
the early stages of the disease, restricted certification may sometimes be possible, provided there is no
haemolytic anaemia and no requirement for chemotherapy or corticosteroids. Frequent review by an
haematologist is necessary.
Chronic lymphocytic leukaemia (CLL) is a relatively benign condition which often requires no treatment.
Applicants with CLL may be assessed as fit provided they remain well and do not need any medication
although periodic review by an haematologist would be indicated.
LYMPHOMAS
Applicants with lymphoma should be considered on an individual basis.
Lymphomas in remission, especially Hodgkin’s Disease2, may be considered for restricted certification
after a disease-free period of at least two years after completion of treatment. Certification should be
dependent on regular annual specialist’s reports.
BLEEDING AND THROMBOTIC DISORDERS
Applicants with a thrombocytopenia under 75 000/mm3 (75×109/L) are unfit for certification. The
condition may be temporary, e.g. in persons with iron deficiency anaemia or alcoholic bone marrow
suppression, and in such cases a fit assessment is possible once the thrombocyte count is normalized.
Applicants with idiopathic thrombocytopenic purpura, treated by splenectomy and with stable platelet
counts for six months, may be considered for certification after cessation of therapy. Platelet counts
should be repeated every six months.
Applicants with an inherited coagulation disorder or any history of factor replacement should normally
be considered unfit for certification. However, bleeding disorders are classified as severe, moderate and
mild according to the level of the deficient factor. Severe and moderate cases of factor VIII deficiency
(classical haemophilia) entails unfitness for professional flying. Mild cases of haemophilia may be
2 Hodgkin’s disease: a form of malignant lymphoma, characterised by painless, progressive enlargement of the
lymphnodes, spleen and general lymphoid tissue. After Thomas Hodgkin, English physician (1798-1866).
ICAO Preliminary Unedited Version — November 2009 III-5-4
considered if there is no history of significant bleeding episodes. Also mild cases of von Willebrands
disease3 may be compatible with certification.
A history of deep vein thrombosis requires a full haematological investigation for underlying pathology
before certification. A history of pulmonary embolism entails unfitness until at least six months after the
completion of the anticoagulant therapy. Applicants with recurrent pulmonary embolism are unfit.
The use of oral anticoagulant medicines such as coumarin and warfarin is always incompatible with
certification. The use of low molecular weight heparine in low dose may be considered acceptable by the
Medical Assessor. The use of anti-platelet agents such as acetylsalicylic acid (Aspirin®) in low dose is
not disqualifying whereas use of more potent anti-platelet agents such as clopidogrel is a bar to flying.
HAEMOGLOBINOPATHIES
The haemoglobinopathies and allied disorders, which all result from inherited abnormalities that affect the
function of human red blood cells, have potentially important effects with regard to medical fitness of
licence applicants.
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Manual of Civil Aviation Medicine 1(145)
