Donor Selection and Deferral

Teaching Aims You will learn to properly select and defer the donor taking into consideration that the donor and patients should not suffer in any way but benefit from the blood donation Learn to identify any factors that might make an individual unsuitable as a donor, either temporarily or permanently. And advise them appropriately.

Donor Selection and Deferral Donor selection is critical to the success of supply of safe blood & its products Protect the donor - Ensures that it is safe for the donor to donate Protect the recipient - Ensures that any risk of transfusion transmitted infection or other adverse effect is minimized

Donor selection Registration of Donor Selection has Four Major Components: Questionnaire about illness. Demographic information & consent for blood donation Physical examination Simple laboratory tests

Responsibility Medical officer, SR/ JR posted in the blood donation complex or camps is responsible for determining the suitability of the donor to donate blood.

Donor Selection Examination of various parameters Trained staff Controlled and validated methods Calibrated and maintained equipment Controlled materials All activities and outcomes are documented Monitoring and evaluation

Donor registration  Must allow full identification and link to donor to current and previous records.  Current information with each donation.  Must be possible to notify donor of any abnormalities in physical exam, medical history or post-donation laboratory tests.

Donor registration should include  Donation date and time.  Last and first name (middle initial if available).  Addresses.  Telephone numbers.  Gender.  Age (or DOB).  Previous deferral record must be consulted.  Confirm identification and source of identification if possible.

Demographic data Donor residence, place of birth and education Donors occupation Date of last donation, if any

Medical history Medical history should be taken by trained health care professional It must be assured that the confidentiality of the donor should be maintained Direct questions or leading questions are allowed in the interview

Medical History  Have you ever donated blood under a different name?  In the past 3 months, have you donated blood?  Have you donated platelet or plasma within hours?  Have you ever been refused as a blood donor or told not to donate blood?  Have you ever had cancer, a blood disease or bleeding disorder?  Have you ever had jaundice, liver disease or positive test for hepatitis?  Have you ever been given growth hormone?

Medical History  Are you feeling well and healthy today?  In the past 3 months, have you had malaria?  In the past 1 year, have you been under a doctor’s care or had a major surgery?  In the past 1 year, have you received blood or had an organ or tissue transplant?  In the past 6 month, have you had tattoo, skin piercing or accidental needle stick?  In the past 1 year, have you had close contact with a person with jaundice or hepatitis?

Medical History In the past 1 year, have you had a positive test for syphilis? In the past have you given money to anyone to have sex with you? For female donors: Are you pregnant? Or had abortion in the past 6 months In the past 4 weeks, have you had any vaccination? In the past 3 days, have you taken aspirin or anything that has aspirin in it?

Medical History  Male donors: have you had sex with another male ever?  Female donors: have you had sex with a male who has had sex, even one time, with another man?  Have you ever taken clotting factor for bleeding disorder?  Have you had a positive test for HIV/AIDS?  Are you giving blood to be tested for HIV/AIDS?  Have you had any symptoms of HIV/AIDS or weight loss?

Physical Examination  General appearance of donor  Determination of hemoglobin Autologous donor Hb g/dl Hct 33-52%. All other type donors Hb g/dl Hct 38-52%.  Pulse  beats/min  Blood pressure  Diastolic mm Hg  Systolic mm Hg

Physical Examination Temperature: Maximum C Donor weight: Minimum 45 Kgs Amount of blood to be drawn  55 Kg – 450ml Kg – 350ml Venepuncture: Inspection of the site of venepuncture

DONOR SELECTION FOR PLATELETPHERESIS  Donor should meet all the acceptable criteria.  The weight of the donor should be >50 kg.  Should be non-reactive for all the TTIs.  Pre-procedure platelet count should be>150,000 per micro- liter.  Donor should not have taken aspirin or any other platelet inhibitor in last hours.  The donor should not be fasting or have had heavy food.  Should have a prominent and easily accessible central antecubital vein

Donation interval  The minimum time gap between two blood donations should be 3 months  Interval between two Plateletphersis is hrs. Not more than two procedures to be done in a week.  Whole blood donation must be deferred for at least 72 hours after plateletpheresis  In case of re-infusion failure after pheresis procedure, donor should not donate whole blood for 3 months

Conditions excluded on medical history to protect the health of recipient  Signs/symptoms suggestive of HIV/ AIDS  Jaundice / hepatitis  Malaria  Cancers  Lung disease / tuberculosis  Thyroid disorders  Recent history of:  Medication, Vaccination, Surgery  Blood transfusion, Acupuncture  Contact with infectious disease  Tooth extraction, Sepsis Donor Deferral on Medical History

 Signs/symptoms suggestive of HIV/ AIDS  Jaundice / hepatitis  Malaria  Cancers  Lung disease / tuberculosis  Thyroid disorders  Minor Surgery  Major Surgery  Blood transfusion, Acupuncture  Contact with infectious disease  Tooth extraction, Sepsis Permanent permanent 3 months permanent 6 months One year 6 months Conditions excluded on medical history to protect the health of recipient

Conditions excluded on medical history to protect the health of donor  Anemia  Low / high blood pressure at the time of donation  Heart disease  Bleeding disorders  Epilepsy  Rheumatic fever  Diabetes Mellitus on Insulin  Kidney disease  Pregnancy  Breast feeding  Menstrual problems Donor Deferral on Medical History

Temporary Deferral of Donors Pregnancy or Delivery Abortion Breast feeding Cold, cough, flu,. Chronic sinusitis Asthmatics Acute Renal Infection 6 months post delivery 6 months Until baby is weaned Until symptoms subside No deferral unless using antibiotics If taking medication and 1 week after attack One week after stopping the treatment and when donor is symptoms free

Temporary Deferral of Donors (vaccination ) Small pox, polio-oral measles, mumps, yellow fever Rubella Anti-serum for tetanus, Diphtheria, gas gangrene, venom etc Rabies vaccination ( Post- exposure) Hepatitis B vaccination 2 weeks 4 weeks 1 year 1 week

Drug History Donors taking : Oral contraceptives/ Analgesics (not for platelets)/ Vitamins, mild sedatives, drugs for hypercholesterolemia may be accepted Isotretinoin/ Finestride- 1 month after last dose Cortisone – 7 days after last dose Antibiotics – 3 days after last dose For uncertain medication-Deferral at the discretion of the screening Doctor after taking a detailed history.

Permanent Deferral of Donors Cardio-vascular Diseases Chronic infection Ulcer disease ( GIT ) Chronic liver disease Endocrinal disorders Epilepsy/ Mental/ Neurological disorders H/o Hepatitis B or C Any signs/symptoms suggestive of AIDS such as– Unexpected weight loss, Persistent diarrhea, lymphadenopathy >1month

Permanent Deferral of Donors Chronic infectious disease: TB, Leprosy Any H/o a Bleeding Disorder H/o Cancer Polycythaemia vera G6PD deficiency Thalassemia/ Sickle cell anaemia. (thalassemia trait may be accepted) Drug History Donors taking: Anti-arrhythmics, anticonvulsants, anticoagulants, cytotoxic drugs.

Private Interview (High Risk Behaviour) If there is a history of multiple sexual partners or sex with Commercial Sex Workers, the donor should be deferred permanently. High risk donors such as long route drivers, jail inmates, homosexuals, I/V drug abusers are to be deferred permanently.

That the donor has under stood all the donor information presented, and have all his questions been answered? That his blood would be tested for Transfusion Transmitted Infections(TTI). That if the screening tests are non reactive, he/she may still transmit TTI. Whether the donor wants to be informed about abnormal test results? SIGNATURE____________________ DATED________________________ Informed consent

Documentation The following documents are to be entered: Donor Screening and Registration Form Donor Deferral Record Register Donor Record Register

Donor Deferral Record Register Name Age/Sex Address Occupation Blood Pressure Weight Hemoglobin First time/Repeat Donor Reason for Deferral Period of Deferral

Donor Record Register  Registration Number  Tube segment Number  Name of Donor  Father’s Name  Age/Sex  Address  Date of Collection  Date of Expiry  Blood Group  Signature of Doctor  Signature of Phlebotomist  Weight  Blood Pressure  Hemoglobin  Type of Donation VD/RD  Type of Bag  Volume of collection  Time of collection  Duration of collection  Adverse Event /comments

Registration & demographic data Hb & weight Low Temporary Deferral & counseling OK Medical history & counseling Permanent deferral Temporary Deferral & Counseling Physical examination OK to donate Phlebotomy Successful Post donation Instruction & refreshments Temporary or Permanent deferral Un Successful DONOR ARRIVES Future Plan

Learning Outcomes Enabled to properly select and defer the donor taking into consideration that the donor and patients would not suffer but benefit from the blood donation