• 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 transmittedinfection 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 48-72

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 11-18 g/dl Hct 33-

52%.

• All other type donors Hb 12.5-18 g/dl Hct 38-52%.

Pulse 60-100 beats/min

Blood pressure Diastolic 60-100 mm Hg Systolic 100-160 mm Hg

Physical Examination

• Temperature:• Maximum 37.5 0C

• Donor weight:• Minimum 45 Kgs• Amount of blood to be drawn

55 Kg – 450ml• 45- 54 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 48-72 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 48- 72hrs. 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 disordersMinor SurgeryMajor Surgery Blood transfusion, Acupuncture Contact with infectious disease Tooth extraction, Sepsis

Permanent

permanent3 monthspermanentpermanentpermanent6 monthsOne year6 months6 months6 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 DonorsPregnancy 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

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 & weightLowTemporaryDeferral &counseling

OKMedical history &

counseling

Permanentdeferral

TemporaryDeferral & Counseling

Physicalexamination

OK to donate

Phlebotomy Successful

Post donationInstruction &refreshments

Temporary or Permanent

deferral

Un Successful

DONOR ARRIVES

FuturePlan

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