Copyright © 2011 by the Department of Health - National Voluntary Blood Services Program (DOH-NVBSP) Published in the Philippines by the Department of Health - National Voluntary Blood Services Program (DOH-NVBSP) Department of Health - National Voluntary Blood Services Program (DOH- NVBSP) Bldg. 19, Ground Fir., San Lazaro Compound, Sta. Cruz, Manila Telephone/Fax: (682) 731 8465, 651 7800 Local 2900, 2901 Website: www.nvbsp.com All rights reserved. Any part of the whole book may be reproduced or transmitted with permission from Department of Health provided it is not sold commecially and without any alteration in any form or by any means. Printed in the Philippines ISBN : 978-971-0597-08-6Republic of the Philippines Department of Health OFFICE OF THE SECRETARY FOREWORD In its continuing effort to promote adequacy, accessibility, safety and quality of blood and blood products, the National Voluntary Blood Services Program (NVBSP) came up with this Manual on Blood Donor Selection and Counseling. This manual was designed to aid the health providers and advocates in applying the standards essential to the selection and screening of potential blood donors, and in the pre- and post-donation counseling. It contains the revised Donor History Questionnaire (DHQ), the DHQ Flowchart and the A-Z Guide to Medical Assessment of Blood Donors which are crucial to efficient selection and screening of blood donors Blood donation requires altruistic intention to help patients in need of blood transfusion therapy. Thus, data and information on the risks of transfusion transmissible infections are also included in this manual. This serve as a guide in deferring the blood donation process for individuals who are suspected to have such infections and so they could be properly advised on the need to manage the infection and to have their blood tested first to ensure the safety of prospective blood recipients. The Confidential Unit Exclusion (CUE) and the list of Voluntary Counseling and Testing (VCT) centers provided in this manual could aid in having the suspected individuals, especially those who are infected with the Human Immunodeficiency Virus (HIV), to voluntarily suspend the donation and for these persons to be guided on where to go for the appropriate medical interventions. It is with high hopes that this Manual on Blood Donor Selection and Counseling will be used extensively in blood service facilities to ensure that blood supplies are safe for the protection of patients needing blood transfusions ENRIQUE T. ONA, MD, FPCS, FACS Secretary of HealthACKNOWLEDGEMENT SIXTO P, ARLEGUI, III, MM President Philippine Blood Coordinating Council MA. RIZALINA S. CHUA, RMT Consultant St. Luke's Medical Center ‘Metropolitan Hospital ANTONIO F. DOMASIAN, JR., RMT Medical Technologist Philippine Children’s Medical Center REX V. FADRIGO, RMT Medical Technologist Philippine General Hospital GODWIN N. HERNAEZ, MD, FPSP Pathologist Veterans Memorial Medical Center DOREEN P. LABAYANDOY, MD, DPSP Pathologist General Emilio Aguinaldo Memorial General Hospital MICHAEL ANGELO F. MARQUEZ, MD Philippine National Red Cross ~ National Blood Center SANDRA B. RIVERA, RMT Medical Technologist Capitol Medical Center SHIREEN SANTIAGO, RMT Medical Technologist Bulacan Blood Center iiMILAGROS D. SISON, RMT Medical Technologist Philippine General Hospital ELIZA B. VALDEZ, MD, FPSP, MHA Blood Bank Head Dr, Jose Reyes Memorial Medical Center Technical Working Group MA. MYSTICA FLODALYN BAUTISTA, MD FPSP Board Member Philippine Blood Coordinating Council MA. LOURDES U. CONCEPCION, MD, EPSP Blood Bank-Head Philippine Children’s Medical Center ELIZABETH Y. ARCELLANA-NUQUI, MD, FPSP Chairman, Committee on Professional Education National Council for Blood Services IMELDA F. PALACOL, MD, FPSP Blood Program Coordinator Provincial Health Office (PHO) ~ Laguna PEDRITO Y. TAGAYUNA, MD, DPSP Medical Specialist IIT Philippine Blood Center MILAGROS M. VIACRUCIS, MD, MPH Regional Blood Program Coordinator Center for Health Development (CHD) - Southern Mindanao |MANUEL L, BARNES, MD, FPSP Blood Bank Head Veterans Memorial Medical Ceater SALVADOR P. AYDANTE, RMT Medical Technologist III Philippine Blood Center MARITES B. ESTRELLA, RN, MM Technical Component Manager Department of Health -Global Fund Round 6-HIV Project Secretariat ANNA-LEAH D. DIPATUAN, MPA - Site Implementation Officer Department of Health -Global Fund Round 6-HIV Project RAMIL P, ESGUERRA Liaison Officer AIDS Society of the Philippines1 ul Iv VI. vi. VuL. Ix XI Table of Contents FOreWOrd .ossesnssts Acknowledgment Table of Contents. General Principles for the Selection of Donors... Blood Donor History Questionnaire... Donor History Questionnaire User's Guide... Donor History Questionnaire Flow Chart Blood Donor Counseling msmsnnusnnensnnsmnnan Appendices A. Code of Ethics for Blood Donation and Transfusion en 69 B. Social Hygiene Clinic, Voluntary Counseling and Testing Centers and Treatment HUDS vascnennmnennne : C. A-Z Guide to Medical Assessment of Blood Donors Timing of Blood Donation when Medications are being taken bY DONOFS wes sie BT ‘Timing of Blood Donation When Donor Received Vaccine D,Basic Information Before Blood Donation E, Tranfusion Trasmissible Infections Harm Reduction Strategies ......... F, 2010 Report on the Global AIDS Epidemic........ 9S Acronyms 103 ReferencesGeneral Principles for the Selection of Donors 1,0 Introduction 2.0 Volunteer Status of Donors ‘The main purpose in selecting individuals for blood donation, or one of the components of blood, is to determine whether that person is in good health. This ensures that the donor is protected against damage to his/ her own health and that the recipient is protected against the transmission of disease, or the administration of blood products. that could be detrimental to the recipient. Ut shall be recognized that the donor selection process contributes significantly to the safety of blood and blood products derived from large plasma pools. ‘As a general rule, only persons in normal health with a good medical history and absence of high risk behavior associated with transfusion -transmissible infections shail be accepted as donors of blood er a component of blood for therapeutic use, In the provision of blood services, all concerned personnel shall observe the International Soci- ety of Blood Transfusion's (ISBT) Code of Ethics for Blood Donation and Transfusion (See Appendix A). ‘The Philippine National Blood Services has adopted the World Health Organization (WHO) definition of voluntary non-remunerated blood donation: “Donation is considered voluntary and non-remunerated if the person gives blood, plasma or cellular components of his/her own free will and receives no payment for it, either in the form of cash, or in kind which could be considered a substitute for money This would include time off work other than that reasonably needed for the donation and travel. Small tokens, refreshments and reimbursements of travel costs are compatible with volun- sary, non-remunerated donation.” 3.0 Informed Consent for Donation ‘Biood Donor Informed consent for donation is a legal and ethical requirement, This implies one's will ingness to donate blood given by a mentally competent person “who has received the necessary information; who has adequately understood the information; and who, after considering the information, has arrived at a decision without having been subjected to coercion, undue influence, or intimidation”. This protects a person’s freedom of choice and respects the person's autonomy.General Principles for the Selection of Donors ‘To obtain blood donor's written informed consent or assent (in the case of blood donors less than 18 years of age), relevant information materials shall be readily available to all potential donors during the recruitment process to enable them to decide whether giving blood is in accordance with their personal interest. A mechanism shall be set in place that allows and encourages the donors to ask questions or seek clarifications . Provision for signed consent is included in the Donor History Questionnaire (DHQ) The donor shall also be made to understand that all personal information includ- ing the results of tests will be kept confidential, If the donor consents, signifi- cantly abnormal findings during physical examination and blood testing will be communicated to the company physician or city/municipal health officer or to a physician of his/her choice. The donor shall also understand that the blood cen- ters are using screening tests and not confirmatory/ definitive tests. As such, there are false positive and false negative results, ‘The donor shall understand that following donation, the blood service facility will assume stew- ardship of the donated gift. The blood center undertakes to manage the gift in a responsible manner and to protect the gift status at all times The donor shall have an opportunity to ask questions and withdraw from giving blood without being exposed to undue embarrassment. The approach to the donor screening adopted in each blood service facility must take into account any special social, cultural and health issues which may have an impact on selection of donors who can provide safe blood products. For a blood donor who is not of legal age (less than 18 years old), a written informed consent shall be obtained from anyone of his/her parents or legally authorized representa- tive (LAR). Relevant information materials shall be provided to the parents or LAR before the informed consent is obtained . The written informed consent thus obtained shall be attached to the donor’s DHQ during the blood donor identification and registration prace- dure of the blood donor screening process. 4.0. Notifications of Significant Findings Results of test for HIV shall not be released unless confirmed by the National Reference Laboratory - the Research Institute of Tropical Medicine (RITM). For units confirmed to be HIV positive, the donor shall be initially counseled and referred to HIV Support Services (like ‘Counseling5.0 6.0 General Principles for the Selection of Donors the HIV/AIDS Core Team) for further management if he/she agrees (See Appendix B) It is emphasized that confirmed Hepatitis B, C, Syphilis and HIV are reasons for permanent deferral. Those with confirmed hepatitis B and hepatitis C are referred to and encouraged to join the Liver Study Group in DOH hospitals. Privacy and Confidentiality Handling of all donors and donation records shall be in accordance with the principle of respect for personal privacy or person's dignity - that is, all personal information must be kept confidential All personal information inciuding the results of tests shall be kept confidential, The Staff in the Blood Services shall ensure that the blood collection venues provide audio privacy that allows the donor to complete the questionnaire in a private and confidential environment. The same principle shall apply-to the donor interview. Whole Blood Donation 6.1 Frequency of Donation It is the policy of the Philippine National Blood Services (PNBS) that donors of whole blood may normally donate every twelve weeks In special circumstances (example, patient needing rare blood type) a medical officer on an individual basis may modify the frequency of donation. The guidelines produced by the Council of Europe are identified below. + For males, up to six standard whole blood donations may be taken per year + For femates, up to four standard whole blood donations may be taken per year It is recommended that these donation rates never be exceeded under any circumstances, The number of donations accepted from any individual donor has to be determined after careful consideration of his weight, dietary habits and with the knowledge that extra care beyond routine hemoglobin estimation may be necessary in the monitoring of donors for iron deficiency. ae 5 Blood Donor Scletion and Counseling ManGeneral Principles for the Selection of Donors 6.2 6.3 6.4 65 6.6 6.7 Quantity of Donation A standard donation is 450ml! + 10% (405 ml to 495ml) exclusive of anticoagulants. Blood bags intended for a collection volume of 450ml + 45ml (i.e. 405ml-495ml) of whole blood contains 63ml of anticoagulant No more than 10.5mi/kg body weight shall be taken as whole blood during one blood donation. Age of Donor The age acceptance ranges are: + New donors between the ages of 16 ~ 60 years (before 61* birthday) + Regular donors may be accepted up to 70 years (before 71* birthday) subject to evaluation by a medical officer. + Lapsed donors (i.e, those donors who have not donated in the previous year) who are over the age of 60 years are eligible to donate subject to evaluation by a medical officer. Weight A standard whole blood donation may be collected froma regular ‘donor weighing 50 kg after assessment by an experienced medical officer. Hazardous Occupations Hazardous occupations and hobbies shall normally entail an interval of not less than 12 hours between donation and returning to the occupation or hobby. Examples of such hazardous occupations or hobbies are piloting an aircraft, driving a bus or train, operating crane and other heavy equipment, climbing of ladders or scaffolding or coconut tree, gliding, and diving. Post-Partum and Breastfeeding Women Post-partum women may donate blood one year after delivery or three months after weaning, whichever is longer. Women who breastfed, including non-mother surrogates shall be deferred for a minimum of three months after weaning. Donor Medical History The donor's medical history shall be evaluated using the donor history questionnaire and shall be thoroughly examined by a qualified medical officer who shall have the final decision on ‘Counseling Manual Blood Donor Selection.6.8 6.9 General Principles for the Selection of Donors whether blood shall be collected from « donor. If the medical officer is in doubt, the donor shali be deferred The A-Z Guide to Medical Assessment of Blood Donors (See Appendix C) provides more specific criteria for acceptance or deferral A history of infection or an exposure to risk of contacting infections is of particular importance in maintaining the safety of blood and blood products used for transfusion. Medications taken by prospective donors may indicate ground for deferral or acceptance with qualifications. A listing of medications to assist in the donor selection and exclusion of use of donations for the production of some components e.g. platelet concentrate, is provided in the A-Z Guide to Medical Assessment of Blood Donors Donor History Questionnaire The donor must be asked to complete and sign a copy of the Donor History Questionnaire (DHQ) on every occasion that he/she attends to donate. The DHQ must be completed and signed by the donor. The person who carries out the medical interview signs the box to certify that the donor has read the Blood Safety Information Kit and that relevant questions have been addressed The DHQ shall include an option for Confidential Unit Exclusion (CUE) for donors who are pressured to donate blood or who are able to recall at-risk behavior/exposure to risk factors during or after blood donation. The DHQ will define the audit trail of donation clearly linking the donor to the donation. DHQs shall be kept for at least 10 years, ideally for the lifetime of the donor, and shall include the donation number and the donor ID number. Donor Interview Donors must completely answer the DHQ except where a reading disability exists. The donor must also undergo an interview where the DHQ is reviewed by the medical officer. The interview shall Blood Donor Salection and Counseling Manual 7be performed in a private environment where there is at least audio privacy and in a manner that allays apprehension and allows time for discussion or explanation and for the donor to ask questions Stl tatoe etait Privacy and confidentiality must be observed at all times. | 6.10 Donor Appearance A complete medical and physical examination of blood donors is | | | | generally not possible in practice. The interviewer has to rely upon the donor's answers to some simple questions concerning his/her medical history and general health, combined with a simple inspection of the donor's appearance and an examination of the heart and lungs . The donor’s appearance has to be judged by a suitably qualified person like a medical officer trained to use accepted guidelines for the selection of blood donors. Special note shall be taken of plethora, poor physique, debilitation, under-nutrition, anemia, jaundice, cyanosis, dyspnea, mental instability, and intoxication from alcohol or narcotic drugs. The skin at the potential venipuncture sites shall be free of lesions. Persons clearly under the influence of alcohol shall be deferred until sober. Tilicit drug taking if admitted or suspected shall debar the person from donating. 6.11 Blood Pressure and Pulse Rate It is recommended that pulse rate (full minute) and blood i pressure be determined in all donors. The pulse rate shall be i regular and between 60 and 100 beats per minute. It is recognized i that the blood pressure is subject to a number of variables but as a guide, the systolic pressure shall not exceed 160mm and the | diastolic pressure - less than 100mm | 6.12 Hemoglobin Estimation The hemoglobin level shall be determined each time the donor presents himself/herself. using a validated procedure. The minimum values before donation are: + Female donors: 125g/L + Male donors: 135g/L | The hemoglobin of the donor must be measured at every attendance 8 ‘Blood Donor Selection and Counseling Menual |Gen Principles for the Selection of Donors The maximum values before donation are: + Female donors: 175g/L. + Male donors: 185g/L 7.0 Pre-Donation Counseling Objectives of donor information and counseling: To maintain safety of blood supply and quality of blood products >» Enable self-deferral by persons with high-risk behavior or have traveled to high-risk areas; > Identify medications being taken/have been taken by the blood donor that may affect the quality of the blood product; To protect the health of the donor To fulfill ethical requirement Pre-donation information, whether written or oral, or both is given to blood donors before donation to allow for informed consent and self-exclusion. This is a routine step in donor selection in every blood donation. (See Appendix D) Pre-donation information includes: Donor’s rights and responsibilities Blood donation process Potential donation-related complications Tests performed on donated blood > Do not emphasize this during advocacy/peptalk to discourage test- seeking behavior. Procedure in the event of a positive test result Donor confidentiality Importance of regular donations Donation intervals TTIs and how they can be avoided High risk behavior Window period of infection ~ that an asymptomatic infected person can transmit the infection to the patient who received his blood donation Importance of maintaining a healthy lifestyle Means of self-deferral > Voluntary self-exclusion > Confidential Unit Exclusion (CUE) Alternate testing sites for those at-risk or for those who want to be tested ‘Blood Donor Selection and Gouneeling Manual o8.0 9.0 Pre-donation counseling enables the donor to assess his/her own level of risk, and suitability as donor. Tt also includes educating the donor on maintaining healthy lifestyle, and on prevention of transfusion transmissible infections. During the pre-donation counseling the donor is re-directed to testing centers should he/she admit having high risk behavior, or having been exposed to high risk persons Post-Donation Instructions Post-donation instructions like post-donation counseling and information is part of donor care, It includes the following: + No smoking for more than one hour; + Drinking more than the usual amount of fluids (> 8-10 glasses 2 day); . Avoid lifting heavy weights or strenuous activities for 24 hours; + Leaving the dressing/bandage on for a minimum of four hours; + Applying pressure for 2 - 5 minutes on the venipuncture, in Case of recurrence of bleeding; and + Lying down with legs elevated, if the donor feels dizzy or lightheaded, ‘The donor is also encouraged to become a regular donor, to avoid high risk activities associated with transfusion transmissible infections and thus, contribute to blood safety. Directed Donations When a person seeks to receive blood from a named donor or a donor wishes to donate blood to be transfused to a named recipient, the practice termed “directed donation”, The request usually occurs within family relationships, in particular parents to children. There is no evidence that directed donations lead to improved patient care nor that they reduce the risk of acquiring transfusion-transmitted infections, There is the rare possibility of graft versus host disease if the donor is a close relative and the recipient is immunocompromised ~ e.g, an infant, a cancer patient, or a transplant patient, In this case, an irradiated blood product is indicated Blood Doner Selection and Counsaling ManusGen for the Selection of Donors Principk eee et ec enne ne fortes eeecuoe Deno, As a general principle, collection of directed donations is discouraged However, if a directed donation is collected, the procedures for collecting, testing, storing, handling and transfusing the unit shall follow the procedures recommended for allogeneic blood donations except as specified this section, In some circumstances, it may be necessary for the Blood Service Facility to seek a compatible donor from relatives. This practice is at the discretion of a Transfusion Medicine Specialist and involves a selected or dedicated donation not a directed donation. Persons who require repeated transfusions (like patients with thalassemia) are encouraged to have a pool of dedicated donors. Dedicated donors minimize antigen exposure and antibody reactions, delay refractoriness, and prolong efficacy of blood products 9.1 Informed Consent for Directed Donations ‘The full procedures involved in the collection and screening of blood donations must be explaincd to the donor. Donors shall also understand that if tests show abnormalities, they would be informed of these. Test-results shall only be communicated to-the-donor or donor's doctor if the donor agrees. When screening tests show abnormalities, the proposed recipient shall only be told that the blood is not suitable for the purpose for which it is required, No further details shall be given. 10.0 Apheresis Donors Apheresis is a procedure used to collect + Plasma (plasmapheresis) or + Cellular components (cytopheresis) which include: > Red cells > Platelets (plateletpheresis) > Granulocytes (granulocytopheresis) » Hemopocitic progenitor cells derived from peripheral blood Apheresis programmes must be undertaken under the supervision of the medical officer. All phases of the process (including the explanation of the process to donors and obtaining their informed consent) shall be performed under the supervision of the medical officer or by a trained personnel reporting to the medical officer.iples for the Selaction of Donors A donor shall be considered for apheresis procedures only where the procedures involved result in products or services shown to serve accepted medical purposes, including prophylaxis therapy and diagnosis, as verified by valid scientific evidence. Informed consent for involvement in an apheresis procedure is required. The prospective donor shall be provided with information on the procedure before initial screening is undertaken Although levels of circulating platelets and leucocytes recover promptly in donors, there is no data presently available to define the maximum numbers of platelets and leucocytes that can be safely collected. The long-term effects of the repeated removal of cellular elements are not known Apheresis donors shall normally meet the requirements for whole blood donation and exceptions to this must be authorized by the medical officer. Such exceptions will only be made when the plasma or platelets are of unusual therapeutic value and only when the medical officer, who is aware of the health status of the donor, has documented that the donor's health permits apheresis donation, In general, platelet and leucocyte donors shall meet the general criteria for donors and the specific criteria for plasma donors. Samples must be taken before the procedure is started and these shall be reviewed as soon as they are available In addition, platelet donors shall not have taken aspirin for 72 hours before donation or other platelet-active drugs (like non-steroidal anti- inflammatory drugs for 48 hours before donation) First-time platelet and leucocyte donors must be assessed by means of a medical examination as well as a detailed investigation of the donor's medical history by a medical officer or a suitably qualified person working under the supervision of the medical officer, 10.1 Age The age acceptance ranges are + First time apheresis donors between the ages of 18 — 60 years + Regular apheresis donors are accepted up to 70 years + Apheresis donors shall have donated at least one whole blood donation in the past two years prior to their initial donation by apheresis ‘Blood Donor Selection and Counseling ManualGeneral Principles for the Selection of Donors Donors who do not meet these criteria may be accepted at the discretion of the medical officer. 10.2 Donor Medical History Other than in exceptional circumstances (to be decided by a responsible medical officer) donors for apheresis procedures shall meet the criteria for ordinary whole blood donation. In addition, for apheresis donors, special attention shall be given to the following conditions: + Abnormal bleeding episodes + Adverse reactions to previous donations + Adequacy of venous access 10.3 Informed Consent The process of securing informed consent is similar to that of whole blood donors and directed donors, However, donors shall be made to understand that the blood collection takes about one and a half to two hours and is associated with more adverse reactions compared to whole blood donation like paresthesia, numbness and other signs of hypocalcemia that the donors shall alert the attending phlebotomist/physician during the procedure, 10.4 Medical Examination A medical officer must perform an evaluation as to the donor’s fitness { to undergo the procedure taking into consideration his weight and height 10.5 Laboratory Examination On at least an annual basis, all apheresis donors must have the following examinations: + A complete blood count + A total protein estimation + Protein analysis, such as determination of total serum or plasma protein and/or electropheresis and/or quality of single proteins, especially albumin and IgG * Total proteins shall not be less than 60g/L. The medical officer shall assess the donor's fitness to continue on the apheresis programme in the light of these laboratory investigations Blood Donor Selection and Counseling Manual |General Principles for the Selection of Donors 11.0 Platelates (Plateletpheresis) 11.1 Donor Medical History Special attention must be given to the taking of medications, in particular aspirin containing compounds, which interfere with the function of platelets. (See Appendix C) 11.2 Laboratory Examination A complete blood count shall be performed with every procedure. Donors for plateletpheresis shall normally have a platelet count in excess of 200 x 10° per litre 11.3 Frequency and Volume of Platelet Donation For routine provision of platelets by apheresis, the donor shall not be subjected to the procedure more than once every 3 days, When combining the collection of plasma with platelets in one apheresis procedure, the total volume of donor plasma and platelets shall not exceed 13% of total blood volume with a maximum of 650m!-(éxclusive of anticoagulant) unless fluid replacement is undertaken. | | 14 ‘Blood Donar Selection and Counseling ManualBlood Donor History Questionnaire Department of Health NATIONAL VOLUNTARY BLOOD SERVICES PROGRAM (BSF Name and Address) Blood Donor History Questionnaire DATE : Venue ‘ Name : Snape ae waa wae Date of Birth: j__f. Age — an Gender Qmaie Oremale Civil Status ;__ Contact number: E-mail address + Nationality i ‘Occupation Preferred Mailing Address Q) Home Address =: = Number, Seek and Saban Baranaay Zip Code : TET DTATER TiyiProwince QO office address Fer Tag ae Muna aod Sea SEE eee eee eee eee eee eee eee cee eee al eee sarang To TEE CHTPOTIRGE TYPE OF DONOR sQvo.unteeR = Qhothers METHOD OF COLLECTION ; Clwhole Blood (Conventional) Chapheresis Instructions : All donors must read the donor educational materials provided by the Blood Service Facility staff before answering. Yes No (Are you 1, Feeling healthy today? 2. Currently taking medication? |__Have you taken any medication from the defi |3. Have you received any vaccination? Irn the past three days lé Have you taken aspirin or anything that has aspirin int? Blood Ganar Selection and Counseling Mancar 7Blood Donor History Question: Yes QUESTION No. 5, FOR FEMALE DONORS: In the past 4 and ¥2 months (6 weeks) 5, Have you been pregnant or are you pregnant now? Last Menstruat Period: [in the past 12 weeks have you [6._Donated blood, platelet or plasma? ‘In the past 12 months have you |7._Hlad a blood transfusion : Had surgical operation, dental extraction? 19. Had a tattoo, ear or Dody piercing, accidental contact with Blood, neadle-stick Injury, and acupuncture? 0. Had séxual contact with high risk individuals? [TL Had Sexual contact with anyone In exchange for material or monetary Gali? 12, Had sexual contact with @ person who has worked abroad? 13. Engaged in casual sexi 14. Lived with a person who has hepatitis? TS; Have you been Imprisoned 46. Have any of your relatives had Creutzfeldt-Jacob (Mad Cow) disease? fave you ever [i7.Lived outside your place of residerice? HE. Livedt outside the Philippines: [15. Usec needles to take drugs, sterolds, or anything not prescribed By your doctor? | 20. Used clotting factor concentrates? ‘21. Had a positive test for the HIV virus, Hepatitis virus, Syphilis or Malaria? — Fact Hepatias? [23. Had malaria’ ‘24, Been told to Nave OF weated Tor genital Wart, SyBRIIS, gonorrhea or other Sexually Transmissible Infections? [25. Had any type of cancer, for exemple Leukemia? Had any problems with your heart and Tangs: 27. Had 2 bleeding condition or a blood disease? 28. Are you giving blood because you wanted to bé tested for FIV oF Hepatitis virus? 29. Are you aware that IF you have the HIV/Hepatts viris, you can give to someone else though you may feel well and have a negative HIV/ Hepatitis test? [BSFs may choose to add local questions here. Donors Signature ——_—_—eeeeeeSSSeeSeeseseseseseseesesess 18 ‘Blood Donor Selection and Counseling ManuatBlood Donor History Question’ “I certify that I am the person referred to in all the entries, which were read and well understood by me. It is my free and voluntary act to donate my blood, aware of its risks during and after extraction. The same have been explained to me in understandable language and dialect that I speak.” “Tam voluntarily giving my blood through ( name of BSF. ) I understand that my blood will be tested for Blood Type, Hemoglobin, Malaria, Syphilis, Hepatitis 8, Hepatitis C and HIV* and no official result will be released to me. If found reactive, I agree to be referred to the appropriate facility for counseling and further management. I certify that I have to the best of my knowledge, truthfully answered the above questions.” Donors Signature *Note: You may include other specific tests done in your BSF US ee ee ee ee CONFIDENTIAL UNIT EXCLUSION (CUE): If at any point during or after your blood donation, you realize that your blood may not be safe for transfusion, please inform the Blood Service Facility staff immediately. Please use your Blood Donation ID Number and the Segment Number written below in identifying your blood donation Contact number of Blood Service Facility : Segment Number eee eer eee eee eeeee eee eeeeeeeeeree reer Place Barcode Sticker of Donation ID No. here: [Blood Donor Selection and Gounaaling Manual 15 | |Blood Donor History Questionnaire FOR BLOOD BANK _USE ONLY PHYSICAL EXAMINATION Body weight : (kg) Blood Pressure :___ Pulse Rate : Temp: General Appearance : skin: HEENT : Heart and Lungs Remarks 2 Accepted Volume _ mi Q Temporarily Deferred 2 Permanently Deferred REASON/S FOR DEFERRAL Place Barcode Sticker of | Donation ID No. het Blood Bank Officer For Phlebotomist use only: Test Result Screened by: Biood Bag: (5) Single /(D) Double /(T) Blood Type pee Hemoglobin Segment Number Time Started Time Ended: PhlebotomistDonor History Questionnaire User's Guide ‘The Donor History Questionnaire (DHQ) User's Guide was designed to aid the donor interviewer in determining if a potential blood donor is eligible to donate, Each Blood Service Facility (BSF) must have a Standard Operating Procedure (SOP) related to donor eligibility to be used in conjunction with the User's Guide and the A to Z GUIDE TO MEDICAL ASSESSMENT OF BLOOD DONORS, ‘The DHQ Interviewer's Guide does not replace the A to Z GUIDE TO ASSESSMENT OF BLOOD DONORS and the BSF’s Standard Operating Procedures (SOP) on Donor Selection for determining donor eligibility. The DHQ User's Guide, the A to Z GUIDE TO MEDICAL ASSESSMENT OF BLOOD DONORS, and the SOP of BSF must be available to staff performing Blood Donor Interview. The DHQ must be administered on the date of donation . All potential blood donors must read the Blood Donor Information Before Donation (See Appendix D) prior to completing the DHQ. Valid identification card with picture and signature may be asked from the donor for verification. The following ID cards are acceptable: PRC card, current school ID, current Company ID, Voter's ID, Postal ID, SSS ID/GSIS ID, TIN ID, Driver's License or current Passport. ‘Methods of Administration ‘The method of administration of the DHQ should be in accordance with the BSE"s SOP. BSFs are reminded that donor screening is an active process involving open communication between donors and trained donor interviewers, and that donors should be encouraged to ask questions and concems at any time during the screening and donation process ration ‘The DHQ was designed for self - administration by the donor, with follow - up review by a trained donor interviewer. A knowledgeable interviewer should be available to the potential blood donor to answer any questions concerning eligibility or the donation process. Since donors may not be able to determine whether they will be deferred until the questionnaire is reviewed by a donor interviewer, they should be instructed to complete the entire questionnaire. However, there will be circumstances in which the donor decides not to complete the questionnaire, For example, the donor may realize that he/she is not eligible to donate, or may simply wish to leave prior to completing the questionnaire. Blood Bonor Selection and Counccling ManualUser's Guide Donor History Questionn: Other Methods of Administration Alternatively, the DHQ may be administered by a trained donor interviewer. It is essential that the donor be encouraged to ask questions and that all of the donor's questions are addressed by the donor interviewer. SOP of BSFs should require that donors be asked if they have any questions and if they have had their questions answered. This does not need to be a specific question on the questionnaire, but may be incorporated into the eligibility process and/or put into the donor consent. ‘The DHQ questions were composed for ease of understanding by the potential donor. The questionnaire, documents and procedure for use were designed, structured and are intended to be used together. The DHQ was evaluated for comprehension; therefore, the wording and the order of the questions should not be changed. The questions are grouped by time period beginning with a question about “Are you” and ending with questions relating to “have you ever.” BSF may choose to add local questions to the end of the DHQ. If a BSF chooses to add “local” questions, they should be grouped at the end of the DHQ in the area designated for additional questions. BSF’ should also use this area to incorporate new questions that are necessary due to new policies, This area should be used until such questions can be formally incorporated into the DHQ by the Technical Committee of the National Council for Blood Services (NCBS). ‘Blood Donor Selection and Counseling ManustDonor History Questionnaire User's Guide Blood Donor Personal Data Name : Sura Fat ane Fie hare Date of Birth : __/___/___ Age — mim) ad 7 yw Gender QMale GFemale Gvil Status: Contact number: E-mail address : Nationality: _ Occupation: Preferred Mailing Address a Home Address : o SEE Tans, Stee and Sibson warenaey Zip Code: __ Towra a Office Address : ass Foor aang Name ‘Namiter and Sree er eee eee Zip Code Baranoey “ewniboaice TYPE OF DONOR, : Q VOLUNTEER 2 Others METHOD OF COLLECTION : Whole Blood (Conventional) @ Apheresis oe * Except for Contact No. and e-mail address, all fields in the “Personal Data” are required fields. It is the responsibility of the Donor Interviewer to check the completeness of data, * Home address must include the House Number, Street Name and Subdivision followed by the Barangay, Town or District and City or Province. + ZIP Code is a required field, The BSF must have @ ready list of ZIP codes in thelr vicinity or Mobile Blood Donation (MBD) sites. * In the TYPE of DONOR sub-field others, the biank line that follows may be used to contain the name of patient if the DHQ is used by a replacement donor. * The field METHOD of COLLECTION was added to promote awareness about apheresis, Interviewer should be able to answer queries pertaining to this Reformatting Materials: To maintain uniformity of the DHQ, all BSF shail use the same format of the DHQ i.e. page formatting, number of column, font, etc .Donor History Questionnaire User's Guide ‘The DHQ uses capture questions that may tequire intervention or follow - up from the donor interviewer. Capture questions are questions that cover a broad topic, and when an affirmative answer is given, adds tional follow-up questions to elicit additional information are asked by the interviewer. Some follow-up questions are included in the User’s Guide, an affirmative response to some questions may require consultation with the BSF’s SOP. BSFs may implement more restrictive deferral policies than described in the User’s Guide per their local SOP. Attention Question: Additionally, in order to assure that donors who self-administer a paper DHQ maintain focus, “attention” question is included . An example of an attention question is cited below. Are you aware that if you have the AIDS/Hepatitis Virus, you can give it to someone else though you may feel well and have a negative HIV Hepatitis test? Each BSP must define the action of the donor interviewer when a donor inappropriately answers, the attention questions. Attention questions may not be necessary when using other techniques to assure donor focus, such as oral screening by a donor interviewer Documentation: (nformation impacting donor eligibility obtained during follow-up questioning should be meticulously documented on the DHQ . I a donor is determined to be ineligible during follow-up questioning, the reason for deferral should be documented in an area in the DHQ next to the specific question, If a donor is determined to be eligible during the follow up questioning an explanation for cach question must be documented in sufficient detail in an area in the DHQ next to the question/s concemed . Example: A donor answers “yes" to, “Are you currently taking medication?” Sample documentation: “Donor taking tetracycline daily for acne prophylaxis: “OK per SOP of the Blood Service Facility or the A-Z Guide to Medical Assessment of Blood Donors” (Appendix C) Each SOP of the Blood Service Facility must define how the donor responses to the follow up questions will be documented on the DHQ. Responses should be documented with sufficient detail to determine the reason for donor acceptance or deferral 26 {load Donor Selection and Counseling ManualDonor History Questionnaire User's Guide Donor’s Informed Consent “I certify that I am the person referred to in all the entries, which were read and well understood by me. It is my free and voluntary act to donate my blood, aware of its risks during and after extraction. The same have been explained to me in understandable language and dialect that I speak.” “Tam voluntarily giving my blood through ( name of BSF _____). T understand that my blood will be tested for Blood Type, Hemoglobin, Malaria, Syphilis, Hepati- Us B, Hepatitis C and HIV* and no official result will be released to me. If found reactive, Iagree to be referred to the appropriate facility for counseling and further management . I certify that I have to the best of my knowledge, truthfully answered the above ques- tions ." Donor’s Signature * Note: You may include other specific tests done in your BSF Interviewer must exert effort in explaining the consent in a manner understandable to the Blood Donor, The donor must sign the consent in the presence of the interviewer. A separate consent for apheresis procedure may be developed by each Blood Service Facility. ‘Counseling Manual WTDonor History Questionnaire Flowchart ‘The User's Guide Hloweharts guide the donor interviewer through the donor history questionnaire process, Each question is a complete section that begins on a new page, so that changes to the DHQ can be easily modified in the User's Guide. Each section contains the following information: Question Question number and the question. Donor Eligibility + This section provides additional information to the donor interviewer on donor eligibility requitements for cach question. Optional field; additional relevant information relating to the donor question. Note Flow Chart: Each question is flow-charted using standard flow-charting symbols. OC square Statement aaa <> Diamond - Question ae <> Oval- Action ED VAM Arrow - Move to the next question The User's Guide Flowchart also includes accompanying notes on Hepatitis for Question #22 Bach question ends with an ARROW that indicates to "move to the next question;” however, blood centers must follow their established policies concerning whether or not the donor eligibility process is terminated when it is known that the donor will be deferred. tions, a “yes” answer calls fora required deferral, either indefinitely or for a specified period oftime. A required deferral is designated in the flow chart by the Action “Defer Donor.” The donor inter- viewer may need to refer to the BSF’s SOP to determine if and when the donor may be eligible to return, 31 Blood Donor Seceiion and CounDonor History Questionnaire Flowchart For other questions, a “yes” answer may not require a deferral; rather, it may trigger a line of ques- tioning to determine if the donor is eligible. The interviewer will need to refer to the BSF's SOP for follow-up questions to determine suitability. For example, if a donor answers “yes” to the ques- tion “Are you currently taking medication?” The interviewer may ask additional questions to ascertain the name of medication and specific indication for use by the donor. Some BSFs may allow donors taking antibiotics for certain indications such as prophylaxis for acne to donate, as defined in their SOP. Other BSFs may defer all donors taking antibiotics, regardless of the indication, Deferral for whatever reasons shall be followed by counseling. There shall be no deferred donor leaving the BSF without any form of counseling, Types of Deferral + Indefinite Deferral - Prospective donor is unable to donate blood for an unspecified period of time due to current condition. . Permanent Deferral ~ Prospective donor will never be eligible to donate blood . ‘Temporary Deferral — Prospective donor is unable to donate blood for a limited period o} time, Donor Eligibility A donor shall be free of any diseases including colds on the day of donation. Donors who are not in good health shall not donate until it is determined that the underlying condition is not a cause for deferral . Confidential Unit Exclusion (CUE) As an option to self - defer, the DHQ includes Confidential Unit Exclusion (CUE) for donors who are pressured to donate blood or who are able to recall at - risk bebavior/exposure to risk factors during or after blood donation. Instruction on CONFIDENTIAL UNIT EXCLUSION (CUE) ‘The interviewer must instruct the donor that if he/she feels that at any point during or after blood donation, he/she remembers there is a risk that his blood is not suitable for transfusion he/she must tear the CUE part in the DHQ to inform the BSF. 32 ‘Blood Donor Selection and Counseling ManualFlowchart Question: 1 Are you fecling healthy and well today? Question #1 ‘Are you feeling healthy today? Refer to A-Z Guide to Medical Assessment of Blood Donors (Appendix C) and assess donor to determine if deferral is indicated, Next Question Deferral Indicated? YES Defer accordingly and counsel Blood Gonor Selection and Counseling ManualDonor History Questionnaire Flowchart Question: 2 Are you currently taking any medication? Donor Eligibility. A donor currently taking any medication may be a reason for deferral if said medication is found in the Medication List (Appendix C) . A donor who answers “yes”, shall prompt the interviewer to ask the donor if any of the drug in the medication list was taken by the donor Are you currently, taking any medication? No Determine the medication(s) and date of the last dose. Refer to A-Z Guide to Medical Assessment of Blood Donors (Appendix €). Next Question Donor took a drug in the Medication List YES Defer accordingly and counsel 34 ling ManualDonor History Questionnaire Flowchart | | Question: 3 Have you received any Vaccination? Donor Eligibility. Certain vaccinations may contain live infectious agents. A donor who has been exposed to @ live infectious agent via vaccination shall not be a donor for a specified period of time. Have you received any vaccination? Determine details of shots and type of vaccine. Determine eligibility based on A-Z Guide to Medical Assessment of Blood (Appendix C) Next Question Deferral Indicated? 35Donor History Questionnaire Flowchart Question: 4. In the past three(3) days, have you taken aspirin or anything that has aspirin? Donor Eligibility. Aspirin and other NSAIDs irreversibly inactivate platelet function. Donors who are taking aspirin or any aspirin - containing medication shall not be the sole source of platelets . Question #4 in the past three(3) days, have you taken aspirin or anything that has aspirin? NO. — YES Consult SOP for appropriate action Blood may be collected in single or Next Question double bag and labeled "NOT FOR PLATELET” 36Donor History Questionnaire Flowchart OOo Question: 5 Female donors : In the past 1 and % months (6 weeks), have you been pregnant or are you pregnant now? ‘Donor Bligibility. A female with a known pregnancy or who has been pregnant in the last six (6) weeks may not be eligible to donate blood . Question #5 In the past 1 and % months, have you been pregiiant or are you pregnant now? Next Question > Defer accordingly and counsel A“NO” answer shall prompt the interviewer to ask for Last Menstrual Period (LMP). The interviewer must rule out any possibility of pregnancy, Refer to A to Z Guide to Medical Assessment of Blood Donors (Appendix ©). TEESE ESTE cece eect cae c Seta eet ee aetna 37 ‘ioad Donor SorQuestion: 6 In the past 12 weeks, have you donated blood, platelet, or plasma? Donor Eligibility. A whole blood donor may donate every 12 weeks; plasma, platelet or leukoapheresis donor may donate every 2 weeks . Question #6 {in the past 12) weeks, have you donated biood, platelet, or plasma? ~ Determine type of donation(s) = Determine date of donation(s) Refer to A to Z Guide to Medical Assessment of Blood Donors (Appendix C) Next Question Deferral indicated? YES Defer accordingly and counsel 38 ‘Blood Donor Selection and Counseling ManualDonor Eligibility. A donor who has received an allogeneic transfusion of blood, platelets, plasma or other blood component shall not donate blood for 12 months following the transfusion, due to possible transmission of infectious disease, Question #7 Question: 7 In the past 12 months, have you had blood transfusion? In the past 12 months, have you had blood transfusion? Defer accordingly and counsel ‘Blood Donor Selection and Counseling MtQuestion: 8 In the past 12 months, have you had surgical operation, dental extraction? them Transfusion - Transmissible Infections (TTIs) Donor Eligibility. Surgical procedures have inherent risks of transmitting infection, arnong | “In the past 12 months, have you had surgical operation, dental extrac- tion? Determine details of dental procedure. Determine eligibility based on A-Z Guide to Medical Assessment of Blood Donors ‘Appendix C) Next Question Deferral indicated? Defer accordingly and counsel 40 Blood Donor Selection and Coun:Donor History Questionnaire Flowchart Question: 9 In the past 12 months have you had a tattoo, ear or body piercing, accidental contact with blood, needle - stick injury, acupuncture? Donor Bligibility. Persons who have had a tattoo, ear or body piercing, accidental contact with blood, needle-stick injury, or acupuncture during the previous 12 months are usually deferred for 12 ‘months from the date of procedure. Unless tattoo, ear or body piercing, and acupuncture have been done using single-use equipment, there may be a risk of transmission of infectious diseases. Inthe past 12 rmanths have you reaie-stck nur, seupunctire? Performed using single use sterile device? Defer for 12 months and counselDoner History Questionnaire Flowc ‘Question: In the past 12 months have you... 10. Had sexual contact with high risk individuals? 11, Had sexual contact with anyone in exchange for material or monetary gain? 12, Had sexual contact with a person who has worked abroad? 13. Engaged in casual sex? 14, Lived with a person who has hepatitis? 15. Been imprisoned? Donor Eligibility. Sexual contact with high risk individuals may be at risk of transmitting infectious diseases. High risk individuals are: 1. Injecting Drug Users. Person who has used needles to take drugs, steroids, or anything not prescribed by doctor. Males who have had sexual contact with another male even once, even if using condom. Person who had sexual contact with anyone in exchange for material or monetary gain. Persons who have had sexual contact with a person who has worked abroad. Probe for sexual behavior of the person “who have worked abroad”, refer to 2010 Report on the Global AIDS Epidemic (Appendix F ). 6. Persons who-engage in casual sex. > Casual seris defined as sexval act between two consenting individuals who are not in a romantic relationship. These sexual encounters are oftentimes repeated with many different partners thereby increasing the risk of transmitting STIs, Persons who have lived with a person who has hepatitis > In certain cases, living with a person with viral hepatitis puts the donor at risk for acquiring viral hepatitis as well vbw 8. Persons who have been imprisoned. > Persons who have been detained or incarcerated in a facility Guvenile detention, lockup, jail, or prison) are deferred for 12 months from the last date of incarceration, These persons ate at higher risk of exposure to infectious diseases. Note: The reason for incarceration (e.g, white-collar crimes, child support) does not change the deferral. 9, Hemodialysis patients. 10. Persons who have had multiple blood transfusion. a Blood Donor Selection and Counseling ManualDonor History Question Question #10 to 15 In the past 12 months have you had sexual contact with high risk individuals? Flowchart | | | | | Next Question Defer accordingly and counsel fection and Counsoling ManualDonor History Questionnaire Flowchart Question 16 Have any of your relatiye/s had Creutzfeldt -Jacob Disease (CJD)? Donor Eligibility. Donors with a blood relative with Creutzfeldt -Jacob Disease (CJD) are indefinitely deferred Note. If laboratory testing (gene sequencing) shows that the donor does not have a mutation associated with familial CJD, the donor is eligible fas any of your relatives had Creutzfeldt- Jacob disease? No or don’t know Next Question YES Was this person related by blood or by marriage? Related by marriage Related by blood Defer indefinitely and counsel 44 ‘Blood Donor Selection and Counceling ManualDonor History Questionnaire Flowchart — S$ — —————eerorc—orvvw ovv— Question 17 Have you lived outside your place of residence? Donor Eligibility. 1) Donors who resided (stayed for six (6) months or more) in a malaria-endemic area and left the area only within the past 12 months shall not donate blood. 2) Donors who visited (stayed less than 6 months) in a malaria endemic area and left the area only within the past 6 months shall not donate blood. 3) Donors who developed malaria or malaria-like illness shall not donate blood until after 3 years from completion of treatment Question #17 Hove you livee outside your place of SK, residence? Determine details of travel; refer to list of Malaria| endemic areas and to A-Z Guide to Medical Assessment of Blood Donors (Appendix) Deferral indicated? YES Defer accordingly and counsel sd Bonar Selection and Counseling ManuDonor History Questionnaire Flowchart Question 18 Have you been abroad? Donor Eligibility. If the donor himself or herself was born in or lived in HIV high risk countries, he/she is indefinitely deferred. If the donor is from couatries in Sub-Saharan Africa (Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger or Nigeria) he/she may have rare strains of HIV that are not consistently detected by all current test methods If the donor resided in countries identified as high risk for HIV by the UNAIDS, he/she is also indefinitely deferred, refer to 2010 Report on the Global AIDS Epidemic (Appendix F). Donors who resided in the United Kingdom (England, Wales, Scotland, Northern Ireland, Isle of Man, Channel Islands) from 1980 to 1996 are indefinitely deferred. Donors who resided for 5 years in Europe are also indefinitely deferred. Question #18 Determine details of travel - country, length period of stay, history of hospitalization & blood transfusion, sexual partners Deferral Indicated? YES Defer accordingly and counsel, Blood Donor Selection and Counsoling ManualDonor History Questionnaire Flowchart Question: 19 Have you ever used needles to take drugs, steroids, or anything not prescribed by your doctor? Donor Eligibility. Donors who are past or present needle - using drug users are permanently deferred due to potential transmission of infectious diseases . Question #19 ‘Have you ever used needles to take drugs, steroids or anything not prescribed by your doctor? a7Donor History Questionnaire Flowchart Question: 20 Have you ever used clotting factor concentrates? Donor Eligibility. A donor who has been exposed to clotting factor concentrates shall not donate blood due to possible transmission of infectious disease. Question #20 Have you ever used clotting factor concentrates? Next Question TF multiple use, defer permanently Ifonly once, defer for 12 monthsDonor History Questionnaire Flowchart At this point, donor is informed that shall he/she remember any incident that may affect his suitability as a blood donor especially recall of high risk behavior described in the leaflet (refer to Blood Donor Information before Donation), he shall inform anyone in the Blood Collection Team or the local Blood Program Coordinator. Question: 21 Have you ever had a positive test for the HIV virus, Hepatitis virus, Syphilis or Malaria? Donor Eligibility. Donors with clinical or laboratory evidence of HIV are indefinitely deferred due to potential transmission of infectious diseases. Question #21 Have you ever had a positive test for the HIV virus, Hepatitis virus, Syphilis or Malaria? Next Question Defer permanently and counsel Blood Donor Selection and Counseling Manat aDonor History Questionnaire Flowchart Question 22 Have you ever had hepatitis? Donor Eligibility. Donors with viral hepatitis or hepatitis of unknown cause within the past 12 months shall not donate blood . (Refer to succeeding notes on hepatitis). Question #22 —Have you ever had Hepatitis? Next Question YES Defer accordingly and counsel (204 Donor Select 1d Couneeling Manual 50Donor History Questionnaire Flowchart DONOR EVENT | EXPLANATION/CLARIFICATION ACTION Hepatitis of Viral History ofjaundice/hepatitis of uaknown Defer for 12 months Origin(Generai where | cause while an ad fiom recovery the type ofthe infective | Tuoewlation injury where there is the possiblity | Defer for 12 months agent is not known) of transmission of infection through infected from event blood Sexual contact with aa infected person Defer for 12 montis from the ast sexual contact Health cave and other professional workers in [Accept hospital laboratories, or caring for people with hepatitis, provided they have NOT suffered an inoculation injury or contamination of non: intact skin or mucosa with blood from an. individual with hepatitis Household contact of mifected person; infective | Defer for 12 months from agent type unknown the last contact/exposure HEPATITIS B (HBV) Infected carriers. A person who is HBsAg Defer permanently | serological positive | ae "A person with HBsAg serological reactive Defer indefinicely until ' (onconfirmed) confirmed negative | For regular repeat donors contracting Acute Defer for 12 months From Hepatits B, Obtain full history and refer 10 the the event and then i medical officer for farther action. reassess. Such donors j may be acceptable - 12 months after acute episode provided there vas clearance of HBsAg within 6 months and that level of 2 100 iu/L of -HBs can be ‘demonstrated in their ‘A current sexual partner of confirmed HBV Defer permanently carrier ‘A past sexual partner of confirmed HBV carrier | Defer for 12 months from the last sexual contact Recipients of HBV immunoglobulin (HBIgG): Defer for 12 montis from Hepatitis B immunoglobulin administered after | inoculation a known exposure (with or without the vaccine) can prolong the incubation period Blood Donor Selection and Counseling Manual arDonor History Questionnaire Flowchart with documented past infection (confirmed) DONOR EVENT EXPLANATION/CLARIFICATION ACTION Recipients of vaccine Case I; Ifthere has been Defer for one week no known exposure from vaccination ‘Recipients of vaccine Case 2: Tfvaccine is Defer for 12 months given post exposure to HBV. from vaccination Household contact (non-sexual) ofa person Defer for 12 months infected with hepatitis B from last contact/ exposure HEPATITIS C (ACV) Serological positive individuals and persons Defer permanently HIV antibody repeat reactive donor (unconfirmed) Defer indefinitely ‘A current sexual partner of confirmed HCV carrier Defer permanently A past sexual partner of confirmed HCV carrier Defer for 12 months from che last sexual contact “Adapted fiom the A-Z Guidelines (2008) ofthe New Zealand Blood Services ‘Blood Donor Selection and Counseling ManuDonor History Questionnaire Flowchart Question 23 Have you had malaria? Donor Eligibility. Potential blood donors who have had malaria and received an appropriate treatment shall be deferred for three (3) years after becoming asymptomatic . Malaria can be transmitted by blood . Question #23 Have you ever had malaria? Next Question Have you been treated and asymptomatic for more than 3 years? Defer permanently and counsel ‘iood Donor Selection and Counssling Manual asDonor History Questionnaire Flowchart Question 24 Have you been told to have or treated for genital wart, syphilis, gonorrhea or other sexually transmissible infections? Donor Eligibility. Donors diagnosed and/or treated for syphilis, gonorrhea or other sexually transmitted infections shall not donate blood because of the risk of transmitting the infection Question #24 Have you ever been told to have or treated for genital wart, syphilis, gonorrhea or other sexually transmissible infections? Next Question Defer permanently and counsel ——_— SSSsSsSsSseSsesesesess 54 ‘Blood Doner Selection and Counseling NanustDonor Question 25 Have you ever had any type of cancer, including leukemia? Donor Eligibility. Donors with a history of cancer (including leukemia) are permanently deferred. Question #25 Have you ever had any type of cancer, including leukemia? Next Question Defer permanently and counsel a no IS BT COR ar |Donor History Questionnaire Flowchart Question 26 Have you ever had any problems with your heart or lungs? Donor Eligibility. Donors must be free of acute respiratory disease. Donors with history of diseases of the heart and lungs, including acute lung disease or colds, must be evaluated. Refer to A-Z Guide to Medical Assessment of Blood Donors (Appendix C) Question #26 Have you ever had any problems with your Determine eligibility per SOP of BSF and counsel Deferral indicated? Defer permanently and counsel Ss 56 [Blood Donor Selection and Counseling banatQuestion 27 Have you ever had a bleeding condition or a blood disease? Donor Eligibility. Donors with a history of bleeding problems shall be evaluated, Refer to Standard Operating Procedures Note. Donors who have been receiving clotting factor concentrates are deferred permanently Question #27 Have you ever hada bleeding condition or a blood disease? YES Determine eligibility per SOP of BSF and counsel Deferral indicated? YES Defer permanently and counsel (ood Bonar Selection and Coun Next Question vo aDonor Flowchart Question 28 Are you giving blood because you want to be tested for HIV virus, or for hepatitis virus? Donor Eligibility. Donors whose motivation for donating blood is to get free testing are deferred. These donors may have high risk behavior, They shall be counseled and properly referred to the nearest Voluntary Counseling and Testing (VCT) center. Donors who need laboratory test for HIV, HBV or HCV for employment or insurance purposes are also deferred. (The blood center does not issue results of tests) Question #28 ‘Are you giving ‘blood because youwant to be tested for HIV virus, or for Hepatitis virus? Determine reason for wanting to be tested for HIV or Hepatitis. Deferral indicated? Yes Defer accordingly, counsel and refer to VCT. 38 ‘Blood Donor Selection and Counseling MantDonor History Questionnaire Flowchart Question 29 Are you aware that if you have the HIV or Hepatitis virus, you can give it to someone else though you may feel well and have negative HIV or Hepatitis test? Donor Eligibility. Donor shall understand that if he donates during the window period, the result of the tests for HTV, HBV or HCV is non - reactive, even though he already has the infection and can transmit this to whoever receives his/her blood . Furthermore, at this phase of the infection, the donor may not show any sign of infection . This is to highlight the importance of honesty in answering the questions in the DHQ . Question #29 Are you awere thet if'you have the HIV of Hepattt's virus, you can giveitto someone else though you may f well and have negative HIV oF Hapatits virus?, YES Proceed to the Section on Informed Consent for NO Donation ‘Educate Gonor about the sub-cinical phase of HIV infection or hapatts, andthe window petiod“inthe testing for HIV or HBV andl HCV Proceed with blood donation? Defer accordingly, counsel and refer to VCT, Note: If the donor answers “no”, refer him/her to a Voluntary Counseling and Testing Center «vcT) Blood Gonor Selection and Couneoling ManualBlood Donor Counseling Counseling Principles Counseling of blood donors is an essential part of achieving the Blood Services’ primary goal of providing adequate and safe blood and blood products. Although the enzyme immunoassay (EIA) testing system for TT's is very sensitive, there is still the risk that infected blood will not be detected when the donor donates during the “window period” when the infection has only recently been acquired and the level of detectable disease markers is still low. Window Period HBV:59 days HCV : 82 days Window Period HIV-1: 21 days =| Faire Nem Immune reaction Infection Time Thus, there is a need for adequate pre-donation information and counseling to ensure selfdeferral of high-risk donors. Blood donor counseling is necessary before and after blood donation, and should be preceded by pre- donation information and discussion. Bffective pre-donation information and pre-donation counsel- ing are important activities of the Blood Services, and are needed to encourage appropriate donor self- deferral. Post-test counseling is not only a necessary part of care for the confirmed HIV-positive donor but is also important in promoting healthy lifestyle and regular blood donation in HIV-negative donors. ‘Counseling Manual 6Blood Donor Counsel Pre-Donation Counseling Pre-donation counseling of donors has two main objectives: 1. To increase donor awareness of + HiVand other Ts +The implications and consequences of donating during the “window period” for those with high risk behavior { + The implications and consequences of being tested reactive and/or confirmed positive for { HLV, hepatitis B, hepatitis C and syphilis 2, To discourage blood donation + By self-deferral of people wanting to use the voluntary blood donation system to avail of free | testing for HIV, hepatitis B, hepatitis C or syphilis + Among people with high-risk behavior or with risk factors associated with the TTIs. ‘These persons should be referred to Voluntary Counseling and Testing (VCT) centers, or alternative counseling and testing facilities. Pre-Donation Counseling Checklist ‘The pre-donation counseling should cover the following: i. Knowledge of HIV and Other Transfusion Transmissible Infections (TTIs) + Transmission awareness and understanding «Implication of donation during the “window period” and false negative test result + Previous request for test for T''Is — when and why ? + Personal acquaintance and involvement with people with HIV 2. Risk History Assessment + Nature of sexual activities, frequency and number ‘+ Injecting drug use and sharp instrament sharing, | + Recent illness and symptoms + Family history of illness + Blood and blood product transfusions, and invasive procedures (tattooing, body piercing) + Previous paid blood donations + Other high-risk behavior/factors associated with TTIs (See Appendix E)Blood Donor Counseling 3. Donation Information + Donation procedure explained and understood + The meaning and reasons for donor self-deferral, and Confidential Unit Exclusion (CUE) + Informed consent to donate explained and obtained 4, Psychosocial Factors and Knowledge + Why is the person donating - to avail of free-testing? + Any symptoms of concem to the donor? + Significance and interpretation of positive and negative test results, including implications for behavior change (healthy lifestyle) and prevention Post-Donation Counseling Post-donation counseling is the highly confidential and individualized face-to-face counseling that is provided by a skilled counselor (trained for this purpose). The counseling should take place as soon as possible after a positive (by confirmatory test in the Research Institute for Tropical Medicine) result is reliably obtained. Post-donation counseling is intended to help the donor cope with the psychological impact of a confirmed positive result. Post-ionation counseling involves the following * Giving the donor enough time to grasp the information + Giving the donor enough time and opportunity to ask questions + Helping the donor cope with the emotional and practical impact of a confirmed positive result especially for HIV + Offering options for continued care for infected donors and their families and/or sexual contact/s through referral to appropriate health facilities. Those found to have HIV infection are counseled to accept referral to the HIV/AIDS Core Team (HACT), Those found to have hepatitis B and hepatitis C are encouraged to enroll themselves in the Liver Study Group in medical centers or regional hospitals, if these services are available in the area. Post-test counseling may involve recognizing and managing — in the very short term — acute psychological reactions to the disclosure of HIV infection, Post-test counseling for donors with HIV infection should therefore be provided only by BSF Staff who have received specific training for handling such cases, or who have access to those who can do so. ‘load Donor Selection and Couneeling ManualBlood Donor Counseling Stages of Blood Donor Counseling, NVBSP Stage 1 Pre-donation information, Stage? Predonation counseling (Voluntary Counseling Services) —T Healthy Litestyie/ Stage 3 Discase Prevention | | Physical Examination, Selection, Reinforced Informed Consent for Testing of Blood Unit Stage 4 — Blood Donation and Testing Stage Stages Post-donation Information and/ Positive/Equ ‘or Counseling Post-donation Counseling J Recruit for Regular Donation 66 ‘Blood Donor Selection and Couneeling ManualAppendix A : Code of Ethics for Blood Donation and Transfusion Ce Code of Ethics for Blood Donation and Transfusion (International Society of Blood Transfusion) Blood Centers: Donors and Donation 1. Blood donation including hematopoietic tissues for transplantation shall, in all circumstances, be voluntary and non-remunerated; no coercion should be brought to bear upon the donor, A donation is considered voluntary and non-remunerated if the person gives blood, plasma or cellular components of his/her own free will and receives no payment for it, either in the form of cash, or in kind which could be considered a substitute for money. This would include time off work other than that reasonable needed for the donation and travel. Small tokens, refresh- ments and reimbursements of direct travel costs are compatible with voluntary, non- remunerated donation, The donor should provide informed consent to the donation of blood or blood components and to the subsequent (legitimate) use of the blood by the transfusion service. A profit motive should not be the basis for the establishment and running of a blood service. The donor should be advised of the risks:connected with the procedure; the donor's health and safety must be protected. Any procedures relating to the administration to a donor of any substance for increasing the concentration of specific blood components should be in compliance with internationally accepted standards. Anonymity between donor and recipient must be ensured except in special situations and the confidentiality of donor information assured. ‘The donor should understand the risks to others of donating infected blood and his or her ethical responsibility to the recipient. Blood donation must be based on regularly reviewed medical selection criteria and not entail discrimination of any kind, including gender, race, nationality or religion. Neither donor nor potential recipient has the right to require that any such discrimination be practiced. Blood must be collected under the overall responsibility of a suitably qualified, registered medical practitioner. All matters related to whole blood donation and hemapheresis should be in compliance with appropriately defined and internationally accepted standards.Appendix A : Code of Ethics for Blood Donation and Transfusion 10 in Donors and recipients should be informed if they have been harmed, Blood is a public resource and access should not be restricted. ‘Wastage should be avoided in order to safeguard the interests of all potential recipients and the donor. Hospitals: Patients 12. 13. 14. 15, 16. 1. 18, Patients should be informed of the known risks and benefits of blood transfusion and/or alterna- tive therapies and have the right to accept or refuse the procedure. Any valid advance directive should be respected. In the event that the patient is unable to give prior informed consent, the basis for treatment by transfusion must be in the best interests of the patient, Transfusion therapy must be given under the overall responsibility of a registered medical practitioner. Genuine clinical need should be the oiily basis for transfusion therapy. i ‘There should be no financial incentive to prescribe a blood transfusion, As far as possible, the patient should receive only those particular components (cells, plasma, or plasma derivatives) that are clinically appropriate and of affordable optimal safety. Blood transfusion practices established by national or international health bodies and other agencies competent and authorized to do so should be in compliance with this code of ethics. 70 ‘Blood Donor Selection and Counseling ManualAppendix B : Social Hygiene Clinic, VCT Centers and Treatment Hubs Global Fund - HIV Project Social Hygiene Clinics (SHC) at Local Government Units - Health Offices Luzon 1. Laoag City 9% Quezon City Dr. Imelda Tamayo Dr, Dottie Mercado SHCPhysician SHCPhysician-Batasan SHC Tel; (077) 772 - 0289 ‘Mobile: (0905) 357 - 6353, 2. Tuguegarao City 10. Quezon City Dr. James Guzman Dr. Suzette Encisa City Health Officer SHCPhysician- Bernardo SHC ‘Tet: (078) 846 - 2197 Mobile: (6916) 478 - 1607 3. Santiago City 11. Quezon City Dr. Robelyn Go Dr, Monia Santos SHCPhysician SHC Physic ia w- Project 7 SHC ‘Tel: (078) 682 - 7687 Mobile: (0918) 618 - 4133 4, San Fernando, La Union ——~ 12, Marikina City Dr. Godofiedo A. Rilloraza Jr Dr. Honielyn Fernando SHCPhysician CityHealth Officer ‘Tel: (072) 888 - 6907 Tel: (02) 943 - 213/688 - 1465 Faxc (072) 700 - $477 [email protected] 5. Baguio City 13. Mandaluyong City Dr, Celia Flor C. Brillantes Dr. Ma, Gloria Laeson SHCPhysician SHCPhysician ‘TeleFax (074) 442 - 9800 Tel: (02) 534-0163 532 - 5001 loc. 292 6. Angeles City 14. Pasig City Dr. Verona V. Guevarra Dr. Rocylene Roque SHOPhysician SHCPhysician Tel: (045) 322 - 2479 Tel: (02) 640 - 9700 7. City of Manila 15, Makati City Dr. Diana Mendoza Dr. Catixio Salud SHCPhysician SHCPhysician Tel: (02) 711 - 6942 ‘Tel: (02) 870 - 1000, Fax: (02) 899-8916 8. Caloocan City 16. Pasay City Dr. Zenaida Calupaz Dr, Loretia Garcia SHCPhysician SHCPhysician Tel: (02) 288 - $811 loc, 2281 Tel: (02) 551 - 4180 7 ‘Siood Donor Seloation and Cot WiAppendix B : Social Hygiene Clinic, VCT Centers and Treatment Hubs 17, Batangas City 20. 18, 19. 22. 2. 25. 26. Dr, Dinah Lucero STICoordinator Tel: (043) 723 - 890/723 - 2472 [email protected] Puerto Galera a. Dr, Teresa Wycoco MunicipaiHealthOfficer Tel: (043) 442 - 0182 Lucena City Dr. Vicente Martinez STICoordinator Tel: (042) 710 - 8320 Cebu City 27. Dr. Ilya Abellanosa Tac - an SHCPhysician ‘Tel: (032) 233 - 0987 Fax: (032) 232 - 6848__ Hoito City 28. Dr. Odetta Villaruel SHCPhysician ‘Tel: (033) 320 - 8151 Bacolod City 29. Dr, Babyiyn Drilon SHC Physician Tel: (034) 434 - 4098434 - $584 Alen, Samar 30. Dr, Daisy F. Abasolo City HealihOfficer/SHCPlysician ‘Tel: (055) 500 - 9032 Catbalogan, Samar Dr. Senecia Q. Yong MunicipalHealth Officer Tel: (053) 342 - 5515/356 - 1139 Fax: (053) 323 - 6517 Puerto Princesa Dr. Funice Herrera SHC Physician Tel: (043) 465 - 8182 Daraga, Albay Dr. Edna Freya B. Tan SHC Physician Tel: (052) 824 - 7959 Calbayog, Samar Dr. Cesar Sabenicio Asst. MunicipalHealth Officer SHCPhysician Tel: (053) 323 - 6517 Isabel, Leyte Rural Health Unit, Isabel, Leyte Dr. Refelina Baje, Health Officer-in-Chargel SHCPhysietan ‘Tel; (053) 337 - 20: Kananga, Leyte Dr. Ma , Cecilia Samosa MunicipalHealthOffeer/ SHCPhysician Tel: (053) 553-9171 Tacloban, Leyte Dr, Mirabelle Reyes SHC Physician ‘Tel: (053) 323 - 3518 Blood Donor Selection and Counseling ManualAppendix B : Social Hygiene Clinic, VCT Centers and Treatment Hubs Min | 31. Davao City 34. General Santos City DD, Jordana Ramiterre Dr. Mely Lastimoso SHC Physician S11 creditor | Tel: (082) 223-4187 Tel: (083) 302 - 392/893 - 5847 | [email protected] [email protected] 52, Surigao City 35. Zamboanga City | Dr. Ivy E . Liamera Dr. Kibtiya A. Uddin SHC Physician SHC Physician Tel: (086) 826 - 206/826 -4108/ Tel: (062) 991 - 5421 $26- 4131 33. Cagayan de Oro City 36, Butuan City Dr. T. Joselito Retuya, Jr. Dr, Jesus Chin - Chui SHC Physician SHC Physician ‘Tel: (08822) 721189 ‘Tel: (085) 342 - 3432 iced Donor Selection and Counseling ManualSocial Hygiene Clinic, VCT Centers and Treatment Hubs Appendix List of Hospital with Voluntary Counseling and Testing (VCT) Centers Luzon 1. Mariano Marcos Memorial Medical 5 Center Batac, Ilocos Norte 2, Southern Isabela General Hospital 6 ‘Santiago City, Isabela 3. Dr, Jose Fabella Memorial Medical 7 Center Lope de Vega Street Sta Cruz, Manila 4, Dr, Jose Reyes Memorial Medical Center — Rizal Avenue, Sta. Cruz, Manila ‘Visayas 8. Eastern Visayas Regional Medical Center Tacloban City 9. Davao Regional Hospital uM. ‘Tagum, Davao del Norte 10, CARAGA Regional Hospital 2. Surigao City East Avenue Medical Center East Aveue, Quezon City Batangas Regional Hospital Barangas City Ospital ng Palawan Puerto Princesa City, Palawan ‘Northern Mindanao Medical Center Cagayan de Oro City Cotabato Regional Medical Center Cotabato City ———S— 74 Blood Donor Selection and Counseling Manual3. 4 ie BR 15. Appendix + Social Hygiene Clinic, VCT Centers and Treatment Hubs: List of Treatment Hubs ocos Training & Regional Medical Center San Femando City, La Union Tel . (072) 6076413 Jose B, Lingad Memorial Medical Center Brgy. San Dolores, San Femando City, Pampanga Tel. (045) 9613921 / 9613989 Cagayan Valley Medical Center Carig, Tuguegarao Cagayan ‘Tel . (078) 3041410/8443789 Baguio Gencral Hospital and Medical Center Gov, Park Rd, Baguio City Tel. (074) 4438342/4424216 loc 381 ‘San Lazaro Hospital (Bahay Kalinga) Quiricada Steet, Sta, Cruz, Manila ‘Tel, 3099543 / 7323776 to 79 ‘Western Visayas Medical Center Q Abeto St, Iloilo City Tet. (033) 3211797/2841 Corazon Locsin Montelibano ‘Memorial Regional Lacson St,, Bacolod City Tel, (034) 4333683/7090244 Southern Philippine Medical Center IP Laurel St, Bajada, Davao City Tel. (082) 2272731 loc. 4205 200 6. 9 10, Visayas 1B. 4, Philippine General Fospital (Sagip Program) Pedro Gil, Manila ‘Tel, 521-8450 ‘The Medical Ontigas Ave., Pasig City Tel, 6356789 loc 6323 ‘Makati Medical Center #2 Amorsolo St., Legaspi Village, ‘Makati City Tel, 8888999 loc 2336, Research Institute for Tropical Medicine Alabang Muntinlupa City Tel, 8097599; 8422628/2445 loc, 332 Bicol Regional Training & Teaching Hospital Legaspi City Tel, (052) 483 - 0636/0017 Vicente Sotto Sr. Memorial Medical Center B. Rodrigue, Sambag II, Cebu City Tel. (032) 2539891 wo 96 Gov. Celestino Gatlares Memorial Hospital M. Parras St. Tagbilaran City. Bohol Tel, (038) 4114868 Zamboanga Medical Center Sia, Catalina, Zamboanga City Tel, (062) 9912934/991 - 6573Appendix C: A-Z Guide to Medical Assessment of Blood Donors A-Z Guide to Medical Assessment of Blood Donors Conditions Timing Conditions A “Abortion/ Miscarriage (without Dilatation and Curettage) (6 weeks from incident “Abortion/Miscarriage (with Dilatation and Curetiage) 12 months from procedure ‘Acne vulgaris {esions not active or infected but on topical medication taking cyproterone acetate (an anti- testosterone) taking tetracycline or erythromycin 2 weeks from completion of treatment ‘aking isotretinoin, wetinoin, adapalene “weeks from last dose lesions active /inflamed 2 weeks from healing taking acitretin, ewetinate (Neotigasoa) years Rom last dose Acupuncture (needle sterilized, ‘practitioner certified) “Age 16 10 65 years old ‘Anytime, ‘more than 65 years old ‘At the discretion of physician Alcoholism, chronic Permanent deferral Alcohol intake 12-24 hours after last intake Allergy Gonor fit and well) hay fever with minor symptoms with or without medications, and donor fitand well “Anytime hay lever with more than minor symptoms with or without medications, and donor fit and well 1 month from last incident ‘moderate allergic reaction Gncluding drug allergy) 1 year from last incident history of severe allergic reaction or anaphylactic shock Permanent deferral ‘Anemia, iron deficiency ‘After treatment, with Hemoglobin of 125g/L_ ‘Anemia, any other cause Permanent deferral ‘Angiogram Permanent deferral Permanent deferral 76 ‘Angioplasty ‘Blood Donor Selection and Counseling ManuAppendix €: A-2 Guide to Medical Assessment of Blood Donors Conditions Timing Conditions ‘Angina pectoris - diagnosis confirmed Permanent deferral “Antacids - taken occasionally for indigestion or heart bum “Anytime “Antibiotic ‘Gepends on the condition for which antibiotic is taken ‘Anti-inflammatory medicines (underlying condition acceptable) + NSAIDs - if blood donation nat for “Anytime platelets * _ NSAIDs- blood donation for Defer for 24 hours from last dose platelets * Aspirin blood donation not for ‘Anytime platelets ‘+ Aspirin - blood donation for Defer for 72 hours from last dose platelets ‘Apheresis + platelet Ta hows © double red cell Té weeks from last apheresis provided height, weight and Hb (>145g/L) criteria are met eee «single red cell 12 weeks * single red cell + platelets 12_weeks: = plasma Tweaks ‘Appendeciomy 12 months after sungery “Arthritis, not on medications “Anytime > on medication , see “ante inflammatory” ‘Asthma, mild (donor fit and well) ‘Anytime - fet on medication, only on inhaler maintenance Asthina, severe Permanent deferral ‘Autoimmune diseases like Systemic Lupus Exythematosus (SLE) Permanent deferral BCG vaccine (see A-Z Guide of Vaccine) 2 weeks fiom last vaccination Biopsy, benign and healed 12 months from the procedure Blood donation, whole blood T2 weeks from last donation, shorter interval may be allowed provided frequency does not exceed 6x in the entire year Bigod transfusion + Whole Blood (WB), Packed Red 12 months from last transfusion Blood Donor Selection and Couneoting Manual 7Appendix C: A-Z Guide to Medical Assessment of Blood Donors Conditions Timing Conditions Blood Cell (PREC), Platelet ‘Concentrate (PC), Fresh Frozen Plasma (FFP) © Glowing factors (Factor VI, DO. ‘Permanent deferral © Blood Transfusion given ia France, Ireland, & United Kingdom Permanent deferral Body piercing (ear/tongue/nose/navel holing) 12 months from procedure month from completion of antibiotics Boils Brain sungery Permanent deferral Bronchiectasis ‘Permanent deferral Bronchitis, acute T month after complete recovery Bronchitis, chronic ‘Anytime, if symptom free for 24 months Brucellosis Permanent deferral Cancer, all types Permanent deferral (Candidiasis (thrush, monilial infection) 1 week from completion of treatment Anytime Cataract Chagas disease Permanent deferral Cellulitis 1 week after recovery and completion of treatment Chicken pox (varicetia ) © infection in donor month after recavery contact with infected person: > contact with no history of previous infection T month after last contact > contact with history of previous infection ‘Accept - anytime ‘9 months after delivery or 3 months after ‘Childbirth weaning Cholecystitis, 1 month after recovery Cholecystectom) 12 months after recovery Cholera vaccine (Gee A-Z Guide of Vaccine) Colitis Permanent deferral - if diagnosis is irritable bowel syndrome Colitis, ulcerative ‘Permanent deferral ‘Common cold 1 week after recover ‘Concussion, mild 3 months after recovery Conjunctivitis 78 ‘Blood Donor Selection and Counseling ManualAppendix C: A-Z Guide to Medical assessment of Blood Donors Conditions Timing + allergic ifmild, may accept + infectious (One week after resolution and completion of antibiotic treatment [Conyuilsions/Seizures/ Epilepsy Permanent deferral ‘Comeal transplant 12 months after procedure [Coronary heart disease Perraanent deferral [Cosmetic procedures (acial “cleaning” T2 montis after procedure [botox injection, dermabrasion, etc.) |Creutafeld Jacob Disease (CJD) at-risk Permanent deferral individuals + Ist degree blood relatives of person with CID + recipients of human neurological Gerived products like human growth hormone, human pituitary gonadotrophin, dura matter __(hyodura) UK: England, Wales, Scotland, Northern Ireland, Iste of Man, & the Channel Islands Permanent deferral = recipient of comeal transplant while in the United Kingdom, Republic of Ireland, France Permanent deferral + recipient of Blood Tranfusion while in United Kingdom, Republic of Ireland, France Permanent deferral [Dengue Fever 1 month after recovery if without Blood Transfusion [Dental suery 12 months after procedure [Dental extraction, uncomplicated 72 hours after procedure [Dental extraction with abscess Tmonth after recovery & off antibiotics Dermatitis ‘After complete healing Diabetes mellitus + controlled by diet & oral medication ‘Anytime ‘+ uncontrolled and on insulin Permanent deferral Diarrhea, infectious i month after complete recovery [Diptheria L T month after complete recovery ‘Blood Donor Selection and Coun 79