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BloodDonorSelectionGuidelines on AssessingDonor Suitability forBlood Donation

BloodDonorSelectionGuidelines on AssessingDonor Suitability forBlood Donation

WHO Library Cataloguing-in-Publication DataBlood donor selection: guidelines on assessing donor suitability for blood donation.1.Blood donors. 2.Blood transfusion. 3.Evidence-based practice. 4.Review. 5.Nationalhealth programs. 6.Guideline I.World Health Organization.ISBN 978 92 4 154851 9(NLM classification: WH 460)Development of this publication was supported by Cooperative Agreement NumberPS024044 from the United States Centers for Disease Control and Prevention (CDC).Its contents are solely the responsibility of the authors and do not necessarily representthe official views of CDC World Health Organization 2012All rights reserved. Publications of the World Health Organization are available on the WHO web site(www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211Geneva 27, Switzerland (tel.: 41 22 791 3264; fax: 41 22 791 4857; e-mail: [email protected]).Requests for permission to reproduce or translate WHO publications – whether for sale or fornoncommercial distribution – should be addressed to WHO Press through the WHO web site(http://www.who.int/about/licensing/copyright form/en/index.html).The designations employed and the presentation of the material in this publication do not implythe expression of any opinion whatsoever on the part of the World Health Organization concerningthe legal status of any country, territory, city or area or of its authorities, or concerning thedelimitation of its frontiers or boundaries. Dotted lines on maps represent approximate borderlines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers’ products does not imply thatthey are endorsed or recommended by the World Health Organization in preference to others of asimilar nature that are not mentioned. Errors and omissions excepted, the names of proprietaryproducts are distinguished by initial capital letters.All reasonable precautions have been taken by the World Health Organization to verify theinformation contained in this publication. However, the published material is being distributedwithout warranty of any kind, either expressed or implied. The responsibility for the interpretationand use of the material lies with the reader. In no event shall the World Health Organizationbe liable for damages arising from its use.

ContentsExecutive summary1Acronyms3Preface4Policy recommendations5Technical recommendations61 Introduction161.1 Blood donor selection161.2 Aim and objectives171.3 Target audience181.4 Methodology17Part 1: National system for blood donor selection2 Establishing a national system for blood donor selection232.1 National policy and legislative framework232.2 National guidelines and criteria on blood donor selection232.3 Public information and donor education252.4 Infrastructure and facilities252.5 Financial and human resources262.6 Quality system262.7 Donor haemovigilance272.8 Monitoring and evaluation283 Assessing donor suitability303.1 Donor selection process303.2 Donor deferral353.3 Donor records363.4 Confidential unit exclusion373.5 Adverse donor reactions and post-donation care37Part 2: Criteria for blood donor selection4 General donor assessment4.1 Age39394.1.1 Lower age limit394.1.2 Upper age limit40

4.2 Donor appearance and inspection404.3 Minor illnesses414.4 Weight414.5 Vital signs424.5.1 Pulse424.5.2 Body temperature424.5.3 Blood pressure424.6 Donor iron status434.6.1 Haemoglobin screening434.6.2 Frequency of donation and iron supplementation444.7 Fluid intake and food464.8 Gender464.8.1 Pregnancy, lactation and menstruation464.8.2 Reducing the risk of transfusion-associatedacute lung injury474.9 Occupation and leisure activities474.10 Special considerations for donor selectionfor apheresis donations485 Donor medical history I: Non-communicable diseases495.1 Haematological disorders5.1.1 Anaemia, including haematinic (iron, B12, folate)deficiency495.1.2 Haemoglobinopathies505.1.3 Enzymopathies and inherited red cell membrane defects505.1.4 Thrombocytopenia515.1.5 Secondary erythrocytosis515.1.6 Hereditary haemochromatosis525.1.7 Coagulation disorders, including haemophilia A and B525.2 Cardiovascular diseases525.2.1 Cardiovascular diseases525.2.2 Hypertension535.2.3 Venous thrombosis and thrombophlebitis545.3 Respiratory diseases545.4 Gastrointestinal diseases565.5 Metabolic and endocrine diseases565.5.1 Diabetes mellitus565.5.2 Thyroid disease565.6 Immunological diseases575.7 Renal and urinary tract diseases57

5.8 Central nervous system diseases585.8.1 Cerebrovascular disease585.8.2 Epilepsy585.8.3 Dementia and other neurodegenerative disorders585.8.4 Multiple sclerosis585.9 Malignant diseases595.10 Musculoskeletal disorders605.11 Skin diseases605.12 Psychiatric disorders616 Donor medical history II: Medical and surgical interventions6.1 Immunizations and vaccinations63636.1.1 Post-exposure prophylaxis636.1.2 Live attenuated viral and bacterial vaccines636.1.3 Inactivated vaccines646.2 Medications646.3 Blood transfusion and transplantation656.3.1 Blood transfusion656.3.2 Organ, stem cell and tissue transplantation666.4 Diagnostic and surgical procedures676.5 Alternative, complementary and traditional medicine687 TTI and donor risk assessment697.1 Transfusion-transmissible infections697.2 Donor risk assessment707.3 Viral infections717.3.1 Hepatitis717.3.2 Human immunodeficiency virus/Acquiredimmunodeficiency syndrome (HIV/AIDS)747.3.3 HTLV I and HTLV II757.3.4 Herpes viruses767.3.5 Mosquito-borne viruses767.3.6 Childhood illnesses: measles, rubella, mumpsand chickenpox787.3.7 Influenza787.4 Protozoal infections787.4.1 Malaria797.4.2 Chagas disease / American trypanosomiasis817.4.3 Babesiosis827.4.4 Leishmaniasis82

7.5 Bacterial infections837.5.1 Syphilis, yaws and gonorrhoea837.5.2 Lyme disease847.5.3 Brucellosis847.5.4 Yersinia infection847.5.5 Salmonella, campylobacter, streptococcus andstaphylococcus857.5.6 Tuberculosis857.6 Rickettsial infections857.7 Prion diseases867.7.1 Creutzfeldt-Jakob disease867.7.2 Variant Creutzfeldt-Jakob disease867.8 Country of residence and travel history877.9 High-risk behaviours877.9.1 High-risk sexual behaviours877.9.2 Injecting drug use887.9.3 Non-injected drugs and alcohol use897.9.4 Detention in prisons and penal institutions897.9.5 Cosmetic treatments and Annexes1 International and national guidelines1142 Example of a blood donor questionnaire1153 Literature search strategies and decision-making process forformulation of recommendations119

Executive summaryBlood transfusion services (BTS) have the responsibility to collect blood onlyfrom donors who are at low risk for any infection that could be transmittedthrough transfusion and who are unlikely to jeopardize their own health by blooddonation. A rigorous process to assess the suitability of prospective donors istherefore essential to protect the safety and sufficiency of the blood supply, andsafeguard the health of recipients of transfusion and blood donors themselves,while ensuring that suitable donors are not deferred unnecessarily.These World Health Organization (WHO) guidelines, Blood donor selection: guidelineson assessing donor suitability for blood donation have been developed to assistblood transfusion services in countries that are establishing or strengtheningnational systems for the selection of blood donors1. They are designed for useby policy makers in national blood programmes in ministries of health, nationaladvisory bodies such as national blood commissions or councils, and bloodtransfusion services.WHO guidance on criteria for the selection of blood donors was first published inthe distance learning materials, Safe Blood and Blood Products, Module 1: SafeBlood Donation (1) in 1994. These earlier recommendations were developed onthe basis of international best practice but did not have a clear evidence base.In 2009, the WHO Blood Transfusion Safety programme (WHO/BTS) convened aguideline development group (GDG) to prepare evidence-based recommendationson criteria for assessing the suitability of blood donors. The GDG also recognizedthe need to provide guidance on establishing national systems for blood donorselection. Details of the members of the GDG and their areas of expertise areprovided in the Acknowledgements.WHO/BTS also established an external review group (ERG) to review and commenton the draft guidelines at various stages of the developmental process. The ERGcomprised members of the WHO Expert Advisory Panel on Blood TransfusionMedicine and experts from WHO Collaborating Centres in Transfusion Medicineas well as directors of national blood transfusion services and blood programmemanagers from each WHO region (see Acknowledgements). The role of the ERGwas to review the draft guidelines and advise WHO on the relevance, applicabilityand feasibility of the recommendations. An advanced draft was reviewed byparticipants and facilitators during an inter-regional workshop on blood donorselection and donor counselling for priority countries in the African and EasternMediterranean regions, June 2011, Nairobi, Kenya.The guidelines are presented in two parts. Part 1 (Sections 2 and 3) addressesthe requirements for an effective national system for blood donor selection; policyrecommendations are provided on p. 5. Part 2 provides guidance on specificcriteria for blood donor selection in relation to general donor assessment, donor1The term “blood donors” includes donors of whole blood, red cells, platelets, plasma andother blood components, donated as whole blood and/or through apheresis.1

medical history and risk assessment for transfusion-transmissible infections(TTI); technical recommendations on donor selection criteria are summarizedon pp. 6–15 and elaborated in Sections 4 to 7.Blood donor selection: guidelines on assessing donor suitability for blood donationwas developed in accordance with the WHO guidelines development process,which requires systematic review of new evidence for key questions andrecommendations, as well as a consideration of programme feasibility and thecost implications of potential new recommendations. A systematic review of thepublished and “grey” literature was conducted covering the period 1995–2011,and also in 2012 for selected topics. Particular efforts were made to identifysystematic literature reviews and evidence related specifically to blood donorselection in low- and middle-income countries. Detailed literature search strategiesand the decision-making process for the formulation of recommendations areavailable in Annex 3.High quality evidence on which to base decisions on the suitability of prospectivedonors for blood donation is, however, limited or even lacking in relation to manymedical conditions and risk behaviours. Where published evidence is lacking,recommendations are based on international best practices and the knowledgeand expertise of members of the guideline development group and externalreview group in the fields of human physiology, pathology and clinical medicine.In conditions where emerging evidence suggests that deferral criteria may berelaxed, a precautionary approach is recommended until good evidence of safetybecomes available. It is anticipated that the recommendations in this documentwill remain valid until 2017 when a review of these guidelines will be undertakento explore any new evidence, particularly in relation to controversial issues orwhere changes in practice may be appropriate.2

AcronymsAIDSAcquired immunodeficiency syndromeBTSBlood transfusion service(s)CDCUnited States Centers for Disease Control and PreventionCJDCreutzfeldt-Jakob diseaseCUEConfidential unit exclusionDIIDDonation-induced iron deficiencyHAVHepatitis A virusHBVHepatitis B virusHCVHepatitis C virusHEVHepatitis E virusHIVHuman immunodeficiency virusHTLV I/IIHuman T-cell lymphotropic viruses I/IIIFRCInternational Federation of Red Cross and Red Crescent SocietiesMSMMen who have sex with menTTITransfusion-transmissible infection(s)UNAIDSJoint United Nations Programme on HIV/AIDSvCJDVariant Creutzfeldt-Jakob diseaseWHOWorld Health Organization3

PrefaceThe safety and availability of blood and blood products for transfusion requiresthe recruitment and selection of voluntary non-remunerated blood donors, thequality-assured screening of all donated blood and the safe and rational clinicaluse of blood. The World Health Organization (WHO) recommends the followingintegrated strategy for blood safety and availability (3).12345Establishment of well-organized blood transfusion services that arecoordinated at national level and that can provide sufficient and timelysupplies of safe blood to meet the transfusion needs of the patientpopulation.Collection of blood from voluntary non-remunerated blood donors atlow-risk of infections that can be transmitted through blood and bloodproducts, the phasing out of family/replacement blood donation and theelimination of paid donation.Quality-assured screening of all donated blood for transfusion-transmissibleinfections, including HIV, hepatitis B, hepatitis C and syphilis, bloodgrouping and compatibility testing, and preparation of blood components.Rational use of blood to reduce unnecessary transfusions and minimize therisks associated with transfusion, the use of alternatives to transfusion,where possible, and safe clinical transfusion procedures.Implementation of effective quality systems, including quality management,documentation, training of all staff and assessment.Each country should establish a national system for blood donor selectionfor the donation of whole blood, red cells, platelets, plasma and other bloodcomponents, donated as whole blood or apheresis donations. The assessmentof donor suitability should be undertaken in accordance with national criteriafor blood donor selection. These criteria should be consistently applied in everyblood donation setting on each occasion of donation to all blood donors, includingvoluntary non-remunerated donors and even where systems are still based onfamily/replacement donors and paid donors.These guidelines on blood donor selection should be used in conjunction withother WHO resources, in particular Towards 100% voluntary blood donation: Aglobal framework for action (4), The Melbourne Declaration on 100% voluntarynon-remunerated donation of blood and blood components (5), Blood donorcounselling: Implementation guidelines (6) and Screening donated blood fortransfusion-transmissible infections (7).Dr Neelam DhingraCoordinatorBlood Transfusion Safety4

Policy recommendations1Each country should establish a national system for blood donor selectionfor the donation of blood or blood components.2All prospective blood donors, either donating as whole blood donations orthrough apheresis donations, should be assessed, prior to blood collection,for their suitability to donate on each occasion of donation, in every blooddonation setting.3National donor selection guidelines and criteria should be based onepidemiological and/or scientific evidence or, where evidence is limited orlacking, on best practices.4Donor acceptance and deferral policies for the prevention of TTI should bebased on up-to-date information on the local epidemiology of infections,the markers screened for, the availability of suitable blood screening andconfirmatory assays, and the technologies in use.5Blood transfusion services should have mechanisms for surveillance tomonitor emerging infections and diseases associated with transmissionthrough transfusion, and assess the risk of transmission and the possibleconsequences to the blood supply of excluding “at-risk” donors.6National donor selection criteria should define conditions of acceptanceand deferral for each criterion.7Adequate resources, including a sufficient number of qualified and trainedstaff, should be made available for the consistent and reliable assessmentof donor suitability for blood donation.8Quality systems should be in place for blood donor selection, includingselection criteria, staff training and documentation.9Blood transfusion services should have systems for the notification andcounselling of individuals who have been deferred from blood donation andfor their referral for further management if any abnormalities are found.10 Blood transfusion services should establish mechanisms for monitoringand evaluation to assess the implementation and effectiveness of donorselection criteria.11 National regulatory mechanisms for the oversight of the functions of bloodtransfusion services should include activities related to blood donor selection.12 National procurement policy and supply systems should encompass theequipment and consumables required for assessing the suitability of blooddonors.5

Technical recommendationsThese technical recommendations provide a summary of recommendations ondonor selection criteria in Sections 4–7, by condition.ConditionAcceptance or deferral criteriaPagenumbersAbortionDefer for up to 6 months46–47AcneAccept provided venepuncture site isunaffected60–61,64–65Also refer to Section 6.2AcupunctureDefer for 12 months following lastprocedure68, 90Age limits for blooddonationUsually 18 to 65 years39–40Alcohol intakeAccept if no signs of intoxication40–41,89AllergyAccept if symptom free57Refer to Section 4.1Defer permanently if history ofanaphylaxisAnaemiaAccept if past history of iron deficiencyanaemia, with a known cause not acontraindication to donation, whentreatment completed and fully recovered43–44,49–50Accept vitamin B12 or folate deficiencywhen fully recovered and onmaintenance treatmentDefer if does not meet minimumhaemoglobin level for blood donation orunder investigation or on treatment foranaemiaDefer permanently if chronic anaemiaof unknown cause or associated withsystemic diseaseAnaphylaxisDefer permanently57AntibioticsAccept 14 days after completion oftreatment41, 55,60, 65Accept if on long-term antibiotics foracneAnkylosing spondylitisDefer permanently60Also refer to Section 5.10ArthritisRefer to Sections 5.6 and 5.10657, 60

AsthmaAccept provided asymptomatic onmaintenance dose of non-steroid and/orinhaled steroid medication54–55,57Defer for 14 days after full recovery fromacute exacerbationDefer for 14 days after completion ofcourse of oral or injected steroidBabesiosisDefer permanently82BiopsyAccept when normal activities resumed67Also refer to Section 6.4Blood transfusionDefer recipient of blood and bloodproducts for 12 months followingtransfusion65–66Defer permanently if on regulartreatment with plasma-derivedcoagulation factorsAlso refer to Section 6.3.1BronchitisDefer for 14 days after full recoveryfrom acute attack and completion oftreatment55Also refer to Section 5.3BrucellosisDefer permanently84BurnsAccept if fully healed61CampylobacterDefer for 28 days following full recovery85Cardiovascular diseasesAccept surgically corrected simplecongenital cardiac malformation with noresidual symptoms52–53Accept asymptomatic disorder: e.g.functional murmurs, mitral valve prolapseDefer permanently all other conditionsAlso refer to Section 5.2Central nervous systemdiseasesAccept if history of epilepsy or seizuresprovided off medication and seizure-freefor 3 years58–59Defer permanently all other conditionsCerebrovascular diseasesDefer permanently58–59Also refer to Section 5.8.1Chagas diseaseRefer to Section 7.4.281–82,87ChickenpoxDefer for 14 days following full recovery78Also refer to Section 7.3.6Chikungunya virusRefer to Section 7.3.577CholecystitisAccept when fully recovered557

Coagulation disordersAccept if carrier for haemophilia A or Bprovided normal coagulation factor levelsand no history of bleeding or treatmentwith blood products52Defer permanently if coagulation factordeficienciesCoeliac diseaseAccept if fully treated55–56ColitisAccept irritable bowel syndrome withoutdebility55Defer active inflammatory bowel diseaseunless well, in long-term remission andmeets minimum haemoglobin levels forblood donationCommon coldRefer to Section 4.341Cosmetic treatment(invasive)Defer for 12 months following lastprocedure68, 90Creutzfeldt-Jakob disease(CJD)Defer permanently sporadic and familialCJD and first-degree relatives58, 65,86–87Defer permanently if history of treatmentwith pituitary-derived human growthhormone, human gonadotrophin, duramater graft, corneal transplantation,neurosurgeryAlso refer to Section 7.7.1Crohn’s diseaseRefer to Section 5.455DementiaDefer permanently58–59Also refer to Section 5.8.3Dengue virusRefer to Section 7.3.577Dental treatmentAccept 24 hours after simple proceduresand 7 days after extraction or endodonticprocedures67DepressionAccept if feeling well61–62DermatomyositisDefer permanently57,60–61DiabetesAccept diabetes mellitus controlledby diet or oral medication provided nohistory of orthostatic hypotension andno evidence of infection, neuropathy orvascular disease56Defer permanently if requires insulintreatment or has complications withmulti-organ involvementDiagnostic proceduresDefer following minor diagnosticprocedure including rigid endoscopy untilnormal activity resumedDefer for 12 months following invasivediagnostic procedure using flexibleendoscopy867

DiarrhoeaAccept 14 days after full recoveryand completion of therapy, includingantibiotics41, 82,83,84–85Accept chronic diarrhoea due to irritablebowel syndrome without debility;otherwise deferDefer for 28 days if symptomssuggestive of Yersinia enterocoliticaDiverticular diseaseAccept if well55Drug useInjecting drug use:88–89Defer permanently individuals with ahistory of injecting drug useAlso refer to Section 7.9.2Non-injected drugs and alcohol use:89Accept if no signs of intoxicationDefer if displaying signs and symptomsof intoxicationEczemaRefer to Section 5.1157, 61EpilepsyAccept if off medication and seizure-freefor 3 years58–59Epstein-Barr virusDefer until 28 days after full recovery76Also refer to Section 7.3.4ErythrocytosisAccept secondary erythrocytosis ifdiagnosis of polycythaemia rubra veraexcluded51EssentialthrombocythaemiaDefer permanently60Fever (non-specific)Defer until 14 days after full recovery41, 42,72,79–81,82, 83,84Also refer to Section 4.3FractureAccept when plaster removed and mobile60Frequency of donationFor whole blood, minimum of 12 weeksfor males, 16 weeks for females44–46Also refer to Section 4.6.2GallstonesAccept if well55Gastro-oesophagealrefluxAccept if mild55GonorrhoeaDefer for 12 months followingcompletion of treatment and assess forhigh-risk behaviour74,83–84Also refer to Section 7.5.1G6PD deficiencyAccept if no history of haemolysisDefer permanently if history ofhaemolysis950–51

HaemochromatosisAccept provided meets other criteria45, 52Haemoglobin level forblood donationNot less than 12.0 g/dl for females43–44,48Not less than 13.0 g/dl for malesAlso refer to Sections 4.6 and 4.10HaemoglobinopathiesDefer permanently thalassaemia majoror sickle cell disease50Also refer to Section 5.1.2HaemophiliaRefer to Section 5.1.752Hepatitis A, hepatitis Eand hepatitis of unknownoriginDefer for 12 months following fullrecovery73–74Hepatitis BRefer to Section 7.3.172–73,87–90Hepatitis CRefer to Section 7.3.173,87–90HerpesAccept cold sores and genital herpesprovided no active lesions76Also refer to Section 7.3.1Defer symptomatic individuals for atleast 28 days following full recoveryDefer permanently individuals with HHV8infection and current or former sexualcontactsAlso refer to Section 7.3.4Hiatus herniaAccept mild cases, provided well55HIV/AIDSRefer to Section 7.3.274–75,83,87–90HTLVRefer to Section 7.3.375HypertensionAccept stable uncomplicatedhypertension controlled by medication53–54Defer if recently started or changed antihypertensive medication until 28 daysafter blood pressure stabilizedDefer permanently if hypertensive heartor renal diseaseHypogammaglobulinaemiaDefer permanently57ImmunizationRefer to Section 6.163–64Immunological diseasesRefer to Section 5.657Infections (acutebacterial)Accept 14 days after full recovery andcompletion of antibiotic treatment41, 85Defer for 28 days following fullrecovery and completion of treatment ifsymptoms suggestive of infection withsalmonella, campylobacter, streptococcusor staphylococcus10

InfluenzaAccept asymptomatic individuals with noclose contact with those having activeinfection78Defer for 14 days after full recovery andcessation of any therapyDefer for 48 hours after vaccinationAlso refer to Section 7.3.7Inoculation injuryDefer for 12 months following exposure73Iron deficiencyRefer to Section 5.1.143–46,49Irritable bowel syndromeAccept, if without debility55LeishmaniasisRefer to Section 7.4.482–83LeukaemiaDefer permanently59–60Lyme diseaseDefer for 28 days following full recoveryand completion of treatment, whicheveris longer84LymphomaDefer permanently59–60MalariaLocal criteria depending on endemicity79–81,87Refer to Section 7.4.1Malabsorption syndromesDefer permanently except treated coeliacdisease55–56Malignant diseasesAccept malignancy “in situ” (e.g. basalcell carcinoma, cervical carcinoma insitu), if successfully treated, regularlymonitored and in good health59–60Defer if current diagnosis of malignancyor less than 5 years since completion oftreatmentDefer permanently if malignantmelanoma, lymphoproliferative orhaematological disordersAlso refer to Section 5.9MeaslesDefer for 14 days following full recovery78Also refer to Section 7.3.6MedicationsTake account of indication for treatment64–65Accept long-term low-dose antibiotics foracneDefer for 14 days following antibiotic useRetinoids, dutasteride, finasteride, aspirinand non-steroidal anti-inflammatory drugs:also refer to Section 7.7MenstruationAccept46–47Minor illnessesDefer for 14 days after full recoveryfrom acute infection and completion ofantibiotic treatment4111

Multiple sclerosisDefer permanently58–59Also refer to Section 5.8.4MumpsDefer for 14 days following full recovery78Also refer to Section 7.3.6MusculoskeletaldisordersAccept acute or chronic simple disorders(e.g. mild rheumatoid arthritis, back pain,sciatica, frozen shoulder, osteoarthritis)if mobile60Defer permanently if systemic diseaseaffecting joints: e.g. severe rheumatoidarthritis, psoriatic arthropathy, ankylosingspondylitisMyelodysplasticsyndromeDefer permanently59–60NephritisRefer to Section 5.757–58Peptic ulcerDefer until completion of treatment andfull recovery55PiercingDefer for 12 months followinglast acupuncture, piercing, tattoo,scarification or invasive cosmeticprocedure68, 90Platelet disordersRefer to Section 5.1.451PolycythaemiaAccept secondary erythrocytosis51,59–60Defer permanently polycythaemia rubraveraPregnancy and lactationDefer during pregnancy and lactationand up to 6 months following delivery ortermination46–47Prisons and penalinstitutionsRefer to Section 7.9.489–90PsoriasisRefer to Section 5.1160–61Psoriatic arthropathyDefer permanently60Also refer to Section 5.10Psychiatric disordersAccept anxiety disorder or mood disorderprovided in generally good health, notobviously over-anxious, depressed ormanic on the day of donation, regardlessof medication61–62Defer permanently psychotic disorderrequiring maintenance treatmentPulmonary embolusRefer to Section 5.2.254Red cell membranedefectsAccept if no history of haemolysis50–51Defer permanently if history ofhaemolysis12

Renal diseasesAccept if fully recovered from acute selflimiting condition (e.g. acute nephritis)provided renal function normal49–50,53–54,57–58Defer permanently if chronic renal diseasecausing ill-health or anaemia or associatedwith chronic or recurrent infectionRespiratory diseasesDefer acute respiratory infectionfor 14 days following full recoveryand completion of therapy, includingantibiotics41,54–55,57Defer permanently if breathless at restor minimal exertion or if cyanosed, hassevere obstructive airways disease(including if on long-term oral steroidtherapy), or chronic or recurrentrespiratory infectionAlso refer to Section 5.3Rickettsial infectionDefer for 6 months following completionof treatment or cessation of symptoms85–86Defer acute Q fever for 2 years followingcompletion of treatment and fullrecovery, whichever is longerDefer permanently chronic Q feverRocky Mountain spottedfeverRefer to Section 7.685–86Rubella infectionDefer for 14 days following full recovery78Also refer to Section 7.3.6Salmonella infectionDefer for 28 days following full recovery85ScarificationRefer to Section 7.9.568, 90SclerodermaDefer permanently60–61Sex workersDefer permanently87–88Sexual behaviour (highrisk)Refer to Section 7.9.187–88Sickle cell diseaseAccept sickle trait provided haemoglobinabove required lower limit50Defer permanently sickle cell diseaseAlso refer to Section 5.1.213

Skin diseasesAccept mild common skin disease (e.g.acne, eczema, psoriasis) if lesions notinfected, venepuncture site is unaffected60–61,64–65Defer if generalized skin disease and onsystemic medicationDefer if contagious skin diseaseDefer permanently if systemic diseaseaffecting skin (e.g. scleroderma,systemic lupus erythematosus,dermatomyositis, systemic cutaneousamyloidosis)Also refer to Sections 5.11 and6.2Streptococcus infectionDefer for 28 days following full recovery85Defer for 14 days following full healing ifrecent superficial but significant woundsStrokeDefer permanently58–59Also refer to Section 5.8.1SurgeryDefer following minor surgery untiltreatment is complete and successfuland normal activity resumed67,86–87Defer for 12 months following majorsurgeryDefer permanently followingneurosurgical procedure, dura matergraft or corneal transplantAlso refer to Sections 6.4 and 7.7SyphilisDefer permanently if has ever had adiagnosis of syphilis83–84Also refer to Section 7.5.1Systemic lupuserythematosusDefer permanentlyTattoo

In 2009, the WHO Blood Transfusion Safety programme (WHO/BTS) convened a guideline development group (GDG) to prepare evidence-based recommendations on criteria for assessing the suitability of blood donors. The GDG also recognized the need to provide guidance on establishing national systems for blood donor selection.