Clinical Diagnostics A

Handouts Week 3

BLOOD BANKING AND TRANSFUSION MEDICINE

The blood bank section is responsible for donor selection, screening of blood products for transfusion
transmissible infections, processing the donor unit into components, compatibility testing and transfusion
reaction investigation.

ABO and other blood group antigens (agglutinogens) are present on the surface of the RBC. Serum
contains natural occurring antibodies (agglutinins) against the ABO antigens, which are easily detected.
Clinically significant antibodies are not naturally occurring and are formed after exposure of the antigen.
This occurs through pregnancy or blood transfusion.

Red blood cell antigens and antibodies are identified by hemagglutination, one of many serologic
techniques.

Blood products are considered to be drugs used to treat the lack of a particular blood component.
Hemolytic transfusion reactions may occur when the recipient's immune system encounters antigens
from transfused blood. Antibodies form in response to antigens, resulting in destruction of donor red
blood cells.

Prior to blood administration/transfusion to a patient, a series of tests are performed to decrease the risk
of an immune-mediated hemolytic reaction caused by incompatible blood. These procedures are
collectively called serologic compatibility testing which includes blood typing, antibody screening and
crossmatchin. Compatibility testing and crossmatching are used interchangeably.

Blood typing is a laboratory test done to determine a person's blood type and the corresponding blood
type of the blood unit to be transfused. Blood typing is performed on patients, blood donors and blood
units.

Antibody screening is routinely used in conjunction with typing and crossmatch before the administration
of blood products, especially red cell products (packed red blood cells and whole blood), to avoid
transfusion reactions and to prevent decreased survival of transfused RBCs. It is also used in antenatal
screening to detect the presence of antibodies in a pregnant woman's serum that could result in hemolytic
disease of the fetus and newborn.

Antibody screening may be performed in advance of a crossmatch for early recognition and identification
of clinically significant antibodies. This allows the selection of blood units least likely to cause
crossmatching delays.

The type and screen are the first pretransfusion compatibility tests performed and are used to identify
the patient's ABO group and Rh type and to detect expected and unexpected antibodies in the patient's
serum, respectively.

If the antibody screening result is positive, additional tests must be performed to identify the antibody.
The crossmatch is the final step of pretransfusion testing as a routine procedure. The donor blood cells
are made to react with patient plasma or serum and observed for agglutination i.e. incompatible blood.
This important step, also known as major crossmatch, serves as the last guard to ensure a safe transfusion.

There are different approaches to crossmatching donor units for transfusion. Regardless of what approach
is selected, the method must demonstrate ABO incompatibility and clinically significant antibodies to red
cell antigens. With most donated blood units now screened for antibodies and most red cells transfused
as packed red cells, the minor crossmatch has become of less significance.

The tests performed during the crossmatch will depend on the results of the antibody screening result
and patient risks of having transfusion reaction. A full serologic crossmatch shall be done in patients with
a history of clinically significant antibodies found with previous testing or found in the current blood
sample.

Clinical Indications/Applications

The crossmatch is routinely used as the final step of pretransfusion compatibility testing.

Purpose of Crossmath:

(1) to serve as a final check of ABO compatibility between donor RBCs and patient plasma or serum
(2) to detect clinically significant antibodies that may have been missed by the antibody screening test.
 IMMUNOHEMATOLOGY

FORWARD OR CELL TYPING

PRINCIPLE
Uses known antisera to the ABO groups to detect and identify ABO antigen on the RBC

SAMPLE
Ideally a 3-5% red blood cell suspension made by diluting venous blood in EDTA with saline should be
used. However, for screening purposes, blood from a capillary puncture can be used.

MATERIALS
Commercially prepared antisera Lancet
Anti A (blue), Anti B (yellow) 70% alcohol
Applicator stick Glass slide
Syringe Cotton balls
Microscope Label pen

PROCEDURE
1. Label slide with patients name
2. Perform a capillary puncture
3. Place two drops of blood on slide approx. one inch apart
4. Add one drop of anti A to one drop of blood and one drop of anti B to the other
5. Mix with end of applicator stick making sure that the mixtures don’t touch each other
6. Gently tilt slide back and forth until wells are well mixed Name
7. Observe for agglutination macroscopically and microscopically

INTERPRETATION
Hemagglutination No hemagglutination
Positive Negative

BLOOD ANTI A ANTI B

GROUP Blue Yellow

“A”

“B”

“AB”

“O”
 REVERSE/SERUM TYPING (Tube Method)

This tests for the presence of naturally occurring antibodies in a persons blood against ABO. It should
never be performed in neonates.

PRINCIPLE
Red Blood Cells with known ABO antigens are mixed with patent’s serum to detect antibodies

SAMPLE
Plasma or serum can be used. However, serum is preferred because it contains less interfering proteins.

MATERIALS
unknown serum Test tube
Known A cells Centrifuge
Known B cells Microscope

PROCEDURE
1. Extract 5 ml of blood from a subject. Place it into a red top tube.
2. Centrifuge the sample and extract the serum.
3. Mark two test tubes with patient’s name or number, label A cell and B cell
4. Place two drops of serum into each tube
5. Add a drop of known A and known B cell suspensions into their respective tubes
6. Mix and centrifuge for 5 minutes
7. Gently shake to dislodge the button of red cells at the bottom.
8. Look for macroscopic and microscopic agglutination. (Refer to reaction image below)

CROSSMATCHING

Traditional crossmatching techniques usually employs testing that uses the patient’s serum or plasma
with the donor’s red cells a.k.a. major crossmatch. The reverse is called minor crossmatch, i.e. the saline-
suspended red patient’s/recipient’s red cells are made to react with the donor plasma.

MATERIALS:
Patient’s serum Dropper
Donor cell suspension Centrifuge
Test tube Microscope

Major cross match.

PROCEDURE.
1. Prepare two test tubes, label the first tube as PS+DC
2. Place one drop of donor cell suspension to the tube.
3. Add two drops of patient’s serum.
4. Mix and centrifuge for 5 minutes.
5. Gently shake to dislodge the button of red cells at the bottom.
6. Look for macroscopic and microscopic agglutination. (Refer to reaction image below)

Note: Positive reaction means an incompatible crossmatch.

Grabbed from:
http://faculty.madisoncollege.edu/mljensen/BloodBank/lectures/Basic_Laboratory_techniques&Reagents.htm

Supplemental Notes:

COOMBS TESTING

Coombs tests employ anti human globulin (AHG) to enhance the immune reaction of weakly agglutinating
IgG antibodies. Antihuman globulin acts as a bridge joining small IgG together to form a lattice that can
be visualized.

The Direct Coombs or Direct Antiglobulin Test (DAT) looks for antibodies that are on the surface of RBC.
This test is positive in Autoimmune Hemolytic Anemia and in the fetal blood in Hemolytic Disease of the
Newborn.

The Indirect Coombs or Indirect Antiglobulin Test (IDAT) or Antibody Screen looks for antibodies in the
liquid portion of the blood. These are seen in multiparous females, individuals who have received
transfusions and the maternal blood in Hemolytic Disease of the Newborn.
EXERCISE: BLOOD BANKING
Name: _____________________________________ Section__________

1. Shown below is a table of reactions from an 80-year old diabetic patient. identify the ABO and Rh typing.
Anti A Anti B Anti D A cell B cell
4+ neg 4+ 2+ 4+

2. What caused the discrepancy in the above case?

3. Can you give Rh negative blood to an Rh positive female? Why or Why not?

4. Two units of packed RBC is transfused to a patient. 15 minutes after the start of the transfusion, the
patient becomes anxious, febrile and hypotensive. You are considering a transfusion reaction. What tests
will you perform to investigate the case?
Principles of Blood Donor Recruitment and Selection
Lifted with permission from the Manual of Donor Selection and Counselling
Published by the National Voluntary Blood Services Program, Department of Health, 2013

Introduction

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.
It 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 nor mal health with a good medical history and absence of high risk behavior
associated with transfusion- transmissible infections shall be accepted as donors of blood or a component of blood for
therapeutic use .
In the pro vision of blood services , all concerned personnel shall observe the International Society of Blood Transfusion’s
(ISBT) Code of Ethics for Blood Donation and Transfusion.

Volunteer Status of Donors

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 voluntary, non-remunerated
donation.”

Informed Consent for Donation

Informed consent for donation is a legal and ethical requirement. This implies one’ s willingness 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 per son’s autonomy.

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 donor s 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 including the results of tests will be kept confidential.
If the donor consents , significantly 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 centers 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 stewardship 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 ha v e 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 ha v e an impact on selection of donors who can provide safe blood
products.
For a blood donor who is not of legal age (less than 18years old), a written informed consent shall be obtained from anyone of
his/her parents or legally authorized representative (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 procedure of the blood donor screening process .

Notification 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
the HIV/AIDS Core Team) for further management if he/she agrees.
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 including 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

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:
 F or males, up to six standard w hole blood donations may be taken per year
 F or females, 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
donor s for iron deficiency.

Quantity of Donation

A standard donation is 450ml + 10% (405ml to 495ml) exclusive of anticoagulants. Blood bags intended for a
collection volume o f 450ml + 45ml (i.e. 405ml-495ml) of whole blood contains 63ml of anticoagulant.
No more than 10.5ml/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 year s (before 61. birthday)
s

 Regular donors may be accepted up to 70 years (before 71 birthday) subject to evaluation by a medical
st

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 from a regular donor weighing 50kg after assessment by an
experienced medical officer.

Hazardous Occupations

Hazardous occupations and hobbies shall normally entail an interval of not less than 12hours 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.

Whether blood shall be collected from a donor. If the medical officer is in doubt, the donor shall be deferred.

The A-Z Guide to Medical Assessment of Blood Donors 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 10years, 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 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. Privacy and confidentiality must be observed at all
times.

Donor Appearance

A complete medical and physical examination of blood donors is generally not possible in practice. The inter viewer
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. Illicit
drug taking if admitted or suspected shall de bar the person from donating.

Blood Pressure and Pulse Rate

It is recommended that pulse rate (full minute) and blood pressure be determined in all donors. The pulse rate shall
be regular and between 60 and 100 beats per minute. It is recognized 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.
 Hemoglobin Estimation

The hemoglobin level shall be determined each time the donor presents himself/herself.
The hemoglobin of the donor must be measured at every attendance using a validated procedure.
The minimum values before donation are:
 Female donor s : 125g/L
 Male donor s : 135g/L

The maximum values before donation are:

 Female donor s : 175g/L
 Male donor s : 185g/L
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 donor s before donation to allow for informed
consent and self-exclusion. This is a routine step in donor selection in every blood donation.
 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
Pre-donation counseling enables the donor to assess his/her own level of risk, and suitability as donor. It 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

A post-donation instruction 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 a day);
 Avoid lifting heavy w eights or strenuous activities for 24 hours ;
 Leaving the dressing/bandage on f or a minim um of four hours ;
 Applying pressure f or 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 is 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 immune compromised – e. g, an infant, a cancer patient, or a transplant patient. In this
case, an irradiated blood product is indicated.

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 in 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.

1.1 Informed Consent for Directed Donations

The full procedures involved in the collection and screening of blood donations must be explained 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.

Apheresis Donors

Apheresis is a procedure used to collect:

 Plasma (plasmapheresis) or
 Cellular components (cytopheresis) which include:
 Red cells
 Platelets (plateletpheresis)
 Granulocytes (granulocytopheresis)
 Hemopoeitic progenitor cells derived from peripheral blood
 Apheresis programmes must be under taken under the super vision 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 super vision of the medical officer or by a trained personnel re p o r ting to
the medical officer.
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 w hen the plasma or platelets are of un usual
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 hour s before donation or other platelet-active drugs (like non-
steroidal anti- inflammatory drugs for 48hours 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 per son working under the super vision
of the medical officer.
 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
Donors who do not meet these criteria may be accepted at the discretion of the medical officer.

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

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 .

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.

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.

Platelets (PlateletPheresis)

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.

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 109 per litre.

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 650ml
(exclusive of anticoagulant) unless fluid replacement is undertaken.

Basic Information before Blood Donation

Basic qualifications

 Age : 16 to 65 years old (written parental consent is required for

o 16 to 17 year old donors)
 Weight : At least 110 pounds (50 Kg)
 Diet : A well-balanced meal is recommended within four hours before donation.
 Health : General good health
 Identification : Valid identification, an ID card may be asked from you such as a driver’s license, PRC card, voter’s
ID, etc.

You are not qualified to donate if the following conditions apply to you:

Risk Behavior for HIV

 Have sexual contracts with multiple sexual partners had high risk individuals
 Have had engaged in men having sex with men (MSM) even once
 Have had syphilis, gonorrhea or other STI in the past 12 months
 Have been engaged in illegal drug use
 Have been imprisoned in the last 12 months

Other Medical Conditions

 Have lung cancer, breast cancer, leukemia, lymphoma and the likes
 Diagnosed to have hepatitis or history of the disease, jaundice (yellowish skin and the eyes)
 Have kidney, lung or liver failure.
Travel
 History of travel to other countries or areas may restrict you from donating blood because of exposure to certain
diseases like Madcow disease, malaria and others. Ask the blood bank personnel for the list of countries or
areas concerned.

DO NOT DONATE
o F or the purpose of getting a free HIV/Hepatitis test. There are available testing facilities and Voluntary Counseling
and Testing (V CT) centers for HIV and AIDS nationwide.
o If you think you are at risk for HIV. Even if you feel well and have a negative result, it is not a guarantee that you are
not infected because test cannot detect infections for a short period of time if you have been exposed to the virus.
 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 Curettage) 12 months from procedure

Acne vulgaris
lesions not active or infected but on topical medication Anytime
taking cyproterone acetate (an anti- testosterone) Anytime
taking tetracycline or erythromycin 2 weeks from completion of treatment
taking isotretinoin, tretinoin, adapalene 4 weeks from last dose
lesions active/inflamed 2 weeks from healing
taking acitretin, etretinate 3 years from last dose
(Neotigason)
Acupuncture (needle sterilized, practitioner certified) Anytime

Age
16 to 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 (donor fit and well)
hay fever with minor symptoms with or without medications, and donor Anytime
fit and well
hay fever with more than minor symptoms with or without 1 month from last incident
medications, and donor fit and well
moderate allergic reaction 1 year from last incident
(including drug allergy)
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
Angioplasty Permanent deferral

Conditions Timing Conditions

Angina pectoris - diagnosis confirmed Permanent deferral

Antacids - taken occasionally for indigestion or heart burn Anytime

Antibiotic depends on the condition for which antibiotic is

taken
Anti-inflammatory medicines (underlying condition acceptable)

NSAIDs - if blood donation not for platelets Anytime

NSAIDs - blood donation for platelets Defer for 24 hours from last dose

Aspirin - blood donation not for platelets Anytime

Aspirin - blood donation for platelets Defer for 72 hours from last dose

Apheresis
platelet 72 hours

double red cell 16 weeks from last apheresis provided height,

weight and Hgb (>145g/L)
criteria are met
single red cell 12 weeks

single red cell + platelets 12 weeks

plasma 4 weeks
Appendectomy 12 months after surgery

Arthritis, not on medications Anytime

on medication , see “anti- inflammatory”

Asthma, mild (donor fit and well) Anytime - if not on medication, only on inhaler
maintenance

Asthma, severe Permanent deferral

Autoimmune diseases like Systemic Lupus Permanent deferral

Erythematosus (SLE) B
BCG vaccine ( see A-Z Guide of Vaccine) 2 weeks from last vaccination
Biopsy, benign and healed 12 months from the procedure
Blood donation, whole blood 12 weeks from last donation; shorter
interval may be allowed provided
frequency does not exceed 6x in the
Blood transfusion entire year

Whole Blood (WB), Packed Red 12 months from last transfusion

Conditions Timing Conditions
Blood Cell (PRBC), Platelet
Concentrate
Clotting (PC),
factorsFresh Frozen
(Factor VIII, IX) Permanent deferral
Plasma (FFP)
Blood Tr ansfusion given in Fr ance, Ireland, & United Kingdom Permanent deferral
Body pier cing (ear/tongue/nose/nave l holing) 12 months from procedure
Boils 1 month from completion of antibiotics
Brain surgery Permanent deferral
Bronchiectasis Permanent deferral
Bronchitis, acute 1 month after complete recovery
Bronc hitis, chr onic Anytime, if symptom free for 2 4 months
Brucellosis Permanent deferral
C
Cancer, all types Permanent deferral
Candidiasis (thrush, monilial infection) 1 week from completion of treatment
Cataract Anytime
Chagas disease Permanent deferral
Cellulitis 1 week after recovery and completion of
Chicken pox (varicella ) treatment

infection in donor 1 month after recovery

contact with infected person:
contact with no history of previous infection 1 month after last contact

contact with history of previous infection Accept - anytime

Childbirth 9 months after delivery or 3 months after

weaning
Cholecystitis 1 month after recovery
Cholecystectomy 12 months after recovery
Cholera vaccine ( see A-Z Guide of Vaccine)
Colitis Permanent deferral - if diagnosis is
irritable bowel syndrome
Colitis, ulcerative Permanent deferral
Common cold 1 week after recovery
Concussion, mild 3 months after recovery
Conjunctivitis
Conditions Timing Conditions

allergic if mild, may accept

infectious One week after resolution and completion of

antibiotic treatment
Convulsions/Seizures/Epilepsy Permanent deferral

Corneal transplant 12 months after procedure

Coronary heart disease Permanent deferral

Cosmetic procedures (facial “cleaning”, botox injection, dermabrasion, etc.)

12 months after procedure
Creutzfeld Jacob Disease (CJD) at-risk individuals
Permanent deferral
1st degree blood relatives of person with CJD UK : England, Wales, Scotland, Nor ther n
Ireland, Isle of Man, & the Channel Islands
recipients of human neurological derived products like human Permanent deferral
growth hormone, human pituitary gonadotrophin, dura matter
(Ly odura)recipient of corneal transplant while in the United Kingdom, Republic of Permanent deferral
Ireland, France
recipient of Blood Transfusion while in United Kingdom, Republic of
Permanent deferral
Ireland, France

D
Dengue Fever 1 month after recovery if without Blood
Transfusion
Dental surgery 12 months after procedure
Dental extraction, uncomplicated 72 hours after procedure
Dental extraction with abscess 1 month after recovery & off antibiotics
Dermatitis After complete healing
Diabetes mellitus
controlled by diet & oral medication Anytime
uncontrolled and on insulin Permanent deferral
Diarrhea, infectious 1 month after complete recovery
Diptheria 1 month after complete recovery
Conditions Timing Conditions
Diverticulosis Anytime
Diptheria, Pe r tussis, Tetanu (DPT) and ( see A-Z Guide of Vaccine)
Diptheria
Drugs, useTetanu (DT) vaccine
of prohibited drugs Indefinite deferral
Duodenal ulcer
3 months after recovery
gastrectomy 12 months after procedure
with complete gastrectomy Permanent deferral
Dysenter y, amoebic/bacillar y 1 month after complete recovery
E
Ear holing ( see “Body Piercing”) 12 months from the procedure
Embolism Permanent deferral

Emphysema Permanent deferral

Encephalitis Permanent deferral
Epilepsy/Convulsion/Seizure Permanent deferral
Epistaxis Anytime if Hemoglobin is 125 g/L and up,
and not due to hematologic disorder
F
Fainting spells Refer to a physician
history of faint during blood Permanent deferral
donation two consecutive times
Fe r tility dr ugs ( see “CJD At-Risk Individuals”) 1 year from completion of investigation for
fertility
Fever of unknown origin (unexplained) 4 months after resolution of feve r, if not
consistent with Malaria
Filariasis
infection Permanent deferral
took medication during Filariasis 2 weeks after intake of anti-Filarial
Elimination Prog ram - MDA medicines
Fr actur e, with surgical inter vention 12 months
G
Gallstone, asymptoma tic Anytime
Gastrectomy, gastroenterostomy 12 months after surgery
Permanent deferral
Gastroenteritis 1 month after recovery
Genital/Perianal wart Permanent deferral
Conditions Timing Conditions
Genital herpes Permanent deferral
Glandular fever 6 months after recovery
Glaucoma - treated by eyedrops other than beta blocker Accept anytime
Gonorrhea Permanent deferral
Gout If quiescent, accept
Gout active 3 months after recovery
H
Hematuria After recovery
Hemorrhoidectomy 12 months after surgery
Hay fever (see Allergy)
Head injuries, minor/severe (see Concussion)
Hepatitis, exposure to close household contact Indefinite deferral
Hepatitis - type of infective agent unknown Indefinite deferral

Hepatitis A 6 months after live r function tests have

normalized, provided that diagnosis is
supported by laboratory tests
Hepatitis B (HBsAg seropositive) Permanent deferral

Hepatitis B (HBsAg seroreactive; Indefinite deferral until confirmed

unconfirmed) seronegative
Hepatitis B - current sexual partner of Permanent deferral
Hepatitis B - past sexual partner of Indefinite deferral
Hepatitis B vaccine (see A-Z Guide of Vaccine)
He patitis B va ccine, plasma-derive d (see A-Z Guide of Vaccine)
Hepatitis immunoglobulin (see A-Z Guide of Vaccine)
Herpes simplex Indefinite deferral
Herpes zoster 1 month after complete recovery
Hydatid disease 6 months after recovery
Hysterectomy 12 months after recovery
Hypertension >160/100 Indefinite deferral
Hyperthyroidism Anytime if not on medication
Hypotension, <90/60 Indefinite deferral
I
Incarceration (jail/prison) 12 months from release
Influenza 1 month after complete recovery
Conditions Timing Conditions
Influenza, contact 3 days from last contact
Influenza, vaccine ( see A-Z Guide of Vaccine)
Intraarticular injection of cortisone 1 month after injection
Insulin ( see Diabetis Mellitus )
 J
Jaundice , obstructive 12 months after recovery
Jaundice, cause undeter mined Indefinite deferral
L

Laryngitis 1 month from recovery and off antibiotic

Leptospirosis 3 months after recovery
Lung, abscess (not malignant) 3 months after recovery and off antibiotic
M
Malaria, infection 3 years after treatment, if asymptomatic
Travel to area endemic for malaria with or without prophylaxis (stay 6 months from departure from area
for < 6 months)

Former resident of malaria endemic area, or stayed in malaria endemic 12 months from date of departure from area
area for 6 months or more

Malignant disease Permanent deferral

Mass Drug Administration (MDA) - Filariasis 2 weeks from treatment
Mass Drug Administration (MDA)- Schistosomiasis 2 weeks from treatment

Measles (Rubeola) 6 weeks after recovery

Measles vaccine ( see A-Z Guide of Vaccine)
Medications ( see A-Z Guide to Medication )
Meningitis 6 months after recovery and if no history of
seizure
Migraine Accept if asymptomatic
Mumps, infection 4 weeks from recovery
contact 1: with no previous infection 4 weeks from last exposure

contact 2: with previous infection Accept anytime

N
Nephritis, acute (pylonephritis) 5 years after recovery & off antibiotic

Nephritis, chronic Permanent deferral

Conditions Timing Conditions
O
Oral polio vaccine ( see A-Z Guide of Vaccine)
Osteomyelitis 6 months after recovery
P
Paget’s disease Permanent deferral
Pancreatitis 1 month after complete recovery
Peptic ulcer 3 months if symptom free
Peritonitis 6 months after recovery
Phlebitis 3 months after recovery
Pneumothorax 6 months after recovery

Poliomyelitis 12 months after recovery

Polycythemia, secondary Permanent deferral (Phlebotomy for
therapeutic purpose only)
Female (maximum 175mmol/L)
Male (maximum 185mmol/L)
Pregnancy ( see Childbirth)
Prolonged bleeding Permanent deferral
Psychiatric disorder Permanent deferral
Pulse rate Anytime if 60-100 beats/min (regular
rhythm)
Psoriasis Never
 Q
Q Feve r Permanent deferral
R
Renal colic Anytime if symptom free
Rabies vaccine (see A-Z Guide of Vaccine)
Raynaud’s disease Permanent deferral
Rheumatic fever Permanent deferral
Rheumatism Anytime, if not on dr ugs
Rubella (German measles)
infection 4 weeks from recovery
contact 1: no previous infection 4 weeks from last exposure
contact 2: with previous infection Accept anytime
vaccination 8 weeks from vaccination
Conditions Timing Conditions
S
Sarcoidosis Permanent deferral
Salmonella food poisoning 12 weeks from recovery
Scarlet fever 4 weeks after recovery
Schistosomiasis Permanent deferral

Schistosomiasis, Mass Drug Administration 2 weeks from treatment

(MDA )
Septicemia 6 months after recovery
Sexually Tr ansmitted Inf ection (STI) Permanent deferral
S exual behavior, risky
Male having Sex with another Male Indefinite deferral
(MSM) even once, even with the use of condom
Having sex with somebody with multiple sexual partner Indefinite deferral

Having sex with an Intravenous (IV) Indefinite deferral

drug user
Having sex with HIV-inf ected heterosexual partner Indefinite deferral

Female who has had sex with an Indefinite deferral

MSM male
Received money or drugs in exchange for sex Indefinite deferral

Casual sex (tends to be repeated) Indefinite deferral

Shingles (herpes zoster)
infection 4 weeks from recovery
contact 1:with no previous infection 4 weeks from last exposure
contact 2:with previous infection Accept anytime
Systemic Lupus Erythematosus (SLE) Permanent deferral
Small pox vaccine ( see vaccine) ( see A-Z Guide of Vaccine)
Syphilis Indefinite deferral
Warts, genital Permanent deferral
Stye 4 weeks after recovery
Sore eyes 4 weeks from recovery
T
Tattooing (permanent not henna) 12 months from procedure
Temperature Anytime if <37ºC
Conditions Timing Conditions
Tetanus, infection 6 months after recovery
passive immunization, post injury 4 weeks from injection
Thrombophlebitis 3 months after recovery
Thyroidectomy (benign tumor) 12 months
Thyroid malignancy Permanent deferral
Tonsillitis 4 weeks after recovery
Tonsillectomy 12 months after recovery
Toxoplasmosis 6 months after recovery
Tr av e l
to UK and Republic of Ireland Permanent deferral
lived or visited
to Malaria for a area
endemic total period of 6 months or more from 1980 6 months from departure from the area
to presentFormer
Tr avel to area endemic
resident for malaria
of malaria endemicwith
area,oror without
stayed in malaria endemic area 12 months from date of departure from the
prophylaxis
for 6 months(stay
Tuberculosis for < 6 months)
or more areamonths after complete recovery/
24
Tuberculin Injection/TB Skin Test/ cure:
1 weekCompletion of chemotherapy +
from injection
Purified Protein Deriva tive (PPD) Test
Typhoid/Salmonella 2 negative follow-up sputum exam

infection 3 months from recovery & stool negative

household contacts 4 weeks from last exposure
Typhus (suitable for plasma donation only)

Typhus vaccine Anytime, if symptom free, a febrile

U
Unexplained weight loss of more than 5 kg. within 6 months Permanent deferral

Upper Respiratory Tract Infection (URTI) 1 week after recovery

Conditions Timing Conditions
V

Vaccines ( see A-Z Guide of Vaccines)

Vitamins Anytime

Vitiligo Accept if part of multisystem disease; if

primary cause unknown - permanent
deferral
 Timing of Blood Donation when
Medications are being taken by Donors
Medications Timing of Donation

A
Acne medication, e. g . Retinoids One month deferral from last dose
Allergy causing drugs: Penicillin, Aspirin 3 weeks after completion
Single dose
Chronic intake 3 days after
3 weeks after last dose
Analgesics, except Aspirin Anytime, if symptom free
Antibiotic other than Anti-TB drugs One month after recovery and
completion of treatment and reasons
for taking antibiotics must be assessed
Anticonvulsant Permanent deferral
Antihistamine/anti-allergy medication Anytime
Anti-inflammatory (non-steroidal) Anytime but not for platelet preparation
Aspirin, Piroxicam
One week after last dose
Chronic
Anytime , but not for platelet
Single preparation
B
Bronchodilators Anytime , if asymptomatic
Beta Blockers Permanent deferral

C
Colchicine Anytime , if over the acute episode of gout
Contraceptive pills, and injection Anytime

D
Decongestant Anytime , if asymptomatic

Digitalis Permanent deferral

DEC + Alben (MDA - Filariasis) Two weeks after treatment

Drugs with no therapeutic claim (food or organic supplements, herbal Anytime

preparations)

F
Fungal medication (oral) One month after resolution
Fungal medication (topical) - for skin/ If involving the phlebotomy site or an
nail/hair infection extensive par t of the body, defer f or one
month after resolution

G
Glutathione , any preparation for a liver disorder Permanent deferral
Glutathione , cosmetic use
Intravenous One year after last dose
O r al/Topical Anytime
Growth hormone Permanent deferral

H
Hypertensive drugs Temporary defer r al, pending Medical
Clearance

Hypoglycemic agent, oral ( see Diabetes, A-Z Guide to Medical

Assessment)

I
Insulin Permanent deferral
Isoretinoin 1 month after last dose
P
Paracetamol ( see Analgesic, A-Z Guide to Medical
Assessment)

Praziquantel (Mass Drug Two weeks from treatment

Administration - Schistosomiasis)
Propecia (hair grower) One month from last dose

Psoriasis medication, e. g . , Tegison Permanent deferral

Psychosis drugs Permanent deferral

S
Steroids preparation, topical Anytime , as long as it is not applied on the
phlebotomy site
V
Vitamins Anytime
 Timing of Blood Donation When Donor Received Vaccine
I. Live attenuated vaccine Timing Donation
AH1N1 Influenza 1 month after vaccination
Bacillus Calmettes-Guerin (BCG) for 1 month after vaccination
Tuberculosis
Chicken pox (Varicella Zoster) 1 month after vaccination
Measles 1 month after vaccination
Mumps 1 month after vaccination

P olio (or al, Sa bin) 1 month after last dose

Rabies (no exposure , f or prophylaxis) 1 month after last dose
Rabies (post animal bite) 12 months after last dose
Typhoid (oral) 1 month after last dose
Yellow fever 1 month after vaccination
Vaccinia (small pox) 1 month vaccination

II. Other Vaccines

Cervical Cancer (HPV) 4 week after vaccination
Japanese encephalitis 3 weeks after vaccination
MMR (Measles , Mumps and Rubella) 8 weeks after vaccination
Plague 4 weeks after vaccination
Rabies (non-exposure) 4 weeks after vaccination
Rubella 8 weeks after vaccination

II. Killed Vaccines/Toxoids

Anthrax Accept, anytime if asymptomatic
Botulism Accept, anytime if asymptomatic
Cholera Accept, anytime if asymptomatic
Diphtheria Accept, anytime if asymptomatic
Hemophilus influenzae type B (HIB) Accept, anytime if asymptomatic
Hepatitis A (non exposure) Accept, anytime if asymptomatic
Hepatitis B (non exposure) 1 week from vaccination
Influenza Accept, anytime if asymptomatic
Meninggococcal Accept, anytime if asymptomatic
P e r tussis (whooping cough) Accept, anytime if asymptomatic
Pneumococcal Accept, anytime if asymptomatic
Tetanus Accept, anytime if asymptomatic
Typhoid (injection only) Accept, anytime if asymptomatic
Timing Donation
Typhus Accept, anytime if asymptomatic

III. Gamma
F orGlobulin
contact with Hepatitis B 6 weeks
One yearfrom
fromlast injection
exposure
F or contact with He patitis A
Tetanus Immnunoglobulin One year from last dose
Rabies, post exposure One year from last dose
EXERCISE: Donor Recruitment
Name: _____________________________________ Section__________

1. Assess the following conditions, classify if the donor is accepted or

temporarily/permanently/indefinitely deferred:

- Six-month old tattoo ______________________________________

- (+) HepB surface antigen _____________________________________
- Acne on Retinoids _____________________________________
- Recent Influenza vaccination _____________________________________
- DM on insulin _____________________________________
- Anticonvulsant medication _____________________________________
- Contraceptive pill _____________________________________
- Rabies vaccinationSix-month ago _____________________________________
- Hypertension controlled _____________________________________
- Conjunctivitis 2 weeks ago _____________________________________
- Schistosomiasis _____________________________________
- Alcohol intake 6 hours prior _____________________________________

2. A 16-year old high school student who is apparently healthy came to your mobile blood donation
activity. Should you allow him to donate? Explain your answer.

3. What should you advise a blood donor after the blood donation?

4. Explain what is Confidential Unit Exclusion (CUE).