but they can safely contribute to the nation’s blood supply [12]. Although 18 years is typically the age at which individuals can take responsibility for their own actions, the lower age limit for blood donation is usually 17 years, and most states have passed laws that also allow donation of whole blood at the age of 16 with parental consent. These special laws dealing with blood donation enable high school students to donate. However, donor safety concerns regarding possible health effects of iron depletion in this age group have led some blood centers to self‐regulatory steps, such as longer minimal donation intervals (e.g., no more than two times per year) and prohibiting automated collection of double red cell units in females younger than 19 years [13].
Obtaining medical history
The medical history is an extremely important part of the selection of donors because it can reveal reasons why donation might not be wise for the donor or reasons why the donor’s blood might pose increased risk for the patient. Because most blood organizations now use the computerized self‐administered history, the interview usually takes less than 10 minutes. Many blood organizations provide the opportunity for the donor to do this online in advance. In addition to obtaining responses to these specific questions (Table 4.2), the interviewer attempts to assess whether the donor is in good general health, is not under the influence of drugs, and is able to give informed consent for the donation. The interview must occur in a setting that provides privacy for the donor. Although complete visual privacy is not always possible, visual distractions should be minimized, and the donor’s answers must not be audible to others. The interviewer reviews the response in the computer‐assisted donor history and then asks specific questions. The varied levels of computer‐assisted donor screening seem to be acceptable to donors and may decrease errors [14].
An interagency task force developed a standard donor history questionnaire (DHQ) that is approved by the FDA (https://www.fda.gov/vaccines‐blood‐biologics/guidance‐compliance‐regulatory‐information‐biologics/biologics‐guidances) and is used as a template by most blood banks. There is supplemental material for the DHQ regarding responses to each question, together with a flow chart defining need for and duration of deferral (http://www.aabb.org/tm/questionnaires/Documents/dhq/v2‐1/DHQ‐v2‐1‐Implementation‐Toolkit.pdf). The DHQ can be self‐administered by the donor or combined with direct questioning and is easily put in a computer‐assisted format. The questions designed to protect the safety of the donor include those regarding medications and whether the donor has a history of heart or lung disease, present or recent pregnancy, recent donation of blood or plasma, or bleeding condition. Questions pertaining to recipient safety include inquiry to the donor’s general health; the presence of a bleeding disorder, Chagas’ disease (although the question is not helpful) [15], or babesiosis; the injection of drugs; blood transfusion; tattoo or ear or body piercing; organ or tissue transplant; travel to areas endemic for malaria, Ebola, or Zika; recent immunizations; contact with persons with hepatitis or other transmissible diseases; ingestion of medications, especially aspirin; or previous notice of a positive test for human immunodeficiency virus/acquired immune deficiency virus (HIV/AIDS).
Individuals who have spent more than 3 months in the United Kingdom from 1980 to 1996 are deferred because of possible exposure to the causative agent of variant Creutzfeldt–Jakob disease, as are those who have spent 5 or more years in selected European countries. Based on studies in the United States and Canada, which have modified restrictions, 1–2% donor loss has been estimated because some form of this question has been included on the questionnaire [16–18].
Table 4.2 Complete list of medical history questions for blood donors.
Source: Fung MK, Eder AF, Spitalnik S, Westhoff CM, eds. Technical Manual, 19th edn. Arlington, VA: American Association of Blood Banks, 2017.
| Are you |
| Feeling healthy and well today? |
| Currently taking an antibiotic? |
| Currently taking any other medication for an infection? |
| Please read the Medication Deferral List |
| Have you taken any medications on the Medication Deferral List in the time frames indicated? (Review the Medication Deferral List.) |
| Have you read the educational materials today? |
| In the past 48 hours, |
| Have you taken aspirin or anything that has aspirin in it? |
| Female donors: Have you been pregnant or are you pregnant now? (Males: check “I am male”) |
| In the past 8 weeks, have you |
| Donated blood, platelets, or plasma? |
| Had any vaccinations or other shots? |
| Had contact with someone who was vaccinated for smallpox in the past 8 weeks? |
| In the past 16 weeks, have you |
| Have you donated a double unit of red cells using an apheresis machine? |
| In the past 12 months, have you |
| Had a blood transfusion? |
| Had a transplant such as organ, tissue, or bone marrow? |
| Had a graft such as bone or skin? |
| Come into contact with someone else’s blood? |
| Had an accidental needle‐stick? |
| Had sexual contact with anyone who has HIV/AIDS or has had a positive test for the HIV/AIDS virus? |
| Had sexual contact with a prostitute or anyone else who takes money or drugs or other payment for sex? |
| Had sexual contact with anyone who has ever used needles to take drugs or steroids, or anything not prescribed by their doctor? |
| Male donors: Had sexual contact with another male? |
| Female donors: Had sexual contact with a male who had sexual contact with another male in the past 12 months? |
| Had sexual contact with a person who has hepatitis? |
| Lived with a person who has hepatitis? |
| Had a tattoo? |
| Had ear or body piercing? |
| Had or been treated for syphilis or gonorrhea? |
| Been in juvenile detention, lockup, jail, or prison for more than 72 consecutive hours? |
| In the past 3 years, have you |
| Been outside the United States or Canada? |
| From 1980 through 1996 |
|
Did you spend time that
|