Assessment of the suitability of individuals to donate following medical and surgical interventions, including vaccinations, should take into consideration whether:
The reason for the intervention is an indication for deferral
The intervention puts the donor at increased risk of harm by blood donation
The intervention could affect the quality or safety of the blood and blood products and patient safety.
6.1. IMMUNIZATIONS AND VACCINATIONS
6.1.1. Post-exposure prophylaxis
The deferral period is determined by the incubation period and “window period” of the infection and the sensitivity of the available screening tests.
Also refer to Section 7.3 on viral infections.
Recommendations
HEPATITIS B
Accept
Individuals who have received hepatitis B post-exposure prophylaxis with vaccine and/or immunoglobulin: accept 12 months after exposure if they have been tested and found to be negative for HBsAg and negative for anti-HBc or, if anti-HBc positive, must have anti-HBs greater than 100 mlU/ml
Defer
6.1.2. Live attenuated viral and bacterial vaccines
Live attenuated viral vaccines include hepatitis A, Japanese encephalitis, influenza, measles, mumps, rubella, polio (oral), smallpox and yellow fever. Bacterial vaccines include BCG, cholera and typhoid.
Blood from a recently vaccinated donor may contain an infective agent which, although not harmful to the donor, is theoretically a risk if the blood is transfused to an immune-suppressed patient.
Some vaccines are not listed here as these vaccines are only given before the age of 16 years and should not be given after the age of 16; hence, they are not of relevance in blood donor selection (144,145).
6.1.3. Inactivated vaccines
Non-live vaccines and toxoids include cholera, diphtheria toxoid, hepatitis B, human papillomavirus (HPV), influenza, meningococcal meningitis, pertussis, pneumococcal, polio (injected), rabies, tetanus toxoid, tick-borne encephalitis and typhoid.
These vaccines pose no risk to the recipients of blood; donors may be accepted provided they are well.
HBV is an exception as vaccination may cause transient HBsAg positivity. A 14–day deferral is therefore recommended provided the donor has not been exposed to infection (also refer to hepatitis B in Section 7.3 on viral infections).
Recommendations
Accept
Defer
6.2. MEDICATIONS
Deferral criteria for medications taken by donors should take into account the underlying condition for which the medication is taken, the pharmacokinetic properties of the medication and the effect of the medication on the quality or safety of the donated blood (146,147,148). Donors should not omit regular medication in order to attend a blood donor session.
There is no published evidence that medications in donated blood have caused adverse effects in a patient receiving transfusion, although it is unlikely that such events would be recognized. European Union legislation requires temporary deferral based on the “nature and mode of action” of the medication (149).
Recommendations
The BTS should consider the following principles in developing deferral criteria for medications:
A plasma concentration of the medication below 10% of the therapeutic level is highly unlikely to be harmful.
When blood components containing < 50 ml donor plasma are transfused to an adult or older child (12 years of age or more), the plasma concentration of any medications taken by the donor will be < 3% and can therefore be disregarded.
If more than 50 ml plasma from a single donor is transfused, or if the recipient is a child less than 12 years of age, the plasma concentration of any donor medication may be more than 10% of the therapeutic level. There is no evidence that this is likely to cause harm; however, BTS may wish to consider additional selection criteria for apheresis donations and for paediatric components. Further research is needed in this area.
Aspirin and non-steroidal anti-inflammatory medications (NSAIDs) irreversibly inhibit platelet aggregation; platelet components should not routinely be prepared using donations from donors who have taken aspirin within 5 days or other NSAIDs within 48 hours.
Teratogenic and fetotoxic medicines deserve particular consideration as there is a theoretical risk of causing a fetal abnormality in the unlikely event that the blood is transfused to a pregnant female during the first trimester. Retinoids (etretinate, acitretin, isotretinoin) are highly teratogenic. Dutasteride and finasteride (prescribed for benign prostatic hypertrophy) have been shown to cause genital abnormalities in male fetuses of experimental animals; there is no evidence of harm in humans.
Accept
Defer
Defer permanently
6.3. BLOOD TRANSFUSION AND TRANSPLANTATION
6.3.1. Blood transfusion
Despite all efforts to assure the safety of blood transfusion, it remains an important risk factor for transfusion-transmitted infections. Hence, anyone who has received transfusion of any blood or blood product should not be accepted as a blood donor for a period of 12 months.
For precautions against the secondary transmission of vCJD and iatrogenic CJD by blood transfusion, also refer to Section 7.7 on prion diseases.
Recommendations
Accept
Defer
Recipients of blood transfusion: defer for 12 months
Former sexual contacts of individuals on regular treatment with plasma-derived coagulation factors: defer for 12 months after last sexual contact
Current sexual contacts of individuals on regular treatment with plasma-derived coagulation factors
Defer permanently
6.3.2. Organ, stem cell and tissue transplantation
A requirement for stem cell or organ transplantation indicates serious underlying disease and such patients should not be accepted as blood donors.
The same criteria apply to allogeneic tissue grafts as to allogeneic blood transfusion. Recipients of tissue grafts performed since 1980 in countries in which the risk of vCJD has been identified should be permanently deferred.
In some countries, recipients of dura mater grafts and corneal transplants are permanently deferred as a precaution against possible transmission of iatrogenic CJD (64,145) (also refer to Section 7.5 on prion diseases).
Recipients of xenografts and non-human organ perfusion should be permanently deferred from blood donation due to the unknown risks of the transmission of animal infections.
Recommendations
Defer
Defer permanently
Recipients of:
- —
Stem cell or organ transplantation
- —
Allogeneic cells or tissue sourced since 1980 from countries in which the risk of vCJD has been identified
- —
Dura mater graft
- —
Corneal transplant
- —
Xenograft
- —
Non-human organ perfusion
6.4. DIAGNOSTIC AND SURGICAL PROCEDURES
The indication for the procedure may be a reason for donor deferral.
Invasive investigations, particularly if associated with tissue biopsy, carry a risk of infection. Flexible endoscopes have been associated with the transmission of hepatitis C (152), although a more recent study reported that this is not a problem provided that good infection control procedures are followed (153).
Individuals awaiting a surgical procedure that is likely to result in blood loss should be temporarily deferred so that iron stores are not compromised pre-operatively. A deferral period of 12 months following major surgery is usually sufficient to allow for the individual's full recovery, restoration of iron stores and resolution of any bacterial infection, and for routine donation testing to detect any transfusion-transmissible viral infections. For patients who receive blood transfusion during surgery, also refer to Section 6.3 on blood transfusion and transplantation.
Deferral criteria for surgical procedures should take into account the underlying condition for which the procedure is indicated. Prospective donors undergoing minor surgical procedures should be deferred until treatment is complete and successful and they have returned to normal activity.
Dental procedures, although minor, are associated with transient bacteraemia (154,155,156).
6.5. ALTERNATIVE, COMPLEMENTARY AND TRADITIONAL MEDICINE
Any therapy involving skin penetration (e.g. acupuncture or scarification) may cause blood-borne infection unless sterile techniques are used. The BTS should be aware of any procedures that are in use locally, including ritual practices and cosmetic treatments, and develop deferral criteria based on the standards of infection control employed and the sensitivity of donation testing (also refer to cosmetic treatments and rituals in Section 7.9 on high-risk behaviours).
