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Blood donor screening: Medical history

INTRODUCTION

A major goal of transfusion medicine practice has been to reduce the risk of transfusion-transmitted infection to as low a level as possible [1]. This discussion will provide a general overview of the blood donor medical history as a means for screening donors in the United States for the possibility that their blood products might transmit such infections. Issues related to the actual procedures involved in blood donor screening and the laboratory testing of donated blood are discussed separately. (See "Blood donor screening: Procedures and processes to enhance safety for the blood recipient and the blood donor" and "Blood donor screening: Laboratory testing".)

RATIONALE

Role of the medical history — Donor screening and laboratory testing of donated blood prior to transfusion are intended to ensure that recipients receive the safest possible blood products. Uniform donor medical history criteria ensure that similar donor screening occurs regardless of the collection facility. While laboratory testing is highly effective at removing units with the potential to transmit infection from the blood supply, the donor medical history makes additional contributions to reducing these and other complications of blood transfusion. (See "Blood donor screening: Laboratory testing".)

Examples include reducing the risk of the following:

Infection with an organism for which blood is not tested (eg, malaria)

Exposure to a medication with teratogenic potential (eg, isotretinoin)

                              

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Literature review current through: Jul 2014. | This topic last updated: Jul 21, 2014.
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References
Top
  1. AuBuchon JP, Birkmeyer JD, Busch MP. Safety of the blood supply in the United States: opportunities and controversies. Ann Intern Med 1997; 127:904.
  2. Kleinman S. Donor screening procedures. In: Clinical Practice of Transfusion Medicine, 3rd ed, Petz L, Swisher S, Kleinman S, et al (Eds), Churchill-Livingstone, New York 1996. p.245.
  3. FDA Guidance for Industry: Acceptable full-length donor history questionnaire and accompanying materials for use in screening human donors of blood and blood components. http://www.fda.gov/cber//blood/bldguid.htm (Accessed on October 06, 2011).
  4. FDA Guidance for Industry: Implementation of an Acceptable Abbreviated Donor History Questionnaire and Accompanying Materials for Use in Screening Frequent Donors of Blood and Blood Components. May 2013. http://www.fda.gov/cber//blood/bldguid.htm.
  5. Katz LM, Cumming PD, Wallace EL, Abrams PS. Audiovisual touch-screen computer-assisted self-interviewing for donor health histories: results from two years experience with the system. Transfusion 2005; 45:171.
  6. Williams AE, Thomson RA, Schreiber GB, et al. Estimates of infectious disease risk factors in US blood donors. Retrovirus Epidemiology Donor Study. JAMA 1997; 277:967.
  7. Glynn SA, Smith JW, Schreiber GB, et al. Repeat whole-blood and plateletpheresis donors:unreported deferrable risks, reactive screening tests, andresponse to incentive programs. Transfusion 2001; 41:736.
  8. Maclennan S, Barbara JA, Hewitt P, et al. Screening blood donations for HCV. Lancet 1992; 339:131.
  9. Doll LS, Petersen LR, White CR, Ward JW. Human immunodeficiency virus type 1-infected blood donors: behavioral characteristics and reasons for donation. The HIV Blood Donor Study Group. Transfusion 1991; 31:704.
  10. Centers for Disease Control and Prevention (CDC). HIV transmission through transfusion --- Missouri and Colorado, 2008. MMWR Morb Mortal Wkly Rep 2010; 59:1335.
  11. Orton SL, Virvos VJ, Williams AE. Validation of selected donor-screening questions: structure, content, and comprehension. Transfusion 2000; 40:1407.
  12. Director, Center for Biologics Evaluation and Research: Recommendations for the prevention of human immunodeficiency virus (HIV) transmission by blood and blood products. Memorandum to all registered blood establishments. April 23, 1992.
  13. Director, Center for Biologics Evaluation and Research, Food and Drug Administration: Recommendations for the deferral of current and recent inmates of correctional institutions as donors of whole blood, blood components, source leukocytes, and source plasma. Memorandum to all registered blood establishments. June 8, 1995.
  14. Director, Center for Biologics Evaluation and Research, Food and Drug Administration: Interim recommendations for deferral of donors at increased risk for HIV-1 group O infection. Memorandum to all registered blood and plasma establishments. December 11, 1996.
  15. Sheppard HW, Dondero D, Arnon J, Winkelstein W Jr. An evaluation of the polymerase chain reaction in HIV-1 seronegative men. J Acquir Immune Defic Syndr 1991; 4:819.
  16. Jackson JB. Human immunodeficiency virus (HIV)-indeterminate western blots and latent HIV infection. Transfusion 1992; 32:497.
  17. Busch MP, Satten GA. Time course of viremia and antibody seroconversion following human immunodeficiency virus exposure. Am J Med 1997; 102:117.
  18. Ridzon R, Gallagher K, Ciesielski C, et al. Simultaneous transmission of human immunodeficiency virus and hepatitis C virus from a needle-stick injury. N Engl J Med 1997; 336:919.
  19. Lindbäck S, Thorstensson R, Karlsson AC, et al. Diagnosis of primary HIV-1 infection and duration of follow-up after HIV exposure. Karolinska Institute Primary HIV Infection Study Group. AIDS 2000; 14:2333.
  20. Germain M, Remis RS, Delage G. The risks and benefits of accepting men who have had sex with men as blood donors. Transfusion 2003; 43:25.
  21. Soldan K, Sinka K. Evaluation of the de-selection of men who have had sex with men from blood donation in England. Vox Sang 2003; 84:265.
  22. Anderson SA, Yang H, Gallagher LM, et al. Quantitative estimate of the risks and benefits of possible alternative blood donor deferral strategies for men who have had sex with men. Transfusion 2009; 49:1102.
  23. Cohen IG, Feigenbaum J, Adashi EY. Reconsideration of the lifetime ban on blood donation by men who have sex with men. JAMA 2014; 312:337.
  24. Available on the United States FDA website at: http://www.fda.gov/cber/faq/msmdonor.htm (Accessed on May 24, 2007).
  25. Seed CR, Kiely P, Law M, Keller AJ. No evidence of a significantly increased risk of transfusion-transmitted human immunodeficiency virus infection in Australia subsequent to implementing a 12-month deferral for men who have had sex with men. Transfusion 2010; 50:2722.
  26. Hurley R. UK lifts lifetime ban on gay men giving blood. BMJ 2011; 343:d5765.
  27. US Department of Health and Human Services, Food and Drug Administration. The code of federal regulations, US Government Printing Office, Washington, DC, 1997; (Revised annually).
  28. Director, Center for Biologics Evaluation and Research, Food and Drug Administration: Donor suitability related to laboratory testing for viral hepatitis and a history of viral hepatitis. Memorandum to all registered blood establishments. December 22, 1993.
  29. Sherertz RJ, Russell BA, Reuman PD. Transmission of hepatitis A by transfusion of blood products. Arch Intern Med 1984; 144:1579.
  30. Goldman M, Xi G, Yi QL, et al. Reassessment of deferrals for tattooing and piercing. Transfusion 2009; 49:648.
  31. Perrillo RP, Gelb L, Campbell C, et al. Hepatitis B e antigen, DNA polymerase activity, and infection of household contacts with hepatitis B virus. Gastroenterology 1979; 76:1319.
  32. Alter MJ. The detection, transmission, and outcome of hepatitis C virus infection. Infect Agents Dis 1993; 2:155.
  33. Guerrero IC, Weniger BG, Schultz MG. Transfusion malaria in the United States, 1972-1981. Ann Intern Med 1983; 99:221.
  34. Nahlen BL, Lobel HO, Cannon SE, Campbell CC. Reassessment of blood donor selection criteria for United States travelers to malarious areas. Transfusion 1991; 31:798.
  35. Mungai M, Tegtmeier G, Chamberland M, Parise M. Transfusion-transmitted malaria in the United States from 1963 through 1999. N Engl J Med 2001; 344:1973.
  36. FDA Guidance for Industry: Recommendations for Donor Questioning, Deferral, Reentry and Product Management to Reduce the Risk of Transfusion-Transmitted Malaria, August 2013. http://www.fda.gov/cber//blood/bldguid.htm (Accessed on March 26, 2014).
  37. Spencer B, Steele W, Custer B, et al. Risk for malaria in United States donors deferred for travel to malaria-endemic areas. Transfusion 2009; 49:2335.
  38. Appleman MD, Shulman IA, Saxena S, Kirchhoff LV. Use of a questionnaire to identify potential blood donors at risk for infection with Trypanosoma cruzi. Transfusion 1993; 33:61.
  39. Leiby DA. Babesiosis and blood transfusion: flying under the radar. Vox Sang 2006; 90:157.
  40. Herwaldt BL, Linden JV, Bosserman E, et al. Transfusion-associated babesiosis in the United States: a description of cases. Ann Intern Med 2011; 155:509.
  41. Gerber MA, Shapiro ED, Krause PJ, et al. The risk of acquiring Lyme disease or babesiosis from a blood transfusion. J Infect Dis 1994; 170:231.
  42. O'Brien SF, Chiavetta JA, Fan W, et al. Assessment of a travel question to identify donors with risk of Trypanosoma cruzi: operational validity and field testing. Transfusion 2008; 48:755.
  43. Dodd RY, Lipton KS. Deferral for risk of leishmaniasis exposure. October 10, 2003. Letter available on the American Association of Blood Banks website at: www.aabb.org (Accessed on October 10, 2003).
  44. Centers for Disease Control and Prevention (CDC). Cutaneous leishmaniasis in U.S. military personnel--Southwest/Central Asia, 2002-2003. MMWR Morb Mortal Wkly Rep 2003; 52:1009.
  45. Mestra L, Lopez L, Robledo SM, et al. Transfusion-transmitted visceral leishmaniasis caused by Leishmania (Leishmania) mexicana in an immunocompromised patient: a case report. Transfusion 2011; 51:1919.
  46. AABB. Association Bulletin #03-14. Deferral for risk of Leishmaniasis exposure. October 10, 2003 www.aabb.org; members only section (Accessed on October 10, 2003).
  47. Cardo LJ. Leishmania: risk to the blood supply. Transfusion 2006; 46:1641.
  48. Ricketts MN, Cashman NR, Stratton EE, ElSaadany S. Is Creutzfeldt-Jakob disease transmitted in blood? Emerg Infect Dis 1997; 3:155.
  49. Brown P. Can Creutzfeldt-Jakob disease be transmitted by transfusion? Curr Opin Hematol 1995; 2:472.
  50. Holman RC, Khan AS, Belay ED, Schonberger LB. Creutzfeldt-Jakob disease in the United States, 1979-1994: using national mortality data to assess the possible occurrence of variant cases. Emerg Infect Dis 1996; 2:333.
  51. Evatt B, Austin H, Barnhart E, et al. Surveillance for Creutzfeldt-Jakob disease among persons with hemophilia. Transfusion 1998; 38:817.
  52. Dodd RY, Sullivan MT. Creutzfeldt-Jakob disease and transfusion safety: tilting at icebergs? Transfusion 1998; 38:221.
  53. Will RG, Ironside JW, Zeidler M, et al. A new variant of Creutzfeldt-Jakob disease in the UK. Lancet 1996; 347:921.
  54. Hill AF, Desbruslais M, Joiner S, et al. The same prion strain causes vCJD and BSE. Nature 1997; 389:448.
  55. Murphy MF. New variant Creutzfeldt-Jakob disease (nvCJD): the risk of transmission by blood transfusion and the potential benefit of leukocyte-reduction of blood components. Transfus Med Rev 1999; 13:75.
  56. Hill AF, Butterworth RJ, Joiner S, et al. Investigation of variant Creutzfeldt-Jakob disease and other human prion diseases with tonsil biopsy samples. Lancet 1999; 353:183.
  57. Burthem J, Roberts DJ. The pathophysiology of variant Creutzfeldt-Jacob disease: the hypotheses behind concerns for blood components and products. Br J Haematol 2003; 122:3.
  58. Houston F, Foster JD, Chong A, et al. Transmission of BSE by blood transfusion in sheep. Lancet 2000; 356:999.
  59. Houston F, McCutcheon S, Goldmann W, et al. Prion diseases are efficiently transmitted by blood transfusion in sheep. Blood 2008; 112:4739.
  60. Hewitt PE, Llewelyn CA, Mackenzie J, Will RG. Creutzfeldt-Jakob disease and blood transfusion: results of the UK Transfusion Medicine Epidemiological Review study. Vox Sang 2006; 91:221.
  61. Lefrère JJ, Hewitt P. From mad cows to sensible blood transfusion: the risk of prion transmission by labile blood components in the United Kingdom and in France. Transfusion 2009; 49:797.
  62. Llewelyn CA, Hewitt PE, Knight RS, et al. Possible transmission of variant Creutzfeldt-Jakob disease by blood transfusion. Lancet 2004; 363:417.
  63. Peden AH, Head MW, Ritchie DL, et al. Preclinical vCJD after blood transfusion in a PRNP codon 129 heterozygous patient. Lancet 2004; 364:527.
  64. Wilson K, Ricketts MN. The success of precaution? Managing the risk of transfusion transmission of variant Creutzfeldt-Jakob disease. Transfusion 2004; 44:1475.
  65. Murphy EL, David Connor J, McEvoy P, et al. Estimating blood donor loss due to the variant CJD travel deferral. Transfusion 2004; 44:645.
  66. Millar CM, Makris M. Dealing with the uncertain risk of variant Creutzfeldt-Jakob disease transmission by coagulation replacement products. Br J Haematol 2012; 158:442.
  67. Dietz K, Raddatz G, Wallis J, et al. Blood transfusion and spread of variant Creutzfeldt-Jakob disease. Emerg Infect Dis 2007; 13:89.
  68. FDA Guidance for Industry: Revised recommendations for the assessment of donor suitability and blood and blood product safety in cases of known or suspected West Nile virus infection. May 2003. http://www.fda.gov/cber/guidelines.htm (Accessed on May 01, 2003).
  69. Orton SL, Stramer SL, Dodd RY. Self-reported symptoms associated with West Nile virus infection in RNA-positive blood donors. Transfusion 2006; 46:272.
  70. Richards C, Kolins J, Trindade CD. Autologous transfusion-transmitted Yersinia enterocolitica. JAMA 1992; 268:154.
  71. Center for Biologics Evaluation and Research, Food and Drug Administration. Guidance for Industry: Recommendations for deferral of donors and quarantine and retrieval of blood and blood products in recent recipients of smallpox vaccine (vaccinia virus) and certain contacts of smallpox vaccine recipients. December 2002.
  72. Centers for Disease Control and Prevention (CDC). Transfusion-related transmission of yellow fever vaccine virus--California, 2009. MMWR Morb Mortal Wkly Rep 2010; 59:34.
  73. Vargas SO, Cannon ME, Benjamin RJ, Longtine JA. Transfusion with blood from a donor with chronic myelogenous leukemia: persistence of the bcr/abl translocation in the recipient. Transfusion 1999; 39:387.
  74. Edgren G, Hjalgrim H, Reilly M, et al. Risk of cancer after blood transfusion from donors with subclinical cancer: a retrospective cohort study. Lancet 2007; 369:1724.
  75. Greenwald P, Woodard E, Nasca PC, et al. Morbidity and mortality among recipients of blood from preleukemic and prelymphomatous donors. Cancer 1976; 38:324.
  76. Acting Director, Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration: Deferral of blood and plasma donors based on medications. Memorandum to all registered blood establishments. July 28, 1993.
  77. Food and Drug Administration. Guidance for industry and FDA review staff: Collection of platelets by automated methods, December 17, 2007. Center for Biologics Evaluation and Research, Rockville MD. Available at: http://www.fda.gov/cber/guidelines.htm (Accessed on April 02, 2009).
  78. Jilma-Stohlawetz P, Hergovich N, Homoncik M, et al. Impaired platelet function among platelet donors. Thromb Haemost 2001; 86:880.
  79. van der Linden GJ, Siegenbeek van Heukelom LH, Meinardi H. Blood donation, a risk for epileptic patients? Vox Sang 1986; 51:148.
  80. Schmidt PJ. Blood donation by the healthy elderly. Transfusion 1991; 31:681.