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Microsoft word - blood education material.doc
FDA REQUIRED READING
Blood Donor Education Materials
MAKING YOUR BLOOD DONATION SAFE
Thank you for coming in today! This information sheet explains how YOU
can help us make the donation process
safe for yourself and patients who might receive your blood. PLEASE READ THIS INFORMATION BEFORE
YOU DONATE! If you have any questions now or anytime during the screening process, please ask blood
center staff. ACCURACY AND HONESTY ARE ESSENTIAL!
Your complete honesty
in answering all questions is very important for the safety of patients who receive your
blood. All information you provide is confidential. DONATION PROCESS: To determine if you are eligible to donate we will:
-Ask questions about health, travel, and medicines
-Ask questions to see if you might be at risk for hepatitis, HIV, or AIDS
- Take your blood pressure, temperature and pulse
- Take a small blood sample to make sure you are not anemic If you are able to donate we will:
- Cleanse your arm with an antiseptic. (If you are allergic to Iodine, please tell us!
-Use a new, sterile, disposable needle to collect your blood DONOR ELIGIBILITY – SPECIFIC INFORMATION; Why we ask questions about sexual contact:
Sexual contact may cause contagious diseases like HIV to get into the bloodstream and be spread through
transfusions to someone else. Definition of “sexual contact”:
The words “have sexual contact with” and “sex” are used in some of the questions we will ask you, and apply to
any of the activities below, whether or not a condom or other protection was used:
1. Vaginal sex (contact between penis and vagina)
2. Oral sex (mouth or tongue on someone’s vagina, penis, or anus)
3. Anal sex (contact between penis and anus) HIV/AIDS RISK BEHAVIORS AND SYMPTOMS
AIDS is caused by HIV. HIV is spread mainly through sexual contact with an infected person OR by sharing
needles or syringes used for injecting drugs. DO NOT DONATE IF YOU: -Have AIDS or have ever had a positive HIV test
- Have ever used needles to take drugs, steroids, or anything not prescribed by your doctor
- Are a male who has had sexual contact with another male, even once, since 1977
- Have ever taken money, drugs or other payment for sex since 1977
- Have had sexual contact in the past 12 months with anyone described above
- Have had syphilis or gonorrhea in the past 12 months
- In the last 12 months have been in juvenile detention, lockup, jail or prison for more than 72 hours
- Have any of the following conditions that can be signs or symptoms of HIV/AIDS:
• Unexplained weight loss or night sweats • Blue or purple spots in your mouth or skin
• Swollen lymph nodes for more than one month
• White spots or unusual sores in your mouth • Cough that won’t go away or shortness of breath
• Fever of more than 100.5˚F for more than 10 days
Remember that you CAN
give HIV to someone else through blood transfusions even if you feel well and have a
negative HIV test. This is because tests cannot detect infections for a period of time after a person is exposed to
HIV. If you think you may be at risk for HIV/AIDS or want an HIV/AIDS test, please ask for information
about other testing facilities. PLEASE DO NOT DONATE TO GET AN HIV TEST! Travel to or birth in other countries:
Blood donor tests may not be available for some contagious diseases that are found only in certain countries. If you
were born in, have lived in, or visited certain countries, you may not be eligible to donate. What happens after your donation:
To protect patients, your blood is tested for hepatitis B and C, HIV, certain other viruses, and syphilis. If your
blood tests positive it will not be given to a patient. You will be notified about test results that may disqualify you
from donating in the future. Please do not donate to get tested for HIV, hepatitis, or any other infections!
Please continue to the back of this page for more information that must be read
Medication Deferral List
Please tell us if you are now taking or if you have EVER taken any of these medications:
- usually given for prostate gland enlargement
- usually given for prostate enlargement
- usually given for baldness
Accutane (Amnesteem, Claravis, Sotret, isotretinoin)
- usually given for severe acne
– usually given for severe psoriasis
– usually given for severe psoriasis
Growth Hormone from Human Pituitary Glands
- used usually for children with delayed or impaired growth
Insulin from Cows (Bovine, or Beef, Insulin)
- used to treat diabetes
Hepatitis B Immune Globulin
- given following an exposure to hepatitis B.
This is different from the hepatitis B vaccine which is a series of 3 injections given over a 6 month period
to prevent future infection from exposures to hepatitis B.
- usually associated with a research protocol
IF YOU WOULD LIKE TO KNOW WHY THESE MEDICINES AFFECT YOU AS A BLOOD DONOR,
PLEASE KEEP READING:
o If you have taken or are taking Proscar, Avodart, Propecia, Accutane, Soriatane, or Tegison
medications can cause birth defects. Your donated blood could contain high enough levels to damage the unborn baby if transfused to a pregnant woman. Once the medication has been cleared from your blood, you may donate again. Following the last dose, the deferral period is one month Proscar, Propecia and Accutane, six months for Avodart and three years for Soriatane. Tegison is a permanent deferral.
o Growth hormone from human pituitary glands
was prescribed for children with delayed or impaired
growth. The hormone was obtained from human pituitary glands, which are found in the brain. Some people who took this hormone developed a rare nervous system condition called Creutzfeldt - Jakob disease (CJD, for short). The deferral is permanent.
o Insulin from cows (bovine, or beef, insulin)
is an injected material used to treat diabetes. If this insulin was
imported into the US from countries in which “Mad Cow Disease” has been found, it could contain material from infected cattle. There is concern that "Mad Cow Disease" is transmitted by transfusion. The deferral is indefinite.
o Hepatitis B Immune Globulin (HBIG)
is an injected material used to prevent infection following an exposure
to hepatitis B. HBIG does not prevent hepatitis B infection in every case, therefore persons who have received HBIG must wait 12 months to donate blood to be sure they were not infected since hepatitis B can be transmitted through transfusion to a patient.
o Unlicensed Vaccine
is usually associated with a research protocol and the effect on blood transmission is
unknown. Deferral is one year unless otherwise indicated by Medical Director.
Travel Deferrals for vCJD
European Countries for ≥ 5 years (1980-present):
-Albania, Austria, Belgium, Bosnia-Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Finland,
France, Germany, Greece, Hungary, Republic of Ireland, Italy, Liechtenstein, Luxembourg, Macedonia, the
Netherlands (Holland), Norway, Poland, Portugal (Azores), Romania, Slovak Republic, Slovenia, Spain,
Sweden, Switzerland, United Kingdom, Serbia and Montenegro.
Geographic Deferral for United Kingdom ≥ 3 months (1980-1996): England, Northern Ireland, Scotland,
Wales, the Isle of Man, the Channel Islands, Gibraltar, and the Falkland Islands.
Military Travel Deferral for vCJD: Total time of 6 months or more associated with a military base in:
¾ From 1980- 1990 in Belgium, Germany, the Netherlands
¾ From 1980- 1996 in Spain, Portugal, Turkey, Italy and/or Greece
Thank you for donating blood today!
Inova Blood Donor Services
The North American Malignant Hyperthermia Registry of MHAUS Report of Acute ADVERSE METABOLIC OR MUSCULAR REACTION TO ANESTHESIA (AMRA Report) INSTRUCTIONS This form is to be filled out by an anesthesiologist or other health care provider. 1. Complete this form each time you suspect a patient may have experienced an adverse metabolic reaction to anesthesia or exerci
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