Transfusion

Treatment with Blood Components, Products and Derivatives.

1. Must not donate if:
At any time the mother has:
a) Received, or thinks they may have received, a transfusion of blood or blood components in a country endemic for malaria or South American trypanosomiasis.  See ‘Discretionary’ section below for exceptions.

b) Has received regular treatment with blood derived coagulation factor concentrates.

c) Intra-uterine transfusion has been required in this pregnancy.

2. Since January 1st 1980:

a) Anywhere in the world, the mother has received, or thinks they may have received, a transfusion of blood or blood components, or intravenous or subcutaneous human normal immunoglobulin. This includes mothers whose babies have required intra-uterine transfusion.

b) Had a plasma exchange performed.

3. Before January 1st 1999:

Treated with prothrombin complex to reverse over-anticoagulation.

1. a) If on medical inquiry it is unlikely that the mother has been
transfused, accept.

b) Received, or thinks they may have received, a transfusion of blood or blood components before 1st Jan 1980, accept – See 3 below if transfused abroad

c) If treatment with human immunoglobulin has been limited to small quantities of specific immunoglobulin as prophylaxis (e.g. rhesus, tetanus, hepatitis, immunoglobulin etc.), accept.
 

d) Treated with prothrombin complex (PCC) to reverse over-anticoagulation after 1st January 1999, accept.

2. Autologous Transfusion:
If only the mother's own blood has been used, accept.

3. Mother transfused in a country endemic for malaria or South American trypanosomiasis:

a) Check the Geographical Disease Risk Index. If transfused in an at risk endemic country and a validated malarial antibody test and/or (as appropriate) a validated test for T.cruzi antibody is negative, at least 4 months after exposure accept. If transfusion happened after January 1st 1980, see point 4 below.

4. Mother transfused since January 1st 1980:

Discuss with the Designated Medical Officer who will decide if the donation may be accepted. The full transfusion history must be recorded and remain part of the documentation.

Bleeding Disorder
Immunoglobulin Therapy
Immunosuppression
Malaria
Prion Associated Diseases
South American Trypanosomiasis Risk
Geographical Disease Risk Index

Transfused donors have previously contributed to the spread of some diseases. This happened with hepatitis C.

All transfused mothers:
Transfusions in some countries may have put the donor at risk of malaria or South American trypanosomiasis. It is necessary to exclude these infections before accepting the donation.

Coagulation concentrates:
People who have received blood derived coagulation concentrates (these are made from the blood of many donors) regularly may have been put at risk of infections that can be passed through blood.

Mothers transfused since 1980:
In the autumn of 2003 a UK recipient of blood, taken from a healthy donor who later developed vCJD, died from vCJD. Since then there has been a very small number of cases of infection with the vCJD prion in recipients of blood from donors who have later developed vCJD. The risk of transplacental infection of a foetus with abnormal prion is not known but, even though it is thought to be small, cannot be ignored.

In view of this, mothers transfused or possibly transfused since 1980  should not normally be accepted. Any history of transfusion after 1980 must be recorded and remain part of the documentation associated with the donation.

Plasma exchange results in the patient having been exposed to multiple donors. In view of the increased vCJD risk, donations may not be taken from individuals who have had a plasma exchange performed since 1980.
Commonly used PCCs, such as Beriplex or Octaplex, currently used in the UK, are prepared from non-UK donors. They are administered as one-off doses to reverse anticoagulation or peri-operative prophylaxis. Since 1999, coagulation factors prepared from UK donors have no longer been used as a risk reduction measure for vCJD transmission.

I) To remove information only relevant to deceased tissue donors.
II) To update guidance relating to South American Trypanosomiasis risk.
III) To add guidance relating to mothers transfused since January 1st 1980.
IV) To harmonise the definition of what constitutes a transfusion.
V) Ensure consistent use of the term ‘mother’ rather than ‘donor’.