General Guide for Self-Evaluation of Blood Donors
By Dr. Sam Thelín
This guide is a compilation of 112 pages of the Official Mexican Standards (Norma Oficial Mexicana) 253-SSA1-2012, and protocols of various blood banks in Mexico, organized by the period of time someone would be excluded from donating, based under various conditions. There are four pages of relevant information to donors, to self-assess whether they are eligible to donate, and to inform them of the measures necessary to help ensure acceptance and safety of blood donation in Mexico. This is a short version, while still being complete. There are terms that many people will not understand; in most cases if someone does not understand some terms, they are probably elements that do not relate to you. Taking various drugs are exclusions for a period of time, but not all of the unsafe drugs are identified in this guide. Likewise there are medications that can be taken without problem (e.g. taking medication for controlling blood pressure is not excluded), but always clarify any doubts at the blood bank before donating blood.
There are three types of blood donation exclusions:
Value out of range. Such as age, weight, hemoglobin, corporal temperature, blood pressure, etc. See #1, #2, and #17.
Conditions found in your presentation. Such as under the effects of drugs, swollen lymph nodes, skin lesions, etc. See #17.
Answers to interview or questionnaire. Some are permanent exclusions as in #3 below. Some are temporary exclusions such as in #4 to #16, which are organized by the amount of time you are prohibited from donating, based on how long it has been since the specified condition or activity no longer applies to you.
. AGE - The donor must be between 18 and 65 years old.
WEIGHT - Must weigh 50 kg or more.
Absolutely cannot donate (see Section 6.5.10 of the NOM):
Anyone who could transmit HIV (example: People who have tested positive for the human immunodeficiency virus, any of its types (type 1 or 2, etc), or those with clinical symptoms of infection.
Anyone who could transmit hepatitis B or C virus (people who had clinical symptoms of hepatitis after ten years of age, and those with a history of clinical or laboratory diagnosis of infection hepatitis B or C, or both).
People who have been or are intravenous drug users abusers.
Anyone who could transmit the causative agent of Chagas Disease (American trypanosomiasis).
Anyone who could potentially transmit the causative agent Creutzfeldt-Jakob or similar PRIONS (people who have a family history of the disease and those who had been reported as belonging to a family at risk for any spongiform encephalopathy disease, people who received tissue that could potentially a transmitter, such as transplant recipients of dura mater or cornea derivatives, those who have received extracts derived from human pituitary gland, those who received insulin from bovine origin, and people who lived in the UK between 1980 and 1996, for an aggregate total equal to, or greater than, 12 months).
Anyone with clinical or laboratory evidence of the following diseases: Visceral Leishmaniasis or Kala-Azar Disease; Babesiosis; Chronic meningitis and encephalitis from acid-alcohol resistant bacilli (BAAR), Cryptococcus, Toxoplasmosis, and diseases caused by lentviruses; Chronic Q fever, and retroviruses such as HTLV - I, HTLV – II (human T-cell lymphotropic virus).
Anyone who continually requires transfusions, such as those with hemophilia or other bleeding disorders, as well as past or present paid suppliers of blood or plasma (in Mexico this is not permitted, and should not pertain to those who donated in another country and were compensated legally).
Anyone with a current or past neoplasm, except localized and completely cured cancers.
Anyone who suffers from, or has had any cardiovascular diseases such as myocardial infarct; arterial or recurrent venous thrombosis; coronary sclerosis; unstable angina; aortic hypertrophy; cardiac dysrhythmias; rheumatic fever with chronic effects, and a history suggestive of fluid retention (edema). *Persons may be accepted as donors if they had congenital heart disease, but it is completely resolved, or those who have had rheumatic fever, but it has been at least two years since then with no signs or symptoms of chronic heart disease from it.
Anyone with chronic lung disease, such as severe chronic bronchitis, emphysema, or chronic severe asthma.
Anyone who has, or has had any of the following neurological diseases: severe central nervous system disease, such as demyelination (Guillain-Barre syndrome, multiple sclerosis), or central nervous system degeneration, phacomatoses (such as Von Recklinghausen disease) , syringomyelia, muscular dystrophies and neuropathies; cerebrovascular disease; epilepsy under continued treatment or a history of seizures (*may accept donors who have had seizures not labelled as epileptic, if they have discontinued any and all treatment for three years or more and have not had any seizures in the last three years); and meningitis or acute bacterial or viral encephalitis with lasting symptoms. *If there are no consequences (symptoms), the donor may be accepted after three months of a full recovery. **Syncope (fainting) or seizures does not exclude someone if they happened only while the person was an infant.
Anyone with severe active gastrointestinal conditions with chronic or recurrent blood loss, malabsorption of iron, or which are secondary to an autoimmune processes; also those who have undergone a total gastrectomy.
Anyone with active or chronic liver disease.
Anyone with kidney diseases such as nephritis or chronic pyelonephritis and other chronic kidney processes.
Anyone with insulin-dependent diabetes mellitus.
Anyone with coagulopathy (abnormal bleeding) or hereditary or constitutional predisposition bleeding disorders.
Anyone with an autoimmune disorder that affects more than one organ * May accept donor if it only affects a single organ.
Anyone with a history of an anaphylactic reaction.
Anyone who received any xenotransplantation (transplant from other species) as well as their sexual partners.
Plasma donors who have used apheresis, and had alloimmunization, such as people who had been transfused or women with a history of previous pregnancies (and had the problem of fetal-maternal erythrocyte incompatibility).
5-year exclusion anyone who had local cancer/tumor (without metastasis) but it has been completely cured. Acute glomerulonephritis.
- 3-year exclusion anyone with any of the following: convulsions not diagnosed as epileptic seizures, without treatment and without presenting convulsions. Brucellosis or isolation of bacteria of the genus Brucella; tuberculosis; osteomyelitis; rheumatic fever (as long as there are no cardiac complications from it), and acute Q fever. Taking acitretin / etretinate, or any experimental vaccine.
- 18-month exclusion anyone taking tamoxifen.'
- 1-year exclusion anyone with conditions or exposure risks (*Waiting period reduced to four months after negative lab exams using nucleic acid amplification method): Potentially infectious exposure through tattooing, acupuncture, electrolysis, piercing of skin and/or mucous membranes for placement of earrings or other ornaments; I.V or I.M. injections without using disposable single-use syringes and needles; catheterization or use of flexible endoscope instruments; direct contact with blood, blood components, tissue, cell suspensions or sexual fluids of human origin, or had them splashing or spraying on mucosa (eyes, mouth, nose, etc.), punctures or otherwise open skin; receiving allogeneic (from another person) transfusions or transplants of tissues or cells; heterologous-assisted reproduction procedures; any sexual risks listed below with anyone infected with HIV, active or chronic viral hepatitis, or persons of unknown or uncertain hepatitis or HIV status; rape victims or anyone engaging in sexual activities of risk, or sharing sex toys contaminated with blood or sexual fluids; inhaled nasal drug abuse (“snorting” drugs), when users share straws, tubes, keys or any other instrument employed for inhalation; close contact with hepatitis patients, and having been in a criminal (jail/prison) or mental health institution more than 72 consecutive hours. Anyone who has had syphilis or other sexually transmitted infections that can be transmitted by transfusion. Anyone who has received vaccines against rabies and tick-borne encephalitis, hepatitis A or B, or who has received immunoglobulins because of risk exposure, or or who has received passive immunization with animal source hyperimmune serum.
- 6-month exclusion anyone who has had any of the following: Toxoplasmosis, and mononucleosis. Major surgery or major accident (*If not fully recovered by the end of six months, blood donation should be postponed until there is a full recovery). During the six months following childbirth, cesarean section, or pregnancy terminated because of death of the fetus at any gestational age. Anyone who has had Malaria requires six months after a negative test for antibodies against the parasite or negative test with micro tube technique with acridine orange. Having taken Dutasteride.
- 3-month exclusion anyone who has had meningitis or acute bacterial or viral encephalitis, without lasting complications. *The exclusion is permanent if there are lasting effects or complications.
- 45-day exclusion anyone who has donated blood within 45 days.
- 28-day exclusion anyone who had been in an area where there were cases of West Nile virus. Those who live with or who have had contact with people who had received measles vaccine. Anyone with contact with infected people. Anyone who has had any of these vaccinations: BCG (tuberculosis), oral poliovirus, measles, rubella, mumps, yellow fever, influenza, typhoid (attenuated agent), cholera (attenuated agent). Anyone taking finasteride, tretinoin (retinoic acid), thalidomide, tetracyclines, and isotretinoin. (Anyone taking any other drug that has proven to be teratogenic should wait until it no longer is a risk to a blood recipient).
- 14-day exclusion anyone with a fever of ≥38º C, flu, or flu-like symptoms.
- 7-day exclusion anyone who underwent simple surgery or uncomplicated tooth extraction
- 5-day exclusion anyone who took acetylsalicylic acid (Aspirin), clopidogrel, diflunisal, phenylbutazone, meloxicam, nabumetone, naproxen, piroxicam, sulindac, or tenoxicam (or NSAIDs and similar anticoagulants that affect platelets).
- 72-hour exclusion cannot have used earrings or similar ornaments placed in any mucosa.
- 48-hour exclusion cannot have taken: aceclofenac, acetamicin, mefenamic acid, diclofenac, dexibuprofen, flurbiprofeno, ibuprofen, indomethacin, ketoprofen, or ketorolac.
- At the moment of medical assessment, donors conditionally cannot donate if any of the following applies to them:
Those who have risks associated with their profession or other activities, and cannot wait more than 12 hours from the time of donation until returning to their activities. In the case of aircraft pilots, the interval should be 24 hours.
Those who have eaten within less than four hours before the time of donation, or who have had more than 12 hours fasting, or have ingested fatty foods food within the last 7 hours (each laboratory that analyses blood for the blood bank before donation may vary slightly on this requirement).
Symptoms of secondary hypotension, or not from antihypertensive drugs (low blood pressure that is not normal for you)
Chronic or acute infections
Acute or chronic lung diseases
Liver disease that is active or chronic
Symptoms from any immunization
Effects of alcohol intoxication, narcotics, marijuana, inhaled agents, amphetamines or stupefacient
Heart rate lower than 50 beats per minute (except in athletes) or greater than 100
Blood pressure of 100 mm/Hg or higher for diastolic, and 180 mm/Hg or higher for systolic (taking medication for controlling blood pressure does not exclude donor).
Axillary body temperature of 37.0° C or higher, or oral 37. 5° C or greater.
Anyone with the following is prohibited until the following problems resolve: allergy, rash, asthma or other generalized allergic reactions, as well as those with allergic skin condition in the area where venipuncture will be made.
Women who are pregnant or lactating.
Anyone having hemoglobin or hematocrit levels below values given in the tables (blood will be tested at time of donation for this).
Altitude at Sea Level
0 a 1500m (4920 feet)
1501m or more (Guadalajara)
* Smoking is not a reason to reject the patient unless there it appears to significantly affect their current health status.
* Women who are having their menstrual period are permitted to donate unless they have associated symptoms.
* The following vaccinations do not exclude anyone from donating, unless they have adverse symptoms due to vaccination: rabies, tick-borne encephalitis, hepatitis A or B virus, as long as they were not given because of possible exposure; vaccines made with dead bacteria or capsular polysaccharide vaccines, such as cholera and typhoid; inactivated virus vaccines, such as polio in its injectable form, and toxoids, such as diphtheria and tetanus.