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Copyright © 2011 by the Department of Health - National Voluntary Blood Services Program (DOH-NVBSP) Published in the Philippines by the Department of Health - National Voluntary Blood Services Program (DOH-NVBSP) Department of Heaith - National Voluntary Blood Services Program (DOH- NVBSP) Bldg. 19, Ground Fir., San Lazaro Compound, Sta. Cruz, Manila Telephone/Fax: (632} 731 8465, 651 7800 Local 2900, 2901 Website: www.nvbsp.com All rights reserved. Any part of the whole book may be reproduced or transmitted with permission from Department of Health provided it is not sold commecially and without any alteration in any form or by any means. Printed in the Philippines ISBN :978-971-0597-08-6

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Republic of the Philippines Department of Health OFFICE OF THE SECRETARY FOREWORD In its continuing effort to promote adequacy, accessibility, safety and quality of blood and blood products, the National Voluntary Blood Services Program (NVBSP) came up with this Manual on Blood Donor Selection and Counseling. This manual was designed to aid the health providers and advocates in applying the standards essential to the selection and screening of potential blood donors, and in the pre- and post-donation counseling. It contains the revised Donor History Questionnaire (DHQ), the DHO Flowchart and the A-Z Guide to Medical Assessment of Blood Donors which are crucial to efficient selection and screening of blood donors. Blood donation requires altruistic intention to help patients in need of blood transfusion therapy. Thus, data and information—on-the risks of transfusion transmissible infections are also included in this manual. This serve as a guide in deferring the blood donation process for individuals who are suspected to have such infections and so they could be properly advised on the need to manage the infection and to have their blood tested first to ensure the safety of prospective blood recipients. The Confidential Unit Exclusion (CUE) and the list of Voluntary Counseling and Testing (VCT) centers provided in this manual could aid in having the suspected individuals, especially those who are infected with the Human Immunodeficiency Virus (HIV), to voluntarily suspend the donation and for these persons to be guided on where to go for the appropriate medical interventions. It is with high hopes that this Manual on Blood Donor Selection and Counseling will be used extensively in blood service facilities to ensure that blood supplies are safe for the protection of patients needing blood transfusions. ENRIQUE T. ONA, MD, FPCS, FACS Secretary of Health

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ACKNOWLEDGEMENT SIXTO P. ARLEGUI, UI, MM President Philippine Blood Coordinating Council MA. RIZALINA S. CHUA, RMT Consultant St. Luke’s Medical Center Metropolitan Hospital ANTONIO F. DOMASIAN, JR., RMT Medical Technologist Philippine Children’s Medicai Center REX V. FADRIGO, RMT Philippine General Hospitai GODWIN N. HERNAEZ, MD, FPSP Pathologist Veterans Memorial Medicai Center DOREEN P. LABAYANDOY, MD, DPSP Pathologist General Emilio Aguinaldo Memorial General Hospital MICHAEL ANGELO F. MARQUEZ, MD Philippine National Red Cross — National Blood Center SANDRA B. RIVERA, RMT Medical Technoologist Capitol Medical Center SHIREEN SANTIAGO, RMT Medical Technologist Bulacan Blood Center ii

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MILAGROS D. SISON, RMT Medical Technologist Philippine General Hospital ELIZA B, VALDEZ, MD, FPSP, MHA Blood Bank Head Dr. Jose Reyes Memorial Medical Center Technical Working Group MA. MYSTICA FLODALYN BAUTISTA, MD FPSP Board Member Philippine Blood Coordinating Council MA, LOURDES U. CONCEPCION, MD, FPSP an Blood Bank-Head a Philippine Children’s Medical Center ELIZABETH Y. ARCELLANA-NUQUI, MD, FPSP Chairman, Committee on Professional Education National Council for Blood Services IMELDA F, PALACOL, MD, FPSP Blood Program Coordinator Provincial Health Office (PHO) - Laguna PEDRITO Y, TAGAYUNA, MD, DPSP Medical Specialist [IT Philippine Blood Center MILAGROS M. VIACRUCIS, MD, MPH Regional Blood Program Coordinator Center for Health Development (CHD) - Southern Mindanao iti

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MANUEL L. BARNES, MD, FPSP Blood Bank Head Veterans Memorial Medical Center SALVADOR P. AYDANTE, RMT Medical Technologist [IT Philippine Blood Center MARITES B, ESTRELLA, RN, MM Technical Component Manager Department of Health -Global Fund Round 6-HIV Project Secretariat ANNA- LEAH D, DIPATUAN, MPA Site Implementation Officer Department of Health -Global Fund Round 6-HIV Project RAMIL P. ESGUERRA Liaison Officer AIDS Society of the Philippines

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II. TI IV VI. VII. VIII. IX. XI. Table of Contents FOE WOT oie cs etececsteveneeve vanes eavensaeacesesesaceasacssesssesceserscssscaeensaeeseacaessenacaeetssrenasas ACKNOWlEAEMENE oes ce ee esesee esate ccaseseeececesenesccecscecsassnesesseseaecsenecseaneatonseteessaes Table of Contents General Principles for the Selection of Donors voces 1 Blood Donor History Questionaire o.cccccecccccsscccccssressrsescnsetecsceseeeeseeeseeteeans 15 Donor History Questionnaire User’s Guide ccccccccccsssscssesrenesneeneeeees 21 Donor History Questionnaire Flow Chart cece seeeesseeseneesessenetieees 29 Blood Donor Counseling .....ccccccccsecscesscssesssercsserseccerecncerssesensecesceseessesessensnes 61 Appendices A. Code of .Ethics for Blood Donation and Transfusion ......... sate OF B. Social Hygiene Clinic, Voluntary Counseling and Testing Centers and Treatment Hus occ cccceseesecscncnscneneneeereceesesentesenees 71 C. A-Z Guide to Medical Assessment of Blood Donors woe 76 Timing of Blood Donation when Medications are being taken DY DOROTS oc ccccceccscesesscseseseesescsecenessesneecansaecaueeaesvesnaerensess 87 Timing of Blood Donation When Donor Received Vaccine........... 89 D.Basic Information Before Blood Donations cseeetenenseeteens 91 E. Tranfusion Trasmissible Infections Harm Reduction Strategies F. 2010 Report on the Global AIDS Epidemic iii cccseteeeeeeeee 95 ACTONY MS occ etcctsseetetsereceensveesvanvanerasensecsecescaeeceeeecacesesesseaesaneniinnesseeseansanver 103 ROfETENCES occ cc ceccces se teneeerecene cee aececaeceeee cece cceee ccs ececeeeeceneeasenenatanenstatenseneenete 107

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Generai Principles for the Selection of Donors 1.0 Introduction The main purpose in selecting individuals for blood donation, or one of the components of blood, is to determine whether that person is in good health. This ensures that the donor is protected against damage to his/ her own health and that the recipient is protected against the transmission of disease, or the administration of blood products that could be detrimental to the recipient. It shall be recognized that the donor selection process contributes significantly to the safety of blood and blocd products derived from large plasma pools. As a general rule, only persons in normal health with a good medical history and absence of high risk behavior associated with transfusion

• transmissible infections shall be accepted as donors of blood or a component of blood for therapeutic use. In the provision of blood services, all concerned personnel shall observe the International Soci- ety of Blood Transfusion's (ISBT) Code of Ethics for Blood Donation and Transfusion (See Appendix A), The Philippine National Blood Services has adopted the World Health Organization (WHO) definition of voluntary non-remunerated blood donation: “Donation is considered voluntary and non-remunerated if the person gives blood, plasma or cellular components of his/her own free will and receives no payment for it, either in the form of cash, or in kind which could be considered a substitute for money. This would include time off work other than that reasonably needed for the donation and travel. Small tokens, refreshments and reimbursements of travel costs are compatible with volun- tary, non-remunerated donation.” 3.0 Informed Consent for Donation Informed consent for donation is a legal and ethical requirement. This implies one’s will- inghess to donate blood given by a mentally competent person “who has received the necessary information; who has adequately understood the information; and who, after considering the information, has arrived at a decision without having been subjected to coercion, undue influence, or intimidation”. This protects a person’s freedom of choice and respects the person's autonomy. Blood Donor Selection and Counseling Manuai 3

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General Principles for the Selection of Donors To obtain blood donor’s written informed consent or assent (in the case of blood donors less than 18 years of age), relevant information materials shall be readily available to all potential donors during the recruitment process to enable them to decide whether giving blood is in accordance with their personal interest. A mechanism shall be set in place that allows and encourages the donots to ask questions or seek clarifications . Provision for signed consent is included in the Donor History Questionnaire (DHQ) . The donor shall also be made to understand that all personal information includ- ing the results of tests will be kept confidential. If the donor consents, signifi- cantly abnormal findings during physical examination and blood testing will be communicated to the company physician or city/municipal health officer or to a physician of his/her choice. The donor shall also understand that the blood cen- ters are using screening tests and not confirmatory/definitive tests. As such, there are false positive and false negative results. The donor shalt understand that following donation, the blood service facility will assume stew- ardship of the donated gift. The blood center undertakes to manage the gift in a responsible manner and to protect the gift status at all times. . The donor shall have an opportunity to ask questions and withdraw from giving blood without being exposed to undue embarrassment. The approach to the donor screening adopted in each blood service facility must take into account any special social, cultural and health issues which may have an impact on selection of donors who can provide safe blood products. For a blood donor who is not of legal age (less than 18 years old), a written informed consent shall be obtained from anyone of his/her parents or legally authorized representa- tive (LAR). Relevant information materials shall be provided to the parents or LAR before the informed consent is obtained . The written informed consent thus obtained shall be attached to the donor’s DHQ during the blood donor identification and registration proce- dure of the blood donor screening process. 4.0 Notifications of Significant Findings Results of test for HIV shall not be released unless confirmed by the National Reference Laboratory - the Research Institute of Tropical Medicine (RITM). For units confirmed to be HIV positive, the donor shall be initially counseled and referred to HIV Support Services (like Blood Donor Setection and Counseling Manual

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General Principles for the Selection of Donors the HIV/AIDS Core Team) for further management if he/she agrees. (See Appendix B) It is emphasized that confirmed Hepatitis B, C, Syphilis and HIV are reasons for permanent deferral. Those with confirmed hepatitis B and hepatitis C are referred to and encouraged to join the Liver Study Group in DOH hospitals. 5.0 Privacy and Confidentiality Handling of all donors and donation records shall be in accordance with the principle of respect for personal privacy or person’s dignity ~ that is, all personal information must be kept confidential. All personal information including the results of tests shall be kept confidential. The Staff in the Blood Services shall ensure that the blood collection venues provide audio privacy that allows the donor to complete the questionnaire in a private and confidential environment. The same principle shall apply to the donor interview. —_ 6.0 Whole Blood Donation 6.1 Frequency of Donation It is the policy of the Philippine National Blood Services (PNBS) that donors of whole blood may normally donate every twelve weeks. In special circumstances (example, patient needing rare blood type) a medical officer on an individual basis may modify the frequency of donation. The guidelines produced by the Council of Europe are i identified below: * For males, up to six standard whole blood donations may be taken per year * For females, up to four standard whole blood donations may be taken per year It is recommended that these donation rates never be exceeded under any circumstances. The number of donations accepted from any individual donor has to be determined after careful consideration of his weight, dietary habits and with the knowledge that extra care beyond routine hemoglobin estimation may be necessary in the monitoring of donors for iron deficiency. Blood Donor Selection and Counseling Manuat 5

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General Principles for the Selection of Donors 6.2 6.3 6.4 6.5 6.6 6.7 Quantity of Donation A standard donation is 450m1 + 10% (405 ml to 495ml) exclusive of anticoagulants. Blood bags intended for a collection volume of 450ml + 45ml (i.e. 405ml-495m1) of whole blood contains 63ml of anticoagulant. No more than 10.5mi/kg body weight shall be taken as whole blood during one blood donation. Age of Donor The age acceptance ranges are: « New donors between the ages of 16 — 60 years (before 61" birthday) « Regular donors may be accepted up to 70 years (before 71* birthday) subject to evaluation by a medical officer. « Lapsed donors (i.e. those donors who have not donated in the previous year) who are over the age of 60 years are eligible to donate subject to evaluation by a medical officer. Weight A standard whole blood donation may be collected froma regular ~-donor weighing 50 kg after assessment by an experienced medical officer. Hazardous Occupations Hazardous occupations and hobbies shall normally entail an interval of not less than 12 hours between donation and returning to the occupation or hobby. Examples of such hazardous occupations or hobbies are piloting an aircraft, driving a bus or train, operating crane and other heavy equipment, climbing of ladders or scaffolding or coconut tree, gliding, and diving. Post-Partum and Breastfeeding Women Post-partum women may donate blood one year after delivery or three months after weaning, whichever is longer. Women who breastfed, including non-mother surrogates shall be deferred for a minimum of three months after weaning. Donor Medical History The donor’s medical history shall be evaluated using the donor history questionnaire and shall be thoroughly examined by a qualified medical officer who shall have the final decision on Blood Donor Selection and Counseling Manual

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General Principles for the Selection of Donors whether blood shall be collected from a donor. If the medical officer is in doubt, the donor shall be deferred. The A-Z Guide to Medical Assessment of Blood Donors (See Appendix C) provides more specific criteria for acceptance or deferral. A history of infection or an exposure to risk of contacting infections is of particular importance in maintaining the safety of blood and blood products used for transfusion. Medications taken by prospective donors may indicate ground for deferral or acceptance with qualifications. A listing of medications to assist in the donor selection and exclusion of use of donations for the production of some components e.g. platelet concentrate, is provided in the A-Z Guide to Medical Assessment of Blood Donors. 6.8 Donor History Questionnaire The donor must be asked to complete and sign a copy of the Donor History Questionnaire (DHQ) on every occasion that he/she —— _attends to donate. Depo The DHQ must be completed and signed by the donor. The person who carries out the medical interview signs the box to certify that the donor has read the Blood Safety Information Kit and that relevant questions have been addressed. The DHQ shall include an option for Confidential Unit Exclusion (CUE) for donors who are pressured to donate blood or who are able to recall at-risk behavior/exposure to risk factors during or after blood donation. The DHQ will define the audit trail of donation clearly linking the donor to the donation. DHQs shall be kept for at least 10 years, ideally for the lifetime of the donor, and shall include the donation number and the donor ID number, 6.9 Donor Interview Donors must completely answer the DHQ except where a reading disability exists. The donor must also undergo an interview where the DHOQ is reviewed by the medical officer. The interview shall Blood Donor Selection and Counseling Manual

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General Principles for the Selection of Donors 6.10 6.11 6.12 be performed in a private environment where there is at least audio privacy and in a manner that allays apprehension and allows time for discussion or explanation and for the donor to ask questions. Privacy and confidentiality must be observed at all times. Donor Appearance A complete medical and physical examination of blood donors is generally not possible in practice. The interviewer has to rely upon the donor's answers to some simple questions concerning his/her medical history and general health, combined with a simple inspection of the donor's appearance and an examination of the heart and lungs . The donor’s appearance has to be judged by a suitably qualified person like a medical officer trained to use accepted guidelines for the selection of blood donors. Special note shall be taken of plethora, poor physique, debilitation, under-nutrition, anemia, jaundice, cyanosis, dyspnea, mental instability, and intoxication from alcohol or narcotic drugs. The skin at the potential venipuncture.sites shall be free of lesions. Persons clearly under the influence of alcohol shall be deferred until sober. Illicit drug taking if admitted or suspected shall debar the person from donating. Blood Pressure and Pulse Rate It is recommended that pulse rate (full minute) and blood pressure be determined in all donors. The pulse rate shall be regular and between 60 and 100 beats per minute. It is recognized that the blood pressure is subject to a number of variables but as a guide, the systolic pressure shall not exceed 160mm and the diastolic pressure - less than 100mm. Hemoglobin Estimation The hemoglobin level shall be determined each time the donor presents himself/herself. The hemoglobin of the donor must be measured at every attendance using a validated procedure. The minimum values before donation are: « Female donors: 125g/L « Male donors: 135g/L Blood Donor Selection and Counseling Manual

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General Principles for the Selection of Donors The maximum values before donation are: « Female donors: 175g/L * Male donors: 185g/L 7.0 Pre-Donation Counseling Objectives of donor information and counseling: . To maintain safety of blood supply and quatity of blood products » Enable self-deferral by persons with high-risk behavior or have traveled to high-risk areas: » Identify medications being taken/have been taken by the blood donor that may affect the quality of the blood product; . To protect the health of the donor . To fulfill ethical requirement Pre-donation information, whether written or oral, or both is given to blood donors before donation to allow for informed consent and self-exclusion. This is a routine step in donor selection in every blood donation, (See Appendix D) Pre-donation information include — . Donor’s rights and respons ies . Blood donation process . Potential donation-related complications . Tests performed on donated blood » Do not emphasize this during advocacy/peptalk to discourage test- seeking behavior. * Procedure in the event of a positive test result e Donor confidentiality . Importance of regular donations . Donation intervals . TTIs and how they can be avoided e High risk behavior . Window period of infection — that an asymptomatic infected person can transmit the infection to the patient who received his blood donation . Importance of maintaining a healthy lifestyle . Means of self-deferral » Voluntary self-exclusion » Confidential Unit Exclusion (CUE) ° Alternate testing sites for those at-risk or for those who want to be tested Blood Donor Selection and Counseling Manual

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General Principles for the Selection of Donors 8.0 9.0 Pre-donation counseling enables the donor to assess his/her own level of risk, and suitability as donor. It also includes educating the donor on maintaining healthy lifestyle, and on prevention of transfusion transmissible infections. During the pre-donation counseling the donor is re-directed to testing centers should he/she admit having high risk behavior, or having been exposed to high risk persons. Post-Donation Instructions Post-donation instructions like post-donation counseling and information is part of donor care. It includes the following: ° No smoking for more than one hour; . Drinking more than the usual amount of fluids (> 8-10 glasses a day); ° Avoid lifting heavy weights or strenuous activities for 24 hours; . Leaving the dressing/bandage on for a minimum of four hours;.. . Applying pressure for 2 — 5 minutes on the venipuncture, in case of recurrence of bleeding; and . Lying down with legs elevated, if the donor feels dizzy or lightheaded. The donor is also encouraged to become a regular donor, to avoid high risk activities associated with transfusion transmissible infections and thus, contribute to blood safety. Directed Donations When a person seeks to receive blood from a named donor or a donor wishes to donate blood to be transfused to a named recipient, the practice is termed “directed donation”. The request usually occurs within family relationships, in particular parents to children. There is no evidence that directed donations lead to improved patient care nor that they reduce the risk of acquiring transfusion-transmitted infections. There is the rare possibility of graft versus host disease if the donor is a close relative and the recipient is immunocompromised — e.g, an infant, a cancer patient, or a transplant patient, In this case, an irradiated blood product is indicated. 10 Blood Donor Selection and Counseling Manual

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General Principles for the Selection of Donors As a general principle, collection of directed donations is discouraged. However, if a directed donation is collected, the procedures for collecting, testing, storing, handling and transfusing the unit shall follow the procedures recommended for allogeneic blood donations except as specified in this section, In some circumstances, it may be necessary for the Blood Service Facility to seek a compatible donor from relatives. This practice is at the discretion of a Transfusion Medicine Specialist and involves a selected or dedicated donation not a directed donation. Persons who require repeated transfusions (like patients with thalassemia) are encouraged to have a pool of dedicated donors. Dedicated donors minimize antigen exposure and antibody reactions, delay refractoriness, and prolong efficacy of blood products. 9.1 Informed Consent for Directed Donations The full procedures involved in the collection and screening of blood i donations must be explained to the donor. Donors shall also understand that if tests show abnormalities, they would be informed of these, Test-results shall only be communicated _to:the-donor or donor’s doctor if the donor agrees. When screening tests show abnormalities, the proposed recipient | shall only be told that the blood is not suitable for the purpose for which it is required. No further details shall be given. 10.0 Apheresis Donors Apheresis is a procedure used to collect: H . Plasma (plasmapheresis) or . Cellular components (cytopheresis) which inciude:

» Red cells » Platelets (plateletpheresis) » Granulocytes (granulocytopheresis) » Hemopoeitic progenitor cells derived from peripheral blood Apheresis programmes must be undertaken under the supervision of the medical officer. All phases of the process (including the explanation of the process to donors and obtaining their informed consent) shall be performed under the supervision of the medical officer or by a trained personne! reporting to the medical officer. Blood Donor Selection and Counseting Manual It

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General Principles for the Selection of Donors A donor shall be considered for apheresis procedures only where the procedures involved result in products or services shown to serve accepted medical purposes, including prophylaxis therapy and diagnosis, as verified by valid scientific evidence. Informed consent for involvement in an apheresis procedure is required. The prospective donor shall be provided with information on the procedure before initial screening is undertaken. Although levels of circulating platelets and leucocytes recover promptly in donors, there is no data presently available to define the maximum numbers of platelets and leucocytes that can be safely collected. The long-term effects of the repeated removal of cellular elements are not known. Apheresis donors shall normally meet the requirements for whole blood donation and exceptions to this must be authorized by the medical officer. Such exceptions will only be made when the plasma or platelets are of unusual therapeutic value and only when the medical officer, who is aware of the health status of the donor, has documented that the donor’s héalth permits apheresis donation. en In general, platelet and leucocyte donors shall meet the general criteria for donors and the specific criteria for plasma donors. Samples must be taken before the procedure is started and these shall be reviewed as soon as they are available. In addition, platelet donors shall not have taken aspirin for 72 hours before donation or other platelet-active drugs (like non-steroidal anti- inflammatory drugs for 48 hours before donation). First-time platelet and leucocyte donors must be assessed by means of a medical examination as well as a detailed investigation of the donor’s medical history by a medical officer or a suitably qualified person working under the supervision of the medical officer. 10.1 Age The age acceptance ranges are: « First time apheresis donors between the ages of 18 — 60 years « Regular apheresis donors are accepted up to 70 years « Apheresis donors shall have donated at least one whole blood donation in the past two years prior to their initial donation by apheresis 12 Blood Donor Selection and Counseling Manual

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General Principles for the Selection of Donors Donors who do not meet these criteria may be accepted at the discretion of the medical officer. 10.2 Donor Medical History Other than in exceptional circumstances (to be decided by a responsible medical officer) donors for apheresis procedures shall meet the criteria for ordinary whole blood donation. In addition, for apheresis donors, special attention shall be given to the following conditions: « Abnormal bleeding episodes « Adverse reactions to previous donations * Adequacy of venous access 10.3 Informed Consent The process of securing informed consent is similar to that of whole blood donors and directed donors. However, donors shall be made to understand that the blood collection takes about one and a half to two hours and is associated with more adverse reactions ——

compared to whole blood donatiénike paresthesia, numbness and other signs of hypocalcemia that the donors shall alert the attending phlebotomist/physician during the procedure. 10.4 Medical Examination A medical officer must perform an evaluation as to the donor’s fitness to undergo the procedure taking into consideration his weight and height. 10.5 Laboratory Examination On at least an annual basis, all apheresis donors must have the following examinations: « A complete blood count ¢ A total protein estimation ¢ Protein analysis, such as determination of total serum or plasma protein and/or electropheresis and/or quality of single proteins, especially albumin and IgG * Total proteins shall not be less than 60g/L The medical officer shall assess the donor’s fitness to continue on the apheresis programme in the light of these laboratory investigations. Biood Donor Selection and Counseling Manuai 13

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General Principles for the Selection of Donors 11.0 Platelates (Plateletpheresis) 11.1 Donor Medical History 11. 3 Special attention must be given to the taking of medications, in particular aspirin containing compounds, which interfere with the function of platelets. (See Appendix C) Laboratory Examination A complete blood count shall be performed with every procedure: Donors for plateletpheresis shall normally have a platelet count in excess of 200 x 10° per litre. Frequency and Volume of Platelet Donation For routine provision of platelets by apheresis, the donor shall not be subjected to the procedure more than once every 3 days. When combining the collection of plasma with platelets in one apheresis procedure, the total volume of donor plasma and platelets shall not exceed 13% of total blood volume with a maximum of 650ml-(Cexclusive of anticoagulant) unless fluid ——— replacement is undertaken. 14 Blood Denar Selection and Counseling Manual

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Blood Donor History Questionnaire Department of Health NATIONAL VOLUNTARY BLOOD SERVICES PROGRAM (BSF Name and Address} Blood Donor History Questionnaire DATE : Venue Name : Surname First Name Middle Name Date of Birth :_/ / Age t mm/ dd / yyyy Gender : imate Ciremaie Civil Status: Contact number: E-mail address : Nationality : Occupation Preferred Mailing Address LL} Home Address rm Number, Strest and Subdivision “Barangay... Zip Code : Town/ District Clty/Province CQ] Office Address Floor Bullding Rame Number and Street Zip Code : Barangay Tawn/ District City {Province TYPE OF DONOR :QWVOLUNTEER =—- others METHOD OF COLLECTION : Chwhole Blood (Conventional) Cl apheresis Instructions : All donors must read the donor educational materials provided by the Blood Service Facility staff before answering. Yes No Are you 1. Feeling healthy today? 2. Currentiy taking medication? Have you taken any medication from the deferral list? 3, Have you received any vaccination? In the past three days 4. Have you taken aspirin or anything that has aspirin in it? Blood Donor Selection and Counseling Manual 17

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Blood Donor History Questionnaire Yes No QUESTION No. 5, FOR FEMALE DONORS: In the past 1 and 2 months (6 weeks) 5. Have you been pregnant or are you pregnant now? Last Menstrual Period: In the past 12 weeks have you 6. Donated blood, platelet or plasma? In the past 12 months have you 7. Had a blood transfusion? 8. Had surgical operation, dental extraction? 9. Had a tattoo, ear or body piercing, accidental contact with blood, needle-stick injury, and acupuncture? 10. Had sexual contact with high risk individuals? Ti. Had séxual contact with anyone In exchange for material or monetary gain? 13. Had sexual contact with a person who has worked abroad? 13. Engaged in casual sex? 14. Lived with a person who has hepatitis? 15. Have you been imprisoned? 16. Have any of your relatives had Creutzfeldt-Jacob (Mad Cow) disease? Have you ever 17. Livéd outside your-place of residence? 18. Lived outside thé Philippines? 19. Used needles to take drugs, steroids, or ahything not prescribed by your dactor? 20. Used clotting factor concentrates? 21. Had a positive test for the HIV virus, Hepatitis virus, Syphilis or Malaria? 22. Had Hépatitis? 23. Had malaria? 24. Been told to have of treated for genital wart, syphilis, gonorrhea or other Sexually Transmissible Infections? 25. Had any type of cancer, for example Leukemia? 26. Had any problems with your heart and lungs? 27. Had a bleeding condition or a blood disease? 28, Are you giving blood because you wanted to be tested for HIV or Hepatitis virus? 29. Are you aware that if you have the HIV/Hepatitis virus, you can give it to someone else though you may feel well and have a negative HIV/ Hepatitis test? BSFs may choose to add local questions here. Donor’s Signature Blood Donor Sefection and Counseling Manuai 18

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Blood Donor History Questionnaire “I certify that I am the person referred to in all the entries, which were read and well understood by me. It is my free and voluntary act to donate my blood, aware of its risks during and after extraction. The same have been explained to me in understandable language and dialect that I speak.” “Tam voluntarily giving my blood through ( name of BSF j. T understand that my blood will be tested for Blood Type, Hemoglobin, Malaria, Syphilis, Hepatitis B, Hepatitis C and HIV* and no official result will be released to me. If found reactive, I agree to be referred to the appropriate facility for counseling and further management. I certify that I have to the best of my knowledge, truthfully answered the above questions.” Donor’s Signature *Note: You may include other specific tests dare in your BSF AP SS set me mes nam tm me Sm pet Et SE Se me nt Sm ME fd tt et me CONFIDENTIAL UNIT EXCLUSION (CUE): If at any point during or after your blood donation, you realize that your blood may not be safe for transfusion, please inform the Blood Service Facility staff immediately. Please use your Blood Donation ID Number and the Segment Number written below in identifying your blood donation. Contact number of Blood Service Facility Segment Number Place Barcode Sticker of Donation ID No. here: Blood Donor Selection and Counseling Manual 19

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Blood Donor History Questionnaire FOR BLOOD BANK USE ONLY PHYSICAL EXAMINATION Body weight : (kg} Blood Pressure ; i Pulse Rate : Temp: General Appearance : Skin HEENT : Heart and Lungs Remarks Q Accepted Volume mi Q Temporarily Deferred | Permanently Deferred REASON/S FOR DEFERRAL Place Barcode Sticker of Donation ID No. here: Blood Bank Officer For Phlebotomist use only: Test Result Screened by: Blood Bag: (S)Single/(D) Double / {7} Blood Type Triple Hemoglobin Segment Number: Time Started: Time Ended: Phlebotomist: 20 Bicod Donor Seiection and Counseling Manual

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Donor History Questionnaire User's Guide The Donor History Questionnaire (DHQ) User’s Guide was designed to aid the donor interviewer in determining if a potential blood donor is eligible to donate. Each Blood Service Facility (BSF) must have a Standard Operating Procedure (SOP) related to donor eligibility to be used in conjunction with the User’s Guide and the A to Z GUIDE TO MEDICAL ASSESSMENT OF BLOOD DONORS. The DHQ Interviewer’s Guide does not replace the A to Z GUIDE TO ASSESSMENT OF BLOOD DONORS and the BSF’s Standard Operating Procedures (SOP) on Donor Selection for determining donor eligibility. The DHQ User’s Guide, the A to Z GUIDE TQ MEDICAL ASSESSMENT OF BLOOD DONORS, and the SOP of BSF must be available to staff performing Blood Donor Interview. The DHQ must be administered on the date of donation . All potential blood donors must read the Blood Donor Information Before Donation (See Appendix D) prior to completing the DHQ. Valid identification card with picture and signature may be asked from the donor for verification. The following ID cards are acceptable: PRC card, current school ID, current Company ID, Voter’s ID, Postal ID, SSS ID/GSIS ID, TIN ID, Driver’s License or current Passport . Methods of Administration The method of administration of the DHOQ should be in accordance with the BSF’s SOP. BSFs are reminded that donor screening is an active process involving open communication between donors and trained donor interviewers, and that donors should be encouraged to ask questions and concerns at any time during the screening and donation process . Self- Administration The DHQ was designed for self - administration by the donor, with follow - up review by a trained donor interviewer. A knowledgeable interviewer should be available to the potential blood donor to answer any questions concerning eligibility or the donation process. Since donors may not be able to determine whether they will be deferred until the questionnaire is reviewed by a donor interviewer, they should be instructed to complete the entire questionnaire. However, there will be circumstances in which the donor decides net to complete the questionnaire. For example, the donor may realize that he/she is not eligible to donate, or may simply wish to leave prior to completing the questionnaire. 23 Blood Donor Selection and Counseling Manual

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Donor History Questionnaire User's Guide Other Methods of Administration Alternatively, the DHQ may be administered by a trained donor interviewer. It is essential that the donor be encouraged to ask questions and that all of the donor’s questions are addressed by the donor interviewer. SOP of BSFs should require that donors be asked if they have any questions and if they have had their questions answered. This does not need to be a specific question on the questionnaire, but may be incorporated into the eligibility process and/or put into the donor consent. The DHQ questions were composed for ease of understanding by the potential donor. The questionnaire, documents and procedure for use were designed, structured and are intended to be used together. The DHQ was evaluated for comprehension; therefore, the wording and the order of the questions should not be changed. The questions are grouped by time period beginning with a question about “Are you” and ending with questions relating to “have you ever.” BSF's may choose to add local questions to the end of the DHQ. Ifa BSF chooses to add “local” questions, they should be grouped at the end of the DHQ in the area designated for additional questions. BSFs should aiso use this area to incorporate new questions that are necessary due to new policies. This area should be used until such questions can be formally incorporated into the DHQ by the:Téchnical‘Committee of the National Council for-Blood-Services (NCBS). 24 Blood Donor Selection and Counseling Manual

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Donor History Questionnaire User's Guide Blood Donor Personal Data Name Surname First Name Middle Name Date of Birth: / / Age : mm/ dd / yyyy Gender : QMale OFemale Civil Status Contact number: E-mail address : Nationality Occupation Preferred Mailing Address Q Home Address : Number, Street and Subdivision Barangay Zip Code : Town/District City/Province Q Office Address : Floor Building Name Number and Street Zip Code: Barangay Town/District City/Province TYPE OF DONOR

Q VOLUNTEER QQ Others METHOD OF COLLECTION : Q > Whole Blood (Conventional) Q > Apheresis ° Except for Contact No. and e-mail address, all fields in the “Personal Data” are required fields. It is the responsibility of the Donor Interviewer to check the completeness of data. . Home address must include the House Number, Street Name and Subdivision followed by the Barangay, Town or District and City or Province. . ZIP Code is a required field. The BSF must have a ready list of ZIP codes in their vicinity or Mobile Blood Donation (MBD) sites. . In the TYPE of DONOR sub-field others, the blank line that follows may be used to contain the name of patient if the DHQ is used by a replacement donor. e The field METHOD of COLLECTION was added to promote awareness about apheresis. Interviewer should be able to answer queries pertaining to this . Reformatting Materials: To maintain uniformity of the DHQ, all BSF shall use the same format of the DHQ ie. page formatting, number of column, font, etc . Blood Donor Selection and Counseling Manual 25

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Donor History Questionnaire User's Guide The DHO uses capture questions that may require intervention or follow - up from the donor interviewer. Capture questions are questions that cover a broad topic, and when an affirmative answer is given, addi- tional follow-up questions to elicit additional information are asked by the interviewer. Some follow-up questions are included in the User’s Guide, an affirmative response to some questions may require consultation with the BSF’s SOP. BSFs may implement more restrictive deferral policies than described in the User’s Guide per their local SOP. Aitention Question: Additionally, in order to assure that donors who self-administer a paper DHQ maintain focus, “attention” question is included . An example of an attention question is cited below. Are you aware that if you have the AIDS/ Hepatitis Virus, you can give it to someone else though you may feel well and have a negative HIV/ Hepatitis test? Each BSF must define the action of the donor interviewer when a donor inappropriately answers the attention questions. Attention questions may not be necessary when using other techniques to assure donor focus, such as oral screening by a donor interviewer. Documentation: Information impacting donor eligibility obtained during follow-up questioning should be meticulously documented on the DHQ . If a donor is determined to be ineligible during follow-up questioning, the reason for deferral should be documented in an area in the DHQ next to the specific question. If a donor is determined io be eligible during the follow up questioning an explanation for each question must be documented in sufficient detail in an area in the DHQ next to the question/s concerned . Example: A donor answers “yes” to, “Are you currently taking medication?” Sample documentation: “Donor taking tetracycline daily for acne prophylaxis: “OK per SOP of the Blood Service Facility or the A-Z Guide to Medical Assessment of Blood Donors” (Appendix C). Each SOP of the Blood Service Facility must define how the donor responses to the follow- up questions will be documented on the DHQ. Responses should be documented with sufficient detail to determine the reason for donor acceptance or deferral . 26 Blood Donor Selection and Counseling Manual

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Donor History Questionnaire User's Guide Donor’s Informed Consent “I certify that I am the person referred to in all the entries, which were read and well understood by me. It is my free and voluntary act to donate my blood, aware of its risks during and after extraction. The same have been explained to me in understandable language and dialect that I speak.” “I am voluntarily giving my blood through ( name of BSF ). I understand that my blood will be tested for Blood Type, Hemoglobin, Malaria, Syphilis, Hepati- tis B, Hepatitis C and HIV* and no official result will be released to me. If found reactive, I agree to be referred to the appropriate facility for counseling and further management . I certify that I have to the best of my knowledge, truthfully answered the above ques- tions .” Donor’s Signature

• Note: You may include other specific tests done in your BSF Interviewer must exert effort in explaining the consent in a manner understandable to the Blood Donor. The donor must sign the consent in the presence of the interviewer. A separate consent for apheresis procedure may be developed by each Blood Service Facility. 27 Biood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart The User’s Guide Flowcharts guide the donor interviewer through the donor history questionnaire process. Each question is a complete section that begins on a new page, so that changes to the DHQ can be easily modified in the User’s Guide. Each section contains the following information: Question : Question number and the question. Donor Eligibility : This section provides additional information to the donor interviewer on donor eligibility requirements for each question, Optional field; additional relevant information relating to the donor question. Note Flow Chart : Each question is flow-charted using standard flow-charting symbols. EI Square - Statement ae <> Diamond - Quéstion/decision point <> Oval - Action €> Va Arrow - Move to the next question The User’s Guide Flowchart also includes accompanying notes on Hepatitis for Question #22. Each question ends with an ARROW that indicates to “move to the next question;” however, blood centers must follow their established policies concerning whether or not the donor eligibility process is terminated when it is known that the donor will be deferred. Donor Deferrals For some questions, a “yes” answer calls for a required deferral, either indefinitely or for a specified period of time. A required deferral is designated in the flow chart by the Action “Defer Donor.” The donor inter- viewer may need to refer to the BSF’s SOP to determine if and when the donor may be eligible to return. 31 Biood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart For other questions, a “yes” answer may not require a deferral; rather, it may trigger a line of ques- tioning to determine if the donor is eligible. The interviewer will need to refer to the BSF’s SOP for follow-up questions to determine suitability. For example, if a donor answers “yes” to the ques- tion “Are you currently taking medication?” The interviewer may ask additional questions to ascertain the name of medication and specific indication for use by the donor. Some BSF's may allow donors taking antibiotics for certain indications such as prophylaxis for acne to donate, as defined in their SOP. Other BSFs may defer all donors taking antibiotics, regardless of the indication, Deferral for whatever reasons shall be followed by counseling. There shall be no deferred donor leaving the BSF without any form of counseling. Types of Deferral ° Indefinite Deferral — Prospective donor is unable to donate blood for an unspecified period of time due to current condition. e Permanent Deferral — Prospective donor will never be eligible to donate blood . Temporary Deferral — Prospective donor is unable to donate blood for a limited period of time. Donor Eligibility A donor shall be free of any diseases including colds on the day of donation. Donors who are not in good health shall not donate until it is determined that the underlying condition is not a cause for deferral . Confidential Unit Exclusion (CUE) As an option to self - defer, the DHO includes Confidential Unit Exclusion (CUE) for donors who are pressured to donate blood or who are able to recall at - risk behavior/exposure to risk factors during or after blood donation. Instruction on CONFIDENTIAL UNIT EXCLUSION (CUE) The interviewer must instruct the donor that if he/she feels that at any point during or after blood donation, he/she remembers there is a risk that his blood is not suitable for transfusion he/she must tear the CUE part in the DHQ to inform the BSF. 32 Biood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart Question: I Are you feeling healthy and well today? Question #1 Are you fealing healthy today? YES Refer to A-Z Guide to Medical Assessment of Blood Donors Next Question (Appendix C) and assess donor to determine if deferral is indicated. NO Deferral indicated? Defer accordingly and counsel 33 Blood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart Question: 2 Are you currently taking any medication? Donor Eligibility. A donor currently taking any medication may be a reason for deferral if said medication is found in the Medication List (Appendix C) . A donor who answers “yes”, shall prompt the interviewer to ask the donor if any of the drug in the medication list was taken by the donor. Question #2 | Are you currently taking any medication? NO Determine the medication(s) and date of the last dose. Refer to A-Z Guide to Medical Next Question Assessment of Blood Donors (Appendix C). Donor took a drug in the Medication List NO Defer accordingly and counsel 34 Blood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart Question; 3 Have you received any Vaccination? Donor Eligibility. Certain vaccinations may contain live infectious agents. A donor who has been exposed to a live infectious agent via vaccination shall not be a donor for a specified period of time. Question #3 NO Have you received any vaccination? ves'| oo . et Determine details of shots and type of vaccine. Determine eligibility based on A-Z Guide to Medical Assessment of Blood Donors (Appendix C) 4 Next Question | NO Deferral indicated? Defer accordingly and counsel Biood Donor Selection and Counseling Manual 35

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Donor History Questionnaire Flowchart Question: 4, In the past three(3) days, have you taken aspirin or anything that has aspirin? Donor Eligibility. Aspirin and other NSAIDs irreversibly inactivate platelet function. Donors who are taking aspirin or any aspirin - containing medication shall not be the sole source of platelets . Question #4 In the past threa(3) days, have you taken aspirin or anything that has aspirin? NO — YES Consult $OP for appropriate action Blood may be collected in single of | a Aloxt Question double bag and labeled "NOT FOR PLATELET” 36 Blood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart Question: 5 Female donors : In the past 1 and % months (6 weeks), have you been pregnant or are you pregnant now? Donor Eligibility. A female with a known pregnancy or who has been pregnant in the last six (6) weeks may not be eligible to donate blood . Question #5 Inthe past 1 and % menths, have you been pregnant-or are --— you pregnant now? Next Question Defer accordingly and counsel A “NO” answer shall prompt the interviewer to ask for Last Menstrual Period (LMP). The interviewer must rule out any possibility of pregnancy. Refer to A to Z Guide to Medical Assessment of Blood Donors (Appendix Cc). Blood Donor Selection and Counseling Manual 37

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Donor History Questionnaire Flowchart Question: 6 In the past 12 weeks, have you donated blood, platelet, or plasma? Donor Eligibility. A whole blood donor may donate every 12 weeks; plasma, platelet or leukoapheresis donor may donate every 2 weeks . Question #6 In the past 12 weeks, have you donated blood, platelet, or plasma? NO YES

• Determine type of donation(s)
• Determine date of donation{s} Refer to A to Z Guide to Medical Assessment of Blood Donors (Appendix C) Next Question NO Deferral indicated? Defer accordingly and counsel 38 Blood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart Question: 7 In the past 12 months, have you had blood transfusion? Donor Eligibility. A donor who has received an allogeneic transfusion of blood, platelets, plasma or other blood component shall not donate blood for 12 months following the transfusion, due to possible transmission of infectious disease. Question #7 In the past 12 months, have you had blood transfusion? Next Question Defer accordingly and counsel Blood Donor Selection and Counseling Manual 39

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Donor History Questionnaire Flowchart Question: 8 In the past 12 months, have you had surgical operation, dental extraction? Donor Eligibility. Surgical procedures have inherent risks of transmitting infection, among them Transfusion - Transmissible Infections (TTIs) . Question #8 In the past 12 months, have you had NO surgical operation, dental extrac- tlon? Determine details of dental procedure. Determine eligibility based on A-Z Guide to Medical Assessment of Blood Donors (Appendix C) Deferral NO Next Question indicated? C Defer accordingly > and couns 2 Counse 40 Blood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart Question: 9 In the past 12 months have you had a tattoo, ear or body piercing, accidental contact with blood, needle - stick injury, acupuncture? Donor Eligibility. Persons who have had a tattoo, ear or body piercing, accidental contact with blood, needle-stick injury, or acupuncture during the previous 12 months are usually deferred for 12 months from the date of procedure. Unless tattoo, ear or body piercing, and acupuncture have been done using single-use equipment, there may be a risk of transmission of infectious diseases. Question #9 In the past 12 months have you had a tattoo, ear of body piercing, accidental contact with blood, needle-stick injury, acupuncture? NO Determine details of tattoo or body _Piercing and acupuncture. Next Question 4 Performed using single use sterile device? Defer for 12 months and counsel Blood Donor Selection and Counseling Manual 4] YES

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Donor History Questionnaire Flowchart Question: In the past 12 months have you... 10, Had sexual contact with high risk individuals? 11. Had sexual contact with anyone in exchange for material or monetary gain? 12. Had sexual contact with a person who has worked abroad? 13. Engaged in casual sex? 14, Lived with a person who has hepatitis? 15. Been imprisoned? Donor Eligibility. Sexual contact with high risk individuals may be at risk of transmitting infectious diseases. High risk individuals are: 1. Injecting Drug Users. Person who has used needles to take drugs, steroids, or anything not prescribed by doctor. Males who have had sexual contact with another male even once, even if using condom. Person who had sexual contact with anyone in exchange for material or monetary gain. Persons who have had sexual contact with a person who has worked abroad. Probe for sexual behavior of the person “who have worked abroad”, refer to 2010 Report on the Global AIDS Epidemic (Appendix F ). 6. Persons who-engage.in casual sex. oop

Casual sex is defined as sexual act between two consenting individuals who are not ina romantic relationship. These sexual encounters are oftentimes repeated with many different partners thereby increasing the risk of transmitting STIs.

Persons who have lived with a person who has hepatitis.

» In certain cases, living with a person with viral hepatitis puts the donor at risk for acquiring viral hepatitis as well Vo wh

Persons who have been imprisoned. » Persons who have been detained or incarcerated in a facility Guvenile detention, lockup, jail, or prison) are deferred for 12 months from the last date of incarceration. These persons are at higher risk of exposure to infectious diseases. Note: The reason for incarceration (e.g. white-collar crimes, child support) does not change the deferral. 9. Hemodialysis patients. 10. Persons who have had multiple blood transfusion. 42 Bload Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart Question #10 to 15 inthe past 12 months have you had sexual contact with high risk individuals? Defer accordingly and counsel Next Question Blood Donor Selection and Counseling Manual 43

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Donor History Questionnaire Flowchart Question 16 Have any of your relative/s had Creutzfeldt -Jacob Disease (CJD)? Donor Eligibility. Donors with a blood relative with Creutzfeldt -Jacob Disease (CJD) are indefinitely deferred. Note. If laboratory testing (gene sequencing) shows that the donor does not have a mutation associated with familial CID, the donor is eligible. Question #16 Has any of your relative/s had Creutzfeldt- Jacob disease? No or don’t know Next Question yy Was this person related by blood or by marriage? Related by marriage Related by blood Defer indefinitely and counsel 44, Blood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart Question 17 Have you lived outside your place of residence? Donor Eligibility. 1} Donors who resided (stayed for six (6) months or more) in a malaria-endemic area and left the area only within the past 12 months shall not donate blood. 2} Donors who visited (stayed less than 6 months) in a malaria endemic area and left the area only within the past 6 months shall not donate blood. 3) Donors who developed malaria or malaria-like illness shall not donate blood until after 3 years from completion of treatment. Question #17 Have you lived outside your place of —_— residence? NO v YES| Next Question »~ Determine details of travel; refer to list of Malaria endemic areas and to A-Z Guide to Medical — Assessment of Blood Donors (Appendix-C}-- - NO Deferral indicated? Defer accordingly and counsel Blood Donor Selection and Counseling Manual 45

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Donor History Questionnaire Flowchart Question 18 Have you been abroad? Donor Eligibility. If the donor himself or herself was born in or lived in HIV high risk countries, he/she is indefinitely deferred. If the donor is from countries in Sub-Saharan Africa (Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger or Nigeria} he/she may have rare strains of HIV that are not consistently detected by all current test methods. If the donor resided in countries identified as high risk for HIV by the UNAIDS, he/she is also indefinitely deferred, refer to 2010 Report on the Global AIDS Epidemic (Appendix F). Donors who resided in the United Kingdom (England, Wales, Scotland, Northern Ireland, Isle of Man, Channel Islands) from 1980 to 1996 are indefinitely deferred. Donors who resided for 5 years in Europe are also indefinitely deferred. Question #18 Have you been abroad? NO Determine details of travel - country, length & period of stay, history of haspitalization & blood transfusion, sexual partners Next Question Deferral NO indicated? Defer accordingly and counsel 46 Blood Denar Selection and Counseling Manual

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Donor History Questionnaire Flowchart Question: 19 Have you ever used needles to take drugs, steroids, or anything not prescribed by your doctor? Donor Eligibility, Donors who are past or present needle - using drug users are permanently deferred due to potential transmission of infectious diseases . Question #19 Have you ever used needles to take drugs, steroids or anything not prescribed by your doctor? Next Question Defer permanently and counsel 47 Blood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart Donor Question: 20 Have you ever used clotting factor concentrates? Eligibility. A donor who has been exposed to clotting factor concentrates shall not donate blood due to possible transmission of infectious disease. Question #20 Have you ever used clotting factor concentrates? Next Question if multiple use, defer permanently and counsel If only once, defer for 12 months 48 Bload Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart At this point, donor is informed that shall he/she remember any incident that may affect his suitability as a blood donor especially recall of high risk behavior described in the leaflet (refer to Blood Donor Information before Donation), he shall inform anyone in the Blood Collection Team or the local Blood Program Coordinator. Question: 21 Have you ever had a positive test for the HIV virus, Hepatitis virus, Syphilis or Malaria? Donor Eligibility. Donors with clinical or laboratory evidence of HIV are indefinitely deferred due to potential transmission of infectious diseases. Question #21 Have you ever had a positive test for the HIV virus, Hepatitis virus, Syphilis or Malaria? Next Question Defer permanently and counsel Blood Donor Selection and Counseling Manual 49

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Donor History Questionnaire Flowchart Question 22 Have you ever had hepatitis? Donor Eligibility. Donors with viral hepatitis or hepatitis of unknown cause within the past 12 months shall not donate blood . (Refer to succeeding notes on hepatitis). Question #22 "Have you ever had Hepatitis? NO _ Next Question YES Defer accordingly and counsel! 50 Blood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart DONOR EVENT EXPLANATION/CLARIFICATION ACTION Hepatitis of Viral Origin(General where the type of the infective agent is not known) History of jaundice/ hepatitis of unknown cause while an adult Defer for 12 months from recovery Inoculation injury where there is the possibility of transmission of infection through infected food Defer for 12 months from event Sexual contact with an infected person Defer for 12 months from the last sexual contact Health care and other professional workers in hospital laboratories, or caring for people with hepatitis, provided they have NOT suffered an inoculation injury or contamination of non- intact skin or mucosa with blood fom an individual with hepatitis Accept Household contact of infected person; infective agent type unknown Defer for 12 months from the last contact/exposure HEPATITIS B (HBV) Infected carriers. A person who is HBsAg serological positive Defer permanently A person with HBsAg serological reactive unconfirmed) Defer indefinitely until confirmed negative For reguiar repeat donors contracting Acute Hepatits B. Obtain full history and refer to the medical officer for farther action. Defer for 12 months from the event and then reassess. Such donors may be acceptable - 12 months after acute episode provided there was clearance of HBsAg within 6 months and that a level of

100 iu/L of anti-HBs can be demonstrated in their serum. A current sexual partner of confirmed HBV carrier Defer permanently A past sexual partner of confirmed HBV carrier Defer for 12 months from the last sexual contact Recipients of HBV immunoglobulin (HBIgG): Hepatitis B immunoglobulin administered after a known exposure (with or without the vaccine) can prolong the incubation period Defer for 12 months from inoculation Blood Donor Selection and Counseling Manual 51

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Donor History Questionnaire Flowchart DONOR EVENT EXPLANA TION/CLARIFICATION ACTION Recipients of vaccine Case 1: If there has been no known exposure Defer for one week from vaccination Recipients of vaccine Case 2: If vaccine is given post exposure to HBV Defer for 12 months from vaccination Household contact (non-sexual) of a person infected with hepatitis B Defer for 12 months from last contact/ exposure HEPATITIS C (HCV) Serological positive individuals and persons with documented past infection (confirmed) Defer permanently HCY antibody repeat reactive donor Defer indefinitely (unconfirmed) A current sexual partner of confirmed HCV Defer permanently carrier A past sexual partner of confirmed HCV carrier Defer for 12 months from the last sexual contact Adapted from the A-Z Guidelines (2008) of the New Zealand Blood Services 52 Blood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart Question 23 Have you had malaria? Donor Eligibility, Potential blood donors who have had malaria and received an appropriate treatment shall be deferred for three (3) years after becoming asymptomatic . Malaria can be transmitted by blood . Question #23 Have you ever had malaria? NO ¥ Next Question ry { Have you been treated and asymptomatic for more than 3 years? YES Defer permanently and counsel Blood Donor Selection and Counseling Manual 53

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Donor History Questionnaire Flowchart Question 24 Have you been told to have or treated for genital wart, syphilis, gonorrhea or other sexually transmissible infections? Donor Eligibility. Donors diagnosed and/or treated for syphilis, gonorrhea or other sexually transmitted infections shall not donate blood because of the risk of transmitting the infection. Question #24 Have you ever been told to have or treated for genital wart, syphilis, gonorrhea or other sexually transmissible infections? Next Question Defer permanently and counsel 54 Blood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart Question 25 Have you ever had any type of cancer, including leukemia? Donor Eligibility. Donors with a history of cancer (including leukemia) are permanently deferred. Question #25 Have you ever had -—-\ — any type of cancer, including leukemia? Next Question Defer permanently and counsel Blood Donor Selection and Counseling Manual 55

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Donor History Questionnaire Flowchart Question 26 Have you ever had any problems with your heart or lungs? Donor Eligibility. Donors must be free of acute respiratory disease. Donors with history of diseases of the heart and lungs, including acute lung disease or colds, must be evaluated. Refer to A-Z Guide to Medical Assessment of Blood Donors (Appendix C) Question #26 Have you ever had any problems with your heartior———* To TEE lungs? NO Determine eligibility per Next Question SOP of BSF and counsel

NO Deferral indicated? Defer permanently and counsel 56 Blood Donor Selection and Counseling Manual

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Donor History Questionnaire Flowchart Question 27 Have you ever had a bleeding condition or a blood disease? Donor Eligibility. Donors with a history of bleeding problems shall be evaluated. Refer to Standard Operating Procedures. Note. Donors who have been receiving clotting factor concentrates are deferred permanently Question #27 Have you ever hada bleeding NO condition or ~@ blood disease? YES Determine eligibility per SOP of BSF and counsel NO Deferral Next Question rN indicated? Defer permanently and counsel Blood Donor Selection and Counseting Manual 57

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Donor History Questionnaire Flowchart Question 28 Are you giving blood because you want to be tested for HIV virus, or for hepatitis virus? Donor Eligibility. Donors whose motivation for donating blood is to get free testing are deferred. These donors may have high risk behavior. They shall be counseled and properly referred to the nearest Voluntary Counseling and Testing (VCT) center. Donors who need laboratory test for HIV, HBV or HCV for employment or insurance purposes are also deferred. (The blood center does not issue results of tests) Question #28 Are you giving blood because you want to be tested for HIV virus, or for Hepatitis virus? Determine reason for wanting to estion be tested for HIV or Hepatitis. NO Deferral indicated? Defer accordingly, counsel and refer to VCT 58 Blood Donor Setection and Counseling Manual i ‘ |

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Donor History Questionnaire Flowchart Question 29 Are you aware that if you have the HIV or Hepatitis virus, you can give it to someone else though you may feel well and have negative HIV or Hepatitis test? Donor Eligibility. Donor shall understand that if he donates during the window period, the result of the tests for HIV, HBV or HCV is non - reactive, even though he already has the infection and can transmit this to whoever receives his/her blood . Furthermore, at this phase of the infection, the donor may not show any sign of infection . This is to highlight the importance of honesty in answering the questions in the DHO . Question #29 Are you aware that if you have the HIV or Hepatitis virus, you can give it to someone else though you may feel well and have negative HIV or Hapatitis virus? YES 4 Proceed to the Section on informed Consent for Donation Educate donor about the sub-clinical phase of HIV infection or hepatitis, and the “window period" in the testing for HIV or HBV and HCV YES Proceed with blood donation? Defer accordingly, counsel and refer to VCT Note: If the donor answers “no”, refer him/her to a Voluntary Counseling and Testing Center (VWCT) Blood Donor Selection and Counseling Manual 59

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Blood Donor Counseling Counseling Principles Counseling of blood donors is an essential part of achieving the Blood Services’ primary goal of providing adequate and safe blood and blood products. Although the enzyme immunoassay (E14) testing system for TTIs is very sensitive, there is still the risk that infected blood will not be detected when the donor donates during the “window period” — when the infection has only recently been acquired and the level of detectable disease markers is still low. Window Period HBV : 59 days HCV : 82 days HIV-1: 21 days } } } | i } j Window Period False Negative Immune reaction | | | Infection Time Thus, there is a need for adequate pre-donation information and counseling to ensure self-deferral of high-risk donors. Blood donor counseling is necessary before and after blood donation, and should be preceded by pre- donation information and discussion. Effective pre-donation information and pre-donation counsel- ing are important activities of the Blood Services, and are needed to encourage appropriate donor self- deferral. Post-test counseling is not only a necessary part of care for the confirmed HIV-positive donor but is also important in promoting healthy lifestyle and regular blood donation in HIV-negative donors. Biood Donor Selection and Counseling Manual 63

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Blood Donor Counseling Pre-Donation Counseling Pre-donation counseling of donors has two main objectives: 1. To increase donor awareness of ¢ HIV and other TTIs * The implications and consequences of donating during the “window period” for those with high risk behavior * The implications and consequences of being tested reactive and/or confirmed positive for : HIV, hepatitis B, hepatitis C and syphilis 2. To discourage blood donation * By self-deferral of people wanting to use the voluntary blood donation system to avail of free testing for HIV, hepatitis B, hepatitis C or syphilis » Among people with high-risk behavior or with risk factors associated with the TTIs. | These persons should be referred to Voluntary Counseling and Testing (VCT) centers, or alternative counseling and testing facilities. Pre-Donation Counseling Checklist The pre-donation counseling should cover the following: i. Knowledge of HIV and Other Transfusion Transmissible Infections (TTIs) « Transmission awareness and understanding * Implication of donation during the “window period” and false negative test result * Previous request for test for TTIs - when and why ? * Personal acquaintance and involvement with people with HIV 2, Risk History Assessment « Nature of sexual activities, frequency and number « Injecting drug use and sharp instrument sharing. i * Recent illness and symptoms * Family history of iiness ® Blood and blood product transfusions, and invasive procedures (tattooing, body piercing) * Previous paid blood donations * Other high-risk behavior/ factors associated with TTIs (See Appendix E) 64 Blood Donor Selection and Counseling Manual

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Blood Donor Counseling 3. Donation Information *« Donation procedure explained and understood * The meaning and reasons for donor self-deferral, and Confidential Unit Exclusion (CUE) * Informed consent to donate explained and obtained 4. Psychosocial Factors and Knowledge « Why is the person donating — to avail of free-testing? « Any symptoms of concern te the donor? * Significance and interpretation of positive and negative test results, including implications for behavior change (healthy lifestyle) and prevention Post-Donation Counseling Post-donation counseling is the highly confidential and individualized face-to-face counseling that i is provided by a skilled counselor (trained for this purpose). The counseling should take place as : soon as possible after a positive (by confirmatory test in the Research Institute for Tropical Medicine) result is reliably obtained. Post-donation counseling is intended to help the donor cope with thé psychological impact of a confirmed positive result. Post-donation counseling involves the following: * Giving the donor enough time to grasp the information ¢ Giving the donor enough time and opportunity to ask questions * Helping the donor cope with the emotional and practical impact of a confirmed positive result especially for HIV ¢ Offering options for continued care for infected donors and their families and/or sexual contact/s through referral to appropriate health facilities. Those found to have HIV infection are counseled to accept referral to the HIV/AIDS Core Team (HACT). Those found to have ; hepatitis B and hepatitis C are encouraged to enroll themselves in the Liver Study Group in
medical centers or regional hospitals, if these services are available in the area. Post-test counseling may involve recognizing and managing — in the very short term — acute psychological reactions to the disclosure of HIV infection. Post-test counseling for donors with HIV infection should therefore be provided only by BSF Staff who have received specific training for handling such cases, or who have access to those who can do so. Blood Donor Selection and Counseling Manual 65

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Blood Donor Counseling Stages of Blood Donor Counseling, NVBSP Stage 1 Pre-donation information t Stage 2 Pre-donation counseling (Voluntary Counseling Services) q Healthy Lifestyle/ Disease Prevention Reinforced Stage 3 Physical Examination, Selection, Informed Consent for Testing of Blood Unit qt Stage 4 Blood Donation and Testing Stage 5 Post-donation Information and/ or Counseling I Recruit for Regular Donation Stage 5 Positive/Equivocal Post-donation Counseling 66 Blood Donor Selection and Counseling Manual

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Appendix A : Code of Ethics for Blood Donation and Transfusion Code of Ethics for Blood Donation and Transfusion (International Society of Blood Transfusion) Blood Centers: Donors and Donation 1. Blood donation including hematopoietic tissues for transplantation shall, in all circumstances, be voluntary and non-remunerated; no coercion should be brought to bear upon the donor. A donation is considered voluntary and non-remunerated if the person gives blood, plasma or cellular components of his/her own free will and receives no payment for it, either in the form of cash, or in kind which could be considered a substitute for money. This would include time off work other than that reasonable needed for the donation and travel. Small tokens, refresh- ments and reimbursements of direct travel costs are compatible with voluntary, non- remunerated donation. The donor should provide informed consent to the donation of blood or blood components and to the subsequent (legitimate) use of the blood by the transfusion service. A profit motive shoutd not be the basis for the establishment and running of a blood service. The donor should be advised of the risksxconnected with the procedure, the donor’s health and safety must be protected. Any procedures relating to the administration to a donor of any substance for increasing the concentration of specific blood components should be in compliance with internationally accepted standards. Anonymity between donor and recipient must be ensured except in special situations and the confidentiality of donor information assured. The donor should understand the risks to others of donating infected blood and his or her ethical responsibility to the recipient. Blood donation raust be based on regularly reviewed medical selection criteria and not entail discrimination of any kind, including gender, race, nationality or religion. Neither donor nor potential recipient has the right to require that any such discrimination be practiced. Blood must be collected under the overall responsibility of a suitably qualified, registered medical practitioner. All matters related to whole blood donation and hemapheresis should be in compliance with appropriately defined and internationally accepted standards. Blood Donor Selection and Counseling Manual 69

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Appendix A : Code of Ethics for Blood Denation and Transfusion Donors and recipients should be informed if they have been harmed. 9, 10. Blood is a public resource and access should not be restricted. 11. Wastage should be avoided in order to safeguard the interests of all potential recipients and the donor. Hospitals: Patients 12, Patients should be informed of the known risks and benefits of blood transfusion and/or alterna- tive therapies and have the right to accept or refuse the procedure. Any valid advance directive should be respected. 13. In the event that the patient is unable to give prior informed consent, the basis for treatment by transfusion must be in the best interests of the patient. 14, Transfusion therapy must be given under the overall responsibility of a registered medical practitioner. ee OF Genuine clinical need should be the only-basis for transfusion therapy. ——— 16. There should be no financial incentive to prescribe a blood transfusion. 17. As far as possible, the patient should receive only those particular components (cells, plasma, or plasma derivatives) that are clinically appropriate and of affordable optimal safety. 18. Blood transfusion practices established by national or international health bodies and other agencies competent and authorized to do so should be in compliance with this code of ethics, 70 Blood Donor Selection and Counseling Manual

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Appendix B : Social Hygiene Clinic, VCT Centers and Treatment Hubs Global Fund - HIV Project Social Hygiene Clinics (SHC) at Local Government Units - Health Offices Laoag City Dr. Imelda Tamayo SHCPhysician Tel: (077) 772 - 9289 Tuguegarao City Dr. James Guzman. CityHealth Officer Tel: (078) 846 - 2197 . Santiago City Dr. Robelyn Go SHCPhysician Tel: (078) 682 - 7687 San Fernando, La Unio: Dr. Godofredo A. Rilloraza Jr. SHCPhysician Tel: (072) 888 - 6907 Fax: (072) 700 - 5477 Baguio City Dr, Celia Flor C. Brillantes SHCPhysicitan TeleFax (074) 442 - 9800 . Angeles City Dr. Verona V. Guevarra SHCPhysictan Tel: (045) 322 - 2479 City of Manila Dr. Diana Mendoza SHCPhysician Tel: (02) 711 - 6942 Caloocan City Dr. Zenaida Calupaz SHCPhysician Tel: (02) 288 - 8811 loc. 2281 Luzon 9. 10. 11. 12. 13. 14, 15. 16. Quezon City Dr. Dottie Mercado SHCPhysictan-Batasan SHC Mobile: (0905) 357 - 6353 Quezon City Dr. Suzette Encisa SHCPhysician-Bernardo SHC Mobile: (0916) 478 - 1607 Quezon City Dr. Monia Santos SHC Physic ia n - Project 7 SHC Mobile: (0918) 618 - 4133 Marikina City Dr. Honielyn Fernando CityHealth Officer Tel: (02) 943 - 2139/688 - 1465 md_honnie@yahoo.com Mandaluyong City Dr. Ma. Gloria Lacson SHCPhysician Tel: (02) 534 - 0163 532 - 5001 loc. 292 Pasig City Dr. Rocylene Roque SHCPhysician Tel: (02) 640 - 9700 Makati City Dr, Calixte Salud SHCPhysicitan Tel: (62) 870 - 1000 Fax: (02) 899 - 8916 Pasay City Dr. Loretta Garcia SHCPhysician Tel: (02) 551 - 4180 Bloed Donor Selection and Counseling Manual 71

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Appendix B : Sociai Hygiene Clinic, VCT Centers and Treatment Hubs 17. 18. 19, 22. 23, 25. 26. Batangas City Dr. Dinah Lucero STICoordinator Tel: (043) 723 - 8890/723 - 2472 dinslucero1970@yahoo.com Puerto Galera 21. Dr. Teresa Wycoco MunicitpalHealthOfficer Tel: (043) 442 - 0182 Lucena City Dr. Vicente Martinez STICoordinator Tel: (042) 710 - 8320 Visayas Cebu City 27, Dr, Ilya Abellanosa Tac - an SHCPhysician Tel: (032) 233 - 0987 Fax: (032) 232 - 6848 Iloilo City 28. Dr. Odetta Villaruel SHCPhysician Tel: (033) 320 - 8151 Bacolod City 29, Dr. Babylyn Drilon SHC Physician Tel: (034) 434 - 4098/434 - 8584 Allen, Samar 30. Dr. Daisy F. Abasolo CityHealthOfficer/SHCPhysician Tel: (055) 500 - 9032 Catbalogan, Samar Dr. Senecia Q. Yong MunicipalHealthOfficer Tel: (053) 342 -5515/356 - 1139 Fax: (053) 323 - 6517 20. Puerto Princesa City Dr. Eunice Herrera SHC Physician Tel: (043) 465 - 8182 Daraga, Albay Dr. Edna Freya B. Tan SHC Physician Tel: (052) 824 - 7959 Calbayog, Samar Dr. Cesar Sabenicio Asst. MunicitpalHealthOfficer SHCPhysician Tel: (053) 323 - 6517 — Isabel, Leyte Rural Health Unit, Isabel, Leyte Dr. Refelina Baje, HealthOfficerin-Charge/ SHCPhysician Tel: (053) 337 - 2055 Kananga, Leyte Dr. Ma . Cecilia Samosa MunicipalHealthOfficer/ SHCPhiysician Tel: (53) 553 - 9171 Tacloban, Leyte Dr. Mirabelie Reyes SHC Physician Tel: (053) 323 - 3518 72 Blood Donor Selection and Counseling Manual

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Appendix B : Social Hygiene Clinic, VCT Centers and Treatment Hubs Mindanao 31. Davao City 34, General Santos City Dr. Jordana Ramiterre Dr. Mely Lastimoso SHC Physician STI Coordinator Tel: (082) 222 - 4187 Tel: (083) 302 - 3922/893 - 5847 pram07@yahoo.com she_mely@yahoo.com 32. Surigao City 35. Zamboanga City Dr, Ivy E . Llamera Dr. Kibtiya A. Uddin SHC Physician SHC Physician Tel: (086) 826 - 3006/826 - 4108/ Tel: (062) 991 - 5421 826 - 4131 33. Cagayan de Oro City 36. Butuan City Dr. T. Joselito Retuya, Jr. Dr. Jesus Chin - Chui SHC Physician SHC Physician Tel: (08822) 721189 Tel: (085) 342 - 3432 Blood Donor Selection and Counseling Manuai 73

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Appendix B : Social Hygiene Clinic, VCT Centers and Treatment Hubs 10. List of Hospital with Voluntary Counseling and Testing (VCT) Centers Mariano Marcos Memorial Medical Center Batac, Ilocos Norte Southern Isabela General Hospital Santiago City, Isabela Dr. Jose Fabella Memorial Medical Center Lope de Vega Street Sta Cruz, Manila Dr. Jose Reyes Memorial Medical Center Rizal Avenue, Sta. Cruz, Manila Eastern Visayas Regional Medical Center Tacloban City Davao Regional Hospital Tagum, Davao del Norte CARAGA Regional Hospital Surigao City Luzon Visayas Mindanao 11. 12. East Avenue Medical Center East Aveue, Quezon City Batangas Regional Hospital Batangas City Ospital ng Palawan Puerto Princesa City, Palawan Northern Mindanao Medical Center Cagayan de Oro City Cotabato Regional Medical Center Cotabato City 74 Blood Donor Selection and Counseling Manual

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Appendix B: Social Hygiene Ci inic, VCT Centers and Treatment Hubs List of Treatment Hubs Luzon 1, Locos Training & Regional Medical 6. Philippine General Hospital (Sagip Center Program) San Fernando City, La Union Pedro Gil, Manila Tel . (072) 6076413 Tel. 521-8450 2. Jose B. Lingad Memorial Medical 7. The Medical City Center Ortigas Ave., Pasig City Brgy. San Dolores, San Fernando Tel. 6356789 loc 6323 City, Pampanga Tel. (045) 9613921 / 9613989 3. Cagayan Valley Medicat Center 8. Makati Medical Center Carig, Tuguegarao Cagayan #2 Amorsolo St., Legaspi Village, Tel . (078) 3041410/8443789 Makati City Tel. 8888999 loc 2336 4. Baguio General Hospital and Medical 9, Research Institute for Tropical Center Medicine Gov. Park Rd., Baguio City 7 Alabang Muntinlupa City Tel. (074) 4438342/4424216 loc 381 Tel. 8097599; 8422628/2445 loc, 332 5. San Lazaro Hospital (Bahay Kalinga) 10, Bicol Regional Training & Teaching Quiricada Street, Sta. Cruz, Manila Hospital Tel. 3099543 / 7323776 to 79 Legaspi City Tel. (052) 483 - 0636/0017 Visayas 11. Western Visayas Medical Center 13, Vicente Setto Sr. Memorial Q. Abeto St., Iloite City Medical Center Tel. (033) 3211797/2841 B. Rodrigue, Sambag II, Cebu City Tel. (032) 2539891 to 96 12, Corazon Locsin Montelibano 14. Gey. Celestine Gallares Memorial Memorial Regional Hospital Lacson St., Bacolod City M. Parras St. Tagbilaran City. Tel. (034) 4333683/7096244 Bohol Tel. (038) 4114868 Mindanao 15. Southern Philippine Medical Center 16. Zamboanga Medical Center JP Laurel St., Bajada, Davao City Tel. (082) 2272731 loc. 4205 Sta. Catalina, Zamboanga City Tel (062) 9912934/991 - 6573 Blood Donor Selection and Counseling Manuai 75

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Appendix C:A-Z Guide to Medical Assessment of Blood Donors A-Z Guide to Medical Assessment of Blood Donors Conditions Timing Conditions A Abortion/ Miscarriage (without Dilatation and Curettage) 6 weeks from incident Abortion/ Miscarriage (with Dilatation and Curettage) 12 months from procedure Acne vulgaris e lesions not active or infected but on Anytime topical medication. ® taking cyproterone acetate (an anti- Anytime testosterone) e taking tetracycline or erythromycin 2 weeks from completion of treatment e taking isotretinoin, tretinoin, adapalene 4 weeks from last dose e lesions active/inflamed 2 weeks from healing e = taking acitretin, etretinate 3 years from last dose (Neotigason) Acupuncture (needle sterilized, _. Anytime practitioner certified) Age * 16to 65 years old Anytime * more than 65 years old At the discretion of physician Alcoholism, chronic Permanent deferral Alcohol intake 12-24 hours after last intake Allergy (donor fit and well} e hay fever with minor symptoms with or without medications, and donor fit and well Anytime e hay fever with more than minor symptoms with or without medications, and donor fit and well 1 month from last incident « moderate allergic reaction (including dnig allergy} 1 year from last incident ¢ history of severe allergic reaction or anaphylactic shock Permanent deferral e Anemia, iron deficiency After treatment, with Hemoglobin of 125g/L Anemia, any other cause Permanent deferral Angiogram Permanent deferral Angioplasty Permanent deferral 716 Biood Donor Selection and Counseling Manual

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Appendix C:A-Z Guide to Medical Assessment of Blood Donors indigestion or heart burn Conditions Timing Conditions Angina pectoris - diagnosis confirmed Permanent deferral Antacids - taken occasionally for Anytime Antibiotic depends on the condition for which antibiotic is taken Anti-inflammatory medicines (underlying condition acceptable) e NSAIDs - if blood donation not for Anytime platelets ¢ NSAIDs - blood donation for Defer for 24 hours from last dose platelets « Aspirin - blood donation not for Anytime platelets * Aspirin - blood donation for Defer for 72 hours from last dose platelets Apheresis * platelet 72 hours e = double red cell 16 weeks from last apheresis provided height, weight and Hgb (>145g/L) criterla are met oe « — single red cell 12 weeks * — single red cell + platelets 12 weeks * plasma 4 weeks Appendectomy 12 months after surgery Arthritis, not on medications Anytime * on medication , see “anti- inflammatory” Asthma, mild (donor fit and well) Anytime - if not on medication, only on inhaler maintenance Asthma, severe Permanent deferral Autoimmune diseases like Systemic Lupus Erythematosus (SLE) Permanent deferral BCG vaccine (see A-Z Guide of Vaccine) 2 weeks from last vaccination Biopsy, benign and healed 12 months from the procedure Blood donation, whole blood 12 weeks from last donation; shorter interval may be allowed provided frequency does not exceed 6x in the entire year Blood transfusion ° Whole Blood (WB), Packed Red 12 months from last transfusion Blood Donor Selection and Counseling Manual 77

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Appendix C:A-Z Guide to Medical Assessment of Blood Donors Conditions Timing Conditions Blood Cell (PRBC), Platetet Concentrate (PC), Fresh Frozen Plasma (FFP) ® Clotting factors (Factor VI, Ex} Permanent deferral e =Biood Transfusion given in France, Treland, & United Kingdom Permanent deferral Body piercing (ear/tongue/nose/navel holing) 12 months from procedure 1 month from completion of antibiotics Boils Brain surgery Permanent deferral Bronchiectasis Permanent deferral Bronchitis, acute 1 month after complete recovery Bronchitis, chronic Anytime, if symptom free for 24 months Brucellosis Permanent deferral Cancer, all types Permanent deferral l week from completion of treatment Candidiasis (thrush, monilia! infection} Cataract 2

Anytime ——_—. Chagas disease Permanent deferral Cellulitis 1 week after recovery and completion of treatment Chicken pox (varicella ) ® infection in donor 1 month after recovery e® contact with infected person:

contact with no history of previous infection 1 month after last contact

contact with history of previous infection Accept - anytime 9 months after delivery or 3 months after Childbirth weaning Cholecystitis 1 month after recovery Cholecystectomy 12 months after recovery Cholera vaccine (see A-Z Guide of Vaccine) Colitis Permanent deferral - if diagnosis is irritable bowel syndrome Colitis, ulcerative Permanent deferral Common cold 1 week after recovery Concussion, mild 3 months after recovery Conjunctivitis 78 Biood Donor Selection and Counseling Manual

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Appendix C:A-Z Guide to Medical Assessment of Blood Donors Conditions Timing e allergic if mild, may accept e infectious One week after resolution and completion of antibiotic treatment Convulsions/Seizures/Epilepsy Permanent deferral Corneal transplant 12 months after procedure Coronary heart disease Permanent deferral Cosmetic procedures (facial “cleaning”, ‘botox injection, dermabrasion, etc.) 12 months after procedure Creutzfeld Jacob Disease (CID) at-risk individuals Permanent deferral e 1st degree blood relatives of person with CJD e recipients of human neurological derived products like human growth hormone, human pituitary gonadotrophin, dura matter __(Lyodura) UK: England, Wales, Scotland, Northern Ireland, Isle of Man, & the Channel Islands Permanent deferral e recipient of corneal transplant while in the United Kingdom, Republic of Ireland, France Permanent deferral * recipient of Blood Tranfusion while in United Kingdom, Republic of treland, France Permanent deferral Dengue Fever 1 month after recovery if without Blood Transfusion Dental surgery 12 months after procedure Dental extraction, uncomplicated 72 hours after procedure Dental extraction with abscess I month after recovery & off antibiotics Dermatitis After complete healing Diabetes mellitus * controlled by diet & oral medication Anytime * uncontrolled and on insulin Permanent deferral Diarrhea, infectious 1 month after complete recovery Diptheria i month after complete recovery Blood Donor Selection and Counseting Manual 79

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Appendix C: A-Z Guide to Medical Assessment of Blood Donors Conditions Timing Conditions Diverticulosis Anytime Diptheria, Pertussis, Tetanu (DPT) and Diptheria Tetanu (DT) vaccine (see A-Z Guide of Vaccine) Drugs, use of prohibited drugs Indefinite deferral Duodenal ulcer * currently on treatment 3 months after recovery « with partial gastrectomy 12 months after procedure ® with complete gastrectomy Permanent deferral Dysentery, amoebic/bacillary 1 month after complete recovery Ear holing (see “Body Piercing”} 12 months from the procedure Embolism Permanent deferral Emphysema Permanent deferral Encephalitis Permanent deferral Epilepsy/Convuision/Seizure Permanent deferral jEpistaxis -and-not due to hematologic disorder Anytime if Hemoglobin is 125 g/L and up, Fainting spells Refer to a physician 2 history of faint during blood donation two consecutive times Permanent deferral Fertility drugs (see “CJD At-Risk Individuals”) 1 year from compiction of investigation for fertility Fever of unknown origin (unexplained) 4 months after resolution of fever, if not consistent with Malaria Filariasis e = infection Permanent deferral e took medication during Filariasis 2 weeks after intake of anti-Filarial Elimination Program - MDA medicines Fracture, with surgical intervention 12 months Gallstone, asymptomatic Anytime 12 months after surgery Gastrectomy, gastroenterostomy * complete Permanent deferral Gastroenteritis 1 month after recovery Genital/Perianal wart Permanent deferral 80 Blood Donor Selection and Counseling Manual

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Appendix C: A- Z Guide to Medical Assessment of Blood Donors Conditions Timing Conditions Genital herpes Permanent deferral Glandular fever 6 months after recovery Glaucoma - treated by eyedreps other than Accept anytime beta blocker Gonorrhea Permanent deferral Gout If quiescent, accept Gout active 3 months after recovery Hematuria After recovery Hemorrhoidectomy 12 months after surgery Hay fever (see Allergy) Head injuries, minor/severe (see Concussion) Hepatitis, exposure to close household Indefinite deferral contact Hepatitis - type of infective agent Indefinite deferral unknown Hepatitis A 6 months after liver function tests have normalized, provided that diagnosis is supported by laboratory tests Hepatitis B (HBsAg seropositive} Permanent deferral Hepatitis B (HBsAg seroreactive; Indefinite deferral until confirmed unconfirmed) seronegative Hepatitis B - current sexual partner of Permanent deferral Indefinite deferral Hepatitis B - past sexual partner of Hepatitis B vaccine (see A-Z Guide of Vaccine) ‘Hepatitis B vaccine, plasma-derived (see A-Z Guide of Vaccine) Hepatitis immunoglobulin (see A-Z Guide of Vaccine) Herpes simplex Indefinite deferral 1 month after complete recovery Herpes zoster Hydatid disease 6 months after recovery Hysterectomy 12 months after recovery Hypertension > 160/100 Indefinite deferral Hyperthyroidism Anytime if not on medication Indefinite deferral Hypotension, <90/60 Incarceration (jail/prison)} 12 months from release Influenza 1 month after complete recovery Blood Donor Selection and Counseling Manual 81

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Appendix C : A - Z Guide to Medical Assessment of Blood Donors Conditions Timing Conditions influenza, contact 3 days from last contact Influenza, vaccine { see A-Z Guide of Vaccine) Intraarticular injection of cortisone 1 month after injection Insulin (see Diabetes Mellitus) Jaundice, obstructive 12 months after recovery Jaundice, cause undetermined Indefinite deferral [Laryngitis 1 month fom recovery and off antibiotic [Leptospirosis 3 months after recovery Lung, abscess (not malignant} 3 months after recovery and off antibiotic Malaria, infection 3 years after treatment, if asymptomatic e Travel to area endemic for malaria with or without prophylaxis (stay 6 months from departure from area for < 6 months) a * Former resident of malaria endemic area, or stayed in malaria endemic area for 6 months or more 12 months from date of departure from area Malignant disease Permanent deferral Mass Drug Administration (WDA) - Filariasis 2 weeks from treatment Mass Drug Administration (MDA) - Schistosomiasis 2 weeks from treatment ‘Measles (Rubeola) 6 weeks after recovery Measles vaccine (see A-Z Guide of Vaccine) Medications (see A-Z Guide to Medication) Meningitis 6 months after recovery and if no history of seizure Migraine Accept if asymptomatic Mumps, infection

• weeks from recovery | ® contact 1: with no previous infection 4 weeks from last exposure »® contact 2: with previous infection Accept anytime WNephritis, acute (pylonephritis) 5 years after recovery & off antibiotic Nephritis, chronic Permanent deferral 82 Blood Donor Selection and Counseling Manual

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Appendix C : A - Z Guide to Medical Assessment cf Blood Donors Conditions Timing Conditions Oral polio vaccine (see A-Z Guide of Vaccine) Osteomyelitis 6 months after recovery Paget’s disease Permanent deferral 1 month after complete recovery Pancreatitis Peptic ulcer 3 months if symptom free Peritonitis 6 months after recovery Phlebitis 3 months after recovery Pneumothorax 6 months after recovery Poliomyelitis 12 months after recovery Polycythemia, secondary e Female (maximum 175mmo!l/L) * Male (maximum 185mmol/L} Permanent deferral (Phlebotomy for therapeutic purpose only) Pregnancy (see Childbirth) Prolonged bleeding Permanent deferral Psychiatric disorder Permanent deferral Anytime if 60 - 100 beats/min (regular Pulse rate rhythm) Psoriasis Never OQ Fever Permanent deferral Renal colic Anytime if symptom free Rabies vaccine (see A-Z Guide of Vaccine) Raynaud’s disease Permanent deferral Rheumatic fever Permanent deferral Rheumatism Anytime, ifnot on drugs Rubella (German measles) e = infection 4 weeks from recovery * contact 1: no previous infection 4 weeks from last exposure ® contact 2: with previous infection Accept anytime * vaccination 8 weeks from vaccination Blood Donor Selection and Counseling Manual 83

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Appendix C : A - Z Guide to Medical Assessment of Blood Donors Conditions Timing Conditions Sarcoidosis Permanent deferral Salmonella food poisoning 12 weeks from recovery Scarlet fever 4 weeks after recovery Schistosomiasis Permanent deferral Schistosomiasis, Mass Drug Administration (MDA) 2 weeks from treatment Septicemia 6 months after recovery Sexually Transmitted Infection (STI) Permanent deferral Sexual behavior, risky e Male having Sex with another Male Indefinite deferral (MSM) even once, even with the use of condom * Having sex with somebody with Indefinite deferral multiple sexual partner * Having sex with an Intravenous (V) Indefinite deferral drug user Indefinite deferral ae Having sex with HIV-infected heterosexual partner e Female who has had sex with an MSM male Indefinite deferral * Received money or drugs in exchange for sex Indefinite deferral e Casual sex (tends to be repeated) Indefinite deferral Shingles (herpes zoster) e = infection 4 weeks from recovery * contact l:with no previous infection 4 weeks from last exposure e contact 2:with previous infection Accept anytime Systemic Lupus Erythematosus (SLE) Permanent deferral Small pox vaccine (see vaccine) (see A-Z Guide of Vaccine) Syphilis Indefinite deferral Warts, genital Permanent deferral Stye 4 weeks after recovery Sore eyes 4 wecks from recovery Tattooing (permanent not henna) 12 months from procedure Temperature Anytime if <37°C 84 Blood Donor Selection and Counseling Manual

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Appendix C : A - Z Guide to Medical Assessment of Blood Donors Conditions Timing Conditions Tetanus, infection 6 months after recovery ¢ passive immunization, post injury 4 weeks from injection Thrombophlebitis 3 months after recovery Thyroidectomy (benign tumor) 12 months Thyroid malignancy Permanent deferral Tonsillitis 4 weeks after recovery Tonsillectomy 12 months after recovery Toxoplasmosis 6 months after recovery Travel « to UK and Republic of Ireland » lived or visited for a total period of 6 months or more from 1980 to present Permanent deferral e to Malaria endemic area

Travel to area endemic for malaria with or without prophylaxis (stay for <6 months) 6 months from departure from the area

Former resident of malaria endemic area, or stayed in malaria endemic area for 6 months or more 12 months from date of departure from the area ‘Tuberculosis 24 months after complete recovery/ cure: Completion of chemotherapy + 2 negative follow - up sputum exam Tuberculin Injection/TB Skin Test/ Purified Protein Derivative (PPD) Test 1 week from injection Typhoid/Salmonella e infection 3 months from recovery & stool negative hd household contacts 4 weeks from last exposure Typhus Guitable for plasma donation only) Typhus vaccine Anytime, if symptom free, afebrile Unexplained weight loss of more than 5 kg. within 6 months Permanent deferral Upper Respiratory Tract Infection (URTD 1 week after recovery Blood Donor Selection and Counseling Manual 85

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Appendix C : A ~ Z Guide to Medical Assessment of Blood Donors Conditions Timing Conditions Vv Vaccines (see A-Z Guide of Vaccines) Vitamins Anytime Vitiligo Accept if part of multisystem disease; if primary cause unknown - pe manent deferral 86 Blood Donor Selection and Counseling Manual

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Appendix C ; Timing of Blood Donation when Medications are being Taken by Donors Timing of Blood Donation when Medications are being taken by Denors Medications Timing of Donation A Acne medication, e. g. Retinoids One month deferral from last dose Allergy causing drugs: Penicillin, 3 weeks after completion Aspirin e Single dose 3 days after e Chronic intake 3 weeks after last dose Analgesics, except Aspirin Anytime, if symptom free Antibiotic other than Anti - TB drugs One month after recovery and completion of treatment and reasons for taking antibiotics must be assessed Anticonvulsant Permanent deferral Antihistamine/ anti - allergy medication Anytime Anti - inflammatory (non - steroidal Anytime but not for platelet preparation Aspirin, Piroxicam a |-—e---—~Chronie One week after last dose . Single Anytime, but not for platelet preparation B Bronchodilators Anytime, if asymptomatic Beta. Blockers Permanent deferral c Colchicine Anytime, if over the acute episode of gout Contraceptive pills, and injection Anytime D Decongestant Anytime, ifasymptomatic Digitalis Permanent deferral DEC + Alben (MDA - Fitariasis) Two weeks after treatment Drugs with no therapeutic claim (food. Anytime or organic supplements, herbal preparations) Blood Donor Selection and Counseling Manuai 87

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Appendix C : Timing of Blood Donation when Medications are being Taken by Donors Medications Timing of Donation Fungal medication (oral) One month after resolution Fungal medication (topical) - for skin/ nail/hair infection If involving the phlebotomy site or an extensive part of the body, defer for one month after resolution Glutathione, any preparation for a iver disorder Permanent deferral Glutathione, cosmetic use « Intravenous ® _Oral/Topical One year after last dose Anytime (Growth hormone Permanent deferral Lypertensive drugs Temporary deferral, pending Medical Clearance Hypoglycemic agent, orat (see Diabetes, A - Z Guide to Medical Assessment) Permanent deferral Tnsulin Isotretinoin 1 month after last dose Paracetamol (see Analgesic, A - Z Guide to Medical Assessment) Praziquantel (Mass Drug Administration - Schistosorniasis) Two weeks from treatment Propecia (hair grower) One month from last dose Psoriasis medication, e. g., Tegison Permanent deferral Psychosis drugs Permanent deferral Steroids preparation, topical Anytime, as long as it is not applied on the phlebotomy site Vitamins Anytime Blood Donor Selection and Counseling Manual

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Appendix C: Timing of Blood Donation when Donors Received Vaccines Timing of Blood Donation When Donor Received Vaccine I. Live attenuated vaccine Timing Donation AHINI Influenza l month after vaccination Bacillus Calmettes - Guerin (BCG) for 1 month after vaccination Polio (oral, Sabin) month after last dose Tuberculosis Chicken pox (Varicella Zoster} 1_month after vaccination Measles 1_month after vaccination Mumps 1_month after vaccination 1 1 Rabies (no exposure, for prophylaxis) month after last dose Rabies (post animal bite} 12 months after last dose Typhoid (oral) 1_month after last dose Yellow fever 1_month after vaccination Vaccinia (small pox} 1_month vaccination I. Other Vaccines Cervical Cancer (HPV) — 4 weeks after vaccination — Japanese encephalitis 3 weeks after vaccination MMR (Measles, Mumps and Rubella} 8 weeks after vaccination Plague 4 weeks after vaccination Rabies (non - exposure} 4 weeks after vaccination Rubella 8 weeks after vaccination Ui. Killed Vaccines/Toxoids Accept, anytime if asymptomatic Anthrax Botulism Accept, anytime if asymptomatic Cholera Accept, anytime if asymptomatic Diphtheria Accept, anytime if asymptomatic Hemophilus influenzae type B (HTB) Accept, anytime if asymptomatic Hepatitis A (non exposure) Accept, anytime if asymptomatic Hepatitis B (non exposure) 1 week from vaccination Accept, anytime if asymptomatic Influenza Meninggococcal Accept, anytime if asymptomatic Pertussis (whooping cough) Accept, anytime if asymptomatic Pneumococcal Accept, anytime if asymptomatic Tetanus Accept, anytime if asymptomatic Typhoid (injection only) Accept, anytime if asymptomatic Blood Donor Selection and Counseling Manuat 89

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Appendix C : Timing of Bload Donation when Medications are being Taken by Donors Timing Donation Typhus Accept, anytime if asymptomatic Ti. Gamma Globulin © For contact with Hepatitis A 6 weeks from last injection « For contact with Hepatitis B One year from exposure ° Tetanus Immnunoglobulin One year from last dose ® Rabies, post exposure One year from last dose 96 Blood Donor Selection and Counseling Manual

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Appendix D: Blood Donors Information Before Donation Basic Information Before Blood Donation Basic qualifications ° Age : 16 to 65 years old (written parental consent is required for 16 to 17 year old donors) « Weight :At least 110 pounds (60 Kg) * Diet : A well-balanced meal is recommended within four hours before donation. ° Health : General good health Identification : Valid identification, an ID card may be asked from you such as a driver's license, PRC card, voter's ID, etc. You are not qualified to donate if the following conditions apply to you: Risk Behavior for HIV . * Have sexual contacts with multiple sexual partners and high risk individuals ° Have had engaged in men having sex with men (MSM) even once ° Have had syphilis, gonorrhea or other STI in the past 12 months ° Have been engaged in illegal drug use ° Have been imprisoned in the last 12 months Other Medical-Conditions e Have lung cancer, breast cancer, leukemia, lymphoma and the likes * Diagnosed to have hepatitis or history of the disease, jaundice (yellowish skin and the eyes) ° Have kidney, lung or liver failure. Travel History of travel to other countries or areas may restrict you from donating blood because of exposure to certain diseases like Madcow disease, malaria and others, Ask the blood bank personnel for the list of countries or areas concerned, o DO NOT DONATE * For the purpose of getting a free HIV/Hepatitis test. There are available testing faciltities and Voluntary Counselling and Testing (VCT) centers for HIV and AIDS nationwide. If you think you are at risk for HIV. Even if you feel well and have a negative result, it is not a guarantee that you are not infected because test cannot detect infections for a short period of time if you have been exposed to the virns. Blood Donor Selection and Counseling Manual

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Appendix E : Tranfusion Transmissible Infections, Harm Reduction Strategies Human Immunodeficiency Virus Signs and Symptoms Early infection More common to develop a brief flu-like illness two to four weeks after becoming infected. Signs and symptoms: e fever « headache ® sore throat swollen lymph glands rash Late infection Patient may remain symptom - free for eight or more years; may develop mild infections or chronic symptoms: e swollen lymph nodes diarrhea weight loss fever cough and shortness of breath Latent phase of infection Occurs approximately 10 or more years after the initial infection — more serious symptoms may begin to appear, and the infection may then meet the official definition of AIDS - a positive HIV-antibody test plus at least one of the following: ¢ Development of an opportunistic infection ¢ ACD4 lymphocyte count of 200 or less — a normal count ranges from 800 to 1,200 Signs and symptoms of opportunistic infections: o soaking night sweats shaking chills or fever higher than 38°C for several weeks dry cough/shortness of breath chronic diarrhea persistent white spots or unusual lesions in the mouth/tongue headaches blurred and distorted vision weight loss eocoao cocoa 92 Blood Donor Selection and Counseling Manual

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Appendix E : Tranfusion Transmissibie Infections, Harm Reduction Strategies Signs and symptoms of later stage HIV infection © persistent, unexplained fatigue o soaking night sweats o shaking chills or fever higher than 38°C for several weeks o swelling of lymph nodes for more than three months o chronic diarrhea o persistent headaches Certain cancers are likely to develop (Kaposi’s sarcoma, cervical cancer and lymphoma) Modes of Transmission sexual transmission through blood transfusion through needle sharing through accidental needle sticks from mother to child Harm Reduction Strategies Practice safe sex _. ~ Reduce alcohol use

: o e Get into regular check-up e Don’t donate blood or body organs. Blood Donor Selection and Counseling Manual 93

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Appendix E : Tranfusion Transmissible Infections, Harm Reduction Strategies Hepatitis B and C Signs and Symptoms loss of appetite nausea and vomiting weakness and fatigue abdominal pain dark urine Jaundice joint pain Modes of Transmission Harm Reduction Strategies through contact with an infected person during sexual activity through transfusion of infected blood through direct unprotected close contact with an infected person's blood, sweat, tears, saliva, menstrual blood and breast milk. through an infected mother to her unborn child during pregnancy. —--=2'—.-Reduce alcohol intake. Se e e ®¢@ eee 6 Get vaccinated for Hepatitis A or B to prevent co-infection. Get into regular check-up. Don’ t donate blood or body organs. Don’ t share personal-use articles that might contain blood. Cover cuts and sores. Don’ t share needles or syringes. Refrain from getting tattoos, body piercings, acupuncture. Practice safe sex. Inform sexual partner(s) you have HBV. Partmers need to be tested and receive medical care if they have the virus. They also need to know their HBV status so that they don’ t infect others. For pregnant females — inform physician of hepatitis B serological status. 94 Biosoc Gonor Selection and Counseling Manual

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Appendix F : 2010 Report on the Global AIDS Epidemic HIV Prevalence Per Country, 2009 Region/Country Estimate Low Estimate-High Estimate Sub-Saharan Africa Angola 2.9 1.6-2.4 Benin 1.2 1.0-1.3 Botswana 24.8 22.8 - 25.8 Burkina Faso 1.2 10-15 Burundi 3.3 2.9-3.5 Cameroon 5.3 4.9 -5.8 Central African Republic 4.7 4.2-5.2 Chad 3.4 2.8-5.1 Comoros 0.1 <0.1-0.1 Congo 3.4 3.1-3.8 Cote de’ Ivoire 3.4 3.1-3.9 Democratic Republic of the Congo ces 1.2-1.6 Equatorial Guinea 5.0 3.5 -6.6 ==lEritrea 0.8 0.6- 1.0 Gabon 5,2 4.2 -6.2 Gambia 2.0 1.3-2.9 Ghana 138 1.6-2.0 Guinea 1.3 1.1 -1.6 Guinea-Bissau 2.5 2.0-3.0 Kenya 6.3 5.8 -8.5 Lesotho 236 22.3 - 25.2 Liberia 1.5 1.3-1.8 Madagascar 0.2 0.2 -0.3 Malawi 11.6 10,0 - 12.1 Mali 1.0 0.8 -1.3 Mauritania 0.7 0.6-0.9 Mauritius 1.0 0.7-1.3 Mozambique 11.5 10.6 - 12.2 Namibia 13.1 11.1-15.5 Niger 0.8 0.7-1.0 Nigeria 3.6 3.3 - 4.0 Rwanda 29 2.5 -3.3 Senegal G9 0.7-1.0 95 Blood Donor Setection and Counseling Manual

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Appendix F: 2010 Report on the Global AIDS Epidemic Region/ Country Estimate Low Estimate - High Estimate Sierra Leone 1.6 1.4-2.1 South Africa 17.8 17.2 - 18.3 Swaziland 25.9 24.9 - 27.0 Togo 3.2 2.5 - 3.8 Uganda 65 5.9-6.9 United Republic of Tanzania 5.6 5.3-6.1 Zambia 13.5 12.8 - 14.1 Zimbabwe 14.3 13.4-15.4 East Asia China 0.1 0.1 -0.1 DPR of Korea tee te Japan <0.1 <0.1- <0,1 Mongolia <O.1 <0.1-<0.1 Repubic of Korea <0.1 <0.1-<0.1 Oceania Australia 0.1 Q.1 - 0.2 Fiji 0.1 0.1 - 0.2 New Zealand. 0.1 0.1 -0.1 Papua New Guinea 09 0.8 - 1.0 South and South East Asia Bangladesh <O.1 <0.1-<0.1 Bhutan 02 0.1 -0.3 Cambodia 0.5 0.4 -0.8 i India 0.3 0.3 - 0.4 Indonesia 0.2 0.1-0.3 Lao Peoples Democratic Republic 0.2 0.2 -0.4 Malaysia 0.5 0.4 - 0.6 Maldives <O.1 <0.1-<0.1 Myanmar 0.6 0.5 -0.7 Nepal 0.4 0.3 - 0.5 Pakistan 0.1 0.1-0.1 96 Blood Donor Selection and Counseiing Manual

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Appendix F : 2010 Report on the Global AIDS Epidemic Region/Country Estimate Low Estimate - High Estimate Philippines <0.1 <0.1-<0.1 Singapore 0.1 0.1-0.1 Sri Lanka <O.1 <0.1-<0.1 Thailand L3 1.0-1.6 Vietnam 0.5 0.3 -0.5 Armenia o1 0.1-0.1 Aserbaijan 01 <0,1- <0.1 Belarus 0.3 0.2 - 0.3 Georgia O1 0.1-0.2 Kazakhstan ol 0.1-0.2 Kyrgystan 0.3 0.2 - 0.5 Republic of Moldova a4 0.4 - 0.6 Russian Federation 1.0 0.9 - 1,2 Tajikistan — 0.2 — 0.1 - 0.3 Ukraine Li 1.0 -1.3 Uzbekistan 0.1 0.1-0.2 Western and Central Europe Austria 0.3 0.2-0.4 Belgium 0.2 0.2 - 0.3 Bulgaria 0.1 0.1-0.1 Croatia <O.1 <0.1-<0.1 Czech Republic <0.1 <0.1- <0.1 Denmark 0.2 0.1-0.2 Estonia 12 10-15 Finland OL 0.1-0.1 France 0.4 0.3 - 0.5 Germany O41 0.1 - 0,2 Greece O.1 0.1 - 0.2 Hungary <O.1 <0.1-0.1 Iceland 03 0.2 -0.4 Treland 0.2 0.2 - 0.3 97 Blood Donor Selection and Counseling Manual

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Appendix F: 2010 Report on the Global AIDS Epidemic Region/ Country Estimate Low Estimate

• High Estimate Israel 02 0.1-0.2 Italy 03 0.2-0.3 Latvia 0.7 0.5-0.9 Lithuania 01 <0.1-0.1 Luxembourg 03 0.2-0.4 Malta 0.1 0.1-0.1 Netherlands 0.2 0.1-0.3 Norway 0.1 0.1-0.2 Poland 1 0.1-0.1 Portugal 06 0.4-0.7 Romania 01 0.1-0.1 Serbia a1 _0.1-0.2 Slovakia <0.1 <0,1 -<0.1 Slovenia <0. <0.1-0.1 Spain OA 0.3-0.4 -—}Sweden 0.1 {—-——--- 0.1-0.2 Switzerland 04 0.3 - 0.5 Turkey <O0.1 <0.1 - <0.1 United Kingdom of Great Britain & Northern Ireland 0.2 0.2 -0.3 North Africa and Middle East Algeria 6.1 0.1-0.1 Djibouti 28 1.9- 3.2 Egypt <0.1 <0.1-<0.1 Tran (Islamic of Republic of} 0.2 0.1-0.2 i Lebanon 0.1 0.1-0.2 | Morocco 0.1 0,.1-0.2 Oman a1 <0,1-0.1 Qatar <Q.1 <0.1-<0.1 Somalia 0.7 0.5 - 1.0 Sudan Ll 0.9-14 Tunisia <0.1 <0.1-0.1 98 Blood Donor Selection and Counseling Manual

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Appendix F: 2010 Report on the Global AIDS Epidemic Region/ Country Estimate Low Estimate - High Estimate North America Canada 0.2 0.1-0.3 Mexico 0.3 0.3-0.4 United State of America 0.6 0.4-0.8 Carribean Bahamas 3.1 1.2-5.4 Barbados 1.4 1.2-1.6 Cuba O.1 0.1-0.1 Dominican Republic 0.9 0.7-1.0 Haiti 1.9 1.7-2.2 Jamaica 1.7 1.1+-2,.5 Trinidad and_ Tobago 1.5 1.1-2.0 Central and South America "| Argentina ——~ 0.5 Belize t Bolivia Brazil Chile Colombia Costa Rica Ecuador E! Salvador Guatemala Guyana Honduras Nicaragua Panama Dl 10 $0 JR JO JR Je le fH POfofoyololco |rnico Paraguay Peru Suriname Uruguay Venezuela jalelalelelelole lololajelole tn] ed fs [oo fo [bo Joo |ha foo foo | is Jue | ca | is]: ojo lsosololoyojcololecel/oyo |ol(ol/ol]cowlslo af a te fis Jade luda da lafwlofalolw fe fo le NPE fue fui fw fo po JO Je TED] RL ~r poy aA pe [orm Blood Donor Selection and Counseling Manual 99

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Acronyms AIDS BCG BFAD BSF BT CHO CJD CUE DHQ DPT DT D&C EIA FEP._ HACT HBsAg HBV HCV HIV HPV ISBT LMP MDA MHO NCBS NSAID NVBSP PC PNBS Acquired Immune Deficiency Syndrome Bacillus Calmette - Guerin (vaccine) Bureau of Food and Drug Administration Blood Service Facility Blood Transfusion City Health Officer Creutzfeldt - Jacob Disease Confidential Unit Exclusion Donor History Questionnaire Diphtheria, Pertussis, Tetanus (vaccine) Diphtheria & Tetanus (vaccine) Dilatation and Curettage Enzyme Immuno - Assay Fresh Frozen Piasma ee HIV/AIDS Core Team Hepatitis B surface Antigen Hepatitis B Virus Hepatitis C Virus Human - Immuno Deficiency Virus Human Papilloma Virus International Society of Blood Transfusion Last Menstrual Period Mass Drug Administration Municipal Health Officer National Council for Blood Services Non-Steroidal Anti - Inflammatory Drug National Voluntary Blood Services Program Platelet Concentrate Philippine National Blood Services Blood Donor Selection and Counseling Manual 103

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Acronyms PPD PRBC SHC SOP STI TB TTI vcT WBC WHO Purified Protein Derivative (Skin Test) Packed Red Blood Cell Social Hygiene Clinic Standard Operating Procedure Sexually Transmitted Infection Tuberculosis (Tuberculous Bacteria) Transfusion-Transmissible Infections United Kingdom Voluntary Counseling and Testing White Blood Celi World Health Organization 104 Blood Donor Selection and Counseling Manual

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References Manual Bureau of Research and Laboratories, Manual o f Standards for Blood Banks and Blood Centers in the Philippines, Department of Health 1996, Ist Edition. Manila, Philippines Website American Association of Blood Banks, Technical Manual 15 th Edition (2005): http://www.aabb.org/sa/ Bureau of Food and Drug Adminstration (BFAD - Food and Drug Administration

• Philippines) http://www.fda.gov.ph International Society of Blood Transfusion: http://www .isbt-web.org/ New Zealand Blood Services, Technical Manual (2008): http://www.nzblood.co.nz/ Reports UNAIDS Global Report 2010 107 Blood Donor Selection and Counseling Manual