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period donations (47) and may lead to the discard of safe donations (48,49). One study suggested that its use may have negative consequences by reducing the perceived responsibility of staff in eliciting a history of high-risk behaviour (40). 3.5 ADVERSE DONOR REACTIONS AND POST-DONATION CARE Donors should be managed in a way that ensures high standards of care and assures them of the importance accorded to their health and well-being by the BTS. Nevertheless, there are recognized adverse reactions that can occur during blood donation; these can generally be minimized or avoided by appropriate donor selection and care, and appropriately trained staff (50,51). Donors who have suffered an adverse reaction have been shown to be less likely to return to donate again (37). Vasovagal episodes and soft tissue injuries (bruises and haematomas at the venepuncture site) are the most common donor reactions. The majority of these are minor and donors usually recover quickly; however, these reactions can be of concern to donors and reassurance should be provided. In some cases, a reaction may prompt the donor to reveal a relevant medical history. A minority of adverse reactions may require medical care outside the BTS and may lead to prolonged symptoms or incapacity. Staff should be trained in the recognition and management of adverse donor reactions, including the provision of first aid. The incidence of bruising should be monitored so that further venepuncture training may be provided to staff as necessary. A system for the reporting and investigation of adverse donor events and reactions should be in place as part of the donor haemovigilance system. Donors should be provided with oral and written advice on the management of bruises and delayed vasovagal events and should also be given information about how to contact the BTS for further advice, if necessary. 38 Part 2 Criteria for blood donor selection 39 4 General donor assessment Only individuals in good health should be accepted as blood donors. Good health is difficult to define, but certain associated parameters may be established from a brief medical history, observation and simple tests. Staff undertaking donor health and risk assessment should be well-trained in the observation of donor appearance and detection of signs of ill health. Staff should receive explicit guidance on what to look for and when to refer a donor to a health-care professional for further medical attention. Donors should feel well on the day of donation and be able to perform their routine daily activities. Information about minor illnesses, exposure to communicable diseases, travel to disease endemic areas, pregnancy and lactation and medical and surgical interventions should be elicited so as to determine suitability for blood donation or the need for deferral. The BTS physician may request additional information and advice about the health of a prospective donor from the donor’s own doctor or specialist. Sections 4, 5, 6 and 7 contain recommendations on acceptance and deferral of donors based on selection criteria which fall into four broad categories: n Conditions that are acceptable n Conditions that require temporary deferral for defined periods of time n Conditions that require permanent deferral n Conditions that require individual assessment. 4.1 AGE 4.1.1 Lower age limit A lower age limit should be set for blood donation, taking into account national legal requirements for consent, the increased risk of vasovagal reactions in younger donors, and the increased iron requirements of adolescents and young menstruating females. The lower age limit for blood donation in most countries is 18 years, although in some countries national legislation permits 16–17 year-olds to donate provided that they fulfil the physical and haematological criteria required and that appropriate consent is obtained. Studies of adverse events in blood donors have shown an increased rate of vasovagal reactions in younger donors (50,52); a study conducted in the United States of America in 2006 reported a 10.7% risk of a vasovagal reaction in donors aged 16–17 years, compared with 8.3% in 18–19 year-olds and 2.8% in donors aged 20 years or older (53). The age of 16 should therefore be an absolute lower limit for blood donation to ensure donor health and safety. Adolescents of either gender are at risk of iron deficiency during the pubertal growth spurt when the average daily total requirement of absorbed elemental iron is 1.50 mg/day for males aged 15–17 years and 1.62 mg/day for females (54,55). 40 Recommendations n The usual lower age limit for blood donation is 18 years n Where permitted by national legislation or in setting a lower age limit of 16 or 17 years for blood donation, the BTS should consider: — The age of legal consent below which parental

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