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permission is required and the need to inform parents/guardians about the process, benefits and risks of blood donation so that informed consent can be obtained — The balance between the benefit of an increased blood supply by recruiting younger donors against the increased risk of adverse reactions in this age group — The increased iron requirement of adolescents and the possible compromise of their iron status by frequent blood donations 4.1.2 Upper age limit Upper age limits for blood donation of between 60 and 70 years have been implemented in the past because of concerns regarding the increasing incidence of cardiovascular disease with age and the potential risk of adverse reactions, which are more likely in first-time donors. There is now extensive published literature on the safety of blood donation in older individuals in both the allogeneic and autologous setting, indicating that vasovagal and other adverse reactions are infrequent in older donors who fulfil normal donor selection criteria (56,57,58,59,60). The upper age limit has been safely removed for regular blood donors in countries where healthy life expectancy is high (56,61,62,63,64). Nevertheless, many BTS have an upper age limit of 60 years for first-time donors. Recommendations n In setting an upper age limit for blood donors, the BTS should consider the healthy life expectancy of the population n The usual upper age limit for blood donation is 65 years n First-time donors older than 60 years and regular donors over the age of 65 may be accepted at the discretion of the responsible physician n First-time donors over 60 years should make their first donation at a donation site where a physician is available 4.2 DONOR APPEARANCE AND INSPECTION The prospective donor should appear generally well and should not be febrile, breathless or suffering from a persistent cough. Donors should be observed to rule out malnutrition or any debilitating condition. They should have a sound mental status and not be under the influence of alcohol or drugs. The colour of exposed skin and mucous membranes should be normal, with no jaundice, cyanosis, flushing or pallor, and no signs of skin infection, rash or obviously enlarged lymph nodes. If body piercings or tattoos are present, the risk of transfusion-transmissible infections (TTI) should be assessed (also refer to Section 7.9.5 on cosmetic treatments and rituals). 41 The venepuncture site should be clean, free from any skin lesions or scars and the arms should be examined for signs of injecting drug use. Antecubital veins should be easily visible or palpable to enable proper venepuncture, thus avoiding any discomfort to the donor and minimizing the risk of major bruises or other soft tissue injury at the venepuncture site. Donors with sight or hearing impairment may be accepted provided clear and confidential communication can be established. If assistance is required, it should be provided by a staff member or other independent person and not a family member or friend. Recommendation n Prospective donors should be accepted only if they appear to be in good health and comply with donor selection criteria 4.3 MINOR ILLNESSES Minor non-specific symptoms (e.g. general malaise, pain, fever, headache, cough, diarrhoea) may indicate the presence of an acute infection that may be transmissible by transfusion. Donors should be asked to confirm that they are free from such symptoms on the day of donation and that they have fully recovered from any recent infection(s). Individuals suffering from minor illnesses and not feeling well should not donate blood. There is no evidence that minor infections such as common upper respiratory infections can be transmitted by transfusion, but it is nevertheless advisable as a precautionary measure to defer blood donation until any such infection has resolved (65). Recommendation Defer n Individuals with a history of recent infection: defer for 14 days following full recovery and cessation of any therapy, including antibiotics 4.4 WEIGHT It is important to set weight limits for blood donation to protect donors from adverse effects, in particular vasovagal episodes and anaemia. Low body weight and low blood volume have been shown to be independent predictors for vasovagal reactions (50,66). It is generally accepted that the volume of whole blood donated should not exceed 13% of blood volume: e.g. a donor should weigh at least 45 kg to donate 350 ml (± 10%) or 50 kg to donate 450 ml ± 10% (67,68). There are no defined upper weight limits for blood donation; however, gross obesity may be a reason for deferral if veins are inaccessible, or if the donor’s weight exceeds the safe loading capacity of the blood collection bed or impairs his/her

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