Purpose: The Abbreviated Donor History Questionnaire User Brochure was designed to aid the donor historian in determining if a prospective donor is eligible to donate and whether the donor is eligible as a frequent donor to use the abbreviated donor history form. Each blood center must have a standard operating procedure (SOP) related to donor eligibility to be used in conjunction with the User Brochure. The User Brochure does not replace an SOP for determining donor eligibility.
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Introduction: The Abbreviated Donor History Questionnaire (aDHQ), like the full-length Donor History Questionnaire (DHQ), must be administered on the day of donation. All prospective donors, including those that meet criteria for screening using the aDHQ, must read the Donor Educational Materials prior to completing the aDHQ. They also must be given the Medication Deferral List, and a list of BSE countries to be used with the aDHQ. As an alternative, one or all of the lists can be prominently displayed at the donation site for the donors’ use while they are completing the aDHQ.
Collection facilities using these screening materials should be aware that these materials were tested in English-speaking donor and non-donor groups and due to practical limitations could not be tested in all possible settings, including with non-English speaking donors.
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Criteria for using the aDHQ: A blood donor is eligible to use the aDHQ if the defined donor criteria for a frequent donor are met AND if the blood collection facility has a system in place that can determine when it is appropriate to use the aDHQ. If the system indicates that a full-length (rather than abbreviated) questionnaire should be administered, this may only be overridden by a supervisor with appropriate documentation.
A frequent donor, defined as one who has previously donated two times using the full-length DHQ, one donation of which occurred within the previous six months, is qualified to use the aDHQ. A donor who is qualified to use the aDHQ, but who does not make a donation because of deferral for a physical finding (such as hemoglobin, temperature, pulse, blood pressure, platelet count) or a deferral of less than 6 months duration remains eligible for the aDHQ at the next donation attempt if it is within 6 months of the last successful donation. For these purposes “successful donation” has taken place when a donor is determined to be eligible to donate whether or not the donation attempt results in a usable component.
For the following reasons, the donor is required to use the full-length questionnaire:
- A donor who has been qualified to use the aDHQ, but subsequently is deferred for 6 months or greater is no longer eligible for the aDHQ and must complete the full-length DHQ at the next two donation attempts. If the two donation attempts using the full-length DHQ are successful (the donor is eligible for donation), the donor may return to using the aDHQ as long as the subsequent donation is within 6 months.
- If at any time more than 6 months lapses between donations, the donor is no longer eligible for the aDHQ and must complete the full-length DHQ at the next two donation attempts. If the two donation attempts using the full-length DHQ are successful (the donor is eligible for donation), the donor may return to using the aDHQ as long as the subsequent donation is within 6 months.
On occasion, new donor history questions will be added. The new questions must be added to the full-length and the abbreviated DHQ. The new questions will remain on the aDHQ for one year from the date the question was added. If the question must be asked at each donation, the question will remain indefinitely on both DHQs.
The blood collection facility must have a standard operating procedure describing actions to be taken when it is determined that an incorrect questionnaire has been administered or if a questionnaire is incomplete. If an eligible donor completed the full-length questionnaire when qualified for an abbreviated questionnaire, no additional action is required with regard to donor or product eligibility. If an abbreviated questionnaire was administered when a full-length questionnaire should have been administered, the SOP must ensure that the donor unit is quarantined until donor eligibility issues have been resolved, in compliance with 21 CFR 640.3(a). If the unit has already been distributed a biological product deviation report must be submitted to the FDA. However, either of these events must be treated as a deviation and investigated as such.
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Methods of Administration: The method of administration of the aDHQ should be in accordance with the blood center’s SOP. Blood collection facilities are reminded that donor screening is an active process involving open communication between donors and trained donor historians, and that donors should be encouraged to voice questions and concerns at any time during the screening and donation process.
Self -Administration: The aDHQ was designed for self-administration by the donor, with follow-up review by a trained donor historian. A knowledgeable historian should be available to the prospective 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 with a donor historian, they should be instructed to complete the entire questionnaire. However, there will be circumstances in which the donor elects not 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. The blood center may elect to defer the donor prior to completion of the entire questionnaire. That would be acceptable as long as the process is specified in the SOP.
Please note: The AABB would like to emphasize that there might be an advantage to having the donor complete the entire questionnaire. Some deferrals will be only temporary, but others may be indefinite/permanent. Depending on the sequence of questions, a donor could be deferred temporarily, only to return at a later date and discover that he/she is permanently deferred due to the answer to another question that was not answered during the first visit.
Other methods of administration: Alternatively, the aDHQ may be administered by a donor historian. If the questionnaire is not self-administered, but is administered by a historian, it is acceptable to defer the donor prior to completion of the entire questionnaire as long as the process is specified in the SOP.
It is essential that the donor be encouraged to ask questions and that all of the donor questions are addressed by the donor historian. Local SOPs 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.
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aDHQ Structure and Content: The aDHQ questions were composed for ease of understanding by the prospective donor. The questionnaire, documents and procedure for use were designed, structured and evaluated collectively and are intended to be used together. The aDHQ 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 “today” and ending with questions relating to “since your last donation.” A collection facility may make minor changes to the timeframe of a question on the aDHQ only if the revision makes the screening criteria more restrictive (for instance, increasing the deferral for aspirin from 48 hours to 72 hours to meet State regulations). If a collection facility chooses to add “local” questions they should be grouped at the end of the aDHQ in the area designated for additional questions. Facilities should also use this area to incorporate new questions that are necessary due to new policies recommended by FDA and/or AABB. This area should be used until such questions can be formally incorporated into the aDHQ by AABB and the aDHQ is accepted by FDA. In order to delineate the proper order of the questions AABB will renumber the questions as needed when questions are added or deleted. Collection facilities may choose to use a different numbering system, but the order of the questions should not be changed. The Educational Material and Medication Deferral List must also be used unabridged except for local additions which should be placed at the end of the materials.
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Reformatting Materials: Centers may choose to format these documents to fit their own individual use. Examples of such modifications include:
- Formatting the questions on the page in a single column, double columns, single page, double pages, etc.
- Placing the numbers in front of the answer boxes, behind the answer boxes, or leaving them out entirely (though for logistical purposes, the Task Force recommends against eliminating the numbers altogether)
- Experimenting with different font types, sizes and colors
- Experimenting with shading to assist donors in staying “on-line”
- Formatting the educational materials and/or medication deferral list as needed to use as a brochure, handout, poster, or whatever is appropriate to suit your own needs, as long as the order, content, and wording are unchanged.
- Editing the flowcharts to include medical criteria specific to your own center as long as any changes or additions are more restrictive; centers should not modify flowcharts to make them less restrictive.
- Gender specific questions: collection centers using Computer Assisted Screening may format the software to ask donors only gender-appropriate questions, so male donors will not be asked questions targeted to females and female donors will not be asked questions targeted to males. The same is true for screening administered by blood center staff. Male donors need not be asked questions targeted to females and female donors need not be asked questions targeted to males.
Questions to detect donors at risk for HIV group O: The questions related to potential risk exposures in Africa are recommended by FDA to identify donors who may be at risk for HIV group O infections. Blood collection agencies utilizing an HIV test that has been approved by FDA for blood screening to include a claim for detection of group O viruses may delete these questions from their screening questionnaire and may renumber the remainder of the questions (and related documents such as flowcharts). All other centers must continue to use these questions as formatted.
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Capture Questions: The aDHQ uses capture questions that may require donor historian intervention or follow-up. Capture questions are questions that cover a broad topic, and when an affirmative answer is given, additional follow-up questions to elicit additional information are asked by the donor historian. Some follow-up questions are included in the User Brochure, but since specific donor eligibility criteria may vary from one blood center to another, an affirmative response to some questions may require consultation with the blood center's SOP. Blood centers may implement more restrictive deferral policies than described in the User Brochure per their local SOP.
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Attention Questions: Additionally, in order to assure that donors who self-administer a paper aDHQ maintain focus, several “attention” questions are included. An example of one of the attention questions is listed below.
In the past 6 weeks, have you been pregnant or are you pregnant now? (Males check “I am male”)
An inappropriate answer to the question would be a male answering “yes” or “no.” Each blood center must define the action of the donor historian when a donor inappropriately answers the attention questions. Attention questions may not be necessary when using other techniques to assure donor focus, such as an audio-visual assisted computer assisted self-interviewing system (CASI) or oral screening by a donor historian.
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Documentation: Information impacting donor eligibility obtained during follow-up questioning should be meticulously documented on the aDHQ. If a donor is determined to be ineligible during follow-up questioning, the reason for deferral should be documented in a designated area on the aDHQ. If a donor is determined to be eligible during follow-up questioning a detailed explanation for each question must be documented in sufficient detail in a designated area on the aDHQ.
Example 1: A donor answers “yes” to “Since your last donation have you been outside the United States or Canada?”
Sample documentation: “Donor traveled to rural area in Quintana Roo, Mexico 6 weeks ago; malaria risk; 12 months deferral.”
Example 2: A donor answers “Yes” to “Since your last donation have you been outside the United States or Canada?”
Sample documentation: “Donor traveled to Africa – Cairo, Egypt – one month ago for three days; OK per SOP.”
Example 3: A donor answers “Yes” to “Since your last donation have you had any new medical problems or diagnoses?”
Sample documentation: “Donor diagnosed with hypertension 2 months ago, well-controlled on meds, normal BP today; OK per SOP.”
Each blood center’s SOP must define how the donor responses to the follow-up questions will be documented on the aDHQ. Responses should be documented with sufficient detail to determine the reason for donor acceptance or deferral.
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Flowcharts: The User Brochure provides flowcharts to guide the donor historian through the donor history questionnaire process. These flowcharts are intended as a resource, and use of the flowcharts is not required. Flowcharts may be revised by blood collection facilities to reflect local policy as long as deferrals are not made less strict than those required by AABB and FDA.
Each question is a complete section that begins on a new page, so that changes to the aDHQ can be easily modified in the User Brochure. Each section contains the following information:
Question: Question number and the question.
Donor Eligibility: This section provides additional information to the donor historian on donor eligibility requirements for each question.
Note: Optional field; additional relevant information relating to the donor question.
Flow Chart: Each question is flow-charted using standard flow-charting symbols.
Square -- Statement
Diamond -- Question/decision point
Oval -- Action
Arrow -- Move to the next question
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.
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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 historian may need to refer to the blood center’s SOP to determine if and when the donor may be eligible to return.
For other questions, a “yes” answer may not require a deferral; rather, it may trigger a line of questioning to determine if the donor is eligible. The donor historian will need to refer to the blood center’s SOP for follow-up questions to determine eligibility. This type of deferral is designated in the flow chart by the Action “Defer donor per SOP.” For example, if a donor answers “yes” to the question “Since your last donation have you had any new medical treatments?” and reports being on antibiotics, a blood center may ask additional questions to ascertain the name of antibiotic and specific indication for use by the donor. Some blood centers may allow donors taking antibiotics for certain indications such as prophylaxis for acne to donate, as defined in their SOP. Other centers may, for simplicity, defer all donors taking antibiotics, regardless of the indication.
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Change Control: Periodically the abbreviated Donor History Questionnaire, the accompanying documents or the procedure for use will be updated or revised by the AABB Donor History Task Force as required for compliance with regulatory and accrediting agencies. AABB Institutions will be notified of the changes and timeline for implementation in existing publications and on the public area of the AABB website, and all updated documents will be made available on the website. It is the responsibility of collecting facilities to make changes in their forms, procedures and processes to incorporate these revisions within the specified time.
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The following terms are defined in the context of their use in the Donor History Questionnaire.
Abbreviated Donor History Questionnaire – An abbreviated version of the Donor History Questionnaire that is intended to be used by frequent blood donors.
Attention Question – Questions in the abbreviated Donor History Questionnaire that are designed to test if the donor is paying attention. EXAMPLE: In the past six weeks, have you been pregnant or are you pregnant now? (Males check: “I am Male”)
Capture Question – A question that covers a broad topic. When an affirmative answer is given, additional follow-up questions to elicit additional information are asked by the donor historian. EXAMPLE: Since your last donation have you been outside the United States or Canada? If the donor answers yes, additional questions must be asked.
Frequent blood donor – A donor who has previously donated two times using the full-length Donor History Questionnaire, one donation of which occurred within the previous six months.
Self-administered Questionnaire – A questionnaire that the donor completes on his/her own, followed by donor health historian review.
Successful donation – A donor is determined to be eligible to donate whether or not the donation attempt results in a usable component.
TYPES OF CONTACT
Contact with Blood – (1) a needlestick or other sharps injury from an instrument that has been used on any individual or patient; (2) exposure to non-intact skin (e.g., skin that is chapped, abraded, or afflicted with dermatitis); (3) a human bite that breaks the skin; (4) exposure to eye, nose, or mouth i.e., the mucous membranes.
Sexual Contact – The meaning of the words “sexual contact with” and “sex” are identical, and apply to any of the following activities, whether or not a condom or other protection was used: (1) Vaginal sex (contact between penis and vagina); (2) Oral sex (mouth or tongue on someone’s vagina, penis, or anus); (3) Anal sex (contact between penis and anus).
Close Contact with Smallpox Vaccination Site – Touching the vaccination site, including the bandages covering the vaccination site; touching/handling materials that might have come into contact with an unbandaged vaccination site, including clothing, towels, and bedding.
Lived With – Residing in the same dwelling. EXAMPLES: house, dormitory, apartment.
TYPES OF DEFERRAL
Indefinite Deferral – Prospective donor is unable to donate blood for someone else for an unspecified period of time due to current regulatory requirements. EXAMPLE: A prospective donor who states that they lived in England for 1 year in 1989 would be deferred indefinitely. This donor would not be able to donate blood until the current requirement changes. These donors may be eligible to donate autologous blood.
Permanent Deferral – Prospective donor will never be eligible to donate blood for someone else. EXAMPLE: A prospective donor states that he/she has Hepatitis C. Additionally; some permanent deferrals may result from the testing performed on a previous donation. These donors may be eligible to donate autologous blood.
Temporary Deferral – Prospective donor is unable to donate blood for a limited period of time. EXAMPLE: A prospective donor who has received a transfusion within the last 12 months would be deferred for 12 months from the date of the transfusion.
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Donor qualification requirements are located in 21 CFR 640.3, 21 CFR 610.41 and AABB Standards for Blood Banks and Transfusion Services, current edition.
Additional donor qualification requirements may be found in FDA memoranda and guidance:
FDA Memorandum, December 12, 1991: Clarification of FDA Recommendations for Donor Deferral and Product Distribution Based on the Results of Syphilis Testing.
FDA Memorandum, April 23, 1992: Revised Recommendations for the Prevention of HIV Transmission by Blood and Blood Products.
FDA Memorandum, April 23, 1992: Revised Recommendations for Testing Whole Blood, Blood Components, Source Plasma, and Source Leukocytes for Antibody to Hepatitis C Virus Encoded Antigen (Anti HCV) in Blood Establishments.
FDA Memorandum, July 28, 1993: Deferral of Blood and Plasma Donors Based on Medications.
Acetretin Safety Information:
Dutasteride Safety Information:
FDA Memorandum December 22, 1993: Donor Suitability Related to Laboratory Testing For Viral Hepatitis and a History of Viral Hepatitis.
FDA Memorandum July 26, 1994: Recommendation for Deferral of Donors for Malaria Risk.
FDA Memorandum, June 8, 1995: Recommendations for the Deferral of Current and Recent Inmates of Correctional Institutions as Donors of Whole Blood, Blood Components, Source Leukocytes, and Source Plasma.
FDA Memorandum, March 10, 1995: Revision of FDA Memorandum of August 27, 1982: Requirements for Infrequent Plasma Donors.
FDA Memorandum, December 14, 1995: Donor Deferral Due to Red Blood Cell Loss During Collection of Source Plasma.
Blood Products Advisory Committee Meeting June 16, 2000: Update on Sexual Transmission of HCV.
FDA Guidance, February 2001: Recommendations for Collecting Red Blood Cells by Automated Apheresis Methods.
FDA Guidance, December 2002: Recommendations for Deferral of Donors and Quarantine and Retrieval of Blood and Blood Products in Recent Recipients of Smallpox Vaccine (Vaccinia Virus) and Certain Contacts of Smallpox Vaccine Recipients.
FDA Guidance, February 4, 2003 (corrected): Recommendations for Deferral of Donors and Quarantine and Retrieval of Blood and Blood Products in Recent Recipients of Smallpox Vaccine (Vaccinia Virus) and Certain Contacts of Smallpox Vaccine Recipients.
FDA Guidance, July 3, 2003: Streamlining the Donor Interview Process: Recommendations for Self-Administered Questionnaires.
FDA Guidance, October 2006: Guidance for Industry Implementation of Acceptable Full-Length Donor History Questionnaire and Accompanying Materials for Use in Screening Donors of Blood and Blood Components.
FDA Guidance, December 17, 2007: Guidance for Industry and FDA Review Staff: Collection of Platelets by Automated Methods.
FDA Guidance, August 2009: Recommendations for management of Donors at Increased Risk for Human Immunodeficiency Virus Type 1 (HIV-1) Group O Infection
FDA Guidance, May 2010: Revised Preventive Measures to Reduce the Possible Risk of Transmission of Cretuzfeldt-Jakob Disease (CJD) and Variant Creutzfeldt-Jakob Disease (vCJD) by Blood and Blood Products
aDHQ v.1.3. eff. Dec 2012