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# Appendix 4: Management of post donation illness

This appendix gives guidance on the management of donations taken from donors who report post donation illness with a (probable) infectious cause.

The actions are based upon the nature and potential severity of the illness, relevant incubation period and the risk of the illness causing harm to a transfusion recipient.??

Recipient notification and lookback/traceback investigations are outside the scope of this guidance. Please follow local policies and procedures.

## Infections

###
Bordetella pertussis (whooping cough)

Incubation period

  7 to 10 days

Action for donation

  Discard if within 10 days

###
Borrelia???burgdorferi???(Lyme disease)

Incubation period

  3 to 30 days

Action for donation

  Acute Lyme disease: discard up to 30 days

  Chronic Lyme disease: no action???required

###
Costochondritis / Coxsackie virus (Bornholm Disease)

Incubation period

  1 to 7 days

Action for donation

  Discard up to 1 week

###
Chickenpox / Varicella???zoster

Incubation period

  10 to 21 days

Action for donation

  Discard if within 3 weeks

###
COVID-19???(SARS-CoV-2)

Incubation period

  2 to 14 days

Action for donation

  Discard if:

  - A SARS-CoV-2 test has been taken and COVID-19 confirmed, and
  - Symptoms and/or the positive test result occurred in the 48-hour period after donation.

  If a SARS-CoV-2 test is negative or has not been taken, refer to the relevant advice on this page for the donor's symptoms.

###
Coxsackie A (hand, foot and mouth disease)

Usually Coxsackie A, but???can be other???enteroviruses.

Incubation period

  3 to 7 days

Action for donation

  Discard up to 7 days

###
Epstein-Barr Virus???(glandular fever)

Incubation period

  30 to 50 days

Action for donation

  Discard up to 50 days

###
Hepatitis (acute, viral)

Incubation period

  HAV: 2 to 6 weeks

  HBV: 6 weeks to 6 months

  HCV: up to 6 months

  HEV: 2 to 8 weeks

Action for donation

  HAV: discard up to 7 weeks

  HBV: discard all in date components*

  HCV: discard all in date components*

  HEV: discard up to 9 weeks

  * seek microbiological advice regarding recall of previous donations if the donor's history and/or testing results suggest this is an acute (recent) infection

###
Herpes???simplex (oral???and genital)

Incubation period

  2 to 12 days for primary infection

  Primary viraemia during incubation period, secondary viraemia at time of symptoms

Action for donation

  For primary infection: discard up to 14 days

  For recurrent infection: no action required if recurrent lesion(s) and lesions were absent or healing when donated

###
HIV

Action for donation

  Discard all in-date components at any interval after donation.

  Seek microbiological advice regarding recall of previous donations if the donor's history and/or testing results suggest this is an acute (recent) infection.

###
HTLV

Action for donation

  Discard all in-date components at any interval after donation

###
Influenza

Incubation period

  Influenza A: 1 to 5 days

  Adenovirus: 4 to 5 days

Action for donation

  No action unless severe systematic symptoms (defined as fever/myalgia ?? cough/cold symptoms)

  If present, discard up to 5 days

###
Legionella (Legionnaires' disease, Pontiac fever)

Incubation period

  Up to 3 weeks

Action for donation

  Discard up to 3 weeks

###
Measles

Incubation period

  10 to 21 days

Action for donation

  Discard up to 3 weeks

###
Mpox

Incubation period

  21 days

Action for donation

  Discard up to 21 days. Follow local processes for public health notification if the component has been transfused.

  If the donor has reported contact with mpox in the 21 days before donation, place the donation on hold and seek public health advice to determine the risk.

###
Mumps

Incubation period

  16 to 18 days

  Primary and secondary viraemia

Action for donation

  Discard up to 3 weeks

###
Mycoplasma (M. pneumoniae)

Incubation period

  1 to 4 weeks

  Mostly headache, malaise, fever, 5???10%???progress to pneumonia.

Action for donation

  Discard up to 3 weeks

###
Parvovirus B19 (Fifth disease, Slapped cheek syndrome)

Incubation period

  13 to 20 days

Action for donation

  Discard up to 3 weeks

###
Rubella (German measles)

Incubation period

  14 to 21 days

Action for donation

  Discard up to 3 weeks

###
Tuberculosis

Action for donation

  Discard all in-date components at any interval post donation.

  Look-back to relevant transfused recipients.

###
West Nile Virus

Incubation period

  3 to 15 days

Action for donation

  Discard up to 15 days

##
Conditions

###
Appendicitis

Action for donation

  No action if confirmed appendicitis and asymptomatic at the time of donation

###

### Bornholm disease

See Costochondritis / Coxsackie virus above.

###
Chest infection

Action for donation

  No action unless systemic symptoms; if present discard up to 5 days

###
Common cold

Action for donation

  No action unless symptoms

###
Conjunctivitis

Action for donation

  No action providing well on the day

###
Diarrhoea and vomiting

Comments

  Causes may include (incubation period given below):

  - Salmonella (12 to 72 hours)
  - Shigella (1 to 7 days)
  - Campylobacter (1 to 11 days)
  - Rotavirus (24 to 72 hours )
  - Norovirus (1 to 2 days)
  - Cryptosporidium (2 to 5 days)
  - Yersinia (4 days)

  With all the above, likely to be significant bacteremia or viraemia.

  Staphylococcal, clostridium and Bacillus cereus???food poisoning???is???all???toxin???induced.

Action for donation

  Discard up to 14 days.

  If???this is an episode of food poisoning which occurred after the donation, no action required.

###
Fifth disease / Slapped cheek syndrome

See Parvovirus B19 above.

###
German Measles

See Rubella above.

###
Glandular fever / kissing disease

See Epstein-Barr Virus above.

###
Hand, foot and mouth disease

See Coxsackie A above.

###
Jaundice

Comments

  Assess whether infective cause possible

Action for donation

  Discard all in-date components after any notification if infection is a possible cause:

  - See specific entry if infective cause identified
  - Discard not required if a non-infective cause (e.g. drug reaction) has been identified

###
Legionnaires' disease / Pontiac fever

See Legionella above.

###
Lyme disease

See Borrelia burgdorferi above.

###
Malaria

Comments

  Any disclosure of illness or risk after donation

Action for donation

  Follow local policies and procedures

###
Shingles (herpes zoster)

Comments

  Possible viraemia for 48 hours???from symptoms and/or rash

Action for donation

  Discard if rash or any???symptoms???develop???within 48 hours.

  Symptoms include tingling of skin, pain or???eruption???of vesicles.

###
Skin disease - cellulitis / erysipelas

Comments

  Streptococcus pyogenes

Action for donation

  Discard up to 1 week

###
Skin disease - impetigo

Comments

  Group A streptococcus

  Staphylococcus aureus

  3 to 5 days incubation period

Action for donation

  No action if no???systemic symptoms; if present,???discard up to 1 week

###
Sore throat

Comments

  May include:

  - Rhinovirus
  - Group A streptococcus (2 to 4 days incubation period)
  - Epstein-Barr Virus (0 to 50 days incubation period)
Action for donation

  If???a sore???throat???is accompanied???by???simple cold???symptoms???and???no systemic symptoms, no???action???is???required.

  Systemic symptoms include malaise, myalgia, fever, headache.

  If systemic symptoms, discard up to 1 week.

  If glandular fever, discard up to 50 days.

###
Transmissible spongiform encephalopathy (prion disease)

Comments

  If informed of a possible or confirmed case of prion associated disease, recall (do not discard) any in date components

Action for donation

  Follow local policies and procedures

###
Urinary tract infection (UTI)

Action for donation

  If symptomatic at donation: discard.

  If asymptomatic at donation: no action unless systemic symptoms, then discard up to 5 days. Systemic symptoms include malaise, myalgia, fever and headache.

###
Whooping cough

See Bordetella pertussis above.

Last updated in WB-DSG Edition 203 Release 63 (31 May 2022)

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