Skip to main content
. Author manuscript; available in PMC: 2013 May 31.
Published in final edited form as: Transfusion. 2011 Oct 20;52(1):134–143. doi: 10.1111/j.1537-2995.2011.03391.x

TABLE 4.

Donor medical history questionnaire content

Number of centers asking each question

Questionnaire content Collection
unit (n = 1)
Hospital
based (n = 5)
Regional
(n = 10)
National
(n = 6)
Total (n = 22),
n (%)
Questions pertaining to donor safety
  Prior donation 1 4 5 4 14 (64)
  Complications after donation 1 3 1 2 7 (32)
  Hypertension 1 5 7 4 17 (77)
  Asthma 1 3 7 3 14 (64)
  Epilepsy 1 4 7 3 15 (68)
  Sickle cell anemia 0 4 4 0 8 (37)
  Pregnancy or breast feeding 1 5 6 6 18 (82)
  Diabetes 1 4 7 4 16 (73)
  Heart, liver, or kidney diseases 1 5 7 4 17 (77)
  Cancer 1 3 2 4 10 (45)
Questions pertaining to recipient safety
  Homosexuality 1 3 6 2 12 (55)
  Injection drug use 0 5 10 3 18 (82)
  Multiple or occasional sex partners 1 4 10 4 19 (86)
  Scarification 1 3 4 1 9 (41)
  Tattoos 1 3 9 4 17 (77)
  Piercing 1 3 8 4 16 (73)
  Recent fever 1 4 10 4 19 (86)
  Transfusion 0 5 10 5 20 (91)
  Jaundice 1 4 3 6 14 (64)
  Chronic coughing 1 3 6 4 14 (64)
  Recent hospitalization 1 5 10 6 22 (100)
  Diarrhea 1 3 7 3 14 (64)
  Recent immunization 1 4 10 4 19 (86)
  STD(s) 1 5 7 6 19 (86)
  Medications 0 4 6 6 16 (73)
  Sexual intercourse with partner with STD 1 3 7 3 14 (64)
  Sexual intercourse with prostitute 0 3 10 1 14 (64)
  History of hemorrhage 0 3 2 1 6 (27)
  Type of donor (volunteer, family, paid) 0 3 4 2 9 (41)

STD = sexually transmitted disease.