Donor Prescreening Questions

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2 Donor Prescreening Questions CDO-384-PRD REV 22r18 Please read the following in its entirety to help guarantee your safety and the safety of the community blood supply and to help ensure you have a positive donation experience. Bonfils recommends that prior to your donation you eat within 2 hours and hydrate for hours. If you would like something to eat or drink before your donation please help yourself to the items in the canteen area. Donors are commonly deferred for the following questions. Bonfils asks these prescreening questions so donors do not spend time answering our full questionnaire only to find they are ineligible for a common reason. Even if you answer no to all of these prescreening questions, you may be ineligible to donate based on the answers given during the full questionnaire and interview process completed just prior to the actual donation. If you answer yes to any of these questions on the day you present to donate, you will NOT be eligible to donate at that time. If you have any questions related to travel or your eligibility to donate as a whole contact Bonfils Donor Relations department at or , opt. 1 or ask a Bonfils staff member at the time of your donation. HEALTH STATUS AND AGE 1. Do you weigh less than 110 pounds or more than 350 pounds? 2. Are you 15 years or younger? 3. Are you ill or not feeling well today? 4. Have you ever been diagnosed with lymphoma and/or leukemia? MEDICATIONS 5. Are you taking antibiotics today for an active infection? 6. Have you taken Accutane, Proscar or Propecia in the last month? 7. Have you taken Coumadin/Warfarin in the last 7 days? TRAVEL AND RESIDENCE ABROAD 8. From 1980 through 1990 were you in Belgium, Germany, the Netherlands or Holland as a member of the U.S. military, a civilian military employee or a dependent of a member of the U.S. military for 6 months or more?* 9. From 1980 through 1996 were you in Spain, Portugal, Turkey, Italy, Sicily or Greece as a member of the U.S. military, a civilian military employee or a dependent of a member of the U.S. military for 6 months or more?* 10. From 1980 to present have you spent time that adds up to 5 years or more in Europe?* 11. In the past 12 months have you spent more than 24 hours in (traveled to) any individual location outside of the U.S. or Canada?* a. If yes, did you travel to any of the countries or cities listed as a malarial risk area on the table on the back of this page? There are many ways to save lives with Bonfils. You can also help through Bonfils marrow program and volunteer opportunities. *Additionally, if you are deferred for these categories, you may still be eligible for research donations. Visit bonfils.org to learn more. PG 1 OF 2

3 The table below is referenced in prescreening question 11a. Like the prescreening questions on this document that reference common deferrals but not all deferrals, this table includes common malarial risk areas but it is not an all-inclusive list. AFGHANISTAN AFRICA Angola Botswana Burundi Cameroon Central African Republic Chad Congo Ethiopia Gabon Gambia Ghana Ivory Coast Kenya Liberia Mozambique Niger Nigeria Rwanda Senegal Sierra Leone Somalia Sudan Tanzania Uganda Zaire Zambia Zimbabwe CAPE VERDE ISLANDS CHINA Dali Banna Chuxiong City Dian Lake Jade Dragon Snow Mountain Jinghong Kunming Lijiang Nansha New Yuanyang Old Yunanyang Panzhihua Shangri-la Shilin Stone Forest Tiger Leaping Gorge Xinje Yunnan CYPRUS Agios Amvrosios Esentepe DOMINICAN REPUBLIC Puerto Plata Punta Cana La Romana Samana HAITI HONDURAS Bay Island Guanja Island Roatan Island Utila Island INDIA INDONESIA IRAN MEXICO Chihuahua City Copper Canyon El Fuerte Hidalgo del Parral Los Mochis Mazatlan Nuevo Mazatlan Nuevo Vallarta Punta Mita Sayulita PANAMA Any area east of the Panama Canal including the region of Colon SOUTH KOREA Any area north of Seoul, including the Demilitarized Zone (DMZ) VENEZUELA CDO-384-PRD REV 2218 PG 2 OF 2

4 Medical Guidelines BASIC REQUIREMENTS FOR BLOOD DONATION BD_4020 BD_001 rev 11 Must be at least 18 years of age or 16 or 17 with written parental or guardian acknowledgement. Weigh at least 110 pounds; if greater than 350 pounds, please call Bonfils Appointment Center at or , opt. 2. For your safety and to ensure a positive donation experience Bonfils recommends that prior to your donation you eat within 2 hours and hydrate for hours. If you would like something to eat or drink before your donation please help yourself to the items in the canteen area. Be in good general health. Proof of identification is required at time of donation. Examples include but are not limited to: driver s license, work badge, school ID, credit card, mail, etc. The donation interval after a whole blood donation is 56 days. Please contact Bonfils Blood Center for the specific interval for other blood product donations. You should not be under the influence of alcohol or recreational drugs at the time of donation. MEDICATIONS Donors should not discontinue taking medications prescribed or recommended by their physicians in order to be eligible to donate. Are you being treated with the following types of medication... Have you taken... which is also called... in the last Feldene piroxicam 2 days Anti-platelet agents Effient prasugrel (usually taken to prevent Brilinta ticagrelor 7 days stroke or heart Plavix clopidogrel attack) Ticlid ticlopidine 14 days Zontivity vorapaxar Xeralto rivaroxaban Fragmin dalteparin Lovenox enoxaparin 2 days Pradaxa dabigatran Anticoagulants or Eliquis abixaban blood thinners (usually to prevent blood Savaysa edoxaban clots in the leg and Coumadin lungs and to prevent Warfilone warfarin stokes) Jantoven Heparin, low 7 days molecular heparin weight heparin Arixta fondaparinux Acne treatment Accutane Amnesteem Absorica Claravis isotretinoin Myorisan 1 month Sotret Zenatane Hair loss remedy Propecia finasteride Proscar finasteride Prostate Symptoms Avodart Jalyn dutasteride 6 months Basal cell skin cancer Erivedge vismodegib Odomzo sonidegib 24 months Relapsing multiple sclerosis Aubagio Teriflunomide 24 months Psoriasis Soriatane acitretin 36 months Tegison etretinate Ever Hepatitis exposure Hepatitis B Immune Globulin HBIG 12 months HEALTH CONDITIONS Ambulatory Aid: For their own safety, donors using any type of temporary ambulatory aids including crutches, canes or other walking aids for a recent injury cannot donate until no longer requiring this assistance. Breastfeeding: Female donors that are breastfeeding are eligible to donate. Cancer: Donor is eligible with a history of basal cell or squamous cell skin cancer or carcinoma in situ. Lymphoma and leukemia are permanent deferrals. All other types of cancer will be assessed at time of donation, but 12 months must have passed since the last treatment and donor must be considered cancer free at time of donation. Colds: Donors are not eligible if they are not feeling well and healthy the day of donation. Diabetes: Donors with diabetes (type I or II) are eligible to donate. Diabetics who ever used bovine insulin manufactured in the United Kingdom are deferred. Heart Disease: Donors with a history of heart disease or heart attacks may be eligible to donate provided six months have elapsed from the incident and approval has been obtained from donor s physician. Donors with Wolff- Parkinson-White syndrome, hypertrophic cardiomyopathy and implanted/internal defibrillators are permanently ineligible. Hemochromatosis/Polycythemia: Donors diagnosed with hereditary hemochromatosis or polycythemia are asked to contact Bonfils Donor Relations. Hepatitis: Donors with a history of hepatitis B or C should refrain from donating. High Blood Pressure: Donors with high blood pressure are eligible to donate if their blood pressure is within an acceptable range when taken on the day of donation, regardless of medication. Malaria: Donor is eligible if symptom free for three years. Pregnant: Donors who are pregnant or have been pregnant in the last 6 weeks are not eligible to donate. Transfusion/Transplants: Donor is deferred for 12 months following a transplant or transfusion of blood or of blood products. PG 1 OF 2

5 VACCINATIONS/IMMUNIZATION Vaccination/Immunization Antitoxins/animal serum injections Measles (rubeola) Mumps Polio Salk (oral vaccine) Typhoid (oral) Yellow fever German measles (rubella) BCG (Bacille Calmette-Guerin) for tuberculosis (TB) disease Hepatitis B (Recombivax, Energix-B, Heptavax) MMR (measles/mumps/rubella) Varicella zoster (chicken pox, Varivax) Shingles (Zostavax) Do Not Donate for 2 weeks 1 month (30 days) HIV/AIDS Individuals who have had a positive test for HIV/ AIDS or who are at risk for contracting HIV/AIDS are permanently deferred from donating blood. Risk factors include: Use of needles to take drugs, steroids or anything not prescribed by your doctor Taking money or drugs for sex BD_4020 BD_001 rev 11 The following risk factors represent a 12-month deferral for the donor from the date of occurrence: Male to male sexual contact in the past 12 months Intimate/sexual contact with any person in the above categories Accidental contact with another person s blood/ body fluid or an accidental needle stick Incarceration for more than 72 consecutive hours EUROPEAN TRAVEL/RESIDENCY CRITERIA CJD Variant Creutzfeldt-Jakob Disease (human form of mad cow disease). Total cumulative time spent in the United Kingdom (see list below) adding up to 3 months or more from indefinitely defers a donor from community donation. However, these donors may be eligible for research donations. Total cumulative time spent in the European Countries listed below of 5 years or more is cause for indefinite deferral from community donation, but does not defer the donor from research donations. COUNTRIES IN UNITED KINGDOM: Channel Islands England Falkland Islands EUROPEAN COUNTRIES: Albania Austria Belgium Bosnia-Herzegovina Bulgaria Channel Islands Croatia Czech Republic Denmark England Falkland Islands Finland France* Germany Gibraltar Isle of Man Northern Ireland Gibraltar Greece Hungary Isle of Man Kosovo Northern Ireland Republic of Ireland Italy (Sicily) Liechtenstein Luxembourg Macedonia Montenegro Netherlands (Holland) Norway * including its overseas departments (e.g., Martinique and others) ** including the Canary Islands and Spanish North African territories *** including the Azores ****formerly Federal Republic of Yugoslavia Scotland Wales Poland Portugal** Romania Scotland Serbia Slovak Republic Slovenia Spain*** Sweden Switzerland United Kingdom Yugoslavia**** Wales ACUPUNCTURE Acupuncture/Dry-needling: Donor is eligible if procedure was performed with single-use equipment. Otherwise, donor is deferred for 12 months. OTHER WAYS TO HELP You can save lives through Bonfils marrow program and volunteer opportunities. Additionally, if you are deferred for the reasons on this document, you may still be eligible for research donations. Visit bonfils.org to learn more. PG 2 OF 2