Liver disease - Whole blood and components

A diagnosis of non-alcoholic fatty liver disease does not necessarily prevent donation. If the donor is otherwise well and managed with diet and lifestyle changes such as exercise, accept.

NAFLD is a common medical condition, caused mainly by lifestyle factors such as weight, type 2 diabetes, high blood pressure and high cholesterol. There is no drug treatment for this condition. It is usually managed with diet and lifestyle changes along with treatment of any associated medical conditions. Regular monitoring of the condition (e.g. blood tests and liver scans) should not preclude donation.

Non-alcoholic steatohepatitis (NASH) is an advanced form of NAFLD. It is caused by an excessive accumulation of fat in the liver. This can progress to chronic liver inflammation and can result in cirrhosis if untreated.

If the donor is well, and

• Not under specialist follow-up, and
• Has not been diagnosed with alcohol related hepatitis or cirrhosis,

accept.

Refer to a Designated Clinical Support Officer if there is uncertainty about the diagnosis or the extent of liver damage.

• Addiction and drug abuse

Alcohol-related liver disease is common but preventable liver damage that is caused by drinking too much alcohol. It is reversible in the early stages when it is characterised mainly by fatty liver changes. In some individuals, it may progress to alcoholic hepatitis and alcoholic cirrhosis.

If the donor is fully recovered and there is no specific guidance for the condition, refer to Infection, general.

• Infection, general
• Hepatitis

For glandular fever:

• Infection, acute

1. If well, even if on treatment to control symptoms. e.g. cholestyramine (Questran®) or ursodeoxycholic acid (also known as ursodiol), accept.
2. If well and taking treatment to suppress the condition, refer to the Autoimmune disease entry.

• Autoimmune disease
• Hepatitis
• Steroid therapy

Autoimmune liver disease in its early stages may be asymptomatic or present with mild symptoms such as itchy skin (pruritis) and fatigue. The donor may require no treatment or treatment for symptom control only for an extended period.

Autoimmune liver disease may be diagnosed during investigation for other conditions, especially other autoimmune conditions. Treatment to suppress these diseases may include steroids, azathioprine and other immunosuppressants. If there is doubt about the diagnosis and treatment, refer to a Designated Clinical Support Officer 

If the donor has recovered, is not on treatment and has been discharged from follow-up, accept.

If there is doubt about the diagnosis, refer to a Designated Clinical Support Officer.

• Addiction and drug abuse
• Tissue and organ recipients

Liver failure may be acute or chronic. Acute liver failure (also known as fulminant liver failure) can be caused by drugs, such as paracetamol overdose, prescription medications, herbal preparations and ingestion of toxins. Liver problems can also occur during pregnancy, e.g acute fatty liver of pregnancy (AFLP) and intrahepatic cholestasis of pregnancy (ICP). Acute liver failure can occur in an individual with no pre-existing liver disease. It is often reversible with full recovery if adequately treated.

Chronic liver failure is caused by longstanding liver disease such as autoimmune liver disease, hepatitis, alcohol related liver disease, liver cirrhosis, haemochromatosis and Wilson’s disease.

Cirrhosis can be caused by many different conditions and by several different liver conditions in combination. Transmissible viruses, some of which are not detected in transfusion service testing, can cause some cases. Because cirrhosis is a sign of worsening or progressive liver disease, it is considered safest not to accept individuals with cirrhosis.

Donors with benign liver cysts or adenomas who are fit and well, even if regularly monitored, accept.

• Malignancy

If in doubt about the diagnosis, refer to a Designated Clinical Support Officer.

1. If the donor is well and stable on treatment for Wilson's disease, accept.
2. If the donor has Gilbert's syndrome and is not visibly jaundiced, accept.
3. For other conditions, see Inherited diseases.

• Haemochromatosis
• Inherited diseases

Wilson's disease is caused by an excessive accumulation of copper in the liver and other organs (e.g. brain). If diagnosed and treated early with chelating agents, such as penicillamine and trientine, and avoidance of high copper foods, the prognosis is good and individuals can lead a normal life. If there is uncertainty about the donor’s health or treatment, refer to a Designated Clinical Support Officer.

Alpha-1-antitrypsin deficiency can occasionally cause liver disease in adults. This may lead to liver failure and the need for liver transplantation.

Gilbert's syndrome is an inherited defect in bilirubin metabolism. It is harmless but can cause jaundice (yellowing of the whites of the eyes). Blood banks are unlikely to use blood that appears jaundiced. This means any visibly jaundiced donation is likely to be wasted.