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# Liver disease - Whole blood and components

### Scenarios

Non-alcoholic fatty liver disease (NAFLD)

Excludes
  Alcoholic fatty liver disease (AFLD)
Obligatory

  Must not donate if:

  - Diagnosed with non-alcoholic steatohepatitis (NASH).
  - Diagnosed with cirrhosis.
Discretionary

  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.

Additional information

  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.

Alcohol-related liver disease

Obligatory

  Must not donate.

Discretionary

  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.

See if relevant
  - Addiction and drug abuse
Additional information

  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.

Infective liver disease

Includes
  Liver abscess, glandular fever, viral hepatitis.
Obligatory

  Refer to the entry for the condition.

  If there is no specific entry, must not donate.

Discretionary

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

See if relevant
  - Infection, general
  - Hepatitis

  For glandular fever:

  - Infection, acute

Autoimmune liver disease

Includes
  Autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC).
Obligatory

  Must not donate if:

  - Under active investigation or treatment, or
  - Associated with inflammatory bowel disease.
Discretionary
  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.
See if relevant
  - Autoimmune disease
  - Hepatitis
  - Steroid therapy
Additional information

  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

Drug or pregnancy induced liver disease

Includes
  Acute liver failure
Obligatory

  Must not donate if:

  - Under active investigation, treatment or follow-up by a specialist.
  - Has received a liver transplant.
  - Has chronic liver failure.
Discretionary

  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.

See if relevant
  - Addiction and drug abuse
  - Tissue and organ recipients
Additional information

  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.

Liver cirrhosis

Obligatory

  Must not donate.

Additional information

  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.

Liver tumours

Includes
  Liver cancer, hepatocellular carcinoma, bile duct cancer.
Obligatory

  Must not donate.

Discretionary

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

See if relevant
  - Malignancy
Additional information

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

Inherited disease affecting the liver

Obligatory

  Refer to the entry for the condition.

  If there is no specific entry, must not donate.

Discretionary
  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.
See if relevant
  - Haemochromatosis
  - Inherited diseases
Additional information

  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.

Version details:

  WB-DSG Edition 203 Release 66 (18 October 2022)

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