Australian Red Cross Lifeblood Blood Donation Referral Tool

Clearance to become a volunteer donor

This form is for patients who do not meet the therapeutic program criteria but are suitable to join the volunteer blood donor panel.

This information will be sent to the Australian Red Cross Lifeblood National Contact Centre. The contact centre will contact your patient and arrange an appointment for donation.

Date: November 21, 2024

My patient has elevated ferritin levels AND/OR carries genetic markers for Haemochromatosis (OTHER THAN C282Y homozygote or H63D/C282Y compound heterozygote). I acknowledge they are NOT eligible for therapeutic venesections at Lifeblood. * My patient would like to become a volunteer blood donor. * My patient is well. I have explained to them that venesection is not a treatment for non haemochromatosis elevated ferritin and have addressed other contributing factors such as metabolic conditions. * I have excluded significant underlying liver disease, malignancy, chronic inflammation, autoimmune conditions or other chronic health conditions to explain the elevated ferritin levels. *

Has your patient ever been diagnosed with hepatitis B, hepatitis C or HIV? *

Yes No [?]

I am therefore comfortable for my patient to be a blood donor. I have explained that as a volunteer blood donor, they are required to meet Lifeblood standard eligibility criteria. *

Should you believe your patient does require therapeutic venesection, you may arrange for this external to Lifeblood. The 'My Iron Manager' App developed by Haemochromatosis Australia, provides a directory of venesection services. https://haemochromatosis.org.au/my-iron-manager-app-2/

High Ferritin App

Clearance to become a volunteer donor