Selection criteria to protect the blood donor in North America and Europe: past (dogma), present (evidence), and future (hemovigilance)

Gamification Approach to Provide Support About the Deferral Experience in Blood Donation: Design and Feasibility Study

BACKGROUND

Multiple studies have examined the impact of deferral on the motivation of prospective blood donors, proposing various policies and strategies to support individuals who undergo this experience. However, existing information and communications technology systems focused on blood donation have not yet integrated these ideas or provided options to assist with the deferral experience.

OBJECTIVE

This study aims to propose an initial gamified design aimed at mitigating the impact of the deferral experience by addressing the drivers of awareness and knowledge, interaction and validation, and motivation. Additionally, the study explores the feasibility of implementing such a system for potential users.

METHODS

We conducted a literature review focusing on the dynamics of motivation and intention related to blood donation, as well as the deferral situation and its impact on citizens. Through this review, we identified weak donor identity, lack of knowledge, and reduced motivation as key factors requiring support from appropriate interventions. These factors were then defined as our key drivers. Taking these into account, we proposed a gamification approach that incorporates concepts from the MDA framework. The aim is to stimulate the aforementioned drivers and expand the concept of contribution and identity in blood donation. For a preliminary evaluation, we designed a prototype to collect feedback on usability, usefulness, and interest regarding a potential implementation of our proposed gamification approach.

RESULTS

Among the participants, a total of 11 citizens interacted with the app and provided feedback through our survey. They indicated that interacting with the app was relatively easy, with an average score of 4.13 out of 5 when considering the 11 tasks of interaction. The SUS results yielded a final average score of 70.91 from the participants' answers. Positive responses were received when participants were asked about liking the concept of the app (3.82), being likely to download it (3.55), and being likely to recommend it to others (3.64). Participants expressed positivity about the implementation of the design but also highlighted current shortcomings and suggested possible improvements in both functionality and usability.

CONCLUSIONS

Although deferral is a common issue in blood donation, there is a missed opportunity in existing ICT services regarding how to effectively handle such experiences. Our proposed design and implementation seem to have captured the interest of prospective users due to its perceived positive usefulness and potential. However, further confirmation is needed. Improving the design of activities that currently rely heavily on extrinsic motivation elements and integrating more social components to create an enhanced activity loop for intrinsic motivation could further increase the value of the proposed project. Future research could involve conducting a more specialized and longitudinal design evaluation with a larger sample size.

Donor complication rates in whole blood, plasma and platelet donors: Age versus experience

BACKGROUND

Many blood banks use upper age limits for donors out of concern for a higher donor complication rate in older donors. Experienced donors are known to have lower donor complication rates, and older donors are often more experienced, confounding the effect of age on donor complication rate.

STUDY DESIGN AND METHODS

We studied donor complication rates in whole blood, plasma, and plateletpheresis donors from 2012 to 2022. Donor complication rates were compared between age groups in inexperienced (<20th donation) and experienced (≥20th donation) donors. In addition to this direct comparison, we made use of logistic regression with finer-grained experience groups, to further quantify the effects of age, experience and other factors on donor complication rate.

RESULTS

While overall rate of vasovagal reaction was lower, rate of moderate/severe vasovagal syncope was highest in 70-79 year donors, however, only reached significance for plasma donors. Furthermore, rates of failed stab were highest in this age group. Hematoma rate showed a U-shaped pattern with regard to age, where the rate was not higher in the 70-79 year age group than in the 18-23 year age group. Pain decreased with age, however, rates were higher in the 70-79 year age group than in the 65-69 year age group.

DISCUSSION

When properly accounting for donor experience, donor complication rate profiles clearly change with age. The increased risk for moderate/severe vasovagal syncope in older donors should be clearly communicated. Extra caution is needed if these donors are accepted for first-time donations.

Medication Deferrals in Blood Donors

Medication use is extremely common in blood donors. Blood centers use various methods to obtain a history of medication use, all of which have strengths and weaknesses. Some data are available to develop policies for medications that impact product quality, transmissible disease testing, and infectious risks. Many blood centers defer donors for use of a small number of highly teratogenic medications, as a precautionary measure. Others also defer for possible harms related to the pharmacologic effects of medications. However, a single exposure to a blood component containing medication, with immediate dilution in the recipient's blood stream, is a very different situation from ongoing use of medication in a patient, with steady state concentrations achieved over time. It is therefore highly unlikely that these effects are relevant for recipient safety.

Review of blood donor deferral with emphasis on donor and patient safety

INTRODUCTION

Blood donor deferral is a part and parcel of the commitment of the blood transfusion services to assure the safety and health of the blood donor as well as the recipient. Periodic review of blood donor deferral is to incorporate or revoke deferral reasons based on the evidence generated in the process of review. Therefore, emphasis must be laid on preparing strategies to only judiciously defer blood donors, recruit and retain first time blood donors, which needs critical appraisal of the existing deferral policies, so that the evidence based changes can be done.

MATERIAL AND METHODS

A retrospective analysis of deferral in blood donors who presented at the blood donation centre of an institute of national importance over a span of nine years (2011-2019). Donors were screened as per the Drugs and Cosmetics Act 1940 and Rules 1945 given by the Ministry of Health and Family Welfare, Govt of India.

RESULTS

There were 1,37,935 donors attempts, out of which 20,167 (14.6%) donors were deferred from donating blood. Most of the deferred donors were male (88.5%), first time (86.1%) and temporarily deferred (87.6%). Almost comparable number of donors (49.1 % & 48.5%) were deferred for donor safety and patient safety reasons respectively. Overall the three most common reasons for deferral were low hemoglobin (21.6%), hypertension (11.4%) and history of jaundice (9%). In donor safety reasons, low hemoglobin (43.4%), hypertension (22.9%) and low blood pressure (4.5%), and in patient safety, a history of jaundice (18.6%), common cold (15.8%), and high-risk behavior (8.8%) emerged as the three most common reasons for deferral respectively.

CONCLUSION

Blood donor deferral is an essential quality indicator of the blood donor selection process. Initiatives like fortification of dietary ingredients with iron, optimizing protein in diet served in schools under mid-day meal program, screening for iron deficiency, hypertension and education about high-risk behavior in schools and colleges may have long term effects of promotion of better health.

Safe Blood Donation from Donors Using Antihypertensive Medication. A Multi-Center Retrospective Quality Study from South-East Norway

Purpose

In Norway, blood donors using antihypertensive medication were deferred until 2015. Following revision of the national directive, these donors could be allowed, providing stable dose for at least 3 months, adequate blood pressure control and no adverse effects caused by the therapy. The new practice was evaluated by a quality study where the major aim was to establish whether donations from blood donors on antihypertensive medication pose a risk to the donor. The risk was assessed by counting the number and categorizing the adverse events related to blood donation. In addition, the quantitative effect of including these donors was calculated.

Subjects and Methods

In this retrospective quality study, blood donors on antihypertensive therapy were recruited from four different blood centers to fill out a questionnaire. A total of 265 donors answered questions regarding their health status, type of medication used, and adverse events connected to blood donation both before and after starting the therapy.

Results

No severe adverse events were observed in donors on antihypertensive medications. The amount of mild adverse events, as exhibited by only 7 persons (0.46%) in this donor population, was the same as for donors without hypertensive treatment.

Conclusion

Blood donation from persons on antihypertensive therapy poses no extra risk of severe adverse events, given the use of screening criteria to identify and bleed only low-risk donors.

Reinduction of the Temporarily Deferred Donors for Laying the Foundation of Safe and Sustainable Blood Supplies: A Review in the Indian Context

Temporarily deferred donors are a forgotten pool of potential blood source. When dealt appropriately, they can easily be inducted back to the main stream pool of voluntary donors. Although there are multiple studies from India on the deferral rates and patterns; not much has been done with respect to the follow up of these donors and active efforts to bring them back to donate blood. In this narrative review, we discuss the impact of temporary deferral, factors affecting the return and appropriate strategies to improve the return rate of these donors.

Are Bradycardic Donors More Likely to Have Adverse Outcomes During Blood Donation?

INTRODUCTION

In order to decrease adverse donor reactions during blood donation, volunteers are screened to safely donate according to the U.S. Food and Drug Administration standards. Volunteers must be normocardic, with a pulse between 50 and 100 beats per minute. Bradycardic volunteers with a pulse lower than 50 beats per minute who otherwise meet requirements may donate with physician approval. Blood donors in military settings tend to be younger and more physically fit than the average donor population, resulting in a higher percentage of bradycardic donors. The relationship between bradycardia and adverse donor reactions has not been well studied. Herein, we aim to compare post-donation adverse reactions and the ability to complete donation between normocardic and bradycardic donors.

MATERIALS AND METHODS

Institutional review board approval was obtained. Records from a single blood donor center located on a large military installation in 2019 were retrospectively reviewed for vital signs, demographics, hemoglobin, and donor reactions. Donors were categorized as normocardic or bradycardic. The two groups were statistically compared using a χ2 test.

RESULTS

Of the 1,601 donors in the study period, 1,514 qualified for donation. Mean age was 26.6 years (range, 17-72 years), with a male to female ratio of 2.1:1. Of these, 1,478 were normocardic and 26 were bradycardic. There was no significant difference in adverse reactions between the two groups (5.6% in bradycardic donors versus 3.6% in normocardic donors, n = 1,514, χ21 = 0.39, P = .53) or percentage of incomplete donations (5.9% in bradycardic and 5.65% in normocardic, n = 1,514, χ21 = 0.003, P = .96).

CONCLUSIONS

Donors with bradycardia are as safe to donate as normocardic donors. In the absence of comorbidities, blood donor centers should ensure their policies consider donation for volunteers with bradycardia.

Supplemental findings of the 2019 National Blood Collection and Utilization Survey

INTRODUCTION

Supplemental data from the 2019 National Blood Collection and Utilization Survey (NBCUS) are presented and include findings on donor characteristics, autologous and directed donations and transfusions, platelets (PLTs), plasma and granulocyte transfusions, pediatric transfusions, transfusion-associated adverse events, cost of blood units, hospital policies and practices, and implementation of blood safety measures, including pathogen reduction technology (PRT).

METHODS

National estimates were produced using weighting and imputation methods for a number of donors, donations, donor deferrals, autologous and directed donations and transfusions, PLT and plasma collections and transfusions, a number of crossmatch procedures, a number of units irradiated and leukoreduced, pediatric transfusions, and transfusion-associated adverse events.

RESULTS

Between 2017 and 2019, there was a slight decrease in successful donations by 1.1%. Donations by persons aged 16-18 decreased by 10.1% while donations among donors >65 years increased by 10.5%. From 2017 to 2019, the median price paid for blood components by hospitals for leukoreduced red blood cell units, leukoreduced apheresis PLT units, and for fresh frozen plasma units continued to decrease. The rate of life-threatening transfusion-related adverse reactions continued to decrease. Most whole blood/red blood cell units (97%) and PLT units (97%) were leukoreduced.

CONCLUSION

Blood donations decreased between 2017 and 2019. Donations from younger donors continued to decline while donations among older donors have steadily increased. Prices paid for blood products by hospitals decreased. Implementation of PRT among blood centers and hospitals is slowly expanding.

How do I think about blood donor eligibility criteria for medical conditions?

Every blood center must determine blood donor eligibility criteria for donors with medical conditions, often based on very limited published data and variable practice. This manuscript briefly outlines possible impacts of donor medical conditions on donor and recipient safety and product quality, and describes the multidisciplinary approach used in Canada to think about donor criteria issues. Many years of experience are distilled into practical considerations in determining criteria, possible sources of information, and factors for successful change implementation, to hopefully assist medical and technical staff engaged in decision-making around donor eligibility.

Blood donation and heavy metal poisoning in developing nations: Any link?

Long term health effects of heavy metal exposure from both occupational and environmental settings involve multi-organ toxicities including but not limited to disturbances of neurological, cognitive, and metabolic processes, immune system dysregulation, carcinogenesis and sometimes permanent disabilities. Humans are exposed to toxic metals through various sources and routes of entry. The risk of heavy metal poisoning from donor blood has been the subject of many scientific investigations. In this review we highlight how the access to a safe and adequate blood transfusion with minimal risk of toxic metals to recipients is a public health challenge, especially in developing nations. For quality assurance purposes, blood donors are screened for various blood-borne pathogens, but screening for toxic metal levels is not routine. Evidence from scientific studies used in this review lends credence to the risk of heavy metal poisoning from donors with high blood concentrations of these heavy metals. The risk of toxicity is exceptionally high in vulnerable populations such as neonates and preterm infants, as well as in pregnant women and other individuals with conditions requiring multiple blood transfusions. This is worse in developing countries where some members of the population engage in illegal refining and artisanal mining activities. In order to reduce toxic metal exposure in vulnerable populations, blood meant for transfusion in vulnerable subjects, e.g. children, should be routinely screened for heavy metal concentrations. Patients receiving multiple blood transfusions should also be monitored for iron overload and its attendant toxicities.

Convalescent Plasma Therapy for Management of COVID-19: Perspectives and Deployment in the Current Global Pandemic

The world is striving against the severe crisis of the COVID-19 pandemic. Healthcare professionals are struggling to treat their patients based on nonspecific therapies. Amidst this uncertainty, convalescent plasma therapy (CPT) has appeared to be an interim adjuvant therapy for severely ill patients of COVID-19 until long-term clinical trial treatment options are available. Considering the transfusion-related hazards, especially lung injuries and microbial transmission, where sensitivity is not ensured, rigorous trials should be conducted to determine this therapy's efficacy. Moreover, the ratio of recovered cases to plasma donors is not satisfying, which questioning this therapy's availability and accessibility. Although some countries are making the treatment free, the attributable cost mandates a justification for its suitability and sustainability. Our article aimed to review the published facts and findings of CPT's effectiveness in lowering the mortality rate of COVID-19. This pandemic showed that healthcare systems worldwide need core reform. A unified global collaboration must align and coordinate to face the current pandemic and enhance world readiness for future outbreaks based on health equity and equality.

Classification of potential blood donors using machine learning algorithms approach

Blood donation is the process of taking blood from someone used for blood transfusions. Blood type, sex, age, blood pressure, and hemoglobin are blood donor criteria that must be met and processed manually to classify blood donor eligibility. The manual process resulted in an irregular blood supply because blood donor candidates did not meet the criteria. This study implements machine learning algorithms includes kNN, naïve Bayes, and neural network methods to determine the eligibility of blood donors. This study used 600 training data divided into two classes, namely potential and non-potential donors. The test results show that the accuracy of the neural network is 84.3 %, higher than kNN and naïve Bayes, respectively of 75 % and 84.17 %. It indicates that the neural network method outperforms comparing with kNN and naïve Bayes.

Blood donation from 2006 to 2015 in Zhejiang Province, China: annual consecutive cross-sectional studies

OBJECTIVES

To describe the basic demographical characteristics of whole blood donors in Zhejiang Province, China, from 2006 to 2015 and to examine the trends in individual characteristics associated with blood donation and the relationship between weight and donation.

DESIGN

Cross-sectional study comparing characteristics of blood donors and annual donations for the period 2006 to 2015.

SETTING

Urban and rural communities in Zhejiang, China (11 cities, 89 districts or counties and 1379 townships).

PARTICIPANTS

3 226 571 volunteer blood donors.

OUTCOME MEASURES

Volume of each whole blood donation and donation frequency. All data were collected by trained staff and entered into a standardised electronic information system.

RESULTS

The number of blood donations generally trended up in Zhejiang Province from 2006 to 2015. Donors were predominately males aged 18 to 25 years, but this major donor age group shifted to the 26 to 45 year range by 2015. The rate of repeated blood donation was 30.8 per cent. The blood volume per donation concentrated in 200 mL and 400 mL categories has been gradually shifted to 300 mL and 400 mL. Approximately one-third of donors had a college education. The average weight of donors increased over time for both men and women. Both the blood volume of each donation and donation frequency were proportional to weight.

CONCLUSIONS

The trend of voluntary non-remunerated blood donation in Zhejiang province is positive. However, given the expected growth in demand for whole blood, more research is needed to increase both the donor pool and the rate of repeated donation. The relationship between body weight and blood donation warrants further study because while improving nutritional status is associated with higher average donation volume and more frequent donations, overnutrition may lead to poorer quality of donated blood. Blood donation may present a unique opportunity for health education and body weight management to monitor and improve population health.

International haemovigilance: what have we learned and what do we need to do next?

The International Haemovigilance Network (IHN) defines haemovigilance as 'a set of surveillance procedures covering the whole transfusion chain (from the collection of blood and its components to the follow-up of recipients), intended to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products, and to prevent their occurrence or recurrence'. IHN, the International Society of Blood Transfusion and World Health Organization work together to support both developing and established haemovigilance systems. Haemovigilance systems provide valuable data on a range of adverse events related to blood donation and clinical transfusion, from donor syncopal events to transfusion-transmitted infections, immunological complications and the impact of human errors. Harmonised definitions for most adverse reactions have been developed and validated internationally. Definitions of pulmonary complications are again under review. Haemovigilance data have resulted in changes in policy, products and practice, and can complement and inform clinical audit and research, leading to improved blood donor safety, optimised product use and better clinical outcomes after transfusion. However, more work is needed. Not all countries have haemovigilance systems in place. More robust data and careful analysis are required to improve the understanding of the causes, occurrence and clinical outcomes of these events. Wider dissemination of results will facilitate health policy development internationally, and implementation of haemovigilance recommendations will support further important progress in blood safety.

Red blood cell components: time to revisit the sources of variability

Quality and safety of red blood cell (RBC) components is managed by screening of donors and strict regulatory controls of blood collection, processing and storage procedures. Despite these efforts, variations in RBC component quality exist as exemplified by the wide range in storage-induced haemolysis. This article provides a brief overview of the variables that contribute or potentially contribute to the quality of stored RBC components, including blood collection, processing, and donor-related variables. Particular focus is made on donor health and lifestyle factors that are not specifically screened and may impact on the physicobiochemical properties of RBCs and their storability. Inflammatory and oxidative stress states may be especially relevant as RBCs are susceptible to oxidative injury. Few studies have investigated the effect of specific donor-related variables on the quality of stored RBC components. Donor-related variables may be unaccounted confounders in the "age of blood" clinical studies that compared outcomes following transfusion of fresher or longer-stored RBC components. The conclusion is drawn that the blood donor is the greatest source of RBC component variability and the least "regulated" aspect of blood component production. It is proposed that more research is needed to better understand the connection between donor-related variables and quality consistency of stored RBC components. This could be very important given the impact of modern lifestyles that sees escalating rates of non-communicable health conditions that are associated with increased oxidative stress, such as hypertension, obesity and diabetes in children and adults, as well as an ageing population in many countries. The effect of these changes to global health and population demographics will impact on blood donor panels, and without significant new research, the consequences on the quality of stored blood components and transfusion outcomes are unknown.

Anonymizing datasets with demographics and diagnosis codes in the presence of utility constraints

Publishing data about patients that contain both demographics and diagnosis codes is essential to perform large-scale, low-cost medical studies. However, preserving the privacy and utility of such data is challenging, because it requires: (i) guarding against identity disclosure (re-identification) attacks based on both demographics and diagnosis codes, (ii) ensuring that the anonymized data remain useful in intended analysis tasks, and (iii) minimizing the information loss, incurred by anonymization, to preserve the utility of general analysis tasks that are difficult to determine before data publishing. Existing anonymization approaches are not suitable for being used in this setting, because they cannot satisfy all three requirements. Therefore, in this work, we propose a new approach to deal with this problem. We enforce the requirement (i) by applying (k,k^m)-anonymity, a privacy principle that prevents re-identification from attackers who know the demographics of a patient and up to m of their diagnosis codes, where k and m are tunable parameters. To capture the requirement (ii), we propose the concept of utility constraint for both demographics and diagnosis codes. Utility constraints limit the amount of generalization and are specified by data owners (e.g., the healthcare institution that performs anonymization). We also capture requirement (iii), by employing well-established information loss measures for demographics and for diagnosis codes. To realize our approach, we develop an algorithm that enforces (k,k^m)-anonymity on a dataset containing both demographics and diagnosis codes, in a way that satisfies the specified utility constraints and with minimal information loss, according to the measures. Our experiments with a large dataset containing more than 200,000 electronic health records show the effectiveness and efficiency of our algorithm.

Blood donor management in china

Despite a steady increase in total blood collections and voluntary non-remunerated blood donors, China continues to have many challenges with its blood donation system. The country's donation rate remains low at 9%o, with over 60% of donors being first-time donors. Generally there is a lack of adequate public awareness about blood donation. The conservative donor selection criteria, the relatively long donation interval, and the small donation volume have further limited blood supply. To ensure a sufficient and safe blood supply that meets the increasing clinical need for blood products, there is an urgent need to strengthen the country's blood donor management. This comprehensive effort should include educating and motivating more individuals especially from the rural areas to be involved in blood donation, developing rational and evidence-based selection criteria for donor eligibility, designing a donor follow-up mechanism to encourage more future donations, assessing the current donor testing strategy, improving donor service and care, building regional and national shared donor deferral database, and enhancing the transparency of the blood donation system to gain more trust from the general public. The purpose of the review is to provide an overview of the key process of and challenges with the blood donor management system in China.

Effect of blood donor characteristics on transfusion outcomes: a protocol for systematic review and meta-analysis

BACKGROUND

Optimal selection of blood donors is of paramount importance in ensuring the safety of blood products. The current selection process is concerned principally with the safety of the blood donor and the safety of the patient that receives the blood. Recent evidence suggests that the characteristics of the donor may affect transfusion outcomes for the recipient.

METHODS

We will conduct a systematic review of the association between major blood donor characteristics and red blood cell (RBC) transfusion outcomes. The primary objective is to assess the association of blood donor characteristics and the risk of adverse short-term and long-term clinical outcomes after RBC transfusion. We will search MEDLINE, EMBASE, Cochrane Central databases, as well as perform manual searches of top transfusion medical journals for prospective and retrospective studies. Study characteristics will be reported and the methodological quality of studies will be assessed. When appropriate, we will provide pooled odds ratio with 95% confidence intervals of the effect estimates, study clinical heterogeneity using pre-defined sensitivity and subgroup analyses, and study statistical heterogeneity using the I2 test.

DISCUSSION

The results of this systematic review will provide an evidence base regarding the potential clinical effects of donor characteristics on transfusion recipients to better guide policy and clinical practice. The evidence gathered from this review will also identify strengths and weaknesses of published studies regarding donor characteristics and transfusion outcomes and will identify knowledge gaps to inform future research in this field of transfusion medicine.

TRIAL REGISTRATION

PROSPERO Registration Number: CRD42013006726.

Gender differences and frequency of whole blood donation in Italian donors: even though I want to, I cannot?

Women are under-represented among blood donors and this difference is particularly strong in Italy. This study explore the reasons for the gender gap using a sample of donors who had stopped donating at least two years previously and analyzing the role of frequency of donation. No significant gender differences emerged between the reasons provided by subjects but Italy was the country with the longest prescribed interval between whole blood donations for women. The gender gap is related to the lengthy interval between successive donations of whole blood and reducing this interval could help increase the proportion of women donors.

A systematic review of factors associated with the deferral of donors failing to meet low haemoglobin thresholds

BACKGROUND/OBJECTIVES

Blood donors attending a donation session may be deemed ineligible to donate blood due to a failure to meet low haemoglobin (Hb) thresholds. Several studies have identified factors associated with a donor falling below these Hb thresholds. A review of these factors will inform future prospective studies and form the basis for predictive models of deferral due to low Hb.

MATERIALS/METHODS

Studies were identified by searching MEDLINE, EMBASE, The Cochrane Library and the WHO International Clinical Trials Registry from 1980 to September 2012. Demographic data, donor history, haematological/biological factors and the primary outcome of deferral due to low Hb were extracted. Analyses were descriptive and quantitative; pooled odds ratios (ORs) were obtained by meta-analysis.

RESULTS

Fifty-five studies met the inclusion criteria. A consistently higher rate of low Hb deferral was reported in females compared with males; meta-analysis showed a significantly greater risk of deferral due to low Hb in females compared with males in studies with universal Hb thresholds for males and females (OR 14.91, 95% confidence interval (CI) 12.82-17.34) and in studies with sex-specific Hb thresholds (OR 8.19, 95% CI 4.88-13.74). Greater rates of deferral due to low Hb were also associated with increasing age, higher ambient temperature, low body weight, shorter inter-donation interval and in donors of Hispanic or African descent.

CONCLUSION

This work will help to define the criteria that should be considered in any large scale study of blood donor deferral, especially those that measure or aim to change failure to meet low Hb thresholds.

A change in standard of minimum hemoglobin for male blood donors in Iran

BACKGROUND

The minimum Hb for blood donation varies from nation to nation. This study assessed the impact of blood donation on donors' iron stores based on different Hb levels. An estimation of drop in the blood collection was made with the new suggested Hb cut-off value.

MATERIALS AND METHODS

2017 male donors were studied. A questionnaire was filled out to gather demographic data, history of donation and risk factors of iron loss. Their blood samples were analyzed for RBC parameters, serum iron, TIBC, and ferritin level. The iron status of all first-time and regular donors was determined for each Hb level. The impact of changing the Hb cut-off value on annual blood collection was assessed.

RESULTS

All of the regular donors with Hb levels <13.1g/dL and 75% of those donors with Hb levels of 13.1-13.5 g/dL had abnormal iron stores. Iron deficiency dropped to 35% in donors with Hb levels of 13.5-14 g/dL. It was estimated that increasing the Hb cut-off from 12.5 g/dL to 13 g/dL or to 13.5 g/dL would cause a drop of 0.82% and 2.77% in the annual blood collection, respectively.

DISCUSSION

A modification in the minimum Hb level for blood donation is necessary when Hb is used as the single criterion for screening donors. Increasing the minimum Hb level will lead to an increase in donor deferral; therefore a comprehensive donor retention program will be needed.

Analysis of donor deferral at three blood centers in Brazil

BACKGROUND

The safety of the blood supply is ensured through several procedures from donor selection to testing of donated units. Examination of the donor deferrals at different centers provides insights into the role that deferrals play in transfusion safety.

STUDY DESIGN AND METHODS

A cross-sectional descriptive study of prospective allogeneic blood donors at three large blood centers located in São Paulo, Belo Horizonte, and Recife, Brazil, from August 2007 to December 2009 was conducted. Deferrals were grouped into similar categories across the centers, and within each center frequencies out of all presentations were determined.

RESULTS

Of 963,519 prospective blood donors at the three centers, 746,653 (77.5%) were accepted and 216,866 (22.5%) were deferred. Belo Horizonte had the highest overall deferral proportion of 27%, followed by Recife (23%) and São Paulo (19%). Females were more likely to be deferred than males (30% vs. 18%, respectively). The three most common deferral reasons were low hematocrit or hemoglobin, medical diagnoses, and higher-risk behavior.

CONCLUSION

The types and frequencies of deferral vary substantially among the three blood centers. Factors that may explain the differences include demographic characteristics, the order in which health history and vital signs are taken, the staff training, and the way deferrals are coded by the centers among other policies. The results indicate that blood donor deferral in Brazil has regional aspects that should be considered when national policies are developed.

Effectiveness of blood donor questionnaire directed at risk factor for transfusion transmitted infections in Pakistani population

Background:

Deferring blood donors who admit to high-risk behavior on questioning are likely to eliminate those in window period for transfusion transmitted infections (TTI). However, many questions have been implemented in some countries as part of donor history questionnaire, based on precautionary principle and not on evidence, and can result in increased donor losses. This study aims to identify effective risk-directed questions having high predictive value, in local context which can form part of blood donor deferral policies. For this, a case control study in a hospital blood bank having donation services was carried out prospectively over a period of three years.

Materials and Methods:

Two hundred and twenty donors, who were repeatedly reactive for HBsAg, anti-HCV, anti-HIV with EIA, and syphilis with TPHA, were the cases. Eight hundred and eighty four controls were the donors who tested negative for all TTI test. All donors answered seven hepatitis risk directed questions and their responses and reactivity status for TTI were used for statistical analysis with SPSS ver. 15.

Results:

Positive predictive value for history of jaundice at any age for HBsAg was 20%, while PPV for history of surgery in previous six months for both HBsAg and anti-HCVHCV was also around 20%, based on pretest probability of 7%. The post-test probability for these questions was around 30%. Odds ratios with 95% CI did not reveal any significant association of hepatitis with any of seven questions. Donor losses after deferring on basis of two questions were 5.3% per year, while deferral rate after all seven questions was 20%.

Conclusions:

Donors should be permanently deferred if there is history of jaundice at any age, while deferral period after surgery should be one year. Other risk-directed questions should not be used to defer donors. Donor deferral policies should be evidence based and questions with proven efficacy should be made part of donor history questionnaire to minimize donor losses.

Prevalence and trends of hepatitis C virus among blood donors in Antananarivo, from 2003 to 2009

PURPOSE OF THE STUDY

Due to anemia and maternal, childhood and infancy diseases, blood transfusion is one of the most important medical cares given in sub-Saharan Africa, including Madagascar. World Health Organization encourages worldwide countries to maximize transfusion security. Until now, there was no data within a large population of blood donors. Therefore, the aim of this study was to assess the prevalence and time trends of hepatitis C virus (HCV) among all first-time blood donors coming into the National Centre of Transfusion Supply in Antananarivo.

MATERIAL AND METHODS

This retrospective study was conducted at the National Centre of Transfusion Supply in Antananarivo from 2003 to May 2009. We looked up to all recorded results of systematic screening of blood donor candidates and we took data about all first-time blood donors, including age and gender. Forty-seven thousand five hundred and ten of 47,636 first-time blood donors were retained, the others were excluded due to lack of some data.

RESULTS

The mean age of our donors was 33.3 years (35.8 for male, and 32.6 for female; P<<0.05). Eighty percent were male (38,225/47,510). HCV prevalence was 0.65% during the period of study and HCV positive donor candidates were older than HCV negative (mean age: 39.1 vs. 33.2; P<<0.05). It was in fact stable from 2003 to 2007, and then decreased. HCV prevalence was higher in women than in men (0.9 vs. 0.6; P<0.05), and it increased by age (P<0.05).

CONCLUSION

Our study found a low prevalence of HCV among blood donors compared to many countries in Africa.

Transfusion safety in francophone African countries: an analysis of strategies for the medical selection of blood donors

BACKGROUND

The goal of selecting a healthy blood donor is to safeguard donors and reduce the risks of infections and immunologic complications for recipients.

STUDY DESIGN AND METHODS

To evaluate the blood donor selection process, a survey was conducted in 28 blood transfusion centers located in 15 francophone African countries. Data collected included availability of blood products, risk factors for infection identified among blood donor candidates, the processing of the information collected before blood collection, the review process for the medical history of blood donor candidates, and deferral criteria for donor candidates.

RESULTS

During the year 2009, participating transfusion centers identified 366,924 blood donor candidates. A mean of 13% (range, 0%-36%) of the donor candidates were excluded based solely on their medical status. The main risk factors for blood-borne infections were having multiple sex partners, sexual intercourse with occasional partners, and religious scarification. Most transfusion centers collected this information verbally instead of having a written questionnaire. The topics least addressed were the possible complications relating to the donation, religious scarifications, and history of sickle cell anemia and hemorrhage. Only three centers recorded the temperature of the blood donors. The deferral criteria least reported were sickle cell anemia, piercing, scarification, and tattoo.

CONCLUSIONS

The medical selection process was not performed systemically and thoroughly enough, given the regional epidemiologic risks. It is essential to identify the risk factors specific to francophone African countries and modify the current medical history questionnaires to develop a more effective and relevant selection process.

Minority donation in the United States: challenges and needs

PURPOSE OF REVIEW

In the United States, blood donation rates of African-Americans are 25-50% of that of white individuals. As African-Americans make up an ever increasing and now substantial minority, and African-American recipients of blood transfusion, both specialized, such as sickle cell disease patients, and general hospitalized patients, have a better chance of receiving phenotype-matched or appropriate red blood cell units when there is a significant percentage of products in the inventory from African-American donors, it is important to understand the reason for the observed difference.

RECENT FINDINGS

Possible reasons for this discrepancy in donation rates include increased rates of donor deferral and ineligibility; increased barriers to donation, such as fear and distrust; and different marketing and education strategies. Thus, to increase the blood availability to African-American recipients, the reasons for these donation rate differences must be better understood and subsequently addressed through improved blood donor recruitment programs. The majority of African-American donor recruitment programs have focused on donating for sickle cell disease patients, particularly children, which have been of limited success.

SUMMARY

Significant improvements in African-American donor recruitment are needed to adequately meet the demand of African-American patients as well as the entire population.

Demographic variations in blood donor deferrals in a major metropolitan area

BACKGROUND

Presenting blood donors are screened to ensure both their safety and that of the recipients of blood products. Donors with identified risks are deferred from donating blood either temporarily or permanently. Minorities are underrepresented as donors in the United States and this may in part be a result of increased donor deferral rates in minorities compared to white individuals.

STUDY DESIGN AND METHODS

Data consisted of deferred and successful blood donor presentations to the American Red Cross Southern Region in the metropolitan Atlanta area in 2004 to 2008. Bivariate and multivariate analyses were conducted by race/ethnicity, age group, and sex.

RESULTS

A total of 586,159 voluntary donor presentations occurred in 2004 to 2008, of which 79,214 (15.6%) resulted in deferral. In the age 16 to 69 years subset (98.3% of the presentations), deferred presentations were mostly women (78.2%). The most common reason for donor deferral was low hemoglobin (62.6%). The donor deferral rate varied by race/ethnicity, age, and sex: whites (11.1%), Hispanics (14.1%), and African Americans (17.9%); 16- to 19-year-olds (17.0%) and 50- to 59-year-olds (11.7%); and females (20.0%) and males (6.2%). Compared to whites and Hispanics, African American females had the highest deferral rate in each age group.

CONCLUSIONS

Minorities are disproportionately impacted by blood donor deferrals. Methods to decrease blood donor deferral rates among African Americans are needed.

Current concerns for blood donor well-being and health

In addition to assuring an adequate and safe blood supply, blood collection agencies are responsible for the well being of donors. Several aspects of the current blood donor experience may negatively impact donor health and require modification. Physicians need to be aware of health-related issues associated with blood donation in order to more effectively counsel patients participating in this critical community service and manage patients referred to them by blood collection agencies.

Proteomics meets blood banking: identification of protein targets for the improvement of platelet quality

Proteomics has brought new perspectives to the fields of hematology and transfusion medicine in the last decade. The steady improvement of proteomic technology is propelling novel discoveries of molecular mechanisms by studying protein expression, post-translational modifications and protein interactions. This review article focuses on the application of proteomics to the identification of molecular mechanisms leading to the deterioration of blood platelets during storage - a critical aspect in the provision of platelet transfusion products. Several proteomic approaches have been employed to analyse changes in the platelet protein profile during storage and the obtained data now need to be translated into platelet biochemistry in order to connect the results to platelet function. Targeted biochemical applications then allow the identification of points for intervention in signal transduction pathways. Once validated and placed in a transfusion context, these data will provide further understanding of the underlying molecular mechanisms leading to platelet storage lesion. Future aspects of proteomics in blood banking will aim to make use of protein markers identified for platelet storage lesion development to monitor proteome changes when alterations such as the use of additive solutions or pathogen reduction strategies are put in place in order to improve platelet quality for patients.