Epidemiology of blood collection in France

The risks of low hemoglobin deferral in a large retrospective cohort of plasmapheresis donors and the influence factors of return for a subsequent donation in China

Background

According to the Technical Operation Procedures for Plasmapheresis Collection Station (2019) in China, plasmapheresis donors with low hemoglobin (Hb) levels (men <12.0 g/dL; women <11.0 g/dL) were deferred for at least 2 weeks. The purpose of this retrospective study was to survey the demographic characteristics of plasmapheresis donors with low Hb deferral (LHD) and identify at-risk LHD donors, so as to enhance donor safety and improve donation service management.

Methods

From 2018 to 2020, a multi-center study involving plasmapheresis donors from 18 plasmapheresis centers in three provinces (Sichuan, Yunnan and Hunan) of China was conducted. Donor demographics (age, sex) and donation information (date of donation, first-time donors vs. repeat donors, the number of lifetime donations, the number of donations in the last 12 months, and whether the LHD donor returned for a subsequent donation) were collected. The Cochran-Mantel-Haenszel method was used to explore the risk factors for LHD while adjusting for the different provinces. Logistic regression analysis was used to investigate the factors influencing the return for a subsequent donation after LHD.

Results

A total of 497,039 plasmapheresis donors were included. Female donors' LHD rate was 0.15% on average, while male donors' LHD rate was 0.01%. Female donors aged 41-50 years old (OR: 2.276, 95% CI [1.333-3.887], p = 0.002) were more likely to experience LHD temporarily than those aged 18-30 years old. For female donors, compared with donations in the winter, they had a higher risk for LHD in the summer (OR: 2.217, 95% CI [1.670-2.943], p < 0.001), spring (OR: 2.402, 95% CI [1.806-3.196], p < 0.001), and fall (OR: 2.002, 95% CI [1.500-2.673], p < 0.001). Among the LHD donors, those who had donated more frequently in the past were more likely to return for a subsequent donation (p = 0.012).

Conclusions

Female donors were at a higher risk of LHD, particularly between the ages of 41 and 50. A clear seasonal pattern in the rate of LHD was observed. In the winter, the risk of LHD was the lowest; thus, it was advised to recruit plasmapheresis donors throughout the winter and to make the required adjustments for recruitment measures during other seasons. The number of previous donations was correlated with the return rate after LHD. Our observations could have practical implications for plasmapheresis donor management.

Source plasma deferral trends: A 3-year analysis of 255 centers in the United States

Background

Plasma contains many important proteins of therapeutic interest including albumin, clotting factors, and antibodies. Source plasma (SP) is in great demand particularly due to a shortage of immunoglobulin. To better understand how to increase supply, we examined SP donor deferrals for the previous 3 years.

Study design

This is a description of donor deferrals at 255 plasma donation centers in the United States for April 1, 2017 to March 31, 2020.

Results

A total of 4 587 923 events were evaluated for the 3‐year period 2017‐2020. There were 873 227 deferrals analyzed for 2017‐2018, 1 765 582 in 2018‐2019, and 1 949 114 for 2019‐2020. The most common deferral each year was for unacceptable blood pressure (BP) or pulse which comprised 27.9%, 28.2%, and 28.3% of deferrals in 2017‐2018, 2018‐2019, and 2019‐2020, respectively. The second most common cause of deferral was for unacceptable hematocrit which comprised 14.1% of deferrals in 2017‐2018, and 16.0% in 2018‐2019 and 2019‐2020. The majority of these deferred donors had low hematocrits and were predominately (~80%) female. Deferral for unacceptable total protein comprised a smaller percentage (~4%) of deferrals.

Discussion

Most donor deferrals were due to unacceptable screening results, particularly high BP, elevated pulse, low protein, and low hematocrit. Although rates of deferrals in other categories have been slightly increasing over time, they comprise a small percentage. Donor education regarding healthy lifestyle choices may improve overall donor health, decrease deferrals, and increase SP supply.

Analysis of blood donor pre-donation deferral in Dubai: characteristics and reasons

Background

To ensure an adequate and safe blood supply, it is crucial to select suitable donors according to stringent eligibility criteria. Understanding the reasons for donor deferral can help in planning more efficient recruitment strategies and evaluating donor selection criteria. This study aims to define donor pre-donation deferral rates, causes of deferral, and characteristics of deferred donors in Dubai.

Materials and methods

This retrospective study was conducted on all donors who presented for allogeneic blood donation between January 1, 2010, until June 30, 2013, in Dubai Blood Donation Centre, accredited by the American Association of Blood Banks. The donation and deferral data were analyzed to determine the demographic characteristics of accepted and deferred donors, and frequency analyses were also conducted.

Results

Among 142,431 individuals presenting during the study period, 114,827 (80.6%) were accepted for donation, and 27,604 (19.4%) were deferred. The overall proportion of deferrals was higher among individuals less than 21 years old (35%, P<0.000), females (44% were deferred compared to 15% of males, P<0.0001), and first-time donors (22% were deferred vs 14% of repeat donors, P<0.0001). The main causes for a temporary deferral were low hemoglobin and high blood pressure.

Discussion

The deferral rate among blood donors in Dubai is relatively high compared to the internationally reported rates. This rate was higher among first-time donors and females, with low hemoglobin as the major factor leading to a temporary deferral of donors. Strategies to mitigate deferral and improve blood donor retention are urged in Dubai to avoid additional stress on the blood supply.

Rates and reasons for blood donor deferral, Shiraz, Iran. A retrospective study

CONTEXT AND OBJECTIVE

Knowledge of the reasons for donor deferral can help in planning more efficient recruitment strategies and evaluating donor selection criteria. This study aimed to investigate the rates and reasons for donor deferral.

DESIGN AND SETTING

Retrospective study at Shiraz Blood Transfusion Center, Shiraz, Iran.

METHODS

141,820 volunteers were interviewed confidentially by physicians before blood donation. The rate of and reasons for donor deferral were investigated according to demographic characteristics. The data were analyzed using the comparison-of-proportions test of the MedCalc statistical software.

RESULTS

43,839 people (30.9%) who had come for blood donation were deferred, 1,973 (4.5%) of them permanently. The deferral rate was significantly higher among women, single individuals and first-time donors, compared with men, married individuals and those with a history of previous donation (P < 0.0001). The deferral rate was significantly higher in the 17 to 30-year-old group (P < 0.05). The reasons for deferral were divided into five categories: risk factors possibly related to HIV or hepatitis (43.6%), underlying diseases (31.9%), non-eligible conditions (13.5%), medications that interfere with blood donation (7.8%) and risk factors that may relate to bacterial or viral infections except HIV and hepatitis infections (3.2%).

CONCLUSION

Effective measures are required for documenting the impact of deferral on blood availability, monitoring the effectiveness of and need for deferral, and determining the reasons and rates of deferral.

Blood Donor Deferral among Students in Northern Japan: Challenges Ahead

BACKGROUND

As Japan's aging society needs more blood, young students comprise a progressively smaller portion of the donor pool. To ensure a safe and sustainable blood supply, it is crucial to select suitable donors. This study aims to evaluate donor deferral rates, causes of deferral, and characteristics of deferred Japanese students.

METHODS

Computerized records of blood centers in northern Japan (Miyagi and Fukushima Prefectures) from March 2010 through March 2011 were retrospectively analyzed.

RESULTS

Among 231,361 individuals visiting during the 12-month period, 24,778 were students. Of these, 19,193 (77%) attempted donation, and 5,585 (23%) were deferred. Low hemoglobin, questionnaire-based interview decisions, and medication were the main reasons for temporary deferral. Age, sex, and blood center location were associated with low hemoglobin; donation history and blood center location were associated with medication-based deferral. The odds ratio among female students deferred for low hemoglobin was 35.48 with a 95% CI of 27.74-45.38.

CONCLUSIONS

These results suggest that continued efforts are needed to motivate deferred potential donors to return, to prevent low hemoglobin especially among females, and to review medical interview decisions, while paying close attention to regional differences.

Analysis of blood donor deferral in Japan: characteristics and reasons

BACKGROUND AND OBJECTIVES

To ensure an adequate and safe blood supply, it is crucial to select suitable donors according to stringent eligibility criteria. This study aims to evaluate donor deferral rates, causes of deferral, and characteristics of deferred Japanese donors.

MATERIALS AND METHODS

Computerized records of blood centers in Miyagi and Fukushima Prefectures from March 2010 through March 2011 were retrospectively analyzed.

RESULTS

Among 231,361 individuals presenting during this period, 186,513 had complete data. Of these 160,763 (86%) attempted donation and 25,750 (14%) were deferred. The overall proportion of deferrals was higher among those less than 20 years old (24% vs 13%, P<0.0001), female (26% vs 7%, P<0.0001), and first-time donors (28% vs 12%, P<0.0001). Factors that were significantly associated with deferral status were female sex [Odds ratio (OR)=4.40], first-time donation attempt (OR=2.42), and donation at Fukushima blood centers (OR=0.57). Main reasons for temporary deferral were low hemoglobin and questionnaire-based interview decisions.

CONCLUSIONS

First-time and female were more frequently deferred whereas those presented at Fukushima blood centers were less frequently deferred. Low hemoglobin was the major contributor for female donors. Strategies to minimize deferral are needed to ensure an adequate and safe blood supply.

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.

Reasons for blood donation deferral in sub-Saharan Africa: experience in Ivory Coast

INTRODUCTION

Blood donor selection is important to ensure the safety of both donors and recipients. There is a paucity of data on reasons for blood donor deferral in Ivory Coast. The aim of this study was to identify the reasons for predonation deferral at a blood collection site at General Hospital, Yopougon Attié in Abidjan.

MATERIALS AND METHODS

The investigators conducted a retrospective audit of data pertaining to donor deferral for blood donors that presented to the general hospital of Yopugon Attié from January 1, 2006 to December 31, 2008.

RESULTS

A total of 10,694 prospective blood donors, presented over the study period, and 24,363 attempts to donate were registered. The majority were repeat blood donors (77.4%). A total of 2618 (10.8%) donors were deferred. The most frequent reason for deferral was a low hemoglobin level (42.5%), with females constituting the majority of those deferred. The second most frequent reason for deferral was a reported change of or new sexual partner (34.3%); male donors were predominant in this group. Additional reasons for deferral included short interdonation interval (4.6%) and reactivity for a screened biomarker (2.3%).

CONCLUSION

Although the rates for permanent and temporary deferral rates are similar between the Ivory Coast and high-middle income countries, the causes and demographics differ. The reasons for exclusion are preventable through awareness and education of prospective blood donors.

Profile of blood donors and reasons for deferral in coastal South India

BACKGROUND

A blood transfusion is a life-saving procedure in many instances. An adequate supply of safe blood is ensured by exercising donor deferral criteria and screening for Transfusion Transmitted Infections (TTI). The aim of this paper is to study the profile of blood donors and reasons for donor deferral in coastal South India.

METHOD

The study was conducted at a tertiary care hospital in Mangalore. All those who donated between 1 January 2008 and 31 December 2008 were included in the study. Data was collected using a pre-tested semi-structured proforma and analysed using SPSS version 11.5.

RESULTS

Most of the donors were under the age of 25 (42.92%). Donors were predominantly male (95.20%). In terms of occupation, most subjects were students (28.01%) followed by businessmen (18.61%). Slightly more than three-quarters of the donors (77.20%) were replacement donors. The main reasons for deferral were consumption of medication in the past 72 hours (15.15%), hypertension (13.18%), a low haemoglobin level (12.34%) and alcohol intake in the past 72 hours (12.20%). Among the TTIs identified, most samples were positive for Hepatitis B surface Antigen - HBsAg (0.87%) or tested positive for Anti-Hepatitis C (HCV antibodies (0.36%).

CONCLUSION

From the study it was concluded that the majority of the donor population was young and educated. The reason for donation was mainly replacement rather than voluntary. This issue needs to be addressed by exercising proactive measures to increase the number of voluntary, nonremunerated, low-risk donors.

Donor return after temporary deferral

BACKGROUND

The consequences of temporary predonation deferral are unsatisfactorily understood. Studies have found that deferral negatively impacts future donor return. However, the applicability of these findings across centers has not been established.

STUDY DESIGN AND METHODS

Using a cohort design, presenting donors with a temporary deferral in 2006 to 2008 in one of six categories (low hematocrit [Hct], blood pressure or pulse, feeling unwell, malaria travel, tattoos or piercing and related exposures, or could not wait or second thoughts) were passively followed for up to a 3-year period for the time to first return after deferral expiration at six US blood centers. Time-to-event methods were used to assess return. We also analyzed which donor characteristics were associated with return using multivariable logistic regression.

RESULTS

Of 3.9 million donor presentations, 505,623 resulted in deferral in the six categories. Low Hct was the most common deferral, had the shortest median time to return (time in days when 50% of deferred donors had returned), and had the largest cumulative proportion of donors returning. Deferrals of shorter duration had better return. Longer-term deferrals (up to 1 year in length) had the lowest cumulative return proportion, which did not exceed 50%. Return was associated with previously identified factors such as repeat donor status, older age, and higher educational attainment regardless of the type of deferral. In addition, return was associated with having been born in the United States and donation at fixed sites.

CONCLUSION

The category of temporary deferral influences the likelihood of future return, but the demographic and donation factors associated with return are largely consistent regardless of the deferral.

Human immunodeficiency virus type 1 incidence among blood donors in France, 1992 through 2006: use of an immunoassay to identify recent infections

BACKGROUND

In France, blood donations found to be positive for the presence of human immunodeficiency virus type 1 (HIV-1) are further tested to detect recent infections (< or =180 days) using an enzyme immunoassay (EIA-RI) developed in 2002. The characteristics of recently infected donors, estimates of HIV-1 incidence, and the residual risk of transfusion-transmitted HIV-1 are presented, in both first-time and repeat donors.

STUDY DESIGN AND METHODS

Of the 1027 donations found to be HIV-1-positive between 1992 and 2006, a total of 459 could be retrospectively tested with the EIA-RI. Multivariate analysis was performed to determine the donor characteristics associated with recent infection. Incidence rates and residual risk obtained with the EIA-RI were compared to classical cohort estimates derived from repeat donor histories.

RESULTS

Of the 459 HIV-1-positive donors studied, 105 (22.9%; 95% confidence interval [CI], 19.2-27.0) were identified as recently infected. Factors independently associated with recent infection were repeat donor status (adjusted odds ratio [AOR], 4.0; 95% CI, 2.4-6.9) and non-B subtypes (AOR, 2.0; 95% CI, 1.2-3.6). Incidence decreased from 4.3 (95% CI, 1.9-9.4) in 1992 through 1994 to 1.3 (95% CI, 0.6-2.8) per 10(5) in 2004 through 2006 in first-time donors and from 3.2 (95% CI, 2.0-5.0) to 0.8 (95% CI, 0.4-1.4) per 10(5) in repeat donors. Incidence and residual risk estimates were similar to those obtained with the classical cohort method.

CONCLUSION

This study suggests that the EIA-RI can be used to estimate HIV-1 incidence in a population with low HIV incidence. The estimated HIV-1 incidence in the blood donor population confirms the extremely low risk (1 in 3,350,000 donations) of HIV-infected blood donations entering the blood supply in France.

Whole blood donor deferral rate and characteristics of the Turkish population

Whole blood (WB) donors are deferred for several reasons, either permanently or temporarily. In this retrospective study, we quantified the rate of and reasons for donor deferral among Turkish donors. Computer records of the last 5 years were analysed to quantify the deferral rate and reasons. Deferrals were categorized as temporary short-term (1-56 days), long-term (57-365 days) and multiple years or permanent (more than 365 days). Deferred donors were also analysed according to gender, age and education level. A total of 95 317 persons were admitted for WB donation: 89.1% of them were male donors and 59.9% were in the 30 to 49-year old age category. Rates of deferral for temporary short-term, long-term, permanent or for unknown reasons were 66, 22.5, 10 and 1.5% respectively. Female donors were deferred more frequently than male donors (25.8 vs. 13.3%, P<or= 0.0001). The deferral rates were significantly different among the different age groups (P < 0.0001). Donor education level had no effect on the deferral rates (P > 0.05). The main reason for deferral was common cold and/or sore throat or elevated temperature (20.4%) in male donors and low haemoglobin (51.6%) in female donors. Although the three uppermost reasons for deferral in women were identical for all age categories, these varied in the male group (high-risk sex partner for the younger group vs. hypertension and low haemoglobin for the older group). Although permanent and temporary deferral rates are similar between the Turkish population and western countries, leading causes vary widely.

The consequences of temporary deferral on future whole blood donation

BACKGROUND

The consequences of temporary deferral are not well understood. This study sought to investigate blood donor return after deferral expiration.

STUDY DESIGN AND METHODS

A retrospective cohort analysis of allogeneic whole-blood donation was conducted. All deferred donors and a random sample of eligible donors were identified from the year 2000, with subsequent blood center visits through December 2005 captured. Stratified results are reported as the percentage returning, rates of return, and time to return. Measures of statistical association and Cox regression modeling are reported.

RESULTS

For first-time (FT) donors, 25 percent of temporarily deferred donors returned during the 5-year follow-up period compared to 47 percent of eligible donors (p < 0.0001); for repeat donors, 81 and 86 percent of deferred and eligible donors returned, respectively (p < 0.0001). Depending on the deferral category, 14 to 31 percent of FT and 58 to 90 percent of repeat donors returned. Rates (per year) of successful donation during the follow-up period were 0.09 for index-deferred FT donors, 0.28 for eligible FT donors, 1.0 for deferred repeat donors, and 1.45 for eligible repeat donors. Multivariate modeling indicated that in addition to deferral, age, sex, race, and education were associated with return in both FT and repeat donors.

CONCLUSION

The effects of deferral were more pronounced than expected, affecting both FT and repeat donors. For FT donors, the type and duration of deferral, while important, were not as relevant as hypothesized because so few returned, suggesting the need to develop appropriate interventions to recapture those donors likely to be eligible.

Quantifying losses to the donated blood supply due to donor deferral and miscollection

BACKGROUND

Donors are deferred for multiple reasons. Losses related to disease marker rates are well established. Donor and donation losses for other reasons, however, have not been extensively quantified.

STUDY DESIGN AND METHODS

To quantify these losses, three data sets from the Blood Centers of the Pacific were combined, permitting detailed analysis of year 2000 allogeneic whole-blood donations.

RESULTS

During 2000, 13.6 percent of 116,165 persons who presented for donation were deferred at presentation. Short-term deferral accounted for 68.5 percent (hematocrit was most common at 60%); long-term deferral accounted for 21 percent (travel to a malarial area and tattoo or other nonintravenous drug use needle exposure were most common at 59 and 29%, respectively); and multiple-year or permanent deferral accounted for 10.5 percent (UK travel [variant Creutzfeldt-Jakob disease] risk and emigration from a malarial area were most common at 38 and 11%, respectively). Disease-marker-reactive donations represented 0.9 percent of donor outcomes. The prevalence of deferral and also miscollection (under- and overweight units) varied by age, sex, and first-time versus repeat donor status. Overall, miscollection led to a loss of 3.8 percent of 100,141 collections, ranging from 1.9 percent in repeat male donors 40 to 54 years of age to 10.7 percent in first-time female donors 16 to 24 years of age.

CONCLUSION

Loss of units from both first-time and repeat donors due to temporary deferral and loss of units from miscollection are more common events than losses due to disease marker testing. Some of these losses may be avoidable and could increase the blood supply without having to recruit new donors.

Blood transfusion in a random sample of hospitals in France

BACKGROUND

Representative information on blood use is scarce. A large-scale study of blood recipients and blood use in France was conducted.

STUDY DESIGN AND METHODS

Based on a random sampling, this study was carried out in teaching and other hospitals between March and December 1997. In each hospital, a patient was included if he or she received an allogeneic or an autologous transfusion during the observation period for that hospital. For each recipient, product and patient characteristics for 24 hours after inclusion were collected.

RESULTS

From the 175 hospitals that had given a transfusion to at least one patient during the observation period, 3206 patients were included. Most transfusion recipients (57%) were over 65 years old; 42 percent were in teaching hospitals and 53 percent in medical wards. Among the 3044 adults, 91 percent received an allogeneic transfusion. Fifty-three percent of allogeneic units were WBC reduced. The indications most frequently reported for allogeneic transfusion were neoplasms (48%) and those for autologous transfusion were disorders of musculoskeletal (63%) or circulatory (15%) systems. The patients in nonteaching hospitals were more often transfused during surgery and were more likely to be aged and to have a musculoskeletal disorder than were patients in teaching hospitals.

CONCLUSION

General collection of such data, within a system of traceability, could provide relevant denominators from which to interpret adverse-reaction data.