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Jagirdar H, Nwobi NH, Swanevelder R, Cockeran R, Bruhn R, Kaidarova Z, Bravo MD, van den Berg K, Custer BS, Vassallo R, Ding Y, Panagiotoglou D, Russell WA. Blood donor return behavior in South Africa and the United States before and during the COVID-19 pandemic. Transfusion 2024. [PMID: 38940011 DOI: 10.1111/trf.17934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Studies preceding the COVID-19 pandemic found that slower time-to-return was associated with first-time, deferred, and mobile drive blood donors. How donor return dynamics changed during the COVID-19 pandemic is not well understood. METHODS We analyzed visits by whole blood donors from 2017 to 2022 in South Africa (SA) and the United States (US) stratified by mobile and fixed environment, first-time and repeat donor status, and pre-COVID19 (before March 2020) and intra-COVID19. We used Kaplan-Meier curves to characterize time-to-return, cumulative incidence functions to analyze switching between donation environments, and Cox proportional hazards models to analyze factors influencing time-to-return. RESULTS Overall time-to-return was shorter in SA. Pre-COVID19, the proportion of donors returning within a year of becoming eligible was lower for deferred donors in both countries regardless of donation environment and deferral type. Intra-COVID19, the gap between deferred and non-deferred donors widened in the US but narrowed in SA, where efforts to schedule return visits from deferred donors were intensified, particularly for non-hemoglobin-related deferrals. Intra-COVID19, the proportion of donors returning within a year in SA was higher for deferred first-time donors (>81%) than for successful first-time donors (80% at fixed sites; 69% at mobile drives). CONCLUSIONS The pandemic complicated efforts to recruit new donors and schedule returning visits after completed donations. Concerted efforts to improve time-to-return for deferred donors helped mitigate donation loss in SA during the public health emergency.
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Affiliation(s)
- Huzbah Jagirdar
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Nkasiobi H Nwobi
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | | | - Riana Cockeran
- South African National Blood Service, Johannesburg, South Africa
| | - Roberta Bruhn
- Vitalant Research Institute, San Francisco, California, USA
- University of California, San Francisco, California, USA
| | | | | | - Karin van den Berg
- South African National Blood Service, Johannesburg, South Africa
- Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
| | - Brian S Custer
- Vitalant Research Institute, San Francisco, California, USA
- University of California, San Francisco, California, USA
| | | | - Yichuan Ding
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
| | | | - W Alton Russell
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
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Munro MG, Mast AE, Powers JM, Kouides PA, O'Brien SH, Richards T, Lavin M, Levy BS. The relationship between heavy menstrual bleeding, iron deficiency, and iron deficiency anemia. Am J Obstet Gynecol 2023; 229:1-9. [PMID: 36706856 DOI: 10.1016/j.ajog.2023.01.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/09/2023] [Accepted: 01/14/2023] [Indexed: 01/26/2023]
Abstract
For reproductive-aged women, the symptom of heavy menstrual bleeding is highly prevalent and a major contributor to iron deficiency and its most severe manifestation, iron deficiency anemia. It is recognized that these 2 clinical entities are not only highly prevalent, but their interrelationship is poorly appreciated and frequently normalized by society, healthcare providers, and affected girls and women themselves. Both heavy menstrual bleeding and iron deficiency, with or without anemia, adversely impact quality of life-heavy menstrual bleeding during the episodes of bleeding and iron deficiency on a daily basis. These combined issues adversely affect the lives of reproductive-aged girls and women of all ages, from menarche to menopause, and their often-insidious nature frequently leads to normalization. The effects on cognitive function and the related work and school absenteeism and presenteeism can undermine the efforts and function of women in all walks of life, be they students, educators, employers, or employees. There is also an increasing body of evidence that suggests that iron deficiency, even in early pregnancy, may adversely impact fetal neurodevelopment with enduring effects on a spectrum of cognitive and psychological disorders, critically important evidence that begs the normalization of iron stores in reproductive-aged women. The authors seek to raise individual, societal, and professional awareness of this underappreciated situation in a fashion that leads to meaningful and evidence-based changes in clinical guidance and healthcare policy directed at preventing, screening, diagnosing, and appropriately managing both disorders. This manuscript provides evidence supporting the need for action and describes the elements necessary to address this pervasive set of conditions that not only affect reproductive-aged girls and women but also the lives of children everywhere.
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Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Alan E Mast
- Versiti Blood Research Institute, Milwaukee, WI
| | - Jacquelyn M Powers
- Department of Pediatrics, Baylor College of Medicine, Houston TX; Cancer and Hematology Center, Texas Children's Hospital, Houston, TX
| | - Peter A Kouides
- Mary M. Gooley Hemophilia Center, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sarah H O'Brien
- Center for Health Equity and Outcomes Research and the Hemostasis and Thrombosis Center, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Division of Pediatric Hematology, Oncology & Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH
| | - Toby Richards
- Division of Surgery, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Michelle Lavin
- National Coagulation Centre, St James' Hospital, Dublin, Ireland; Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Barbara S Levy
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, CA; Department of Obstetrics and Gynecology, The George Washington University, Washington, DC
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Cipek V, Ferenac Kiš M, Ratić D, Piškorjanac S, Samardžija M, Kralik K, Samardžija M. REASONS FOR DEFERRAL IN DEFERRED VOLUNTARY BLOOD DONORS IN EASTERN CROATIA. Acta Clin Croat 2023; 62:93-105. [PMID: 38304378 PMCID: PMC10829957 DOI: 10.20471/acc.2023.62.01.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2024] Open
Abstract
When choosing a voluntary blood donor (VBD), it is important to ensure the donor health, and at the same time to produce a quality and safe blood product. The donor selection process leads to donor rejection related to their current health condition. The aim of this study was to determine gender differences in VBDs, to examine the reasons for their rejection, and to determine the share of permanently and temporarily deferred VBD, especially due to low hemoglobin levels. The research was conducted in eastern Croatia in the 2014 to 2018 period. The study included 144,041 blood donations from a total of 80,418 VBDs, of which 83.3% of donations were from male VBDs and 16.7% from female VBDs. There were 11.46% of temporarily deferred and permanently rejected donors. Out of all temporarily deferred donors and possible reasons for deferral, the largest share of deferrals referred to a reduced hemoglobin level, which accounted for 54% in female VBD and 46% in male VBD. Female VBDs made up to one-third of total VBDs and account for one-sixth of total blood donations. Low hemoglobin was the most common reason for VBD deferral. Gender and age are related to blood hemoglobin levels in rejected and accepted donors. Female VBDs represent a potential reservoir for increasing the total number of VBDs.
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Affiliation(s)
- Vladimir Cipek
- Fresenius Kabi, EMEA Region, Bad Homburg, Germany
- University Hospital Centre Osijek, Department of Transfusion Medicine, Osijek, Croatia
| | - Marina Ferenac Kiš
- University Hospital Centre Osijek, Department of Transfusion Medicine, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Dalibor Ratić
- University Hospital Centre Osijek, Department of Transfusion Medicine, Osijek, Croatia
| | - Silvija Piškorjanac
- University Hospital Centre Osijek, Department of Transfusion Medicine, Osijek, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marko Samardžija
- Nord-Trøndelag Hospital Trust – Namsos Hospital, Department of Internal Medicine, Namsos, Norway
| | - Kristina Kralik
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marina Samardžija
- University Hospital Centre Osijek, Department of Transfusion Medicine, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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4
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Spencer BR, White JL, Patel EU, Goel R, Bloch EM, Tobian AA. Eligibility Considerations for Female Whole Blood Donors: Hemoglobin Levels and Iron Status in a Nationally Representative Population. Transfus Med Rev 2023; 37:27-35. [PMID: 36528466 PMCID: PMC10787604 DOI: 10.1016/j.tmrv.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
Blood collection from minority populations improves the transfusion support of patients with sickle cell disease and thalassemia, but efforts are challenged by high deferral rates for hemoglobin (Hb) eligibility thresholds. This study sought to evaluate hemoglobin and iron status of a representative US female population to assess the suitability of 12.0 g/dL as minimum hemoglobin. Data were extracted from the National Health and Nutrition Examination Surveys (NHANES), 1999-2010. A national sample designed to reflect potential female blood donors (weight ≥110 lbs, not pregnant, no infectious marker reactivity, and no blood donation in past year) aged 16 to 49 years was analyzed for Hb and serum ferritin (SF) measures by race/ethnicity (N = 6937). Mean Hb and SF and the prevalence of iron deficiency ([ID] SF<12 ng/mL and SF<26 ng/mL) and low Hb (<12.5 g/dL and <12.0 g/dL) were estimated. Multivariable modified Poisson regression compared the prevalence for ID or low Hb at each cutoff by race/ethnicity. Mean SF values were higher and ID prevalence was lower in Non-Hispanic (NH) White (SF = 45.3 ng/mL, SF<12 ng/mL = 8.2%) than NH Black (SF = 39.6 ng/mL, SF<12 ng/mL = 14.2%) and Hispanic (SF = 36.5 ng/mL, SF<12 ng/mL = 12.7%) females. Compared to NH White females (13.7 g/dL), mean Hb was lower in NH Black (12.6 g/dL) and Hispanic females (13.4 g/dL). The percentage with Hb<12.5 g/dL was >4 times greater in NH Black (39.1%) and >2 times greater in Hispanic females (16.5%) compared to NH White (8.6%). Within 0.5 g/dL incremental categories of Hb, NH Black had higher mean SF levels and lower prevalence of SF<12 ng/mL or <26 ng/mL compared to NH White and Hispanic females. At Hb of 12.0 to 12.4g/dL, NH Black females had better measures of iron status (SF = 39.1 ng/mL, %SF<12 ng/mL = 12.0%) than NH White (SF = 33.6 ng/mL, %SF<12 ng/mL=15.8%) and Hispanic (SF = 30.4 ng/mL, %SF<12 ng/mL=15.5%) females whose Hb was 12.5 to 12.9 g/dL. Adjusting for age and Hb, the prevalence ratio for low SF was significantly lower in NH Black compared to NH White females at both SF<26 ng/mL (adjusted prevalence ratio [aPR] = 0.83, 95%CI = 0.76-0.92) and SF<12 ng/mL (aPR = 0.66, 95%CI = 0.52-0.83). NH Black females with Hb 12.0 to 12.4g/dL have better iron stores than NH White and Hispanic females whose Hb is 12.5 to 12.9 g/dL. The distribution of Hb and iron may support the safe collection of blood for female donors below the current Hb eligibility requirement of 12.5 g/dL.
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Affiliation(s)
| | - Jodie L White
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Eshan U Patel
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Aaron Ar Tobian
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
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5
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Xiao G, Dong D, Wang Y, Li C, Huang GT, Yang H, Huang J, Chen F. 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. PeerJ 2023; 11:e14999. [PMID: 36935911 PMCID: PMC10019327 DOI: 10.7717/peerj.14999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
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.
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Affiliation(s)
- Guanglin Xiao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Demei Dong
- Beijing Tiantan Biological Products Company Limited, Beijing, China
| | - Ya Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Changqing Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Gong tian Huang
- Shanghai RAAS Blood Products Company Limited, Shanghai, China
| | - Hui Yang
- Nanyue Biopharming Corporation Ltd, Hengyang, China
| | - Jing Huang
- Jiange Plasmapheresis Station, Sichuan Yuanda Shuyang Pharmaceutical Company Limited, Guangyuan, China
| | - Fei Chen
- Cangxi Plasmapheresis Station, Sichuan Yuanda Shuyang Pharmaceutical Company Limited, Guangyuan, China
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6
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M Ferreira C, Vieites Y, Goldszmidt R, B Andrade E. The effect of temporary deferrals on donor return: A 26-year assessment in a setting without retention activities. Transfusion 2022; 62:1583-1593. [PMID: 35855649 DOI: 10.1111/trf.17025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies that describe the negative association between temporary deferrals and donor return rates commonly come from settings where mechanisms are in place to win back lapsing donors. There is little evidence on the size and prevalence of this negative association in settings with no such retention activities. STUDY DESIGN AND METHODS We use data from more than 2 million donation attempts made at a blood collection agency in Brazil over a 26-year period. We describe the distribution of deferrals across donor demographic and behavioral characteristics, and estimate multivariate survival analysis models with matched samples to measure the impact of deferrals on return rates. We control for sex, race, age, education, donation type, number of previous attempts, previous donations, and previous deferrals. We test for heterogeneous effects in interaction models with selected donor demographic and behavioral characteristics. RESULTS Temporary deferrals were associated with a 50% decrease in the likelihood of return. Although the effect was observed for all population subgroups and across the full length of the dataset, it varied in magnitude. The influence of deferrals was more negative among older donors and those reporting replacement motives, and less negative among more educated donors and those with a previous donation. DISCUSSION We found that temporary deferrals meaningfully harm donor careers in a setting where specific retention activities are absent. Although the effects are widespread across the population and persistent in time, there are also heterogeneities, which must be considered when designing interventions targeted at wining-back specific groups of deferred donors.
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Affiliation(s)
- Claudio M Ferreira
- Brazilian School of Public and Business Administration, Fundação Getulio Vargas (FGV-EBAPE), Rio de Janeiro, Brazil
| | - Yan Vieites
- Brazilian School of Public and Business Administration, Fundação Getulio Vargas (FGV-EBAPE), Rio de Janeiro, Brazil
| | - Rafael Goldszmidt
- Brazilian School of Public and Business Administration, Fundação Getulio Vargas (FGV-EBAPE), Rio de Janeiro, Brazil
| | - Eduardo B Andrade
- Brazilian School of Public and Business Administration, Fundação Getulio Vargas (FGV-EBAPE), Rio de Janeiro, Brazil
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7
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Urbina A, García-Otálora MA, Mendoza-Romero D, Rocha F, Rodriguez A, Palomino F, Weinauer F. Deferral due to low hemoglobin and predictors of permanence in the blood donation system of repeat female blood donors. Transfus Apher Sci 2021; 61:103340. [PMID: 34896008 DOI: 10.1016/j.transci.2021.103340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the deferral rate due to low hemoglobin (Hb) in repeat female blood donors and identify the factors affecting their permanence in the blood donation system. MATERIALS AND METHODS 8,368 repeat female blood donors who donated from January 2012 to December 2018 were included. Bivariate analysis and Kaplan-Meier curves were used to identify the covariates possibly associated with developing low Hb, and Cox proportional hazards modeling was used to adjust for all confounders. RESULTS The global deferral rate due to low Hb was 2.4 %. According to baseline Hb, the frequency of low Hb was 0.7-4.1 %, and it was higher in platelet donors (5.8-9.1 %) than in whole blood donors (1.9 %). The main predictors were baseline Hb (compared to the first quartile; hazard ratio [HR] = 0.487 for the second quartile; 0.234 for the third; and 0.095 for the fourth); change in Hb (HR = 2.689 for a >0.49 g/dL change, compared to smaller changes); the type of donation (compared to whole blood donors, HR = 2.317 for platelet donors); and donation interval (compared to >12.5 month intervals; HR = 2.220 for 8.0-12.5 months; HR = 5.658 for 5.4-8.0 months; and HR = 9.452 for <5.4 months). CONCLUSIONS In female blood donors at moderate altitude, the probability of developing low Hb increases with a baseline Hb of 13.5-14.0 g/dL, with a change in Hb >0.49 g/dL, in platelet donors, and with donation intervals <12.5 months. These four predictive factors can be used together for early identification of donors at risk of developing low Hb, to institute appropriate measures.
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Affiliation(s)
- Adriana Urbina
- Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Carrera 24 #63C-69, Quinta Mutis, Bogotá, D.C., Colombia.
| | - Michel-Andrés García-Otálora
- Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Carrera 24 #63C-69, Quinta Mutis, Bogotá, D.C., Colombia
| | - Dario Mendoza-Romero
- Fundación Universitaria del Area Andina, Facultad de Ciencias de la Salud y el Deporte, Calle 69 #15-40, Bogotá, Colombia
| | - Felix Rocha
- Banco Nacional de Sangre, Cruz Roja Colombiana, Av Carrera 68 #68B-31, Bogotá, D.C., Colombia
| | - Ayda Rodriguez
- Banco Nacional de Sangre, Cruz Roja Colombiana, Av Carrera 68 #68B-31, Bogotá, D.C., Colombia
| | | | - Franz Weinauer
- German RC Blood Services, Working Group of the GRC, Am Mühlberg 14 B Starnberg, D- 82319, Germany
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Dei-Adomakoh Y, Asamoah-Akuoko L, Appiah B, Yawson A, Olayemi E. Safe blood supply in sub-Saharan Africa: challenges and opportunities. Lancet Haematol 2021; 8:e770-e776. [PMID: 34481544 DOI: 10.1016/s2352-3026(21)00209-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022]
Abstract
The low recruitment and retention of blood donors in sub-Saharan Africa is a grave concern for blood transfusion services in the region. This problem is exacerbated by factors such as a high prevalence of transfusion-transmissible infections and anaemia, over-reliance on family replacement donors, resource constraints, and poor communication with the public. To improve blood safety and availability, innovative intervention strategies must be developed and implemented. The primary objective of this Series paper is to discuss the available evidence in the region and to provide recommendations on how to improve safe blood supply in sub-Saharan Africa. These recommendations include a call for renewed attention to donor recruitment in blood transfusion centres, a consistent and structured educational intervention, the development and adherence to national policies on blood donor selection with focus on voluntary donations, and comprehensive screening of donations for transfusion-transmissible infections. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Yvonne Dei-Adomakoh
- Department of Haematology, University of Ghana Medical School, Accra, Ghana.
| | - Lucy Asamoah-Akuoko
- Research and Development Department, National Blood Service Ghana, Accra, Ghana
| | - Bernard Appiah
- Department of Public Health, Falk College, Syracuse University, Syracuse, NY, USA
| | - Alfred Yawson
- Department of Community Medicine, University of Ghana Medical School, Accra, Ghana
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9
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Sapiano MRP, Jones JM, Savinkina AA, Haass KA, Berger JJ, Basavaraju SV. Supplemental findings of the 2017 National Blood Collection and Utilization Survey. Transfusion 2021; 60 Suppl 2:S17-S37. [PMID: 32134122 DOI: 10.1111/trf.15715] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION This report provides supplemental results from the 2017 National Blood Collection and Utilization Survey on characteristics of the donor population, autologous and directed donations and transfusions, platelets, plasma and granulocyte transfusions, pediatric transfusions, severe donor-related adverse events, cost of blood units, hospitals policies and practices, and inventory, dosing, and supply. METHODS Weighting and imputation were used to generate national estimates including number of donors, donations, donor deferrals, autologous and directed donations and transfusions, severe donor-related adverse events, platelet and plasma collections and transfusions, number of cross-match procedures, irradiation and leukoreduction, and pediatric transfusions. RESULTS Between 2015 and 2017, successful donations decreased slightly by 2.1% with a 10.3% decrease in donations by persons aged 16-18 years and a 14.4% increase in donations by donors aged >65 years. The median price paid for blood components by hospitals decreased from $211 to $207 for leukoreduced red blood cell units, from $523 to $517 for leukoreduced apheresis platelet units, and from $54 to $51 for fresh frozen plasma units. Plasma transfusions decreased 13.6%, but group AB plasma units transfused increased 24.7%. CONCLUSION Between 2015 and 2017, blood donations declined slightly because of decreases in donations from younger donors, but the number of donations from older donors increased. The price hospitals pay for blood has continued to decrease. Plasma transfusions have decreased, but the proportion of plasma transfusions involving group AB plasma have increased.
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Affiliation(s)
- Mathew R P Sapiano
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jefferson M Jones
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexandra A Savinkina
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Kathryn A Haass
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James J Berger
- U.S. Department of Health and Human Services, Office of HIV/AIDS and infectious Disease Policy, Office of the Assistant Secretary for Health, Washington, DC
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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10
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Spencer BR, Fox MP, Wise LA, Cable RG, Mast AE. Iron status and self-reported fatigue in blood donors. Transfusion 2020; 61:124-133. [PMID: 32974931 DOI: 10.1111/trf.16095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 12/21/2022]
Abstract
Fatigue is a reported symptom of iron depletion, but studies in blood donors show no conclusive link. We conducted an observational analysis of data from the STRIDE randomized trial to evaluate association of iron status with self-reported fatigue. STUDY DESIGN AND METHODS Three blood centers randomly assigned 692 frequent donors to education or iron supplementation treatments. Biomarkers for iron status were measured during 20 to 24 months of follow-up. A fatigue score was derived from an 11-item questionnaire at baseline and final visits, and associations between iron status and fatigue were assessed. RESULTS Final lab and questionnaire data were evaluable from 337 subjects. At baseline, female sex, older age, and anemia were associated with fatigue, but iron status was not. Mean (±SD) fatigue score change was 0.0 (±0.5). Mean (±SD) increase in iron stores was 1.0 (±3.5) mg/kg, but changes in body iron stores were not associated with fatigue score changes (0.01 per mg/kg; 95% CI, -0.01 to 0.02) or with fatigue (RR, 1.01; 95% CI, 0.99 to 1.04). The only factor associated with fatigue score changes was baseline fatigue (0.36; 95% CI, 0.25 to 0.48). CONCLUSION Among high-frequency donors, neither iron status at baseline nor changes in iron status predicted fatigue during follow-up, with improvements limited to those with higher levels of baseline fatigue. Assessment of the association between iron and fatigue in blood donors benefits from careful consideration of study design and the study population.
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Affiliation(s)
- Bryan R Spencer
- American Red Cross, Scientific Affairs, Dedham, Massachusetts, USA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.,Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ritchard G Cable
- American Red Cross, Scientific Affairs, Dedham, Massachusetts, USA
| | - Alan E Mast
- Blood Research Institute, Versiti, Milwaukee, Wisconsin, USA.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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11
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Bäckman S, Valkeajärvi A, Korkalainen P, Arvas M, Castrén J. Venous sample is superior to repeated skin-prick testing in blood donor haemoglobin second-line screening. Vox Sang 2020; 115:617-623. [PMID: 32314403 DOI: 10.1111/vox.12920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/02/2020] [Accepted: 03/26/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Blood donor haemoglobin concentration (Hb) is commonly measured from a skin-prick sample. However, the skin-prick sample is prone to preanalytical error and variation, which may lead to false deferrals due to low Hb. STUDY DESIGN AND METHODS We assessed the efficacy of two second-line screening models for the evaluation of blood donors failing the initial skin-prick test. In the venous model (n = 305), Hb was measured from a venous sample at the donation site. In the skin-prick model (n = 331), two additional skin-prick samples were measured. All on-site Hb measurements were performed with HemoCue Hb201+ (HemoCue AB) point-of-care (POC) device. Hb in the venous samples was later also determined with a hematology analyzer (Sysmex XN, Sysmex Co.) to obtain the donor's correct Hb. A questionnaire evaluated Blood Service nurses' preferences regarding Hb assessment. RESULTS Significantly less donors were deferred from donation with venous model (40%) than with skin-prick model (51%; chi-square test P = 0·004). Only two donors (0·7%) were incorrectly accepted in the venous model. Further, Blood Service nurses preferred venous model over skin-prick model. After the study, the venous model was implemented nationwide, and in the first two months after implementation, the deferral rate due to low Hb decreased from 2·7% to 1·9%. CONCLUSION A venous sample for blood donor Hb second-line screening significantly decreased low Hb deferrals compared to repeated skin-prick testing without compromising donor safety. Valuable donations can be recovered by implementing a practical second-line screening model based on venous sampling.
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Affiliation(s)
- Sari Bäckman
- Finnish Red Cross Blood Service, Helsinki, Finland
| | | | | | - Mikko Arvas
- Finnish Red Cross Blood Service, Helsinki, Finland
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12
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Mast AE, Langer JC, Guo Y, Bialkowski W, Spencer BR, Lee TH, Kiss J, Cable RG, Brambilla D, Busch MP, Page GP. Genetic and behavioral modification of hemoglobin and iron status among first-time and high-intensity blood donors. Transfusion 2020; 60:747-758. [PMID: 32163187 DOI: 10.1111/trf.15743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Some people rapidly develop iron deficiency anemia following blood donation, while others can repeatedly donate without becoming anemic. METHODS Two cohorts of blood donors were studied. Participants (775) selected from a 2-year longitudinal study were classified into six analysis groups based on sex, donation intensity, and low hemoglobin deferral. Associations with iron supplement use, cigarette smoking, and four genetic variants of iron metabolism were examined at enrollment and with longitudinal regression models. An unbiased assessment of genetic variability and ability to repeatedly donate blood without experiencing low hemoglobin deferral was conducted on participants (13,403) in a cross-sectional study who were examined by genome wide association (GWA). RESULTS Behaviors and genetic variants were associated with differences in hemoglobin and ferritin change following repeated donation. At least weekly iron supplement use was associated with improved status in first-time donors, while daily use was associated with improved status in high-intensity donors. Cigarette smoking was associated with 0.5 g/dL increased hemoglobin in high-intensity donors. A736V in TMPRSS6 was associated with a rapid drop in hemoglobin and ferritin in first-time females following repeated donation. Conversely, the protective TMPRSS6 genotype was not enriched among high-intensity donors. H63D in HFE was associated with increased hemoglobin in female high-intensity donors. However, no differences in genotype between first-time and high-intensity donors were found in GWA analyses. CONCLUSION Behavioral and genetic modifiers contributed to first-time donor hemoglobin and iron status, while iron supplement use was more important than underlying genetics in high-intensity donors.
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Affiliation(s)
- Alan E Mast
- Blood Research Institute Versiti, Milwaukee, Wisconsin, USA.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Yuelong Guo
- RTI International, Durham, North Carolina, USA
| | | | - Bryan R Spencer
- American Red Cross Scientific Affairs, Dedham, Massachusetts, USA
| | - Tzong-Hae Lee
- Vitalant Research Institute, San Francisco, California, USA
| | - Joseph Kiss
- Vitalant Northeast Division, Pittsburgh, Pennsylvania, USA
| | - Ritchard G Cable
- American Red Cross Scientific Affairs, Farmington, Connecticut, USA
| | | | - Michael P Busch
- American Red Cross Scientific Affairs, Dedham, Massachusetts, USA
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13
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Iqbal H, Tameez Ud Din A, Tameez Ud Din A, Chaudhary FMD, Younas M, Jamil A. Frequency and Causes of Deferral among Blood Donors Presenting to Combined Military Hospital Multan. Cureus 2020; 12:e6657. [PMID: 32082957 PMCID: PMC7017926 DOI: 10.7759/cureus.6657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background & Aim It is of great importance to carefully choose appropriate donors according to strict eligibility criteria, so as to guarantee an adequate and safe blood supply. The aim of this study was to determine the rate of deferral in blood donors and evaluate the different causes of deferral in Multan. Materials & Methods This prospective study was carried out at the Blood Bank of Combined Military Hospital (CMH) Multan. All donors who came for the donation of blood from 1st February to 30th September 2019 were evaluated after taking their consent. The data was analyzed to determine the frequency and causes of deferral using Statistical Package for the Social Sciences (SPSS) version 20. Results Among 3348 individuals presenting for blood donation, 433 (12.9%) were deferred (427 males and only six females). The mean age of deferred individuals was 28.96 + 6.42 years. The youngest individual was 18 years, while the eldest one was 51 years of age. Almost 65% of the individuals were less than 30 years of age. The most frequent cause of deferral was low hemoglobin. Anemia was the leading cause of deferral in more than half of the individuals (n = 221). Hepatitis C virus (HCV) infection was the second most frequent cause of deferral, seen in 83 (19.2%), followed by hepatitis B virus (HBV) infection (n = 49, 11.3%), syphilis (n = 36, 8.3%), thrombocytopenia (n = 18, 4.2%), and active infection (n = 14, 3.2%). Other rarer causes included early donation, thrombocytosis, polycythemia, pancytopenia, malaria, allergies, insulin, and tuberculosis. Conclusion Deferral for blood donation is a significant problem in Multan and accounts for almost 13% of all prospective blood donors. Our results stress the importance of addressing the problem of anemia which is the most prevalent cause of temporary deferral for blood donation in this region of the world.
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Affiliation(s)
- Hamid Iqbal
- Hematology, Combined Military Hospital Multan, Multan, PAK
| | | | | | | | - Muhammad Younas
- Chemical Pathology, Combined Military Hospital Multan, Multan, PAK
| | - Abdur Jamil
- Internal Medicine, Central Michigan University, Saginaw, USA
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14
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Browne A, Fisher SA, Masconi K, Smith G, Doree C, Chung R, Rahimzadeh M, Shah A, Rodriguez SA, Bolton T, Kaptoge S, Wood A, Sweeting M, Roberts DJ. Donor Deferral Due to Low Hemoglobin-An Updated Systematic Review. Transfus Med Rev 2020; 34:10-22. [PMID: 31806414 DOI: 10.1016/j.tmrv.2019.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/30/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
Blood donors attending a donation session may be deferred from donating blood due to a failure to meet low hemoglobin (Hb) thresholds. This costs the blood donor service and donors valuable time and resources. In addition, donors who are deferred may have more symptoms, and as a direct and/or indirect effect of their experience, return rates of donors deferred for low Hb are reduced, even in repeat donors. It is therefore vital that low Hb deferral (LHD) is minimized. The aim of this updated systematic review is to expand the evidence base for factors which affect a donor's risk of deferral due to low Hb. Studies were identified by searching MEDLINE, Embase, The Cochrane Library, and the WHO International Clinical Trials Registry to March 2019. Demographic data, donor history, hematological/biological factors, and the primary outcome of deferral due to low Hb were extracted. Our primary outcome was deferral due to low Hb. Analyses were descriptive and quantitative; pooled odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by meta-analysis using random-effects models. A total of 116 studies met the inclusion criteria. Meta-analysis showed a significantly greater risk of LHD in females compared with males in studies applying universal Hb thresholds for males and females (OR 14.62 95% CI 12.43-17.19) and in those which used sex-specific thresholds (OR 5.73, 95% CI 4.36-7.53). Higher rates of LHD were also associated with increasing age in men, low body weight, shorter interdonation interval, donors of Hispanic or African descent, higher ambient temperature, donors with low ferritin levels, and donation in a fixed donor center. There was conflicting evidence on the effect of new and repeat donor status, and blood group. This work has strengthened the evidence of the previous review in identifying factors that should be considered in studies of donor deferral and highlighting areas in need of further study, including ABO and Rh blood groups, previous platelet donation, diet, smoking, time of day, and genetic data. These factors may lead to individually tailored donation criteria for safe and efficient donation in the future.
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Affiliation(s)
- Andrew Browne
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Sheila A Fisher
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK; BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
| | - Katya Masconi
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Graham Smith
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK; BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK; BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ryan Chung
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Mana Rahimzadeh
- Oxford University Medical School, John Radcliffe Hospital, Oxford, UK
| | - Akshay Shah
- BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Silvia Alonso Rodriguez
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Thomas Bolton
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Stephen Kaptoge
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Michael Sweeting
- Department of Health Sciences, University of Leicester, University Road, Leicester
| | - David J Roberts
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK; BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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15
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Sweegers MG, Kraaij MG, Hurk K. First do no harm: iron loss in whole blood donors. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/voxs.12527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Marian G.J. Kraaij
- Centre for Clinical Transfusion Research Sanquin Research Leiden the Netherlands
- Department of Transfusion Medicine and Department of Donor Affairs Sanquin Blood Bank Amsterdam the Netherlands
| | - Katja Hurk
- Donor Studies Sanquin Research Amsterdam the Netherlands
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16
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Davison TE, Masser BM, Gemelli CN. Deferred and deterred: a review of literature on the impact of deferrals on blood donors. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/voxs.12520] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tanya E. Davison
- Clinical Services and Research Australian Red Cross Blood Service Melbourne Vic Australia
| | - Barbara M. Masser
- Clinical Services and Research Australian Red Cross Blood Service Melbourne Vic Australia
- School of Psychology The University of Queensland Brisbane QLD Australia
| | - Carley N. Gemelli
- Clinical Services and Research Australian Red Cross Blood Service Melbourne Vic Australia
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17
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Okoroiwu HU, Asemota EA. Blood donors deferral prevalence and causes in a tertiary health care hospital, southern Nigeria. BMC Health Serv Res 2019; 19:510. [PMID: 31331326 PMCID: PMC6647304 DOI: 10.1186/s12913-019-4352-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 07/16/2019] [Indexed: 12/27/2022] Open
Abstract
Background Blood transfusion is a life-saving intervention. However, the safety of the donor and the recipient is paramount. This study was aimed at determining the blood donation deferral pattern of University of Calabar Teaching Hospital. Methods A retrospective analysis of the prospective donors’ data of University of Calabar Donor clinic within the period of March 2015 to February 2016 was conducted. Data were extracted from the donor register and analyzed. Prospective donors were screened and interviewed for causes of temporary and permanent deferrals. Result Out of the 1886 screened prospective donors, 164 (8.69%) were deferred. Though the minority of the donor population, female donors had the highest deferral rate (33.33%). There were 31.10 and 68.90% cases of temporary and permanent deferrals, respectively. Hepatitis B virus (HBV) was the highest (31.71%) cause of overall deferral as well as permanent deferral. Anemia was the major (21.95%) cause of temporary deferral as well as the second cause of overall deferrals. Commercial and replacement donors constituted 68.28 and 31.71% of the deferral cases, respectively. Conclusion HBV was found to be the overall leading cause of deferral in the studied area. This outcome poses a public health concern and should elicit measures to curb the infection rate.
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Affiliation(s)
- Henshaw Uchechi Okoroiwu
- Department of Medical Laboratory Science, Haematology Unit, University of Calabar, Calabar, Nigeria.
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18
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Bruhin A, Goette L, Haenni S, Jiang L, Markovic A, Roethlisberger A, Buchli R, Frey BM. The Sting of Rejection: Deferring Blood Donors due to Low Hemoglobin Values Reduces Future Returns. Transfus Med Hemother 2019; 47:119-128. [PMID: 32355471 DOI: 10.1159/000500679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/28/2019] [Indexed: 11/19/2022] Open
Abstract
Background Roughly one quarter of short-term temporary deferrals (STTD) of blood donors are low-hemoglobin deferrals (LHD), i.e. STTD due to a hemoglobin (Hb) value falling below a cutoff of 125 g/L for female and 135 g/L for male donors. Since voluntarily donating blood is a prosocial activity, donors may perceive deferral as social exclusion, which can cause social pain, decrease self-esteem, and lead to antisocial behavior. However, little is known about the causal impacts of LHD on donor return. Study Design and Methods We conducted a quasi-experiment with 80,060 donors invited to blood drives in the canton of Zurich, Switzerland, between 2009 and 2014. Within a narrow window of Hb values around the predetermined cutoff, the rate of LHD jumps discontinuously. This discontinuous jump allows us to quantify the causal effects of LHD on donor return, as it is uncorrelated with other unobserved factors that may also affect donor return. Results We found different behavioral reactions to LHD for female and male donors. Female donors do not react to the first LHD. However, after any repeated LHD, they are 13.53 percentage points (p <0.001) less likely to make at least 1 donation attempt within the next 18 months and make 0.389 fewer donation attempts (p <0.001). Male donors react to the first LHD. They are 5.32 percentage points (p = 0.139) less likely to make at least 1 donation attempt over the next 18 months and make 0.227 (p = 0.018) fewer donation attempts. After any repeated LHD, male donors are 13.30 percentage points (p = 0.004) less likely to make at least 1 donation attempt and make 0.152 (p = 0.308) fewer donation attempts. Conclusion LHD have detrimental impacts on donor return, especially if they occur repeatedly - suggesting that avoiding false LHD and helping donors to better cope with them helps to maintain the pool of prospective donors.
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Affiliation(s)
- Adrian Bruhin
- Faculty of Business and Economics (HEC Lausanne), University of Lausanne, Lausanne, Switzerland
| | - Lorenz Goette
- Department of Economics, University of Bonn, Bonn, Germany.,Department of Economics, National University of Singapore, Singapore, Singapore
| | - Simon Haenni
- Department of Economics, University of Zurich, Zurich, Switzerland
| | - Lingqing Jiang
- Department of Economics, University of Essex, Colchester, United Kingdom
| | | | | | - Regula Buchli
- Blood Transfusion Service, Swiss Red Cross, Schlieren, Switzerland
| | - Beat M Frey
- Blood Transfusion Service, Swiss Red Cross, Schlieren, Switzerland
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19
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Spencer BR, Bialkowski W, Creel DV, Cable RG, Kiss JE, Stone M, McClure C, Kleinman S, Glynn SA, Mast AE. Elevated risk for iron depletion in high-school age blood donors. Transfusion 2019; 59:1706-1716. [PMID: 30633813 PMCID: PMC6499707 DOI: 10.1111/trf.15133] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND High school students 16 to 18 years-old contribute 10% of the US blood supply. Mitigating iron depletion in these donors is important because they continue to undergo physical and neurocognitive development. STUDY DESIGN AND METHODS Study objectives were to determine the prevalence of iron depletion in 16- to 18-year-old donors and whether their risk for iron depletion was greater than adult donors. Successful, age-eligible donors were enrolled from high school blood drives at two large US blood centers. Plasma ferritin testing was performed with ferritin less than 12 ng/mL as our primary measure of iron depletion and ferritin less than 26 ng/mL a secondary measure. Multivariable repeated-measures logistic regression models evaluated the role of age and other demographic/donation factors. RESULTS Ferritin was measured from 4265 enrollment donations September to November 2015 and 1954 follow-up donations through May 2016. At enrollment, prevalence of ferritin less than 12 ng/mL in teenagers was 1% in males and 18% in females making their first blood donation, and 8% in males and 33% in females with prior donations. Adjusted odds for ferritin less than 12 ng/mL were 2.1 to 2.8 times greater in 16- to 18-year-olds than in 19- to 49-year-olds, and for ferritin less than 26 ng/mL were 3.3- to 4.7-fold higher in 16- to 18-year-olds. Progression to hemoglobin deferral was twice as likely in 16- to 18-year-old versus 19- to 49-year-old females. CONCLUSION Age 16 to 18 years-old is an independent risk factor for iron deficiency in blood donors at any donation frequency. Blood centers should implement alternate eligibility criteria or additional safety measures to protect teenage donors from iron depletion.
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Affiliation(s)
- Bryan R. Spencer
- American Red Cross, Scientific Affairs, Dedham, MA, United States
| | - Walter Bialkowski
- Blood Research Institute, BloodCenter of Wisconsin Milwaukee, WI, United States
| | | | - Ritchard G. Cable
- American Red Cross, Scientific Affairs, Farmington, CT, United States
| | - Joseph E. Kiss
- Institute for Transfusion Medicine, Pittsburgh, PA, United States
| | - Mars Stone
- Blood Systems Research Institute, San Francisco, CA, United States
| | | | | | - Simone A. Glynn
- National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Alan E. Mast
- Blood Research Institute, BloodCenter of Wisconsin Milwaukee, WI, United States
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, United States
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20
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Klinkenberg EF, Huis In't Veld EMJ, de Wit PD, van Dongen A, Daams JG, de Kort WLAM, Fransen MP. Blood donation barriers and facilitators of Sub-Saharan African migrants and minorities in Western high-income countries: a systematic review of the literature. Transfus Med 2019; 29 Suppl 1:28-41. [PMID: 29493019 PMCID: PMC7379919 DOI: 10.1111/tme.12517] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/24/2018] [Accepted: 01/27/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The present study aimed to gain more insight into, and summarise, blood donation determinants among migrants or minorities of Sub-Saharan heritage by systematically reviewing the current literature. BACKGROUND Sub-Saharan Africans are under-represented in the blood donor population in Western high-income countries. This causes a lack of specific blood types for transfusions and prevention of alloimmunisation among Sub-Saharan African patients. METHODS/MATERIALS Medline, EMBASE, PsycINFO and BIOSIS were searched for relevant empirical studies that focused on barriers and facilitators of blood donation among Sub-Saharan Africans in Western countries until 22 June 2017. Of the 679 articles screened by title and abstract, 152 were subsequently screened by full text. Paired reviewers independently assessed the studies based on predefined eligibility and quality criteria. RESULTS Of the 31 included studies, 24 used quantitative and 7 used qualitative research methods. Target cohorts varied from Black African Americans and refugees from Sub-Sahara Africa to specific Sub-Saharan migrant groups such as Comorians or Ethiopians. Main recurring barriers for Sub-Saharan Africans were haemoglobin deferral, fear of needles and pain, social exclusion, lack of awareness, negative attitudes and accessibility problems. Important recurring facilitators for Sub-Saharan Africans were altruism, free health checks and specific recruitment and awareness-raising campaigns. CONCLUSION The findings of this review can be used as a starting point to develop recruitment and retention strategies for Sub-Saharan African persons. Further research is needed to gain more insight in the role of these determinants in specific contexts as socioeconomic features, personal histories and host country regulations may differ per country.
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Affiliation(s)
- E. F. Klinkenberg
- Department of Donor StudiesSanquin ResearchAmsterdamThe Netherlands
- Department of Public HealthAcademic Medical Center, University of AmsterdamAmsterdamThe Netherlands
| | - E. M. J. Huis In't Veld
- Department of Donor StudiesSanquin ResearchAmsterdamThe Netherlands
- Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
| | - P. D. de Wit
- Department of Donor StudiesSanquin ResearchAmsterdamThe Netherlands
- Department of Public HealthAcademic Medical Center, University of AmsterdamAmsterdamThe Netherlands
| | - A. van Dongen
- School of Psychology, University of New South WalesSydneyAustralia
| | - J. G. Daams
- Medical LibraryAcademic Medical Center, Univeristy of AmsterdamAmsterdamThe Netherlands
| | - W. L. A. M. de Kort
- Department of Donor StudiesSanquin ResearchAmsterdamThe Netherlands
- Department of Public HealthAcademic Medical Center, University of AmsterdamAmsterdamThe Netherlands
| | - M. P. Fransen
- Department of Public HealthAcademic Medical Center, University of AmsterdamAmsterdamThe Netherlands
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21
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Malard L, Richard P, Maire F, Djoudi R, Gross S, Fillet A. Factors associated with recovery of haemoglobin levels after whole‐blood donation in the French West Indies in 2015. Transfus Med 2018; 29 Suppl 1:72-75. [DOI: 10.1111/tme.12563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/21/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- L. Malard
- Medical DepartmentEFS Siège La Plaine Saint‐Denis France
| | | | - F. Maire
- ETS Guadeloupe‐Guyane Pointe à Pitre France
| | | | - S. Gross
- Medical DepartmentEFS Siège La Plaine Saint‐Denis France
| | - A.‐M. Fillet
- Medical DepartmentEFS Siège La Plaine Saint‐Denis France
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22
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Perez GE, Gammon RR, Whitaker BI, Vassallo RR, Stubbs JR. Impact of changes to donor hemoglobin criteria on the rate of donor deferral. Transfusion 2018; 58:2581-2588. [PMID: 30264396 DOI: 10.1111/trf.14950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Food and Drug Administration's requirements for "Blood and Blood Components Intended for Transfusion or Further Manufacturing Use" (Final Rule) effective May 2016 changed eligibility criteria for blood donors. A multivariate analysis was performed to measure its impact on donor deferral rates. STUDY DESIGN AND METHODS Four blood centers submitted data for similar 6-month periods before and after implementation of the Final Rule. Data included presenting donors, units collected, deferrals, intended products from deferred donors, deferral reasons, presenting donor demographics, donor hemoglobin (Hgb), hematocrit (HCT), pulse, blood pressure (BP), temperature, and other reasons for deferral. Data were aggregated and periods compared. RESULTS After Final Rule implementation, successful donations decreased by 1.3% (83.1%-81.9%), despite a 0.2% increase in presenting donors. The rate of Hgb/HCT, pulse, and deferrals increased, while deferrals for other reasons decreased. Male Hgb/HCT deferral rates increased 1.2% (4213 total). Black male donors' Hgb/HCT deferral rate increased (2.7%-5.2%) but was counterbalanced by an overall 3.7% decrease in black female Hgb/HCT deferrals. While Hgb/HCT deferrals of black donors remained stable overall (17.0% vs. 16.2%), this trend was not observed by all centers. Deferrals for pulse increased (0.2%), as did BP deferrals (0.2%). CONCLUSION Although there was a small increase in presenting donors after implementation of the Final Rule, there was a decrease in successful donations. While it appeared that deferral in black donors was unchanged, this trend was not observed across all centers. Pulse and BP deferrals rose dissimilarly among centers, according to individual procedures.
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Affiliation(s)
- Gabriela E Perez
- Department of Research and Data Analysis, AABB, Bethesda, Maryland
| | | | | | - Ralph R Vassallo
- Corporate Medical Affairs, Blood Systems, Inc., Scottsdale, Arizona
| | - James R Stubbs
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota
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23
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Castrén J, Arvas M, Valkeajärvi A, Korkalainen P, Syrjälä M. The impact of analytical variation of hemoglobin measurement on blood donors' hemoglobin and deferral rates. Transfusion 2018; 58:2157-2165. [PMID: 30179256 DOI: 10.1111/trf.14825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Donors' hemoglobin (Hb) level must be tested before blood donation. Low Hb is the leading reason for donor deferral. Many donor-related and external factors associated with low Hb are known, but no studies have been conducted concerning the effects of analytical variation on donor Hb measurements and deferrals. STUDY DESIGN AND METHODS The effects of donors' age, the seasonal and daily distribution of donations, and batch-to-batch variation in HemoCue Hb 201+ cuvettes on donors' capillary Hb (cHb) measurements and deferrals were analyzed for more than 1.7 million donor visits in 2010 to 2016 at a national blood establishment. Furthermore, approximately 3.1 million cHb measurements from the years 2000 to 2009 were included in analyses to correlate measured cHb value and Hb deferral rate. RESULTS A significant correlation between the mean annual cHb and Hb deferral rate was observed in both women and men. The season of the donation was the strongest explanatory factor for the monthly variation of predonation cHb (explaining 25 and 31% of the variation in women and men, respectively). Batch-to-batch variation in HemoCue cuvettes explained 6.8% of monthly variation in women and 7.4% in men. Monthly changes in donors' age distribution explained 2.5% of monthly variation in women and 2.4% in men. CONCLUSION Small and, in most clinical settings, negligible analytical variation in Hb measurement methods can have significant consequences when used for Hb screening of blood donors. This should be minimized by using methods in which analytical variation is under control and kept as low as possible.
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Affiliation(s)
| | - Mikko Arvas
- Finnish Red Cross Blood Service, Helsinki, Finland
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Fillet AM, Gross S. [Prevention of anemia in blood donors]. Transfus Clin Biol 2017; 24:143-147. [PMID: 28687193 DOI: 10.1016/j.tracli.2017.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 12/01/2022]
Abstract
The prevention of anemia of blood donor is a main issue for donor safety and self-supplying. This prevention is done in one hand by donor deferral whose haemoglobin level is under defined threshold and in other hand by preventing iron deficiency. Some subgroups of donors are at increased risk for developing iron deficiency and adverse effects of iron deficiency: premenopausal females; donors with haemoglobin values near the minimum for eligibility and frequent donors. Different interventions could be used: lengthening the inter-donational interval and/or decreasing the number of donations per year; donor ferritin testing to evaluate iron store and at least donor iron supplementation.
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Affiliation(s)
- A-M Fillet
- EFS siège, direction médicale, 20, avenue du Stade-de-France, 93218 La Plaine Saint-Denis, France.
| | - S Gross
- EFS siège, direction médicale, 20, avenue du Stade-de-France, 93218 La Plaine Saint-Denis, France
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Sultan S, Irfan SM, Baig MA, Usman SM, Shirazi UA. Insight into donor deferral pattern based on peripheral blood counts: An experience from South Pakistan. Asian J Transfus Sci 2017; 11:151-155. [PMID: 28970684 PMCID: PMC5613423 DOI: 10.4103/0973-6247.214357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Donor deferral owing to anemia is one of the major causative factors of temporary donor rejection, which is preventable and treatable. The basic knowledge about frequency, types, and severity of anemia among donors will help plan a strategy to promote donor recruitment and overall national health. OBJECTIVE The objective of this study was to provide the predonation deferral rate of the healthy blood donors based on peripheral blood counts and second to determine the types of anemia along with its severity. MATERIALS AND METHODS Prospective records of all the reported donors were collected from January 2014 to December 2015 at Liaquat National Hospital, Karachi, Pakistan. Donor samples were analyzed on an automated hematology analyzer. RESULTS Overall, 36,954 potential donors reported to the blood bank, out of which 33,853 were selected and 3101 were deferred, which makes the deferral rate of 8.39%. Majority of donors (n = 2663 [7.20%]) were deferred based on peripheral blood counts. Based on peripheral count, anemia (91.8%) represents the major cause of deferral, followed by raised total leukocyte count (3.7%) and polycythemia (3.3%), and thrombocytopenia (1.0%) was the least potential cause. Microcytic-hypochromic anemia was found in 58.5% of the donors followed by normocytic and macrocytic anemia in 38.9% and 2.4%, respectively. Mild anemia was seen in 78.2% followed by moderate and severe anemia in 20.5% and 1.18%, respectively. CONCLUSION A high prevalence of anemia among blood donors signifies deteriorating health status not only in donor population but also in general population. This situation calls for more concerted efforts as otherwise it would lead to decreased blood donor pool.
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Affiliation(s)
- Sadia Sultan
- Department of Hematology and Blood Bank, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Syed Mohammed Irfan
- Department of Hematology and Blood Bank, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Mohammad Amjad Baig
- Department of Hematology and Blood Bank, Liaquat National Hospital and Medical College, Karachi, Pakistan
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Genetic factors associated with iron storage in Australian blood donors. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 16:123-129. [PMID: 28151393 DOI: 10.2450/2016.0138-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 10/03/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Blood donors are at risk of developing iron deficiency and/or iron deficiency anaemia. This may affect their health and affect their eligibility to give subsequent donations. Investigating genetic factors that may predispose donors to high or low iron stores is of interest; this may assist with providing optimal management strategies for maintaining donor health. This study aimed to investigate whether the presence of selected single nucleotide polymorphisms (SNPs) affecting parameters of iron status were associated with ferritin levels in Australian donors. MATERIALS AND METHODS Samples (n=800) were collected from non-first-time blood donors in Queensland. Plasma ferritin levels were quantified and the genotypes for ten SNPs, identified by a review of relevant literature, were determined for each sample. Associations between SNPs and ferritin levels were investigated. RESULTS Three SNPs were associated with ferritin levels. In male donors, high ferritin levels were associated with the variant allele (G) of the SNP rs3923809 in the BTBD9 gene. An association with ferritin levels was also identified with the SNP rs235756 in the BMP2 gene in males. The SNP rs4820268 in the TMPRSS6 gene was associated with ferritin levels in females, with donors with the AG genotype being three times more likely to have low ferritin levels. DISCUSSION Variants in the genes TMPRSS, BTBD9 and BMP2 were associated with ferritin levels in Australian blood donors. These findings provide support that genetic testing may be useful for the generation of predictive algorithms that may allow for management strategies to be tailor-made for individual donors.
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Blood donors' physical characteristics are associated with pre- and post-donation symptoms - Donor InSight. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 15:405-412. [PMID: 27416579 DOI: 10.2450/2016.0023-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/06/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Observational data suggest that some donors might benefit from donating while others may be harmed. The aim of this study was to investigate the prevalence and potential, routinely measured, determinants of pre- and post-donation symptoms. MATERIALS AND METHODS In Donor InSight, questionnaire data from 23,064 whole blood donors (53% female) were linked to routinely measured data on donors' physical characteristics (haemoglobin, blood pressure, body mass index and estimated blood volume) from the Dutch donor database. Absolute and relative associations between donors' physical donor and the presence of pre- and post-donation symptoms were studied using multivariable logistic regression. RESULTS Pre-donation symptoms (lack of energy, headaches) were reported by 3% of men and 3% of women. Five percent of men and 4% of women reported positive post-donation symptoms (feeling fit, fewer headaches). Negative symptoms (fatigue, dizziness) were more common, occurring in 8% of men and 19% of women. All the studied donors' physical characteristics were positively associated with pre- and positive post-donation symptoms and negatively associated with negative symptoms. Body mass index was most consistently and independently associated with symptoms. DISCUSSION Donors' physical characteristics, in particular body mass index, were consistently associated with pre- and post-donation symptoms. This indicates that subgroups of donors more and less tolerant to donation might be identifiable using routinely measured data. Further research is warranted to study underlying mechanisms and potential strategies to predict and prevent donor reactions.
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Gorlin J, Katz L, Elsmore D, Kirbach K, Erickson Y, Hove A, Black C, Walsh-Jahnke R. Prevalence of blood donor iron deficiency and feasibility ferritin-based iron replacement: a blood collection agency-based study. Vox Sang 2016; 111:206-8. [DOI: 10.1111/vox.12408] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/01/2016] [Accepted: 03/21/2016] [Indexed: 11/28/2022]
Affiliation(s)
- J. Gorlin
- Innovative Blood Resources/Memorial Blood Centers; St Paul MN USA
| | - L. Katz
- Americas Blood Centers; Washington DC USA
| | - D. Elsmore
- Innovative Blood Resources/Memorial Blood Centers; St Paul MN USA
| | - K. Kirbach
- Mississippi Valley Regional Blood Center; Davenport IA USA
| | - Y. Erickson
- Mississippi Valley Regional Blood Center; Davenport IA USA
| | - A. Hove
- Innovative Blood Resources/Memorial Blood Centers; St Paul MN USA
| | - C. Black
- Mississippi Valley Regional Blood Center; Davenport IA USA
| | - R. Walsh-Jahnke
- University of Minnesota Laboratory Medicine and Pathology; Minneapolis MN USA
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Bäckman S, Larjo A, Soikkeli J, Castrén J, Ihalainen J, Syrjälä M. Season and time of day affect capillary blood hemoglobin level and low hemoglobin deferral in blood donors: analysis in a national blood bank. Transfusion 2016; 56:1287-94. [DOI: 10.1111/trf.13578] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 02/12/2016] [Accepted: 02/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Sari Bäckman
- Finnish Red Cross Blood Service; Helsinki Finland
| | - Antti Larjo
- Finnish Red Cross Blood Service; Helsinki Finland
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Lotfi R, Kroll C, Plonné D, Jahrsdörfer B, Schrezenmeier H. Hepcidin/Ferritin Quotient Helps to Predict Spontaneous Recovery from Iron Loss following Blood Donation. Transfus Med Hemother 2015; 42:390-5. [PMID: 26733771 DOI: 10.1159/000440825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 05/06/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Iron supplementation is generally recommended for blood donors even though there are inter-individual differences in iron homeostasis. METHODS Ferritin levels of repeat donors were compared with first-time donors, retrospectively. Prospectively, we tested 27 male repeat donors for the following parameters at the day of blood donation as well as 1, 3, 7, 10, and 56 days thereafter: ferritin, hepcidin, transferrin, transferrin receptor, hemoglobin, erythropoietin, reticulocytes, hemoglobin in reticulocyte, twisted gastrulation protein homolog 1, and growth differentiation factor-15. RESULTS 56 days after blood donation, donors' average ferritin dropped to 55% (range 30-100%) compared to the initial value. Of all tested parameters hepcidin showed the highest and most significant changes beginning 1 day after donation and lasting for the whole period of 56 days. Along with ferritin, there was a high variation in hepcidin levels indicating inter-individual differences in hepcidin response to iron loss. Donors with a hepcidin/ferritin quotient < 0.3 regained 60% of their initial ferritin after 56 days, while those with a quotient ≥ 0.3 reached less than 50%. CONCLUSION As hepcidin appears to integrate erythropoietic and iron-loading signals, clinical measurement of hepcidin (together with the hepcidin-ferritin ratio) may become a useful indicator of erythropoiesis and iron kinetics.
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Affiliation(s)
- Ramin Lotfi
- Institute for Transfusion Medicine, University Hospital Ulm, Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Services Baden-Württemberg-Hessen, Ulm, Germany
| | - Christine Kroll
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Services Baden-Württemberg-Hessen, Ulm, Germany
| | - Dietmar Plonné
- MVZ Humangenetik Ulm, Abteilung Laboratoriumsmedizin, Ulm, Germany
| | - Bernd Jahrsdörfer
- Institute for Transfusion Medicine, University Hospital Ulm, Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Services Baden-Württemberg-Hessen, Ulm, Germany
| | - Hubert Schrezenmeier
- Institute for Transfusion Medicine, University Hospital Ulm, Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Services Baden-Württemberg-Hessen, Ulm, Germany
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Risk factors for deferral due to low hematocrit and iron depletion among prospective blood donors in a Brazilian center. Rev Bras Hematol Hemoter 2015; 37:306-15. [PMID: 26408364 PMCID: PMC4685101 DOI: 10.1016/j.bjhh.2015.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 04/27/2015] [Accepted: 05/27/2015] [Indexed: 11/29/2022] Open
Abstract
Objective Deferral of blood donors due to low hematocrit and iron depletion is commonly reported in blood banks worldwide. This study evaluated the risk factors for low hematocrit and iron depletion among prospective blood donors in a large Brazilian blood center. Method A case–control study of 400 deferred donors due to low hematocrit and 456 eligible whole blood donors was conducted between 2009 and 2011. Participants were interviewed about selected risk factors for anemia, and additional laboratory tests, including serum ferritin, were performed. Bivariate and multivariate analyses were performed to assess the association between predictors and deferral due to low hematocrit in the studied population and iron depletion in women. Results Donors taking aspirins or iron supplementation, those who reported stomachache, black tarry stools or hematochezia, and women having more than one menstrual period/month were more likely to be deferred. Risk factors for iron depletion were repeat donation and being deferred at the hematocrit screening. Smoking and lack of menstruation were protective against iron depletion. Conclusion This study found some unusual risk factors related to gastrointestinal losses that were associated with deferral of donors due to low hematocrit. Knowledge of the risk factors can help blood banks design algorithms to improve donor notification and referral.
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Abstract
More than 9 million individuals donate blood annually in the United States. Between 200 and 250 mg of iron is removed with each whole blood donation, reflecting losses from the hemoglobin in red blood cells. Replenishment of iron stores takes many months, leading to a high rate of iron depletion. In an effort to better identify and prevent iron deficiency, blood collection centers are now considering various strategies to manage donor iron loss. This article highlights laboratory and genetic tests to assess the iron status of blood donors and their applicability as screening tests for blood donation.
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Affiliation(s)
- Joseph E Kiss
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, and The Institute for Transfusion Medicine, 3636 Boulevard of The Allies, Pittsburgh, Pittsburgh, PA 15213, USA.
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Kiss JE, Brambilla D, Glynn SA, Mast AE, Spencer BR, Stone M, Kleinman SH, Cable RG. Oral iron supplementation after blood donation: a randomized clinical trial. JAMA 2015; 313:575-83. [PMID: 25668261 PMCID: PMC5094173 DOI: 10.1001/jama.2015.119] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although blood donation is allowed every 8 weeks in the United States, recovery of hemoglobin to the currently accepted standard (12.5 g/dL) is frequently delayed, and some donors become anemic. OBJECTIVE To determine the effect of oral iron supplementation on hemoglobin recovery time (days to recovery of 80% of hemoglobin removed) and recovery of iron stores in iron-depleted ("low ferritin," ≤26 ng/mL) and iron-replete ("higher ferritin," >26 ng/mL) blood donors. DESIGN, SETTING, AND PARTICIPANTS Randomized, nonblinded clinical trial of blood donors stratified by ferritin level, sex, and age conducted in 4 regional blood centers in the United States in 2012. Included were 215 eligible participants aged 18 to 79 years who had not donated whole blood or red blood cells within 4 months. INTERVENTIONS One tablet of ferrous gluconate (37.5 mg of elemental iron) daily or no iron for 24 weeks (168 days) after donating a unit of whole blood (500 mL). MAIN OUTCOMES AND MEASURES Time to recovery of 80% of the postdonation decrease in hemoglobin and recovery of ferritin level to baseline as a measure of iron stores. RESULTS The mean baseline hemoglobin levels were comparable in the iron and no-iron groups and declined from a mean (SD) of 13.4 (1.1) g/dL to 12.0 (1.2) g/dL after donation in the low-ferritin group and from 14.2 (1.1) g/dL to 12.9 (1.2) g/dL in the higher-ferritin group. Compared with participants who did not receive iron supplementation, those who received iron supplementation had shortened time to 80% hemoglobin recovery in both the low-ferritin (mean, 32 days, interquartile range [IQR], 30-34, vs 158 days, IQR, 126->168) and higher-ferritin groups (31 days, IQR, 29-33, vs 78 days, IQR, 66-95). Median time to recovery to baseline ferritin levels in the low-ferritin group taking iron was 21 days (IQR, 12-84). For participants not taking iron, recovery to baseline was longer than 168 days (IQR, 128->168). Median time to recovery to baseline in the higher-ferritin group taking iron was 107 days (IQR, 75-141), and for participants not taking iron, recovery to baseline was longer than 168 days (IQR, >168->168). Recovery of iron stores in all participants who received supplements took a median of 76 days (IQR, 20-126); for participants not taking iron, median recovery time was longer than 168 days (IQR, 147->168 days; P < .001). Without iron supplements, 67% of participants did not recover iron stores by 168 days. CONCLUSIONS AND RELEVANCE Among blood donors with normal hemoglobin levels, low-dose iron supplementation, compared with no supplementation, reduced time to 80% recovery of the postdonation decrease in hemoglobin concentration in donors with low ferritin (≤26 ng/mL) or higher ferritin (>26 ng/mL). TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01555060.
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Affiliation(s)
- Joseph E Kiss
- Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | | | - Simone A Glynn
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | | | - Mars Stone
- Blood Systems Research Institute, San Francisco, California
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Miller CS, Westgate PM. Implications of medical screenings of patients arriving for dental treatment: the results of a comprehensive laboratory screening. J Am Dent Assoc 2014; 145:1027-35. [PMID: 25270701 PMCID: PMC4388436 DOI: 10.14219/jada.2014.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The authors conducted medical laboratory screenings in a dental setting to determine the relationships between the laboratory test results and self-reported medical health findings. METHODS The authors collected serum, urine and medical histories from 171 patients (116 [68 percent] women; mean age, 43.4 years) who arrived for dental treatment as a component of a clinical trial and performed complete blood cell counts, standard blood chemistry panels and urinalysis on the samples. RESULTS The authors found 414 abnormal laboratory test results (an average of 2.42 per patient). Eighty-three percent of participants had one or more abnormal test results, 83 percent had abnormal test results and did not indicate a relevant disease in their medical history, and 18 percent had laboratory test results outside the 99 percent reference range (that is, > three standard deviations from the mean). Abnormal test results were significantly associated with sex, age, race and medical history (P< .05). Abnormal test results associated with kidney disease were related to patients with cardiovascular disease and diabetes, as well as those who tended to be on average older than 50 years. CONCLUSIONS The high frequency of significant abnormal laboratory test results detected in this study suggests that many patients may be unaware of their medical statuses. PRACTICAL IMPLICATIONS Abnormal laboratory test results are detected frequently in the serum and urine of patients arriving for dental treatment, which could indicate undiagnosed disease and less than optimal medical management.
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Affiliation(s)
- Craig S Miller
- Dr. Miller is a professor of oral medicine, Department of Oral Health Practice, Center for Oral Health Research, Oral Medicine Section, MN 324, College of Dentistry, University of Kentucky, 800 Rose St., Lexington, Ky. 40536-0297, e-mail . Address correspondence to Dr. Miller
| | - Philip M Westgate
- Dr. Westgate is an assistant professor, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington
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Custer B, Bravo M, Bruhn R, Land K, Tomasulo P, Kamel H. Predictors of hemoglobin recovery or deferral in blood donors with an initial successful donation. Transfusion 2014; 54:2267-75. [DOI: 10.1111/trf.12628] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Brian Custer
- Blood Systems Research Institute; San Francisco California
| | | | - Roberta Bruhn
- Blood Systems Research Institute; San Francisco California
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Abstract
PURPOSE OF REVIEW This review examines the recent research on the prevalence, determinants and importance of low iron in blood donors, and on the efforts to reduce or prevent iron depletion in donor populations. RECENT FINDINGS Female donors, especially younger women, are at highest risk for donation-induced low iron, but menopausal women and high-frequency donors of both sexes also face considerable risk for iron depletion. Predonation screening for hemoglobin contributes little information on donor iron status. Consumption of supplemental iron is helpful in preventing or reversing low iron, and waiting longer between donations also facilitates the recovery of the iron lost through donation. SUMMARY Although the impact of phlebotomy-related iron depletion on donor health requires better documentation, measures are available now that can be deployed on a targeted or standardized basis. Blood centers, regulators, and donors should continue to evaluate different approaches for addressing this problem, with the likely outcome that no single measure is optimal for maintaining adequate collections while safeguarding donor health.
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Spencer BR. Have it your way: customized donor management in the information age. Transfusion 2014; 54:758-61. [DOI: 10.1111/trf.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Bryan R. Spencer
- New England Blood Services Region; American Red Cross; Dedham MA
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Madrona DP, Herrera MDF, Jiménez DP, Giraldo SG, Campos RR. Women as whole blood donors: offers, donations and deferrals in the province of Huelva, south-western Spain. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 12 Suppl 1:s11-s20. [PMID: 23245721 PMCID: PMC3934236 DOI: 10.2450/2012.0117-12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 09/12/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Women seem more willing to donate blood than men despite the limitations that affect their donation rate. The aim of our study was to determine the role of women in altruistic donation of blood in Huelva, a province in south-western Spain. MATERIALS AND METHODS We registered 87,601 offers to donate whole blood between January 1st, 2005 and December 31st, 2009. We statistically analysed variables such as sex, age, offers, deferrals and donations, problems in venous access, vasovagal reactions, weight and blood pressure to establish their significance according to donor gender. RESULTS With regards to gender, 52.3% of donors were women and 47.7% men. Of the 87,601 offers to donate blood, 46.5% were from females and 53.5% from males. More females than males made their first donation during the study period. However, 43.9 % of donations were from women, whereas 56.1% were from men. Overall 8.7% of offers were deferred, 62.7% of which due to a low haemoglobin concentration, which was the most frequent cause of deferral in women. Difficulties in venous access and vasovagal reactions were also more frequent in female donors than in male donors. By the end of the study period, donor fidelity was 58.6% for men and 48.6% for women. DISCUSSION In the province of Huelva, women are more altruistically inclined than men to give blood, with the percentages of donors and first-time donors being higher among females. However, there are restrictions to women giving blood, especially low haemoglobin concentration, which reduce the number of female blood donations. Women also have more difficulty when blood is withdrawn and are more susceptible to vasovagal reactions, which negatively affect their experience as donors. Measures should be taken to reduce these barriers to encourage women to continue to offer to donate blood, thereby ensuring that they become regular donors, which is a key factor in guaranteeing an adequate supply of blood within the region of Andalusia.
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Affiliation(s)
- Dalmiro Prados Madrona
- Correspondence: Dalmiro Prados Madrona, Finca Santa Catalina, 9, 21110 Aljaraque, Spain, e-mail:
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Predictors of low haematocrit among repeat donors in São Paulo, Brazil: Eleven year longitudinal analysis. Transfus Apher Sci 2013; 49:553-9. [DOI: 10.1016/j.transci.2013.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 08/23/2013] [Accepted: 09/20/2013] [Indexed: 11/22/2022]
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41
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Mast AE. Low hemoglobin deferral in blood donors. Transfus Med Rev 2013; 28:18-22. [PMID: 24332843 DOI: 10.1016/j.tmrv.2013.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/04/2013] [Accepted: 11/08/2013] [Indexed: 11/18/2022]
Abstract
Low hemoglobin deferral occurs in about 10% of attempted whole blood donations and commonly is a consequence of iron deficiency anemia. Pre-menopausal women often have iron deficiency anemia caused by menstruation and pregnancy and have low hemoglobin deferral on their first donation attempt. Frequent donors also develop iron deficiency and iron deficiency anemia because blood donation removes a large amount of iron from the donor and the 56-day minimum inter-donation interval for donors in the United States is not sufficient for recovery of hemoglobin and iron stores. Other causes for low hemoglobin deferral range from a medically insignificant deferral of a woman with hemoglobin between 12.0 and 12.4 g/dL, which is within the normal reference range but below the 12.5 g/dL needed to donate blood, to anemia caused by an unrecognized malignancy in a "healthy" individual attempting to donate blood. The diverse causes of anemia in blood donors make it difficult to provide accurate information to donors about the cause of their low hemoglobin deferral and complicate implementation of programs to prevent them by blood collecting agencies. This article reviews how hemoglobin is measured and the demographics and causes of low hemoglobin deferral in blood donors. It provides recommendations for how blood collection agencies can provide donors with accurate information about the cause of their deferral and discusses programs that can be implemented to decrease these deferrals in regular donors.
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Affiliation(s)
- Alan E Mast
- Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI, USA; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA.
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Kleinman S, Busch MP, Murphy EL, Shan H, Ness P, Glynn SA. The National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study (REDS-III): a research program striving to improve blood donor and transfusion recipient outcomes. Transfusion 2013; 54:942-55. [PMID: 24188564 DOI: 10.1111/trf.12468] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/11/2013] [Accepted: 09/11/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) is a 7-year multicenter transfusion safety research initiative launched in 2011 by the National Heart, Lung, and Blood Institute. STUDY DESIGN AND METHODS The domestic component involves four blood centers, 12 hospitals, a data coordinating center, and a central laboratory. The international component consists of distinct programs in Brazil, China, and South Africa, which involve US and in-country investigators. RESULTS REDS-III is using two major methods to address key research priorities in blood banking and transfusion medicine. First, there will be numerous analyses of large "core" databases; the international programs have each constructed a donor and donation database while the domestic program has established a detailed research database that links data from blood donors and their donations, the components made from these donations, and data extracts from the electronic medical records of the recipients of these components. Second, there are more than 25 focused research protocols involving transfusion recipients, blood donors, or both that either are in progress or are scheduled to begin within the next 3 years. Areas of study include transfusion epidemiology and blood utilization, transfusion outcomes, noninfectious transfusion risks, human immunodeficiency virus-related safety issues (particularly in the international programs), emerging infectious agents, blood component quality, donor health and safety, and other donor issues. CONCLUSIONS It is intended that REDS-III serve as an impetus for more widespread recipient and linked donor-recipient research in the United States as well as to help assure a safe and available blood supply in the United States and in international locations.
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Affiliation(s)
- Steven Kleinman
- Department of Pathology, University of British Columbia, Victoria, British Columbia, Canada
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Baart AM, Vergouwe Y, Atsma F, Moons KGM, de Kort WLAM. Prediction of hemoglobin levels in whole blood donors: how to model donation history. Transfusion 2013; 54:925-32. [DOI: 10.1111/trf.12430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/08/2013] [Accepted: 07/08/2013] [Indexed: 12/31/2022]
Affiliation(s)
- A Mireille Baart
- Department of Donor Studies, Sanquin Research, Nijmegen, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Smith GA, Fisher SA, Dorée C, Roberts DJ. A systematic review of factors associated with the deferral of donors failing to meet low haemoglobin thresholds. Transfus Med 2013; 23:309-20. [PMID: 23829880 DOI: 10.1111/tme.12046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/22/2013] [Accepted: 04/23/2013] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Graham A Smith
- Haematology Department, Barnet and Chase Farm Hospitals NHS Trust; Systematic Review Initiative, NHS Blood and Transplant
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Richard P, Ould Amar K. Du donneur au receveur : particularités de la chaîne transfusionnelle dans les DOM. Transfus Clin Biol 2013; 20:59-67. [DOI: 10.1016/j.tracli.2013.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gonçalez TT, Sabino EC, Schlumpf KS, Wright DJ, Mendrone A, Lopes M, Leão S, Miranda C, Capuani L, Carneiro-Proietti ABF, Basques F, Ferreira JE, Busch M, Custer B. Analysis of donor deferral at three blood centers in Brazil. Transfusion 2013; 53:531-8. [PMID: 22845775 PMCID: PMC3595366 DOI: 10.1111/j.1537-2995.2012.03820.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Thelma T Gonçalez
- Blood Systems Research Institute, San Francisco, California; the Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.
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Mast AE, Schlumpf KS, Wright DJ, Johnson B, Glynn SA, Busch MP, Olbina G, Westerman M, Nemeth E, Ganz T. Hepcidin level predicts hemoglobin concentration in individuals undergoing repeated phlebotomy. Haematologica 2013; 98:1324-30. [PMID: 23445875 DOI: 10.3324/haematol.2012.070979] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Dietary iron absorption is regulated by hepcidin, an iron regulatory protein produced by the liver. Hepcidin production is regulated by iron stores, erythropoiesis and inflammation, but its physiology when repeated blood loss occurs has not been characterized. Hepcidin was assayed in plasma samples obtained from 114 first-time/reactivated (no blood donations in preceding 2 years) female donors and 34 frequent (≥3 red blood cell donations in preceding 12 months) male donors as they were phlebotomized ≥4 times over 18-24 months. Hepcidin levels were compared to ferritin and hemoglobin levels using multivariable repeated measures regression models. Hepcidin, ferritin and hemoglobin levels declined with increasing frequency of donation in the first-time/reactivated females. Hepcidin and ferritin levels correlated well with each other (Spearman's correlation of 0.74), but on average hepcidin varied more between donations for a given donor relative to ferritin. In a multivariable repeated measures regression model the predicted inter-donation decline in hemoglobin varied as a function of hepcidin and ferritin; hemoglobin was 0.51 g/dL lower for subjects with low (>45.7 ng/mL) or decreasing hepcidin and low ferritin (>26 ng/mL), and was essentially zero for other subjects including those with high (>45.7 ng/mL) or increasing hepcidin and low ferritin (>26 ng/mL) levels (P<0.001). In conclusion, hepcidin levels change rapidly in response to dietary iron needed for erythropoiesis. The dynamic regulation of hepcidin in the presence of a low levels of ferritin suggests that plasma hepcidin concentration may provide clinically useful information about an individual's iron status (and hence capacity to tolerate repeated blood donations) beyond that of ferritin alone. Clinicaltrials.gov identifier: NCT00097006.
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Affiliation(s)
- Alan E Mast
- Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI, USA.
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Kleinman S, King MR, Busch MP, Murphy EL, Glynn SA. The National Heart, Lung, and Blood Institute retrovirus epidemiology donor studies (Retrovirus Epidemiology Donor Study and Retrovirus Epidemiology Donor Study-II): twenty years of research to advance blood product safety and availability. Transfus Med Rev 2012; 26:281-304, 304.e1-2. [PMID: 22633182 PMCID: PMC3448800 DOI: 10.1016/j.tmrv.2012.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The Retrovirus Epidemiology Donor Study (REDS), conducted from 1989 to 2001, and the REDS-II, conducted from 2004 to 2012, were National Heart, Lung, and Blood Institute-funded, multicenter programs focused on improving blood safety and availability in the United States. The REDS-II also included international study sites in Brazil and China. The 3 major research domains of REDS/REDS-II have been infectious disease risk evaluation, blood donation availability, and blood donor characterization. Both programs have made significant contributions to transfusion medicine research methodology by the use of mathematical modeling, large-scale donor surveys, innovative methods of repository sample storage, and establishing an infrastructure that responded to potential emerging blood safety threats such as xenotropic murine leukemia virus-related virus. Blood safety studies have included protocols evaluating epidemiologic and/or laboratory aspects of human immunodeficiency virus, human T-lymphotropic virus 1/2, hepatitis C virus, hepatitis B virus, West Nile virus, cytomegalovirus, human herpesvirus 8, parvovirus B19, malaria, Creutzfeldt-Jakob disease, influenza, and Trypanosoma cruzi infections. Other analyses have characterized blood donor demographics, motivations to donate, factors influencing donor return, behavioral risk factors, donors' perception of the blood donation screening process, and aspects of donor deferral. In REDS-II, 2 large-scale blood donor protocols examined iron deficiency in donors and the prevalence of leukocyte antibodies. This review describes the major study results from over 150 peer-reviewed articles published by these 2 REDS programs. In 2011, a new 7-year program, the Recipient Epidemiology and Donor Evaluation Study-III, was launched. The Recipient Epidemiology and Donor Evaluation Study-III expands beyond donor-based research to include studies of blood transfusion recipients in the hospital setting and adds a third country, South Africa, to the international program.
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Affiliation(s)
- Steven Kleinman
- Department of Pathology, University of British Columbia, Victoria, British Columbia, Canada.
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Gandhi MJ, Duffy K, Benike M, Jenkins S, Stubbs JR. Effect of increasing hemoglobin cutoff in male donors and increasing interdonation interval in whole blood donors at a hospital-based blood donor center. Transfusion 2012; 52:1880-8. [PMID: 22313024 DOI: 10.1111/j.1537-2995.2011.03533.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The NHANES-III survey found hemoglobin (Hb) concentrations of more than 13.5 g/dL and more than 12.0 g/dL in normal Caucasian males and females. In the United States, a Hb of least 12.5 g/dL is required for blood donation, which allows "anemic" males to donate while excluding "normal" females. Low Hb is the major cause of deferral in donors and deferrals are associated with decreased donor return rates. Additionally, frequent blood donations are associated with depletion of body iron stores. Analysis of the effect of various Hb cutoffs and interdonation intervals on our center's blood supply is presented. STUDY DESIGN AND METHODS Whole blood donor data for a 12-month period were studied. Potential effects on the blood supply by increasing male Hb eligibility levels and/or increasing the interdonation interval were analyzed. RESULTS A total of 13,519 individuals (females, 56%) donated 30,678 units (mean frequency, male 2.7 and females 2.1) with the majority (42%) donating once. Increasing the male Hb eligibility to at least 13.5 g/dL will decrease collections by 1457 (5%) units. In addition, decreasing the female Hb eligibility to at least 12.0 g/dL will result in total gain of 307 (1%) units. Considering 12-week interdonation interval and Hb eligibility of at least 13.5 g/dL (male) and at least 12.5 g/dL (female) results in decrease of 11% (3352) units. CONCLUSIONS Increasing the Hb cutoff for male donors and/or interdonation interval for all donors will decrease available blood, some of which may be reduced by decreasing the Hb cutoff for females to at least 12.0 g/dL. As a majority of the donors donate only once with mean donation frequency being 2.4, it may be possible to overcome this shortfall by targeted recruitment of donors donating once.
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Affiliation(s)
- Manish J Gandhi
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Mast AE, Steele WR, Johnson B, Wright DJ, Cable RG, Carey P, Gottschall JL, Kiss JE, Simon TL, Murphy EL. Population-based screening for anemia using first-time blood donors. Am J Hematol 2012; 87:496-502. [PMID: 22460662 PMCID: PMC3525330 DOI: 10.1002/ajh.23171] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 01/24/2012] [Accepted: 02/16/2012] [Indexed: 11/09/2022]
Abstract
Anemia is an important public health concern. Data from population-based surveys such as the National Health and Nutrition Examination Survey (NHANES) are the gold standard, but are obtained infrequently and include only small samples from certain minority groups. We assessed whether readily available databases of blood donor hemoglobin values could be used as a surrogate for population hemoglobin values from NHANES. Blood donor venous and fingerstick hemoglobin values were compared to 10,254 NHANES 2005-2008 venous hemoglobin values using demographically stratified analyses and ANOVA. Fingerstick hemoglobins or hematocrits were converted to venous hemoglobin estimates using regression analysis. Venous hemoglobin values from 1,609 first time donors correlated extremely well with NHANES data across different ages, genders, and demographic groups. Cigarette smoking increased hemoglobin by 0.26-0.59 g/dL depending on the intensity. Converted fingerstick hemoglobin from 36,793 first time donors agreed well with NHANES hemoglobin (weighted mean hemoglobin of 15.53 g/dL for donors and 15.73 g/dL for NHANES) with similar variation in mean hemoglobin by age. However, compared to NHANES, the larger donor data set showed reduced differences in mean hemoglobin between Blacks and other races/ethnicities. Overall, first-time donor fingerstick hemoglobins approximate US population data and represent a readily available public health resource for ongoing anemia surveillance.
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Affiliation(s)
- Alan E. Mast
- Blood Center of Wisconsin, Milwaukee, WI
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | | | | | | | - Ritchard G. Cable
- New England Region, American Red Cross Blood Services, Farmington, CT
| | - Patricia Carey
- Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, OH
| | | | | | | | - Edward L. Murphy
- University of California, San Francisco and Blood Systems Research Institute, San Francisco, CA
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