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Vinkenoog M, Toivonen J, Brits T, de Clippel D, Compernolle V, Karki S, Welvaert M, Meulenbeld A, van den Hurk K, van Rosmalen J, Lesaffre E, Arvas M, Janssen M. An international comparison of haemoglobin deferral prediction models for blood banking. Vox Sang 2023. [PMID: 36924102 DOI: 10.1111/vox.13426] [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: 11/02/2022] [Revised: 02/04/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Blood banks use a haemoglobin (Hb) threshold before blood donation to minimize donors' risk of anaemia. Hb prediction models may guide decisions on which donors to invite, and should ideally also be generally applicable, thus in different countries and settings. In this paper, we compare the outcome of various prediction models in different settings and highlight differences and similarities. MATERIALS AND METHODS Donation data of repeat donors from the past 5 years of Australia, Belgium, Finland, the Netherlands and South Africa were used to fit five identical prediction models: logistic regression, random forest, support vector machine, linear mixed model and dynamic linear mixed model. Only donors with five or more donation attempts were included to ensure having informative data from all donors. Analyses were performed for men and women separately and outcomes compared. RESULTS Within countries and overall, different models perform similarly well. However, there are substantial differences in model performance between countries, and there is a positive association between the deferral rate in a country and the ability to predict donor deferral. Nonetheless, the importance of predictor variables across countries is similar and is highest for the previous Hb level. CONCLUSION The limited impact of model architecture and country indicates that all models show similar relationships between the predictor variables and donor deferral. Donor deferral is found to be better predictable in countries with high deferral rates. Therefore, such countries may benefit more from deferral prediction models than those with low deferral rates.
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Affiliation(s)
- Marieke Vinkenoog
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Leiden Institute of Advanced Computer Science, Leiden University, Leiden, The Netherlands
| | - Jarkko Toivonen
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Tinus Brits
- Business Intelligence, South African National Blood Service, Johannesburg, South Africa
| | | | - Veerle Compernolle
- Dienst voor het Bloed, Belgian Red Cross Ugent, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Surendra Karki
- Research and Development, Australian Red Cross Lifeblood, Sydney, Australia
| | - Marijke Welvaert
- Research and Development, Australian Red Cross Lifeblood, Sydney, Australia
| | - Amber Meulenbeld
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | | | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Mikko Arvas
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Mart Janssen
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
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Abstract
PURPOSE OF REVIEW This review examines recent research on the prevalence and importance of iron deficiency in blood donors, and on efforts to mitigate it. RECENT FINDINGS Premenopausal females, teenagers, and high-frequency donors are at the highest risk for donation-induced iron deficiency, in both high-resource and low-resource settings. The physiology relating iron stores to hemoglobin levels and low hemoglobin deferral is well elucidated in blood donor populations, yet the clinical effects attributable to iron loss in the absence of anemia are challenging to identify. Expanded adoption of ferritin testing is improving donor management but may cause decreases in the blood supply from temporary donor loss. The potential for personalized donor management is emerging with development of computational models that predict individual interdonation intervals that aim to optimize blood collected from each donor while minimizing low hemoglobin deferrals. SUMMARY Measures to reduce iron deficiency are available that can be deployed on a standardized or, increasingly, personalized basis. Blood centers, regulators, and donors should continue to evaluate different tactics for addressing this problem, to obtain a balanced approach that is optimal for maintaining adequate collections while safeguarding donor health.
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Affiliation(s)
| | - Alan E. Mast
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI
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Vinkenoog M, van Leeuwen M, Janssen MP. Explainable haemoglobin deferral predictions using machine learning models: Interpretation and consequences for the blood supply. Vox Sang 2022; 117:1262-1270. [PMID: 36102148 PMCID: PMC9826045 DOI: 10.1111/vox.13350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Accurate predictions of haemoglobin (Hb) deferral for whole-blood donors could aid blood banks in reducing deferral rates and increasing efficiency and donor motivation. Complex models are needed to make accurate predictions, but predictions must also be explainable. Before the implementation of a prediction model, its impact on the blood supply should be estimated to avoid shortages. MATERIALS AND METHODS Donation visits between October 2017 and December 2021 were selected from Sanquin's database system. The following variables were available for each visit: donor sex, age, donation start time, month, number of donations in the last 24 months, most recent ferritin level, days since last ferritin measurement, Hb at nth previous visit (n between 1 and 5), days since the nth previous visit. Outcome Hb deferral has two classes: deferred and not deferred. Support vector machines were used as prediction models, and SHapley Additive exPlanations values were used to quantify the contribution of each variable to the model predictions. Performance was assessed using precision and recall. The potential impact on blood supply was estimated by predicting deferral at earlier or later donation dates. RESULTS We present a model that predicts Hb deferral in an explainable way. If used in practice, 64% of non-deferred donors would be invited on or before their original donation date, while 80% of deferred donors would be invited later. CONCLUSION By using this model to invite donors, the number of blood bank visits would increase by 15%, while deferral rates would decrease by 60% (currently 3% for women and 1% for men).
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Affiliation(s)
- Marieke Vinkenoog
- Department of Donor Medicine ResearchSanquin ResearchAmsterdamthe Netherlands,Leiden Institute of Advanced Computer ScienceLeiden UniversityLeidenthe Netherlands
| | - Matthijs van Leeuwen
- Leiden Institute of Advanced Computer ScienceLeiden UniversityLeidenthe Netherlands
| | - Mart P. Janssen
- Department of Donor Medicine ResearchSanquin ResearchAmsterdamthe Netherlands
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Blood donors, iron deficiency and supplementation options - Will clinical trials help moving forward? Transfus Apher Sci 2022; 61:103530. [DOI: 10.1016/j.transci.2022.103530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Chin LT, Woon JY, Kuo SW, Lu SC. Decreased levels of ferritin, mild thrombocytosis, and increased erythropoietin are sequential events among frequent plateletpheresis donors: Implication for a ferritin screen. Transfus Apher Sci 2022; 61:103501. [PMID: 35835689 DOI: 10.1016/j.transci.2022.103501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is generally recognized that repeat apheresis increases the risk for iron deficiency, thus may impact on the blood homeostasis. With regard to donor vigilance, we clarified the mid- to long-term effects of plateletapheresis by comparing the most frequent donors with the first-time ones in hematological and biochemical tests. METHODS Levels of erythropoietin (EPO), hemoglobin (Hb) and ferritin were analyzed in double-unit (500 mL whole blood or 6 × 1011 apheresis platelets) donations in three male cohorts, with identifiers of first-time whole-blood donors (n = 30), first-time platelet donors transited from maximal whole blood to apheresis (n = 30) and frequent donors subjected to extreme plateletpheresis (n = 90), respectively. According to the number of donations, the last earnest cohort, who donate almost 24 times a year, was further subdivided into three groups- casual (76-120 life-time donations in 5 years), mediocre (121-168 within 7 years) and enthusiastic (≥169 within 7 years and a month). RESULTS Regardless of the donation experience in whole blood or plateletpheresis, iron deficiency (serum ferritin concentrations <15 μg/L) was identified in all earnest cohorts. The ferritin means were significantly lower in plateletpheresis groups, with the lowest values in the enthusiastic group. EPO levels showed a significant inverse correlation with ferritin (p = 0.015, r = -0.224). Long-term earnest donors had the lowest iron stores accompanied by a later thrombocytosis and a final increase in EPO was revealed. CONCLUSION Regular ferritin screens are crucial to ensure a high level of donor health protection.
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Affiliation(s)
- Li-Te Chin
- Department of Microbiology, Immunology and Biopharmaceuticals, National Chiayi University, Chiayi City, Taiwan, ROC; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Jun Yu Woon
- Department of Microbiology, Immunology and Biopharmaceuticals, National Chiayi University, Chiayi City, Taiwan, ROC
| | - Sau-Wei Kuo
- Tainan Blood Center, Taiwan Blood Services Foundation, Tainan, Taiwan, ROC
| | - Shih-Chien Lu
- Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan, ROC; Tainan Branch, Chinese Blood Donation Association, Tainan, Taiwan, ROC.
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