Blood donor management in china

The Chinese cardiorespiratory and circulatory system at work in women and men: a case-control study

Background

The physiology of prominent prognostic factors in the cardiorespiratory system remains unchartered in the world's largest ethnic group: Hans Chinese (HC). This study assessed and contrasted the fundamental variables in HC and European-American (EA) individuals.

Methods

Healthy HC and EA adults (n = 140, 43% ♀) closely matched by age, sex and physical activity were included. Body composition (DXA) and haematological variables (haemoglobin mass, blood volume (BV)) were measured at rest. Pulmonary O2 uptake (VO2) measurements along with cycle ergometry designed for accurate transthoracic echocardiography were implemented to assess cardiorespiratory structure/function up to peak effort.

Findings

HC presented with higher body fat and lower lean body mass (LBM) percentage than EA irrespective of sex (P ≤ 0.014). BV did not differ whereas blood haemoglobin concentration was lower in HC compared with EA, particularly in females (P = 0.009). Myocardial diastolic and overall function at rest was enhanced in HC versus EA (P < 0.001). During exercise, heart volumes and output per unit of body size did not differ between ethnicities, whereas larger heart volumes per unit of LBM were found in HC versus EA in females (P ≤ 0.003). At high exercise intensities, VO2 (-16%) and the arteriovenous O2 difference (-28%) were markedly reduced in HC compared with EA in females (P ≤ 0.024). In males, no physiological difference between HC and EA was observed during exercise.

Interpretation

Notwithstanding lower LBM, HC are characterised by similar BV and cardiac capacity but reduced peak VO2 than EA in females, partly explained by low ethnic-specific blood O2 carrying capacity.

Funding

Early Career Scheme (106210224, to D.M.) and Seed Fund (104006024, to D.M.).

Effect of large volume red blood cell apheresis on cardiovascular functions in healthy donors

BACKGROUND

Requirements of blood transfusions rise rapidly in China. Improving the efficiency of blood donation could help maintaining sufficient blood supplement. We conducted a pilot research to investigate the reliability and safety of collecting more units of red blood cell by apheresis.

METHODS

Thirty-two healthy male volunteers were randomized into two groups: red blood cell apheresis (RA) (n = 16) and whole blood (WB) donation (n = 16). RA group donated individualized RBC volumes by apheresis according to the volunteers' basal total blood volumes and haematocrit levels, WB group donated 400 mL whole blood. All volunteers were scheduled seven visit times in 8 weeks' study period. The cardiovascular functions were assessed by laboratory examinations, echocardiography and cardiopulmonary functional tests. All results were compared between groups at the same visit time and compared between visit 1(before donation) and other visit times within the same group.

RESULTS

The average donated RBC volume in RA group and in WB group was 627.25 ± 109.74 mL and 175.28 ± 8.85 mL, respectively(p < 0.05); the RBC, haemoglobin and haematocrit levels changed significantly between times and between groups (p < 0.05). Cardiac biomarker levels such as NT-proBNP, hs-TnT and CK-MB did not change significantly between times or between groups (p > 0.05). The echocardiographic and cardiopulmonary results did not change significantly between times or between groups during the whole study period(p > 0.05).

CONCLUSIONS

We provided an efficient and secure method for RBC apheresis. By harvesting more RBC volumes at one single-time, the cardiovascular functions did not change significantly compared with traditional whole blood donation.

Exploring Blood Donation Challenges and Mobilization Mechanisms in North China During the COVID-19 Pandemic: A Qualitative Study

Purpose

The coronavirus disease 2019 (COVID-19) pandemic disrupted the supply of blood globally, resulting in numerous studies focusing on the challenges in maintaining blood supply, and the responses to it, in countries with a mixed blood donation model. This study explored blood donation challenges and mobilization mechanisms in North China, which employs a non-remunerative donation model, during the COVID-19 pandemic’s first wave.

Materials and Methods

A qualitative approach was adopted to investigate blood donation practices in Chengde from April to June 2020. Data were collected from eight blood donors, six potential donors, three blood donation station leaders, and two government officials, through semi-structured interviews.

Results

The major challenge for blood supply was decreased blood donations, owing to lockdown restrictions, and individual and familial apprehensions. Mobilization mechanisms included bureaucratic and ideological mobilization. However, although group blood donation alleviates the pressure on supply chains during emergencies, it is detrimental to the cultivation of civic engagement in the long run.

Conclusion

This study contributes to the understanding of how countries with uncompensated blood donation models respond to public health emergencies. It suggests that striking a balance between the society’s and the state’s perception of blood donation would allow the state to incorporate the different “voices” of society, and devise an inclusive blood donation policy.

The effect of temporary deferrals on donor return: A 26-year assessment in a setting without retention activities

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.

Cohort Profile: The Shaanxi Blood Donor Cohort in China

Purpose

The Shaanxi Blood Donor Cohort was set up to investigate the impact of blood donation on the health of donors compared with non-blood donors. The specific aims of the study include (1) identifying the geographical and temporal trends of incidence for diseases in both blood donors and non-blood donors; (2) assessing the impact of environmental exposures, lifestyle, body mass index (BMI) and blood type on disease burdens, stratified between blood donors and non-blood donors; and (3) among blood donors, investigating if regular blood donation has a positive impact on donors’ health profiles, based on a cohort with a mixed retrospective and prospective study design.

Participants

A total of 3.4 million adults, with an equal number and identical demographic characteristics (year of birth, sex and location of residence) of blood donors and non-blood donors, were enrolled on 2012. The one-to-one matching was conducted through a repeated random selection of individuals without any history of blood donation from the Shaanxi Electronic Health Records. The cohort has been so far followed up to the end of 2018, summing to nearly 24 million years of follow-up. The cohort will be followed up prospectively every 3 years until 2030.

Findings to Date

Of the 1.7 million blood donors, 418,312 (24.5%) and 332,569 (19.5%) individuals were outpatients and inpatients, accounting for 1,640,483(96.2%) outpatient and 496,061 (29.1%) inpatient visits. Of the same number of non-blood donors, 407,798 (23.9%) and 346,097 (20.3%) individuals were hospital outpatients and inpatients, accounting for 1,655,725 (97.1%) outpatient and 562,337 (33.0%) inpatient visits. The number of outpatient and inpatient visits by non-blood donors was 0.9 and 3.9% higher than those of the blood donors (p < 0.01). Blood donors demonstrate significantly fewer inpatients visits than non-blood donors for major chronic disease categories (p < 0.01).

Future Plans

We are currently exploring the long term benefits of blood donation on major chronic disease categories and multimorbidities in this large population cohort. The study results are adjusted by the “healthy donor effect.” This cohort study will continue until 2030.

Assessment of Performance of Blood Banks in India: A National Level Cross Sectional Study

India lacks comprehensive information about blood transfusion systems, which could help ensure universal access to safe blood through evidence-based strategies and programs. We conducted the first national assessment of blood bank systems, services, practices, and performance in India. We conducted a cross-sectional survey of all 2626 blood banks and assessed the administrative, technical, and quality aspects in 2016. In addition to descriptive analysis, we compared the means of different variables using independent t-test or ANOVA and a generalized linear model. We performed linear regression analysis between the collection of blood per 100 people and the number of blood banks per million people. The disaggregated mean score of quality management system and overall performance are presented by different groups. Besides, we graded the performance based on tertile classification, as low, medium and high-performance blood banks. Of the 2493 blood banks that participated in the study, most were public (38%) or not-for-profit(38%), and 51% had component separation facilities. Of the 11.65 million units of blood collected annually, 72% was through voluntary blood donation. There were 2.2 blood banks per one million people, collecting around one unit per 100 persons annually with wide variation between states. The mean overall performance score was 62(95% confidence interval [CI]:61.6-62.5), and the mean quality management system score was 57.4(95% CI:56.8-58.0), with significant variation across different categories of blood banks. This assessment provides critical information for developing evidence-based policies, programs, and monitoring systems to improve the performance of blood transfusion services in India.

DEL in China: the D antigen among serologic RhD-negative individuals

BACKGROUND

Providing RhD-negative red cell transfusions is a challenge in East Asia, represented by China, Korea, and Japan, where the frequency of RhD-negative is the lowest in the world.

FINDINGS

Among 56 ethnic groups in China, the RhD-negative frequency in Han, the prevalent ethnicity, is 0.5% or less, similar to most other ethnic groups. The Uyghur ethnic group has the highest reported RhD-negative frequency of up to 4.7%, as compared to 13.9% in the US. However, an estimated 7.15 million RhD-negative people live in China. The RhD-negative phenotype typically results from a loss of the entire RHD gene, causing the lack of the RhD protein and D antigen. The DEL phenotype carries a low amount of the D antigen and types as RhD-negative in routine serology. The DEL prevalence in RhD-negative individuals averages 23.3% in the Han, 17% in the Hui and 2.4% in the Uyghur ethnicities. The Asian type DEL, also known as RHD*DEL1 and RHD:c.1227G > A allele, is by far the most prevalent among the 13 DEL alleles observed in China.

CONCLUSION

The purpose of this review is to summarize the data on DEL and to provide a basis for practical strategy decisions in managing patients and donors with DEL alleles in East Asia using molecular assays.

Assessing the performance of a plateletpheresis unit at a tertiary-care academic medical center in Mexico: A 6-year experience

BACKGROUND

Optimization of platelet (PLT) apheresis collection is a priority to satisfy the increasing demand of hemato-oncology patients. We assessed the performance of a plateletpheresis unit supporting hematology patients.

STUDY DESIGN AND METHODS

This descriptive retrospective study included 561 plateletpheresis collections from 2013 to 2018. For data analysis, descriptive statistics and receiver operating characteristic (ROC) curve were used. A 5-item satisfaction questionnaire was analyzed.

RESULTS

Ninety percent of the donors were males. The median plateletpheresis time was 89 minutes; its success rate was 92.5%; median donor PLT count was 232 × 10⁹ /L, women median PLT count was 247 × 10⁹ /L vs 231x10⁹ /L in men (P = .017). Seventy-seven percent donors were candidates for a double product and 24.5% were processed; 20.8% of these donors had a weight ≤75 and 79.2% >75 kg, P = .003, and 6.6% were women and 93.4% men, P = .161. Thirty-six of donors had ≥250 × 10⁹ /L and 16.8% was processed as a triple product. ROC analysis showed that with donor PLT counts ≥200 × 10⁹ /L the sensitivity for obtaining double products was 0.981 and specificity 0.714, with an area under the curve (AUC) = 0.877. The adverse effect rate was 4.3%. Of the potential donors, 6.3% were rejected. The cost of processing single or double products was 430 USD. Comfort and time spent during plateletpheresis were areas for improvement.

CONCLUSION

Platelet count and donor weight predicted PLT yield and obtaining double products. Women had higher PLT counts, but no significant difference was found between donor gender and processed products. Assessment of the apheresis unit can help to improve its performance.

The development of a legal framework for blood donation and blood safety in China over 24 years

Background

This study analyzes the regulation of and developments in blood donation in China from 1996 to 2019, and demonstrates the government’s efforts to improve blood safety.

Results

Since the implementation of the Blood Donation Law in 1998, the number of blood donors in China increased by 275% from 1998 to 2018 (from 4 million to 15 million). The principle of no-fault liability was proposed and has been applied since 2010 to the tort liability related to blood transfusion malpractice. In 2015, mutual blood donation accounted for 4.2% of the national collection. However, in some provinces of China, the percentage of mutual blood donation increased from 9.3 to 35.6% in 2016. The National Health Commission canceled mutual blood donation in March of 2018. Since 2015, nucleic acid amplification testing has become a routine test item for screening blood.

Conclusions

The Chinese government institutionalized the voluntary non-remunerated donation principle, enacted regulations for the management of blood transfusion, and adopted advanced blood testing technology to sustain blood supply and ensure blood safety. Despite increased blood donation, blood shortages persist. The quality and safety of blood collection can be further improved through the cancellation of mutual blood donation and incentive measures for voluntary non-remunerated donation of blood, which needs facilitation by governmental legislation.

Estimating the incidence of HIV infection in repeat blood donors with low average donation frequency

BACKGROUND

The standard approach to estimating HIV incidence in repeat blood donors includes only donors who made two or more donations in an estimation interval. In China and some other countries, large proportions of repeat donors donate only once in a 1- or 2-year interval. The standard approach may not represent risk among all repeat donors in these areas. Two approaches to including all repeat donors in the incidence estimate were evaluated in a simulation study.

STUDY DESIGN AND METHODS

Under one approach, a donor infected at the first donation contributes a partial case to incidence that equals the proportion of time since the preceding donation that is in the estimation interval. Under the other, that donor contributes a full case if at least half the time since the previous donation is in the estimation interval and nothing otherwise. Infections identified at the second or subsequent donations in the interval contribute full cases as usual. The simulations involved proportions with single donations of 11% to 65% combined with a variety of patterns of rising, falling, or constant incidence.

RESULTS

The partial-case approach was unbiased under more test conditions than the whole-case approach and exhibited smaller bias when both were biased. Under both approaches, bias >10% occurred only when rates of single donations >50% were combined with large changes in incidence over time.

CONCLUSION

The partial-case approach performed better than the whole-case approach. The conditions producing bias >10% are so extreme that they are unlikely to be encountered in the field.

Distribution characteristics of ABO and RhD blood groups among the voluntary blood donors in Chongqing: A retrospective study

The distribution characteristics of ABO and RhD blood groups in the world were different and the data were limited. The aim was to investigate the distribution characteristics of ABO and RhD blood groups in Chongqing, and to provide scientific-effective data for a more reasonable blood collection program. We retrospectively analyzed 795 698 blood donors who had donated blood from 2014 to 2019 at the Chongqing Blood Center. The data on ABO and RhD blood groups were extracted based on blood management system. We used percentages to describe the extraction of data on blood donors by gender, age, and nationality. The data on the distribution of ABO (A, B, AB and O) and RhD (RhD-Positive and RhD-Negative) blood groups were reported also in percentages. Of those, 427 516 (53.73%) were males and 368 182 (46.27%) were females. Among all the blood donors, 321 916 (40.46%) were under the age of 25, followed by 26-35 years age group (22.65%), 36-45 years age group (18.95%), 46-55 years age group (16.98%) and 56-60 years age group (0.96%). There were 755439 (94.94%) of the blood donors who were of the Han nationality. The distribution of blood groups O, A, B and AB were 35.54%, 31.90%, 24.14% and 8.42%, respectively. The distributions of RhD-Negative group was found in 4362 (0.55%) blood donors. The distribution characteristics of the ABO and RhD blood group should be considered when improving blood collection program in Chongqing.

Estimation of the number of blood donors during the COVID-19 incubation period across China and analysis of prevention and control measures for blood transfusion transmission

BACKGROUND

The aim of this study was to estimate the number of blood donors during the COVID‐19 incubation period across China.

STUDY DESIGN AND METHODS

In this study, we developed a predictive model to estimate the number of blood donors during the COVID‐19 incubation period among 34 provincial regions in China. Our main assumption was that blood donors of all ages in different regions have a stable blood donation intention and the same infection risk.

RESULTS

First, we estimated the number of blood donors during the COVID‐19 incubation period in Wuhan city, Hubei Province, and China, from December 31, 2019 to March 17, 2020. Second, we compared the number of blood donors during the COVID‐19 incubation period in all provinces across China. In addition, we found that if all RBCs, plasma, and cryoprecipitation were stored in isolation until the 14th day, the potential risk of SARS‐CoV‐2 transmission through blood transfusion was reduced by at least 65.77% after the blood donor safely passed the COVID‐19 incubation period. Moreover, if the detection of SARS‐CoV‐2 RNA was carried out on all platelets, the potential risk would be reduced by 77.48%.

CONCLUSIONS

Although the risk is low, with the rapid spread of the COVID‐19 and the appearance of alarmingly high infectivity and a high fatality rate, appropriate measures should be taken by health departments to ensure the safety of clinical blood.

Effective methods for reactivating inactive blood donors: a stratified randomised controlled study

BACKGROUND

Recruiting of sufficient numbers of donors of blood products is vital worldwide. In this study we assessed the efficacy and cost-effectiveness of telephone calls and SMS reminders for re-recruitment of inactive blood donors.

METHODS

This single-centre, non-blinded, parallel randomised controlled trial in Guangzhou, China included 11,880 inactive blood donors whose last donation was between January 1 and June 30, 2014. The donors were randomly assigned to one of two intervention groups (telephone call or short message service [SMS] communications) or to a control group without intervention. SMS messages with altruistic appeal were adopted in the SMS group; in addition to altruistic appeal, reasons for deferral of blood donation were also asked in the telephone group. All participants were followed up for 1 year. The primary outcome was re-donation rate, and rates in different groups were compared by intention-to-treat (ITT) analysis and estimation of the average treatment effect on the treated (ATT). Secondary outcomes were the self-reported deterrents. Other outcomes included the re-donation interval, and the incremental cost-effectiveness ratio (ICER) of telephone calls and SMS reminders on re-recruitment.

RESULTS

ITT analysis revealed no significant differences in the re-donation rate among the three groups. ATT estimations indicated that among compliers, telephone calls significantly increased re-donation compared to both SMS reminders and no intervention. Donor return behaviour was positively associated with receiving reminders successfully, being male, older age, and previous donation history. The SMS reminder prompted donors to return sooner than no reminder within 6 months, and according to ICER calculations, SMS reminders were more cost-effective than telephone calls. Donors reported time constraints as the most main causes of self-deferral in the telephone group, and altruistic appeal had a positive effect on these donors.

CONCLUSIONS

Interventions to reactivate inactive blood donors can be effective, with telephone calls prompting more donors to return but at a greater cost than SMS messages. SMS reminder with altruistic appeal can urge donors to re-donate sooner within 6 months than no reminder.

TRIAL REGISTRATION

NCT03366441 (Reactivation of Inactive Blood Donors). Retrospectively registered 4 December 2017.

Overall prevalence of human parvovirus B19 among blood donors in mainland China: A PRISMA-compliant meta-analysis

BACKGROUND

Human parvovirus B19 (B19V) infection exhibits a broad range of clinical outcomes. Blood transfusion is a common route of B19V transmission. However, information about the overall prevalence of B19V infection and B19V genotypes among blood donors in mainland China is lacking.

METHODS

This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search for studies reporting the B19V prevalence among blood donors in mainland China from 2000 to 2018 was performed. The prevalence of B19V was estimated through a meta-analysis of the relevant literature. A comprehensive meta-analysis program was used for data processing and statistical analysis.

RESULTS

Twenty-one eligible articles were included, involving 48,923 participants assessed for B19V-DNA, 12,948 participants assessed for anti-B19V immunoglobulin M (IgM), and 8244 participants assessed for anti-B19V immunoglobulin G (IgG). The analysis revealed the pooled estimates of the prevalence rates of B19V-DNA, anti-B19V IgM, and anti-B19V IgG among blood donors to be 0.7% (95% confidence interval [CI] 0.2-2.4%), 2.7% (95% CI 1.7-4.3%), and 33.6% (95% CI 28.2-39.4%), respectively. Moreover, phylogenetic analyses indicated that 142 of 169 (84.0%) B19V isolates belonged to Genotype 1.

CONCLUSIONS

The overall prevalence of B19V among blood donors is not high in mainland China, and most isolates belong to Genotype 1.

Metagenomic analysis of potential pathogens from blood donors in Guangzhou, China

OBJECTIVES

This study aimed to identify the emerging/reemerging pathogens in blood donation samples.

BACKGROUND

A metagenomic analysis has previously been used to look for pathogens but in this study, the relationship with aminotransferase (ALT) is described.

METHODS/MATERIALS

Excluding samples reactive to hepatitis B virus, hepatitis C virus, human immunodeficiency syndrome virus or syphilis and plasma samples were stratified into three groups of ALT levels (IU/L): A ≤ 50, B 51 to 69 and C ≥ 70, respectively. Each group was mixed in a pool of 100 samples, from which DNA and cDNA libraries were established for next generation sequencing and analysis. Pathogens of interest were identified by immunoassays, nested-polymerase chain reaction, phylogenetic analysis and pathogen detection in follow-up donors.

RESULTS

Several new or reemerging transfusion-transmitted pathogens were identified; Streptococcus suis, Babesia species and Toxoplasma gondii were found in the three ALT groups, Epstein-Barr virus (EBV) only in group C. Ten S. suis nucleic acid positive samples were detected, all closely phylogenetically related to reference strains. A donor in group A carried both S. suis genome and specific IgM in follow-up samples. This strain was identified as nontoxic S. suis. Five samples contained a short fragment of Babesia species SpeI-AvaI gene, while T. gondii was identified in 20 samples as a short fragment of 18S rDNA gene. In group C, two samples contained EBV genome.

CONCLUSIONS

Blood donations that contained S. suis, Babesia species and T. gondii sequences might represent potential transfusion risks. EBV, a potential cause of elevated ALT, was detected. Metagenomic analysis might be a useful technology for monitoring blood safety.

HIV prevalence and incidence estimates among blood donors in five regions in China

BACKGROUND

Previous data, although scant, indicated that the incidence of HIV in China has increased over the past decade. There is a growing concern about the impact of the HIV epidemic on blood safety.

METHODS AND MATERIALS

We used donation data from five geographically-disperse blood centers in 2013-2016 participating in the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) China program to estimate HIV prevalence and incidence among blood donors. Multivariable logistic regression model was used to examine factors associated with HIV infection in Chinese blood donors.

RESULTS

The overall HIV prevalence among first-time donors from 2013 through 2016 was 68.04 per 100,000 donors (95% CI 61.68-74.40). The HIV incidence rate was estimated to be 37.93 per 100,000 person-years (95% CI 30.62-46.97) among first-time donors and 20.55 per 100,000 person-years (95% CI 16.95-24.91) among repeat donors. There was substantial variation in HIV prevalence and incidence rates across blood centers. Multivariable logistic regression results showed that among first-time donors, being male, older than 25 years, minority ethnicity, less than college education, and certain occupations (commercial services, factory workers, retired, unemployed, or self-employed) were associated with positive HIV confirmatory testing results.

CONCLUSION

HIV prevalence and incidence among blood donors remain low in the selected five regions in China; however, an increasing trend is observed at some blood centers. It is important to monitor HIV epidemiology in Chinese blood donors on a continuous basis, especially among populations and regions of higher risk.

Association between syphilis seroprevalence and age among blood donors in Southern China: an observational study from 2014 to 2017

OBJECTIVE

This study investigated the association between syphilis seroprevalence and age among blood donors, and described the distribution of serological titres among syphilis-infected donors, aiming to confirm the syphilis epidemic characteristics and to promote effective interventions for older adults.

METHODS

Data were obtained from the Shenzhen Programme for Syphilis Prevention and Control in 2014-2017. Blood samples were screened using the ELISAs, and confirmed using the Treponema pallidum particle agglutination assay (TPPA) and toluidine red unheated serum test (TRUST).

RESULTS

Among 394 792 blood donors, 733 tested TPPA and TRUST positive (active infection), and 728 tested only TPPA positive (historical infection). The overall prevalence of syphilis seropositivity was 370.1 per 100 000 (95% CI 351.1 to 389.0 per 100 000); the prevalence of active infection was 185.7 per 100 000 (95% CI 172.2 to 199.1 per 100 000). People aged ≥45 years displayed a prevalence of 621.8 per 100 000 in syphilis seropositivity and 280.5 per 100 000 in active infection, which were 3.8 times and 2.4 times higher than that for people aged <25 years, respectively. The prevalence of syphilis seropositivity (χ²_trend=311.9, p _trend<0.001) and active infection (χ²_trend=72.1, p _trend<0.001) increased significantly with age. After stratification by gender and year of donation, the increasing trend of prevalence with age remained (p _trend<0.05), except for the prevalence of active infection in males and females in 2014. About 16.3% of donors with active infection and aged ≥45 years had a TRUST titre of ≥1∶8, lower than that of patients aged <25 years (51.3%) and 25-34 years (34.1%).

CONCLUSIONS

The findings confirm the high prevalence of syphilis among older adults, and suggest the need to increase awareness among healthcare providers and deliver more targeted prevention interventions for older adults to promote early testing.

Population-based projections of blood supply and demand, China, 2017-2036

Objective

To estimate the long-term effect of the changing demography in China on blood supply and demand.

Methods

We developed a predictive model to estimate blood supply and demand during 2017–2036 in mainland China and in 31 province-level regions. Model parameters were obtained from World Population Prospects, China statistical yearbook 2016, China’s report on blood safety and records from a large tertiary hospital. Our main assumptions were stable age-specific per capita blood supply and demand over time.

Findings

We estimated that the change in demographic structure between 2016 (baseline year) and 2036 would result in a 16.0% decrease in blood supply (from 43.2 million units of 200 mL to 36.3 million units) and a 33.1% increase in demand (from 43.2 million units to 57.5 million units). In 2036, there would be an estimated shortage of 21.2 million units. An annual increase in supply between 0.9% and 1.8% is required to maintain a balance in blood supply and demand. This increase is not enough for every region as regional differences will increase, e.g. a blood demand/supply ratio ≥ 1.45 by 2036 is predicted in regions with large populations older than 65 years. Sensitivity analyses showed that increasing donations by 4.0% annually by people aged 18–34 years or decreasing the overall blood discard rate from 5.0% to 2.0% would not offset but help reduce the blood shortage.

Conclusion

Multidimensional strategies and tailored, coordinated actions are needed to deal with growing pressures on blood services because of China’s ageing population.

Current approaches to increase blood donations in resource-limited countries

BACKGROUND

Low- and middle-income countries (LMIC) suffer from chronic or seasonal blood shortage. The first review was published in 2007.

METHODS

The review of literature since 2005 presented here uncovered a fairly large number of articles justifying the grouping of blood donation issues into five geographical areas sharing common background. These are Sub-Saharan Africa (SSA), Muslim countries, India, China/South East Asia and Latin America/Caribbean islands (LA&C).

RESULTS

SSA countries start collecting at 16-18 years of age in schools where female donors can be reached better than in other settings. Community-oriented culture favours family donors who need, similar to volunteer non-remunerated donors (VNRD), to be actively induced to repeat donation. Muslim countries share the contradiction of religion encouraging blood donation but restrain women from donating. The active involvement of religious leaders and the progressive easing of female participation are the keys to increasing blood donation. In India, 'social duty' is a major inducement to blood donation but also benefits and rewards. Ways of involving female donors by reducing the donation age to 16 years and providing donor education in schools need to be considered. In China and East Asia, the option of small-volume donation impairs blood collection without being justified by scientific evidence but is a concession to culture. Reducing the donation age would also help the supply. In LA&C, the concept of 'social capital' was developed as a complement or alternative to the theory of planned behaviour.

CONCLUSIONS

Strategies to improve blood donation and repeat donation should be innovative and adapted to local or regional culture and environment.

Problems and challenges: development of blood transfusion services in Mainland China within the context of health-care system reform

OBJECTIVE

To evaluate the development of blood transfusion services in Mainland China within the context of health-care system reform.

BACKGROUND

China launched a health-care reform program in 2009 to redistribute health-care resources, which are currently over-concentrated in well-developed cities. A geographically equitable blood transfusion service is key to achieving this goal.

METHODS

Based on the national survey of blood establishments in July 2015, total blood collection, whole-blood donations per 1000 population and the supply and demand relationship were analysed at the administrative region level. Areas at different developmental levels were compared in terms of total blood collection and human resources.

RESULTS

In 2014, Mainland China's 31 provinces showed wide variation, with total blood collection in blood facilities ranging from about 1000 units to over 600 000 units (each 200 mL), and the whole-blood donation rate per 1000 population, ranging from 1·48 to 17·09. 69% of the country's total collection, was concentrated in 29 provincial capitals, and 31% was in 311 non-capital cities. Of 97 personnel with doctorates, 74 worked in 32 provincial blood establishments, whereas the remaining 23 worked at the other 318 blood stations. In most provinces, per permanent resident donation was within 2-4 mL, and blood volume per inpatient was 10-35 mL regardless of the development of the transfusion service.

CONCLUSION

In 2014, China had an imbalanced development and insufficient access to blood transfusion services. This service must be redeployed at the national level to facilitate health-care reform in China.

Donor protection: Iron supplementation for frequent blood donors in Korea

OBJECTIVE

This study aimed to evaluate the effect of oral iron supplementation in frequent donors in Korea, based solely on donation history.

STUDY DESIGN

The hemoglobin (Hb) level, ferritin level, soluble transferrin receptor (sTfR), total iron binding capacity (TIBC), and transferrin saturation of frequent donors at high risk for iron deficiency were compared to those of first donors. The frequent donors took iron supplements for 4 weeks and the same tests were repeated after 2 and 4 weeks to evaluate their effects.

RESULT

A total of 53 male and 57 female frequent donors were recruited. After 4-week iron supplementation, among the men, the prevalence of a: low Hb level (<13.0 g/dL) decreased from 25% to 2%; low ferritin level (<15.0 ng/mL) decreased from 58% to 4%; iron deficient erythropoiesis (IDE) (log(sTfR/ferritin) ≥ 2.07) decreased from 77% to 33%. Among the women, the percentage of a: low Hb level (<12.0 g/dL) decreased from 44% to 9%; low ferritin level decreased from 79% to 11%; IDE decreased from 95% to 47%. In total, 15 male (28.3%) and 29 female (56.9%) blood donors reported undesirable side effects related to iron supplementation. No serious adverse events were reported.

CONCLUSION

Ferritin level, a reliable indicator of iron status, increased and IDE decreased significantly after four-week iron supplementation in the female, but not in the male, donor group, compared to those of control donors. Four-week oral iron supplement was not enough to restore iron storage level in the male donor group.

Estimation of hepatitis B-positive rates in Chinese blood donors by combining predonation and postdonation screening results

BACKGROUND

Chinese blood centers use Hepatitis B surface antigen (HBsAg) rapid test (RT) in pre-donation and two rounds of screening with different enzyme-linked immunosorbent assays in post-donation. Nucleic acid testing (NAT) on screening non-reactive (SC-) donations has been gradually implemented since 2010. Yet RT+ and SC-/NAT+ donors are seldom included in hepatitis B virus (HBV) positive rate estimates in Chinese blood donors.

METHODS

We performed HBsAg neutralization test (NT) on whole blood (WB) with pre-donation RT+ results and post-donation screening reactive (SC+) samples from Mianyang and Chongqing in 2015. The annual totals of pre- and post-donation NT+ donors were combined with the annual totals of SC-/NAT+ donors to derive the estimated HBV positive rates.

RESULT

In Mianyang and Chongqing, 59.4% and 68.2% of RT+ donors in Jan-Aug 2015 contributed for NT, 95.5% and 97.2% of which were NT+ respectively. In 2015, 422 and 667 donors from Mianyang and Chongqing respectively were HBsAg RT+, yielding estimated 403 and 648 pre-donation RT+/NT+ deferrals. 411 and 668 post-donation SC+ samples were NT tested from Mianyang and Chongqing, of which 249 and 323 were NT+ respectively. An estimated 63 donors in Mianyang and 88 donors in Chongqing were SC-/NAT+. The estimated HBV confirmed positive rate in blood donors are 1.59% in Mianyang and 1.01% in Chongqing.

CONCLUSION

Pre-donation HBsAg RT effectively intercepts donations from HBV infected donors. Using NT confirmatory results from RT+, SC+ and SC-/NAT+ donors, this study provides a model for more accurate estimation for HBV positive rates in China.

Incentives for Blood Donation: A Discrete Choice Experiment to Analyze Extrinsic Motivation

Background: Demographic trends affect size and age structure of populations. One of the consequences will be an increasing need for blood products to treat age-related diseases. Donation services rely on voluntariness and charitable motivation. It might be questioned whether there will be sufficient blood supply with voluntary donation. The present study focused on elicitation of preferences for incentives and aimed to contribute to the discussion on how to increase donation rates. Methods: A self-administered discrete choice experiment (DCE) was applied. Respondents were repeatedly asked to choose between hypothetical blood donation centers. In case of reluctance to receiving incentives a none-option was included. Random parameter logit (RPL) and latent class models (LCM) were used for analysis. Results: The study sample included 416 college students from the US and Germany. Choice decisions were significantly influenced by the characteristics of the donation center in the DCE. Incentives most preferred were monetary compensation, paid leave, and blood screening test. LCM identified subgroups with preference heterogeneity. Small subgroups indicated moderate to strong aversion to incentives. Conclusion: The majority of the sample positively responded to incentives and indicated a willingness to accept incentives. In face of future challenges, the judicious use and appropriate utilization of incentives might be an option to motivate potential donors and should be open to discussion.

A survey of the blood supply in China during 2012-2014

OBJECTIVES

The aim of this study was to identify the status of the blood supply in China during 2012-2014.

BACKGROUND

China is a middle-income country, which contains more than 20% of the world population. Increasing the blood supply in China, along with increased healthcare coverage, involves many challenges.

METHODS

A survey questionnaire regarding blood centre activities was sent to all of the blood centres in 32 provinces via the Internet. The data were collected from the responses and analysed using Microsoft Excel 2013.

RESULTS

The total supply of whole blood and red blood cells (RBCs) in 2012 was 18 644 700 units; in 2013, 18 985 800 units; and in 2014, 19 658 800 units. A similar trend of the total platelet supply was also observed during the same period of 2012-2014, as follows: 1 019 100 units in 2012, 1 168 400 units in 2013 and 1 276 200 units in 2014. Similarly, the plasma supply was 27 529 300 units in 2012 and 27 657 600 units in 2013, which rose to 28 307 500 units in 2014. The total cryoprecipitate supply was 1 653 900, 1 891 300 and 2 366 500 units in 2012, 2013 and 2014, respectively. When the blood supply was analysed according to the geographic regional population, large differences in the rates of blood supply between regions were evident.

CONCLUSIONS

The blood product supply in China is steadily increasing. Blood centres in China continue to face challenges regarding their ability to provide a sufficient blood supply in the future.

Frequencies and ethnic distribution of ABO and RhD blood groups in China: a population-based cross-sectional study

OBJECTIVES

ABO and RhD blood groups are key factors affecting blood transfusion safety. The distribution of ABO and RhD blood groups varies globally, but limited data exist for ethnic distributions of these blood groups in Asian populations. We aimed to evaluate the distribution of ABO and RhD blood groups among Chinese ethnic groups.

DESIGN

A population-based cross-sectional study.

SETTING

Data on ABO groups and ethnicities were obtained from the National Free Preconception Health Examination Project (NFPHEP) with participants from 220 counties of 31 provinces in China PARTICIPANTS: There were 3 832 034 participants aged 21-49 years who took part in the NFPHEP from January 2010 to December 2012 and were included in this study.

OUTCOME MEASURES

The proportion of ABO and RhD blood groups among different ethnic groups was calculated.

RESULTS

ABO and RhD blood distribution was significantly different among nine ethnic groups (P<0.001). Compared with other ethnic groups, the Yi group had more A phenotypes (34.0%), and the Manchu (33.7%) and Mongolian (33.3%) ethnic groups had more B phenotypes. The Zhuang group had the greatest proportion of O phenotypes (41.8%), followed by the Miao group (37.7%). AB phenotypes were more frequent in the Uygur ethnic group (10.6%) but lower in the Zhuang group (5.5%). Meanwhile, RhD negativity (RhD-) was greater in the Uygur group (3.3%) than in the Mongolian (0.3%) and Manchu ethnic groups (0.4%). O RhD- blood groups were more frequent in the Uygur group (0.8%) than in the other ethnic groups (0.1%-0.4%, P<0.001).

CONCLUSION

ABO and RhD blood phenotypes vary across different ethnic groups in China. The diversity in the distribution of the ABO and RhD blood groups in different ethnic groups should be considered when developing rational and evidence-based strategies for blood collection and management.

Challenges and Research in Managing Blood Supply in China

Although considerable progress has been made in improving the blood service system in China over the last 2 decades, many challenges remain. A number of issues have received public attentions; however, others continue to be underacknowledged and controversial. This article describes 3 of these important and less emphasized issues: first, the ambiguity of the definition of voluntary nonremunerated blood donation and its relationship to an adequate blood supply; second, the current inadequacies of cost recovery from the blood service system; and third, the lack of a universally implemented program of hemovigilance. Currently, there is controversy regarding these challenges. Open recognition and discussion offers the prospect of bringing solutions closer to reality.

Molecular diagnosis of the human immunodeficiency, Hepatitis B and C viruses among blood donors in Lomé (Togo) by multiplex real time PCR

This study aimed to compare the sensitivity of multiplex PCR to ELISA technique in the instantaneous detection of HBV, HCV and HIVin blood samples from donors of the National blood Transfusion Centre in Togo. A total of 440 blood samplesfrom volunteer were collected and tested by ELISA and multiplex PCR for HBV, HCV and HIV detection. Among the 440 volunteer blood donors, 83% were female and 17% were male. Age range of 20-29 years was more represented (73%). Whereas, multiplex PCR detected more cases of HBV than ELISA (50% vs 33%, P=0.0155);ELISA more detected HCV than PCR (34% vs 3%, P<0.0001) and HIV (26% vs 7%, P<0.0001). Confirming these observations our data showed that multiplex PCR was more sensitive in the detection of HBV. The sensitivity of ELISA for the detection of HCV and HIV was elevated compared to multiplex PCR. Multiplex PCR was more specific that ELISA for the detection of HCV and HIV.Interestingly, our data showed that the gender do not influenced the sensitivity of either ELISA or multiplex PCR to detect these viruses. This study showed the limit of both ELISA and multiplex PCR in the detection of HBV, HCV and HIV.

Citrate anticoagulation: Are blood donors donating bone?

An estimated 2.4 million volunteer apheresis blood donation procedures were performed in the United States in 2010, and increases in the proportion of transfused blood products derived from apheresis blood collections have been consistently reported. Anticoagulation is required during apheresis and is achieved with citrate. Donor exposure to citrate causes an acute physiological response to maintain serum mineral homeostasis. Some data are available on the sequelae of this acute response in the days and weeks following exposure, raising questions about bone mineral density in regular apheresis donors. New research is emerging that addresses the potential long-term health outcomes of repeated citrate exposure. This article reviews the acute physiological response to citrate anticoagulation in volunteer blood donors, presents contrasting perspectives on the potential effects of citrate exposure on bone density, and identifies key knowledge gaps in our understanding of long-term health outcomes in apheresis donors. J. Clin. Apheresis 31:459-463, 2016. © 2015 Wiley Periodicals, Inc.