A study on confidential unit exclusion at Shiraz Blood Transfusion Center, Iran

Subjective donor deferral as a tool for increased blood transfusion safety: A cross-sectional observational study

OBJECTIVES

This study aims at evaluating whether subjective donor deferral (SDD) has the potential for increasing blood transfusion safety.

BACKGROUND

Appropriate donor selection via clinical and serologic screening is necessary to prevent transfusion-transmissible infections (TTIs). One additional strategy adopted by some Brazilian blood transfusion centers (BTCs) is the rejection of a donation by the pre-donation interviewer based on subjective factors.

METHODS/MATERIALS

We conducted a STROBE-guided cross-sectional study including 105 005 prospective donors who presented to our BTC between 1 January 2013, and 31 December 2015. Donors were evaluated for age, gender, education level, donation type and history, confidential unit exclusion, SDD, and results of serologic screening for TTIs.

RESULTS

Even after controlling for potential confounding variables, subjectively deferred donors were more likely to have at least one reactive serology in the standard screening (OR: 2.80; 95% CI: 2.13-3.69; P < .001). They also had a higher risk for testing positive for syphilis (OR: 4.47; 95% CI: 3.05-6.55; P < .001), hepatitis B (OR: 5.69; 95% CI: 2.48-13.08; P < .001), and HIV (OR: 6.14; 95% CI: 3.22-11.69; P < .001).

CONCLUSIONS

Routine implementation of SDD in donor selection may be an effective additional measure to avoid TTIs, highlighting the importance of interviewer experience, perspicacity, and face-to-face contact with donors for blood safety assurance.

Evaluation of the confidential unit exclusion on Iranian blood donors: An 11-year experience

BACKGROUND:

Confidential unit exclusion (CUE) was recommended by the Food and Drug Administration to permit blood donors confidentially exclude their donation for transfusion. However, its effectiveness as a safety measure to the blood supply is debated.

AIMS:

We, therefore, evaluated its benefit in identifying donors at risk of transmitting transfusion-transmissible infections (TTIs) and increasing blood safety in our population.

SETTINGS AND DESIGN:

This was a cross-sectional and retrospective study. The study was performed at the South Khorasan Blood Transfusion Center.

MATERIALS AND METHODS:

In this descriptive and retrospective study, data of CUE use and data of confirmed positive TTI markers were analyzed for the study period 2006–2016.

STATISTICAL ANALYSIS:

Data were analyzed using SPSS software version 16.

RESULTS:

Out of 165,267 donations, the CUE option was selected by 493 (0.3%) donors, most frequently by first-time blood donors, by men, by donors with <12 years schooling, and by 18–24-year-old donors. The data revealed that donations from CUE donors had no higher infection rates. Moreover, CUE showed low sensitivity (0.6%) and low positive predictive value (0.6%) in detecting TTI markers.

CONCLUSION:

The data do not provide any indication of a safety advantage from CUE; thus, we recommend that the procedure of CUE can be discontinued.

Confidential unit exclusion (CUE): Double edged sword for blood transfusion center: A ten-year study on volunteer blood donors in Kohgiluyeh and Boyer Ahmad province, Iran

BACKGROUND

Confidential unit exclusion (CUE) is a mechanism developed in the1980s to increase blood safety by allowing donors to indicate confidentially if they think their blood is not safe for transfusion. While it has been used widely around the world, the efficacy of this strategy is still unclear. The present study evaluated the efficacy of the CUE system at the Blood Transfusion Center of Kohgiluyeh and Boyer Ahmad Province (KBTC), Iran by comparing the prevalence of transfusion-transmitted infectious (TTIs) in CUE and non-CUE groups.

METHODS

This descriptive study used data from all volunteer blood donors over a ten-year period. Donors were classified in two groups: CUE and non-CUE. Screening tests were performed for hepatitis B surface antigens (HBs-Ag), hepatitis C virus antibody (HCV-Ab), and Human immunodeficiency virus antibody (HIV-Ab) and any repeatedly reactive results were confirmed by standard methods. Significant differences were determined by Chi² test. The sensitivity, specificity and PPV of the CUE system were also calculated.

RESULTS

In the present study, the non-CUE and CUE groups consisted of 98.94% and 1.06% of volunteer blood donors, respectively. First-time donors selected the CUE option more often than repeated and regular donors. The prevalence of TTIs was significantly higher in the CUE group and CUE sensitivity, specificity, and PPV were 5.5%, 98.95%, and 0.96%, respectively.

CONCLUSION

We recommend the CUE system be pursued for further enhancement of blood safety. However, further studies are needed to establish the overall usefulness of this procedure throughout the whole country.