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ORIGINAL ARTICLE
Year : 2019  |  Volume : 46  |  Issue : 3  |  Page : 86-89

Analysis of predonation deferral of blood donors in a tertiary care hospital


Department of Pathology, School of Medicine, D Y University, Navi Mumbai, Maharashtra, India

Date of Web Publication28-Jan-2020

Correspondence Address:
Dr. S Sudhamani
Department of Pathology, School of Medicine, D Y University, Nerul, Navi Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_40_19

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  Abstract 


Background: Transfusion medicine forms an important part of healthcare practice. Healthy blood donors are the starting point for blood transfusion safety. Blood donors can be rejected for various reasons, either temporary or permanent. To ensure safety and good quality of blood donation, donor selection becomes an important criterion for the safety of both the donor and recipient. Therefore, it is important to study the pattern of deferrals, to reduce unnecessary deferrals, and to encourage blood donation. Objectives: The objective was to study and analyze various causes of deferral of blood donors and to categorize donors according to the type of deferrals, age, and gender. Materials and Methods: This was a retrospective analysis carried out at a tertiary hospital for 3 years. Details of their age, gender, and physical and laboratory tests were recorded as per the standard protocol. Results were then statistically analyzed with emphasis to know the causes of deferral. Results: A total of 1522 (13.1%) out of 11,665 donors were rejected. Among them, 638 were men (41.9%) and 884 were women (58.1%) with a female-to-male ratio of 1.4:1. Majority donors belonged to the age group of 18–30 years (65.5%). The most common reason for temporary deferral was low hemoglobin (54.6%) while that of permanent deferral was hypertension (4.1%). Conclusion: This study emphasized the need for better nutrition to improve the hemoglobin level which was the most common cause for temporary deferral and increased awareness to decrease the other causes of deferrals of blood donors.

Keywords: Blood donation, deferral, predonation, transfusion safety


How to cite this article:
Kumar SH, Sudhamani S, Roplekar P. Analysis of predonation deferral of blood donors in a tertiary care hospital. J Sci Soc 2019;46:86-9

How to cite this URL:
Kumar SH, Sudhamani S, Roplekar P. Analysis of predonation deferral of blood donors in a tertiary care hospital. J Sci Soc [serial online] 2019 [cited 2020 May 27];46:86-9. Available from: http://www.jscisociety.com/text.asp?2019/46/3/86/277001




  Introduction Top


Blood transfusion is a vital part of healthcare system, and providing safe blood to recipients is of paramount importance.[1]

According to the statistics provided by the WHO, the annual worldwide collection of units of blood is around 81 million per year. However, developing countries contribute to only 39% of the collection in spite of having 82% of the world's population. The requirement of blood in India is 8 million units every year, but the number of units collected annually is 5.5–6 million units which contributes to a significant shortage of blood units.[2] This indicates that regular awareness programs regarding blood donation are necessary in developing countries such as India to overcome this shortage of blood products and to improve the effectiveness of medical health care.

However, before blood donation, it is necessary to assess the suitability of the individual to donate blood or blood components using predonation health screening criteria.[3],[4] This is important to avoid adverse reactions such as blood transfusion reactions, maintain the donor quality, and also protect both the donor and the recipient.[3],[4]

It is proved that voluntary non-remunerated blood donors from low risk population are the safest and form the foundation for sustainable blood supply.[1],[4] Hence, it is also important that the selection process should not have adverse impact on the deferred donors who might not return for blood donation due to discouragement.[5]

This study was undertaken to systematically study the various causes for deferrals so that evidence-based rational donor selection criteria can be recommended to reduce the number of future deferrals.


  Materials and Methods Top


The present study was conducted retrospectively over 3 years from January 2015 to December 2017 at a tertiary care postgraduate teaching hospital.

Both voluntary and replacement donors were included in the study.

The potential donors were initially registered and made to fill a donor questionnaire in which the donor was asked to fill their demographic data and answer questions regarding their health status. Standard guidelines laid down by Director General Health Services and Drug Controller of India were followed for donor selection and deferral. Criteria for selection of blood donors and deferral laid down by Governing Body of National Blood Transfusion Council (October 2017) were used as well by National AIDS Control Organization (NACO).

Physical examination was performed which included examination of the weight, pulse, blood pressure, and body temperature. Hemoglobin was checked using the finger prick copper sulfate solution method. The donor was then accepted or rejected temporarily or permanently. First-time and repeat donors were not segregated. All repeat presentations were considered as independent attempts for blood donation for the sake of simplicity of analysis. The data were taken from donor register and donor questionnaire, compiled and statistically analyzed, and categorized according to age, gender, and cause of deferral.


  Results Top


Of a total of 11,665 potential blood donors, 10,143 (86.9%) were accepted for blood donation and 1522 (13.1%) were rejected due to various reasons.

Of the 1,522 deferred donors, 638 were men (41.9%) and 884 were women (58.1%) with a female-to-male ratio of 1.4:1.

The mean age group for maximum deferral of donors in both genders was observed to be 18–30 years [Table 1].
Table 1: Age and gender distribution of deferral respondents

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A total of 1,375 (90.3%) were temporary deferrals while 147 (9.7%) were permanent deferrals, indicating that most of the deferrals were due to preventable causes.

The top five causes for temporary deferral in rank order were anemia 832 (54.6%); recent ingestion of medications 164 (10.7%); recent history of fever or infections (dengue, malaria, typhoid, and tuberculosis) 116 (7.6%); low weight (<45 kg) and/or underage (<18 years) 99 (6.5%); and miscellaneous causes such as inadequate sleep, piercing, or tattoo in the past year 77 (5.1%).

Other rare causes of temporary deferral included alcohol, smoking, jaundice in the past year, and history of recent blood transfusion [Table 2] and [Chart 1].
Table 2: Temporary deferrals

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The main causes for permanent deferral of the prospective donor in decreasing order were hypertension 61 (4.1%); low blood pressure 51 (3.3%); diabetes mellitus 22 (1.4%); asthma 8 (0.5%); epilepsy 3 (0.2%); and kidney/heart disease 2 (0.1%) [Table 3].
Table 3: Permanent deferrals

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  Discussion Top


The term “blood bank” was first coined by Dr. Bernard Fantus in 1937 at Cook County Hospital in Chicago.[4] The collection of blood from voluntary, nonremunerated, and low-risk populations is the need of the day to ensure safety and quality of blood for transfusion.[6] Strict criteria for blood donation are not only necessary to safeguard the health of donors but also extremely important so as to prevent transfusion transmittable infections spreading to the recipient.

Worldwide, all blood banks face shortage of blood units due to paucity of healthy voluntary blood donors. Deferral of blood donors leads to loss of precious blood and demotivation of donors.[7]

The causes of donor deferral may serve as an indirect indicator of disease burden in the general population.

In our study, it was noted that the most common age group for donor rejection was 18–30 years (65.5%) in concordance with other studies [3],[4],[8],[9] [Table 4].
Table 4: Comparison with other studies

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Among the donors rejected, women constituted 58% of the population with a female-to-male ratio of 1.4:1. This is in contrast to a study by Jethani et al.,[1] where males constituted 68% and females 32% of the deferred donors.

Of the total 11,665 donors, the overall deferral rate in our study was 13.1%. This was similar to a study by Valerian et al. where the deferral rate was 12.7%.[8] The deferral rates were much lower at 6% and 2.6% in studies by Sundar et al. and Jethani et al., respectively.[1],[10] Variation in deferral rate in other studies may be attributed to the differences in donor selection criteria, regional and sociocultural factors, variation in motivation, and awareness among different populations.

It is noted that temporary causes of deferral (90.3%) are more common as compared to the permanent causes (9.7%) and found to be highly significant in our study, in concordance with other studies such as those by Jethani et al.,[1] where temporary deferrals accounted for 87.5% and permanent for 12.5% of total deferrals.

The most common cause of rejection was anemia in both genders stressing the need for increased awareness and nutritional supplements, especially in females of reproductive age group. This is similar to other studies [10],[11] except that of Shah et al.,[4] where the most common cause of rejection was jaundice (35.71%) [Table 4].

Apart from anemia, other common causes of temporary rejection in our study in the decreasing order of frequency are medications (10.7%), infections (7.6%), and miscellaneous causes (5.1%). These causes are readily correctable and are of minor significance. In contrast, alcohol was the second most common cause of rejection in the study conducted by Bhosale et al.,[9] but it was the sixth most common cause of rejection in our study. The reason for this variation may be attributed to regional and cultural differences. It is important to educate the public regarding advantages of quitting alcohol and tobacco smoking as this not only improves overall health of the population but also leads to increase in prospective healthy blood donors.

The most common causes for permanent deferral were hypertension (4.1%), followed by hypotension (3.3%) and diabetes mellitus (1.4%), who were not on medication. Similar results were observed in the study conducted by Bhosale et al.[9] Hypertension, most commonly seen in males, often goes unnoticed and is usually diagnosed first during donor examination. It is important to counsel the donors regarding this permanent deferral and refer them for further management.

It is recommended that a proper record of follow-up and information regarding management of temporarily deferred donors should be maintained at transfusion centers so that they can be recruited back for future donation.

Regular assessment of deferral pattern in transfusion centers will help in planning strategies to minimize donor rejection.


  Conclusion Top


Increased awareness among the voluntary donors regarding deferral criteria is necessary to decrease the rate of deferral in the population.

It is important to identify the common causes for deferral in the blood bank to minimize deferrals and to retain potential donors. It is recommended that all the potential blood donors should be informed about the cause and duration of deferral so that appropriate measures can be taken to correct the cause and recruit them back in cases of temporary deferrals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jethani N, Goyal V, Pachori G, Agrawal S, Kasliwal N, Ali G. Analysis of predonation blood donor deferral characteristics in Ajmer (Rajasthan) region. Int J Med Sci Public Health 2016;5:2435-42.  Back to cited text no. 1
    
2.
Baxi A. Misconceptions over Shortage in India. The Economic Times; 10 February, 2008.  Back to cited text no. 2
    
3.
Bashawri LA. A review of predonation blood donor deferrals in a university hospital. J Family Community Med 2005;12:79-84.  Back to cited text no. 3
    
4.
Shah A, Joshi P, Aghera GB, Shah KJ. A study on analysis of blood donation deferral during blood donation camp at tertiary-care teaching hospital in south Gujarat region. Int J Med Sci Public Health 2016;5:894-7.  Back to cited text no. 4
    
5.
Al Shaer L, Sharma R, AbdulRahman M. Analysis of blood donor pre-donation deferral in Dubai: Characteristics and reasons. J Blood Med 2017;8:55-60.  Back to cited text no. 5
    
6.
Shrivastava M, Shah N, Navaid S, Agarwal K, Sharma G. Blood donor selection and deferral pattern as an important tool for blood safety in a tertiary care hospital. Asian J Transfus Sci 2016;10:122-6.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Kapse V, Agrawal A, Gahine R, Bhaskar V. The evaluation of predonation blood donor deferrals in a tertiary care center: A 3-year study. Int J Sci Stud 2019;6:36-40.  Back to cited text no. 7
    
8.
Valerian DM, Mauka WI, Kajeguka DC, Mgabo M, Juma A, Baliyima L, et al. Prevalence and causes of blood donor deferrals among clients presenting for blood donation in northern Tanzania. PLoS One 2018;13:e0206487.  Back to cited text no. 8
    
9.
Bhosale A, Rukhsar A, Dombale V, Desai M, Madhekar N. A retrospective deferral analysis of blood donors in a tertiary care medical college blood bank unit: An experience from rural Konkan of Western Maharashtra. J Evol Dent Sci 2017;6:7040-3.  Back to cited text no. 9
    
10.
Sundar P, Sangeetha SK, Seema DM, Marimuthu P, Shivanna N. Pre-donation deferral of blood donors in South Indian set-up: An analysis. Asian J Transfus Sci 2010;4:112-5.  Back to cited text no. 10
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11.
Bobati SS, Basavraj V, Prakash P. Analysis of predonation loss of blood donors due to deferrals – In a tertiary care hospital set up. Int J Health Allied Sci 2016;5:15-8.  Back to cited text no. 11
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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