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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 5  |  Issue : 1  |  Page : 15-18

Analysis of predonation loss of blood donors due to deferrals - in a tertiary care hospital set up


Department of Transfusion Medicine, JSS Medical College and Hospital, JSS University, Mysore, Karnataka, India

Date of Web Publication13-Jan-2016

Correspondence Address:
Shreedevi S Bobati
Department of Transfusion Medicine, JSS Medical College and Hospital, JSS university Shivaratrishwara Nagar, Mysore - 570 015, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.173874

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  Abstract 

Context: Blood is a living tissue that is transfused into another human body and hence blood safety is a major issue in transfusion medicine. It is well-known that a large number of apparently healthy donors are deferred from successful blood donation because of varied reasons. They are the potential motivated donors the society is losing. Hence, it is very important to analyze the reasons for deferral and retain the motivated donors.
Aims: The objective of this study was to determine the various causes and its proportion for blood predonation deferrals.
Settings and Design: Department of transfusion medicine, Tertiary Care Hospital, Mysore, Karnataka, India.
Materials and Methods: A retrospective study was carried out by retrieving the data of deferred blood donors over a period of 1-year from January 2014 to December 2014.
Results: Among 8894 donors screened, 8.62% (n = 767) were deferred from blood donation. The main reason for deferral was low hemoglobin (Hb) (25.3%), followed by alcohol consumption (21%), high blood pressure (14%), under age and underweight (12.4%), medication (6%), tattooing (4.3%), dental extraction (3.1%), sleep deficit (3%), and miscellaneous causes (5.7%). Interesting observation in our study was that 47 males were deferred due to high Hb levels (6%) ranging from 18.8 to 23 g%.
Conclusion: Increased public education on common causes of donor deferral may lower deferral rates by allowing prospective donors to “prescreen” themselves. Thus, the temporary deferrals can be prevented by proper health care education, creating awareness, and guiding to improve their health status for future donation.

Keywords: Blood donors, deferral, low hemoglobin


How to cite this article:
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

How to cite this URL:
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 [serial online] 2016 [cited 2019 Sep 21];5:15-8. Available from: http://www.ijhas.in/text.asp?2016/5/1/15/173874


  Introduction Top


Millions of people need blood transfusions every year. Some may need blood during surgery, others depend on it after an accident or because they have a disease that requires blood components. The minimum need to meet a nation's basic requirement for blood is approximately about 1% of the population (10/1000 population); these requirements are directly proportional to the type of advanced health care systems in any country.[1] According to the WHO, over 81 million of blood units are collected annually worldwide, but only 39% are collected in developing countries which have 82% of the world's population.[2] India with its huge population of over 1 billion is lacking behind in blood collection. India's blood requirement is about 9–9.5 million units per year, but collection is just about 5–5.5 million units per year. There is a continuous shortage of about 4 million blood units each year in recent years.[2] Karnataka state contributes about 500,000 units, with 62% coming via voluntary blood donation.[3]

Strict donor selection criteria and rigorous screening tests have been laid down to ensure blood safety of the blood donors and recipients. The collection of blood only from voluntary, nonremunerated blood donors from low-risk populations ensures the safety, quality, availability, and accessibility of blood transfusion.

Donors with definite risks are deferred from donating blood either temporarily or permanently. The reasons and rates of deferral differ from region to region and from one center to another.

Deferrals lead to loss of precious whole blood donors and blood units available for transfusion purposes. When a donor is deferred, not only is his or her unit of blood lost, but the rejection imparts a negative message about blood donation to the potential donor community, particularly if deferral is made on grounds that seem frivolous.[4]

This calls attention!!!!

The present study was conducted with an objective to assess the reasons and rate for donor deferrals, to categorize the deferral causes, and analyze the reasons so that a strategy could be developed to recruit the temporarily deferred donors.


  Materials and Methods Top


The predonation deferrals data were analyzed retrospectively for whole blood donation between January 2014 and December 2014. Blood donors were selected by medical officer on the basis of prescreening tests such as questionnaire followed by clinical details, physical examination, including blood pressure (BP) with systolic between 100 and 180 mmHg and diastolic between 50 and 100 mmHg were accepted for blood donation, pulse (60–100 b/m), weight (>50 kg), temperature (37.5°C), hemoglobin (Hb) estimation (more than 12.5 g/dl by the coulter method in the department and outdoor camps by HemoCue Hb), and age (18–60 years).

The criteria for prospective blood donor selection was strictly followed as per the Technical Manual (Directorate General of Health Services, MOH and FW, Government of India) and NACO Guidelines.[5] Donors presenting at the department of transfusion medicine as well as outdoor voluntary camp donors were included in the study. Deferral reasons were analyzed among relative-voluntary, male-female, and various age group categories.

Statistical analysis

Data collected were entered in MS-Excel 2010 and analyzed using the same software. Descriptive statistical measures such as percentage, mean, and standard deviation were applied.


  Results Top


A total of 8894 donors were registered during the study period. Of these donors, 8525 (95.85%) were males and 369 (4.14%) were females. After the predonation screening process, 8127 (91%) donors were eligible for blood donation. Among them, 7971 (98.08%) were males and 156 (2%) were females. Seven hundred and sixty-seven (8.62%) donors were deferred for various reasons which comprised 483 volunteer donors and 284 replacement donors. Out of 767 deferred donors, 554 were males and 213 were females [Table 1]. The most common reason for deferral was low Hb levels accounting to 25.3%, highest in female population. The other leading causes in order of frequency were alcohol consumption within 72 h, hypertension and elevated Hb levels accounting to 158 (21%), 106 (14%), and 47 (6%), respectively, seen exclusively in males. High Hb levels (6%) ranging from 18.8 to 23 g% was noted in 31–40 years of age group. Large percentage of female donors from outdoor camps were deferred on the basis of age criteria being less than 18 years of age and for being under weight (12.4%). The remaining causes for deferral were donors on medication (6%), tattooing (4.3%), dental extraction (3.1%), sleep deficit (3%), and miscellaneous causes (5.7%) [Table 2].
Table 1: Profile of whole blood donors

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Table 2: Causes and distribution of deferral by age and sex

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  Discussion Top


The theme of world blood donor day for this year 2015 is “Thank you for saving my life.” World Blood Donor Day is celebrated every year by the people in many countries around the world on 14th of June as it is birth anniversary of Sir Karl Landsteiner born in 1868. This event celebration was first started in the year 2004 aiming to raise the public awareness about the need for safe blood donation. National and International efforts are on to ensure safe blood supply through screening education.

Majority of the donors in our study were first-time replacement donors, followed by repeat nonremunerated voluntary blood donors. In the present study, deferral rate was 8.62%, which was in accordance with blood donor deferral rates found in the literature, ranging from 5.6% to 35.6%.[6] The major cause for such higher rates in the study of Charles et al. was high-risk of sexual activity, which was not seen so significantly in any of the other studies and in the present study.[7],[8]

History of alcohol consumption within 72 h was the second leading cause in the present study exclusively seen in males, with high percentage in the age group of 31–40 years and was also second highest deferral cause as seen in the studies done by Bahadur et al. and Shah et al.[9],[10] World Health Organization states that the amount of alcohol consumption has raised in India, and 11% of the population is indulged in heavy or binge-drinking.[11] This needs attention and can be resolved by counseling the donors and educating them about the adverse effects of alcohol as its consumption is a risk factor for raising BP and higher cancer incidence with high mortality.

Hypertension was the third cause of deferral in the present study (14%) exclusively seen in males. Hypertension was the leading cause in the study done by Girish et al. with high deferral rate accounting to 39.95%.[12] Hypertension often goes undiagnosed and is usually an incidental finding in rural area. This signifies hypertension as the common undiagnosed epidemic in rural health sectors.[13] However, any blood donor suffering from a marked degree of hypertension has to be dealt with care as the sudden removal of 350 or 450 ml of blood may precipitate a cerebral catastrophe.[14]

Around 12.4% of the deferral was due to age being less than 18 years and underweight. All the donors were young and enthusiastic students at outdoor camps arranged in colleges. They were attended by the medical officer and educated about the donor's criteria, advised to include nutritious food in their diet to gain weight, and can be fit to donate once they attain 18 years of age. Previous studies have shown very higher deferral rates as comparable to the present study.

One among the deferral causes noted in our study was high Hb levels (6%) in males, which is not mentioned in any of the studies in literature. Most of donors had a history of smoking and in few of them, the cause could not be identified. This incidental finding is an alarming sign noted in the present study and these individuals were referred to the hematologist for complete workup.

Only 6% of deferrals were due to donors on medication in past 72 h whereas history of medication was the leading cause of deferral constituting around 15.15% in the study of Unnikrishnan et al.[13]

In our study, tattooing constituted 4% of deferral. Tattooing has been associated with serological evidence of hepatitis B and C viruses, as well as HIV infection and syphilis, which are known to be transmissible by blood transfusion. These associations are of higher magnitude for individuals having two or more tattoos unprofessionally applied and are common among drug addicts and prisoners.[15]

Low deferral rate of 3% was noted for dental extraction and sleep deficit, followed by 5.7% of miscellaneous causes which were hypotension, dog bite, flu, typhoid, diabetes, surgery, and previous blood donation within 3 months.

Deferral criteria can be revalidated and modified according to regional prevalent donor demographics as most of the blood banks focus at recruiting new donors while ignoring the retention and re-entry of deferred donors. This can be achieved by analyzing the reason of deferrals, addressing the issue, and ameliorating the causes.

Most of the donors in the present study were deferred temporarily because of modifiable reasons; hence, all the deferred donors at our department are counseled by blood bank counselor regarding the cause of deferral and motivated to return back for blood donation. Alcohol consumption and tobacco smoking associated with high Hb level were important causes for deferral in our study. The need for educating the population regarding the advantages of quitting consumption of alcohol and tobacco smoking from the root levels inculcating values in children and advising adult population of side effects may contribute toward improving public health and motivating prospective donors to return for blood donation.

To conclude, deferred donors should be helped to overcome their problems, so that they can be prevented from being permanently deferred and encouraged to become permanent donors. It is high time for all the blood banks to take stock of present and future precious blood units lost due to these deferrals, as most of deferral data are not widely recorded and reported to policy makers for transfusion services. If collected and studied in a systematic way, it will definitely improve the collection of blood from prospective blood donors.

Acknowledgment

The authors would like to thank all the donors and staff in the Department of Transfusion Medicine, JSS Hospital, Mysore, Karnataka, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
WHO. Media Centre, Fact Sheets, Blood Safety and Availability, Facts and Figures from the 2014 Blood Safety Survey, Fact Sheet No. 279; 2014. Available from: http://www.who.int/mediacentre/factsheets/fs279/en/index.html. [Last assessed on 2014 Nov 29; Last updated on 2014 Jun 01].  Back to cited text no. 1
    
2.
Chaitanya Kumar IS, Yashoverdhan. Efforts to meet the challenges of 100% voluntary blood donation. Asian J Transfus Sci 2011;5:68-9.  Back to cited text no. 2
    
3.
Annual Action Plan. Karnataka State AIDS Prevention Society; 2010-2011. p. 129.  Back to cited text no. 3
    
4.
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. 4
[PUBMED]  Medknow Journal  
5.
DGHS Guidelines, Ministry of Health and Family Welfare, Saran; 2003.  Back to cited text no. 5
    
6.
Kasraian L, Negarestani N. Rates and reasons for blood donor deferral, Shiraz, Iran. A retrospective study. Sao Paulo Med J 2015;133:36-42.  Back to cited text no. 6
    
7.
Charles KS, Hughes P, Gadd R, Bodkyn CJ, Rodriguez M. Evaluation of blood donor deferral causes in the Trinidad and Tobago national blood transfusion service. Transfus Med 2010;20:11-4.  Back to cited text no. 7
    
8.
Chaudhary RK, Gupta D, Gupta RK. Analysis of donor-deferral pattern in a voluntary blood donor population. Official J Br Blood 1995;5:209-12.  Back to cited text no. 8
    
9.
Bahadur S, Jain S, Goel RK, Pahuja S, Jain M. Analysis of blood donor deferral characteristics in Delhi, India. Southeast Asian J Trop Med Public Health 2009;40:1087-91.  Back to cited text no. 9
    
10.
Shah SD, Shah MC, Bhatnagar NM, Gajjar MD, Soni SA, Patel TR. Analysis of blood donor deferral characteristics in a tertiary care hospital in a blood bank – A review. Southeast Asian J Case Rep Rev 2013;2:389-95.  Back to cited text no. 10
    
11.
Alcohol Consumption in India on the Rise: WHO Report From; 14 May, 2014. Available from: http://www.mid-day.com/articles/alcohol-consumption-in-india-on-the-rise-who report/15299173/index.html. [Last assessed on 2014 Nov 10].  Back to cited text no. 11
    
12.
Girish CJ, Chandrashekhar TN, Ramesh BK, Kanitkar SM. Pre-donation deferral of whole blood donors in district transfusion centre. J Clin Diagn Res 2012;6:47-50.  Back to cited text no. 12
    
13.
Unnikrishnan B, Rao P, Kumar N, Ganti S, Prasad R, Amarnath A, et al. Profile of blood donors and reasons for deferral in coastal South India. Australas Med J 2011;4:379-85.  Back to cited text no. 13
    
14.
Mollison PL. Blood Transfusion in Clinical Medicine. Oxford: Blackwell Scientific Publications; 1961.  Back to cited text no. 14
    
15.
Nishioka Sde A, Gyorkos TW, MacLean JD. Tattoos and transfusion-transmitted disease risk: Implications for the screening of blood donors in Brazil. Braz J Infect Dis 2002;6:172-80.  Back to cited text no. 15
    



 
 
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