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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 6  |  Issue : 4  |  Page : 154-156

Analysis of the reasons for deferral of prospective blood donors in a Tertiary Care Hospital in North India


1 Department of Transfusion Medicine, Government Medical College, Patiala, Punjab, India
2 Department of Transfusion Medicine, Medanta Medicity, Gurgaon, Haryana, India

Date of Web Publication16-Dec-2015

Correspondence Address:
Kanika Taneja
Janak Surgicare, 47 Ranjeet Bagh, Passey Road, Patiala - 147 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-5127.171988

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  Abstract 

Background: Blood donor deferral is a painful and sad experience for the donor, organizer as well as screening doctors. The rate and reasons of deferral differ from region to region and center to center. The shortage of safe blood donors is frequent, and it is important to understand the causes of deferral in voluntary donors. The aim of this study was to analyze the incidence of donor deferral, causes of deferral, and apply relevant findings to modify the recruitment strategy to decrease the temporary deferral rate. This strategy could increase the pool of voluntary donors without compromising on the quality of the blood and safety of the recipient. Materials and Methods: Data from voluntary blood donation camps held in the blood bank and outdoor camps from August 2014 to August 2015 were analyzed retrospectively. Based on the history and physical examination findings; all blood donors coming for the donation were classified into fit for donation or deferred donor. Results: A total of 24,062 subjects registered for donation during the study period (August 2014 to August 2015) out of which 4125 were deferred prior to donation. The incidence of deferral was 17.1%. Most common reasons for deferral were anemia (2107 out of 4125) accounting for 51% of deferred donors, abnormal blood pressure 6.8% (281/4125), and history of medication 18% (743/4125). Majority of them were temporary deferrals 86.1% (3822/4443). Permanent deferral accounted for 13.9% (621/4443). Most of these deferred donors were aged between 18 and 30 years old. Most common reason for deferral in males and females both was anemia with an incidence of 32.7% (900/2750) and 87.7% (1207/1375) in males and females, respectively. Discussion and Conclusion: Insight into the reasons of donor deferral is very important to avoid the permanent loss of the donor as blood donation program is the life force behind any blood bank or hospital. Deferral study also indicates the health status of the general population. Since most of the deferrals are temporary deferrals, and we should give a clear message for the reason for deferral, so that they return for donation in the future.

Keywords: Blood bank, blood donor deferral, deferral reasons


How to cite this article:
Taneja K, Bhardwaj K, Arora S, Agarwal A. Analysis of the reasons for deferral of prospective blood donors in a Tertiary Care Hospital in North India. J Appl Hematol 2015;6:154-6

How to cite this URL:
Taneja K, Bhardwaj K, Arora S, Agarwal A. Analysis of the reasons for deferral of prospective blood donors in a Tertiary Care Hospital in North India. J Appl Hematol [serial online] 2015 [cited 2020 Apr 1];6:154-6. Available from: http://www.jahjournal.org/text.asp?2015/6/4/154/171988


  Introduction Top


Blood transfusion service is a pillar of tertiary care hospital without which efficient medical care is impossible. In order to safeguard the health of recipient and the donors alike, many measures have been taken to make blood transfusion safe. Most important is the stringent process of donor selection aimed at assessing the suitability of prospective donors.[1] Individuals who are disqualified from donating blood are known as deferred donors.[2] Donor deferral is a painful experience and must be handled carefully because it leads to loss of precious whole blood donors and they are less likely to return for blood donation in the future.[2] Knowledge of the rate and causes of donor deferral can guide the recruitment strategy of organizers.[3] The criteria for prospective blood donor selection and deferral can guide the recruitment strategy of organizers.[2] The criteria for prospective blood donor selection and deferral in India are provided by the drugs and cosmetic act of 1940, last amended in 2001, supplemented by the technical manual (Directorate General of Health Services, MOH and FW, Government of India).[1] A few studies done in the past have highlighted different reasons for deferral. The present study was undertaken to analyze the deferral incidence, the pattern among blood donors in blood bank so that temporarily deferred donors are identified and properly counseled to improve their quality so that we can increase the pool of voluntary donors without compromising on the quality of the blood and safety to the donor and the recipient.[3]


  Materials and Methods Top


This retrospective study was carried out in the blood bank of Government Medical College, Patiala (India) and outdoor camps conducted by the blood bank during the period from August 2014 to August 2015. Data were collected from the records maintained by the department. A questionnaire filled by the donor and the doctor was used to collect data. All donors were evaluated on the basis of medical history, physical examination, hemoglobin (Hb), body weight, age, blood pressure (BP), pulse, and temperature. Criteria laid down by the Director General Health Sciences, and the Drug and Cosmetic Act 1940 (last amended 2001) were followed. Cut-off for Hb was 12.5 g/dl, body weight not <45 kg, age limit 18–60 years, systolic BP 100–180 mmHg, and diastolic BP 50–100 mmHg. Data were analyzed using Microsoft Excel (Microsoft. Microsoft Excel. Redmond, Washington: Microsoft, 2008. Computer Software).


  Results Top


A total of 19,937 people were selected fit to donate during the period of study, of whom 18,322/19,937 (91.8%) were males, and the rest were females 1398/19,937 (8.2%). Of the total 24,062 registered, 4125 donors were deferred due to various reasons. Among the deferred donors, 2750 were males, and 1375 were females. Percentage of deferral among a total number of registered males and females were 11.4% (2750/24,062) and 5.7% (1375/24,062), respectively. [Table 1] shows the demographic profile of donors. Out of 24,062 donors presenting for donation, 4125 were deferred prior to donation and 318 donors were deferred after the donation (due to transfusion transmitted infections mainly HIV, hepatitis B surface antigen, hepatitis C virus seropositivity). Therefore, a total of 4443 were deferred predonation and postdonation from a pool of 24,062 registered donors in the period from August 2014 to August 2015. Deferred donors were further categorized as temporary and permanent. This was done to facilitate counseling and help temporarily deferred donors to become healthy donors in the future. Out of a pool of 4125 predonation deferrals, only 303 donors (those suffering from chronic hypertension and epilepsy) and 318 blood bags after donation (due to seropositivity) amounting to 621/4443 were categorized as permanent deferrals [Table 2]. Males constituted the major group among donors being 91.8% (18,322/19,937), and the rest were females.
Table 1: Demographic profile of donors

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Table 2: Causes of permanent deferrals and their proportions

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A major pertain of donors were from outdoor camps conducted nearby 17,981 (90.1%) while 1956 (9.9%) was the collection from camps held in the blood bank. Positivity of transfusion-transmitted infections and hypertension and history of epilepsy were the reasons for permanent deferrals. While anemia, underage, underweight, medicines, allergy, tattoo and rabies vaccine, and typhoid were temporary deferrals.

Most common reason of deferral in our study was anemia (Hb <12.5 g/dl) with 32.7% in males and 87.7% in females.


  Discussion Top


Donor selection is the most important step for improving the safety of blood and blood products. Insight into the causes of deferral resulting from rigorous screening has been the focus of our attention for more than a decade.[4] Since reasons for deferral have not received much attention, this study was conducted to analyze donor deferral patterns to quantify the loss due to defamed donors and to understand the health problems of the donor population.[5]

The rate and reasons for deferral differ from region to region and from one center to another. Donor deferral rates in blood centers vary from 3.55% to 24% leading to huge losses in terms of available units for transfusion every year.[2],[6]

In our study, 4125 out of total 24,062 registered prospective blood donors were found unfit to donate due to various reasons, the majority (97.4%) for temporary reasons; and a smaller subset (621/24,062) being permanently deferred [Table 3]. Most of the deferred donors were males 66.6% (2750/4125), with women constituting only 33.3% (1375/4125) of the donors.
Table 3: Causes of temporary deferrals and their proportions

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The incidence of deferral in our institute was 17.1%, more than that reported in previous studies. Rathod et al. 2014 reported a deferral rate of 3.55% in Gujarat.[2] Awasthi et al. reported 10.4% rate from a Tertiary Hospital in North India.[3] A similar study from South India reported 5.12%.[4] This indicates a higher prevalence of anemia in our population.

The major causes of deferral in males in this study were anemia (32.7%), hypertension (9.8%), and medication (26.1%). The leading causes of deferral among females were anemia (87.7%), abnormal BP (0.8%), medication (1.6%) [Table 4]. With such a high incidence of anemia, it may be useful to setup an anemia clinic along with blood donation camps so as to treat, counsel and maintain follow-up of temporarily deferred donors due to anemia.
Table 4: Leading causes of deferrals among donors

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By knowing the causes of deferral, proper recruitment strategies can be devised whereby people in the community can prescreen them self before donation. People should be informed about common causes of deferral such as abstaining from alcohol, smoking, and medicines within 72 h. Besides this, if a donor is deferred due to any other reason, he should be informed about the cause and period deferral and proper counseling should be done to help them overcome the problem before the next visit.


  Conclusion Top


The incidence of deferral of prospective donors in our institute was more than the existing literature due to a higher incidence of anemia in our region. Majority of deferrals are temporary and measures such as education of donors, setting up anemia clinics along with donation camps could help in retaining temporarily deferred donors. Furthermore, proper education and screening could help in improving donor as well as recipient safety.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest

 
  References Top

1.
The Gazette of India: Extraordinary, Ministry of Health and Family Welfare, Notification GSR 6(E); 04 January, 2001.  Back to cited text no. 1
    
2.
Rathod K, Gupta M, Shah M. Analysis of blood donor derferral characteristics in a blood bank at tertiary care hospital attached to medical college in Gujarat. Bienn J GAPM 2012;1:142-5.  Back to cited text no. 2
    
3.
Awasthi S, Dutta S, Haritwal A, Ansari M, Arathi N, Agarwal D. Evaluation of the reasons for pre-donation deferral of prospective blood donors in a tertiary teaching hospital in North India. IJPH 2010;1:1-3.  Back to cited text no. 3
    
4.
John F, Varkey M. Evaluation of blood donor deferral causes in a Tertiary Hospital, South India. Int J Biomed Adv Res 2015;6:253.  Back to cited text no. 4
    
5.
Ekwere T, Ino-Ekanem M, Motilewa O, Ibanga I. Pattern of blood donor deferral in a Tertiary Hospital, South-South, Nigeria: A three-year study review. Int J Blood Transfus Immunohematology 2014;4:7.  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
    



 
 
    Tables

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



 

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