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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 6  |  Issue : 3  |  Page : 111-114

Implication of deferral pattern on the donor pool: Study at a Tertiary Care Hospital


1 Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
2 Department of Immunohematology and Blood Transfusion, Malabar Cancer Institute, Thalassery, Kerala, India

Date of Web Publication18-Sep-2015

Correspondence Address:
Shamee Shastry
Department of Immunohematology and Blood Transfusion, KMC, Manipal University, Manipal, Karnataka
India
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Source of Support: Nil., Conflict of Interest: There are no conflicts of interest.


DOI: 10.4103/1658-5127.165649

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  Abstract 

Background and Objectives: Donor screening process is one of the most important steps in protecting the safety of blood supply. Donors who do not meet specified criteria are deferred either temporarily or permanently. These criteria are designed to protect both donors and patient safety. Due to the varied rates and reasons for deferrals in the existing literature, we aimed to evaluate the patterns and prevalence of deferrals in our institution. Materials and Methods: This retrospective study was conducted at a Tertiary Care Hospital, Karnataka, Southern India, to evaluate the various reasons for blood donor deferral from January 2011 to January 2014. Demographic data of blood donors was obtained through the blood bank database and secondary measures such as the type of deferral (permanent/temporary, pathogenic/nonpathogenic, and harmful to donor/recipient) were assessed. Results: A total of 54,653 subjects presented to our blood bank during this period out of which 2935 (5.6%) were deferred. The deferral to donor percentage was higher in females (36.54%) than males (3.64%). Low hemoglobin was the major deferral criterion seen in our participants (48.1%) followed by hypertension (16.4%), underweight (8.9%). Low pulse rate and fasting donor were the least prevalent reasons. A total of 36.8% of reasons for deferral were harmful to donors, 88.2% were nonpathogenic, and 98.1% were temporary causes. Conclusion: Variations in donor deferral may be attributed to different donor selection criteria in different regions and centers. Hence, it is important to know the common causes of donor deferral in a region so that measures may be taken to improve the donor pool.

Keywords: Blood donation, deferrals, donors


How to cite this article:
Chenna D, Shastry S, Murugesan M, Baliga PB. Implication of deferral pattern on the donor pool: Study at a Tertiary Care Hospital. J Appl Hematol 2015;6:111-4

How to cite this URL:
Chenna D, Shastry S, Murugesan M, Baliga PB. Implication of deferral pattern on the donor pool: Study at a Tertiary Care Hospital. J Appl Hematol [serial online] 2015 [cited 2021 Dec 2];6:111-4. Available from: https://www.jahjournal.org/text.asp?2015/6/3/111/165649

Mohandoss Murugesan.



  Introduction Top


Blood transfusion can be a vital life-saving procedure in current medical and surgical procedures for which adequate and safe blood supply should be maintained. It is a prerequisite that the blood collection process does not harm either the donor or the recipient who can be achieved by following stringent donor selection criteria and donor counseling. Donor selection criteria established by the blood banking personnel aimed to assess prospective donor health to determine their suitability for donating blood.[1] The Food and Drug Administration's Code of Federal Regulations and the AABB Standards for Blood Banks and Transfusion Services define the donor eligibility criteria which are designed to protect both the donor and the recipient.[2],[3]

Although the majority of these suggested criteria are applicable widely in all the situations, they might be highly dependent on the variables such as demographic, cultural, anthropometric, and endemic disease patterns due to which they have to be locally improvised and modified. Due to these variables, there would be varied prevalence's in the donor deferral which needs to be investigated. Detailed studies regarding the various patterns in the donor deferral were reported from developed and developing countries [4],[5],[6],[7],[8],[9],[10] with only a few reports from developing nations like India.[11],[12],[13],[14],[15],[16],[17],[18] According to National AIDS control organization's statistics, the annual rate of blood donation is about 7.4 million units against the requirement of 10 million units in India. One of its policies includes to launch extensive awareness programs for donor information, education, motivation, recruitment, and retention to ensure adequate availability of safe blood. Though we have both voluntary and replacement donations who do not get any incentives, 100% voluntary blood donation is our goal. Due to the paucity of studies in our study area, we aimed to evaluate the profile of deferral among blood donors in Udupi district, Karnataka, Southern India.


  Materials and Methods Top


We conducted a retrospective study to evaluate the various causes for blood donor deferral in our institution from January 2001 to January 2014. Every donor (both voluntary and replacement) had a brief physical examination, detailed medical history and hemoglobin estimation were taken by qualified personnel as per recommendations of Directorate General of Health Sciences, Government of India.[19] Physical examination included pulse and blood pressure (BP). The subjects who fulfilled the following criteria of physical examination such as pulse rate (80–100 beats/min), systolic BP (120–160 mm of Hg), diastolic (60–100 mm of Hg), and hemoglobin (>12.5 g%) were considered for blood donation. Demographic data related age, gender, and reason for deferral were routinely recorded in our blood bank software. Hemoglobin estimation was done by automated cell counter (Sysmex KX-21).

The causes for donor deferral are further classified as temporary or permanent [Table 1], pathogenic or nonpathogenic [Table 2], and harmful to donor/recipient/both [Table 3]. We have considered only the medical reasons for evaluation. People who were rejected at the initial stage of counseling due to suspected high-risk behavior were not taken into consideration.
Table 1: Classification of deferral reasons into temporary and permanent

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Table 2: Classification of deferral reasons into pathogenic and nonpathogenic

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Table 3: Classification of deferral reasons whether harmful to donor recipient or both

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Data were retrieved from the software (developed by Institutional Information Technology Department and is dedicated to blood bank) by two examiners and evaluated for missing data after which they were subjected to analysis. All the analysis was done using SPSS version 14 (SPSS Inc, Chicago, IL, USA) and percentages were calculated using descriptive statistics to represent the prevalence of deferral patterns. Institutional ethical clearance was obtained for the study (IEC265/2015).


  Results Top


Of the 54,653 subjects who presented to our department during the study period, a total of 2935 (5.6%) subjects were deferred. The age of deferred donors ranged from 17 to 65 years. The rate of deferral was the highest in the age group of 46–60 years (11.53%) followed by 31–40 years (5.51%) and then 18–30 years (4.61%). Among the total deferred donors, 60.2% were males and 39.8% females. About 75% of deferred donors were voluntary and 25% of replacement donors. The deferral percentage among females was 36.54%. The most common reason for deferral was low hemoglobin (48.7%), followed by BP (18.6%) and underweight (8.9%). Among donors deferred due to low hemoglobin, 72.2% of donors were females. Among nonpathogenic causes of deferral, temporary deferral was 11.8% and permanent was 8.8%. Among pathogenic causes of deferral, temporary was 88.2% and permanent was 91.2%. Low hemoglobin was the most common cause for deferral rate due to temporary causes (98.1%), as well as nonpathogenic causes (88.2%). When the deferral causes were analyzed as harmful to donor, recipient or both maximum were deferred in view of safety of both (48.7%), again low hemoglobin being the main reason [Table 4]. The trend due to low hemoglobin at our center is similar to that of the total deferral [Figure 1].
Table 4: Frequency of deferral reasons

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Figure 1: Trend of total deferral pattern against low hemoglobin

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  Discussion Top


An adequate supply of blood is required but not at the cost of either donor or recipient safety. Donor selection process is a most important preliminary step in blood banking and should follow stringent medical and regulatory rules ensuring both donor and recipient safety. Donor deferral can be implicated as loss of time, manpower, and other valuable resources both for the donors and medical personnel and can have a negative impact on blood donation among donors.[11] Hence, every attempt should be made to decrease the donor deferral keeping in view of the safety in both donor and recipients.

The overall deferral rate in our study was 5.6% which was consistent with other reported Indian studies by Kulkarni (4.27%),[20] Sharma et al. (5.1%),[21] Bahadur et al. (9%),[12] Sundar et al. (5.84%),[14] Unnikrishnan et al. (5.2%),[16] and Malaysian study by Rabeya et al. (5.6%)[10] However, few Indian studies by Chaudhary et al. (16.4%, the most common underweight and low hemoglobin),[11] Mangwana (17.88%, low hemoglobin and history of drug intake),[22] Agnihotri (11.6%, low hemoglobin),[15] Rehman et al. (12.4%, low hemoglobin)[18] reported higher deferral similar to that reported from developed countries by Lim et al. (14.4%, ingestion of medication, influenza),[5] Zou et al. (12.8%, low hemoglobin),[8] and Shaz et al. (15.6%, low hemoglobin).[7] Charles et al. reported deferral rate of 35.6% due to high-risk sexual activity, replacement system which pressures unsuitable relatives and friends into donation and α and β thalassemia traits which are prevalent in Trinidad and Tobago.[4] Such possible differences in deferral rates could be due to different donor selection criteria (lack of scientific and accurate cut-off point of hemoglobin, lack of compulsory blood screening for transmittable viral diseases in the past studies, donation interval, high-risk sexual activities, and imposition of religious restriction on donation) followed elsewhere or various prevailing medical and endemic conditions.

The rate of deferral in 46–60 years age group was high which may be due to the comorbidities such as hypertension and diabetes. Nonpathogenic causes for deferral (age, weight, or low hemoglobin) constituted up to 88% which implied that most of the subjects were deferred in view of their safety (donor) than recipient which is generally thought otherwise. Pathogenic causes for deferral (Allergy, on antibiotics, surgery, jaundice, lesion at phlebotomy site) are important in avoiding adverse reactions due to transfusion such as allergic or febrile non hemolytic reactions and also to prevent teratogenic effect of drugs on fetus as the donated blood may be transfused to a pregnant mother. When the reasons for deferral were analyzed as per harmful to donor, recipient, or both, a total of 48.7% were harmful to both (low hemoglobin).

The most common cause for deferral in our study was low hemoglobin concentration which was similar to previous studies conducted elsewhere.[7],[10],[12],[18],[21] However, few studies reported various reasons such as hypertension,[15],[17] medication in the past 72 h,[16] and underweight [11] as the most common causes of deferral. The trend of overall deferral rate at our center is mainly influenced by donor elimination due to low hemoglobin. Determining the donor iron status will help to rule out iron deficient status among them.

In our study, we found that temporary causes for deferral such as low hemoglobin, underweight, under the age (<18) constituted to 98% which was similar to the previous studies.[17] This implied that with appropriate donor counseling, motivation, and necessary treatment interventions, we can decrease the rate of deferrals and improve the donor pool.


  Conclusion Top


Variations in donor deferral may be attributed to different donor selection criteria in different regions and centers. Hence, it is important to know the common causes of donor deferral in a region so that measures may be taken to improve the donor pool.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Cumor A. Local Health History Criteria. Baltimore, MD: American Red Cross Blood Services; 1985.  Back to cited text no. 1
    
2.
Zou S, Eder AF, Musavi F, Notari EP, Fang CT, Dodd RY, et al. Implementation of the uniform donor history questionnaire across the American Red Cross Blood Services: Increased deferral among repeat presenters but no measurable impact on blood safety. Transfusion 2007;47:1990-8.  Back to cited text no. 2
    
3.
AABB. Standards for Blood Banks and Transfusion Services. 26th ed. Bethesda: American Association of Blood Banks; 2009.  Back to cited text no. 3
    
4.
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. 4
    
5.
Lim JC, Tien SL, Ong YW. Main causes of pre-donation deferral of prospective blood donors in the Singapore Blood Transfusion Service. Ann Acad Med Singapore 1993;22:326-31.  Back to cited text no. 5
    
6.
Gülen H, Tüzün F, Ayhan Y, Erbay A, Oztürk E, Inan S, et al. The evaluation of blood donor deferral causes. Pediatr Hematol Oncol 2006;23:91-4.  Back to cited text no. 6
    
7.
Shaz BH, James AB, Hillyer KL, Schreiber GB, Hillyer CD. Demographic variations in blood donor deferrals in a major metropolitan area. Transfusion 2010;50:881-7.  Back to cited text no. 7
    
8.
Zou S, Musavi F, Notari EP, Rios JA, Trouern-Trend J, Fang CT. Donor deferral and resulting donor loss at the American Red Cross Blood Services, 2001 through 2006. Transfusion 2008;48:2531-9.  Back to cited text no. 8
    
9.
Birjandi F, Gharehbaghian A, Delavari A, Rezaie N, Maghsudlu M. Blood donor deferral pattern in Iran. Arch Iran Med 2013;16:657-60.  Back to cited text no. 9
    
10.
Rabeya Y, Rapiaah M, Rosline H, Ahmed SA, Zaidah WA, Roshan TM. Blood pre-donation deferrals – A teaching hospital experience. Southeast Asian J Trop Med Public Health 2008;39:571-4.  Back to cited text no. 10
    
11.
Chaudhary RK, Gupta D, Gupta RK. Analysis of donor-deferral pattern in a voluntary blood donor population. Transfus Med 1995;5:209-12.  Back to cited text no. 11
    
12.
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. 12
    
13.
Kagu MB, Ahmed SG, Bashir MA, Malah MB, Usoro A, Gimba I, et al. Deferral patterns of voluntary blood donors at the National Blood Transfusion Service, North East Zonal Centre, Maiduguri. Afr J Med Med Sci 2010;39:119-25.  Back to cited text no. 13
    
14.
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. 14
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Agnihotri N. Whole blood donor deferral analysis at a center in Western India. Asian J Transfus Sci 2010;4:116-22.  Back to cited text no. 15
[PUBMED]  Medknow Journal  
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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. 16
    
17.
Girish CJ, Chandrashekhar TN, Ramesh BK, Kantikar 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. 17
    
18.
Rehman S, Arif SH, Mehdi G, Mirza S, Saeed N, Faraz Y. The Evaluation of Blood Donor Deferral Causes: A Tertiary Care Centre-based Study. J Blood Disord Transfus 2012;3:131.  Back to cited text no. 18
    
19.
Saran RK. Transfusion Medicine Technical Manual, Directorate General of Health Services. 2nd ed. New Delhi: Govt. of India; 2003.  Back to cited text no. 19
    
20.
Kulkarni N. Analysis of donor deferral in blood donors. J Evol Med Dent Sci 2012;1:1076-82.  Back to cited text no. 20
    
21.
Sharma T, Singh B, Bhatt GC. Profile of deferral of blood donors in regional blood transfusion center in North India. Asian J Transfus Sci 2013;7:163-4.  Back to cited text no. 21
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Mangwana S. Analysis of blood donor deferral pattern: Scenario in a Tertiary Health Care Hospital in India. Asian J Transfus Sci 2013;7:160-1.  Back to cited text no. 22
[PUBMED]  Medknow Journal  


    Figures

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    Tables

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


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