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 Table of Contents  
SHORT COMMUNICATION
Year : 2016  |  Volume : 1  |  Issue : 2  |  Page : 81-84

Evaluation of deferral pattern among the blood donors in Islamabad, Pakistan


Islamabad Blood Transfusion Authority, Ministry of National Health Services, Government of Pakistan, Islamabad, Pakistan

Date of Web Publication6-Sep-2016

Correspondence Address:
Usman Waheed
Islamabad Blood Transfusion Authority, Ministry of National Health Services, Government of Pakistan, Islamabad
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-8893.189857

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  Abstract 


Introduction: Temporary or permanent deferrals lead to loss of valuable blood donors and blood units accessible for transfusion purposes. Understanding the rate and reasons of donor deferral provides direction for recruitment and retention strategies of blood donation. The current study was conducted to investigate the prevalence and causes of deferral in blood donors in Islamabad, the federal capital of Pakistan.
Materials and Methods: A structured pilot-tested questionnaire was sent to all 19 licensed blood banks of Islamabad through the Islamabad Blood Transfusion Authority. Data submission is a prerequisite for licensing with the authority. The study was conducted between January and December 2015.
Results: Most of the deferrals were because of anemia (41%), which was more prevalent in females. Other common causes for deferral in our study were underweight, low blood pressure, and under/overage. Less common causes were the use of certain medications, recent blood donation, history of fainting, and fear of needle.
Conclusion: It is imperative to investigate the rate and reasons of donor deferral to guide the recruitment and retention efforts. Donor sensitization on the criteria of recruitment needs to be addressed on priority basis through the public/donor awareness campaigns.

Keywords: Deferral, donor, Pakistan


How to cite this article:
Waheed U, Zaheer HA. Evaluation of deferral pattern among the blood donors in Islamabad, Pakistan. Glob J Transfus Med 2016;1:81-4

How to cite this URL:
Waheed U, Zaheer HA. Evaluation of deferral pattern among the blood donors in Islamabad, Pakistan. Glob J Transfus Med [serial online] 2016 [cited 2020 Feb 19];1:81-4. Available from: http://www.gjtmonline.com/text.asp?2016/1/2/81/189857




  Introduction Top


Blood donor selection is a cornerstone of blood safety.[1],[2],[3] The increasing demand of blood and blood components in the developing countries like Pakistan reflects the need for mobilization of more voluntary blood donors to ensure a safe supply of blood and blood components. The donor selection process needs constant monitoring to guarantee that it achieves its objectives of ensuring donor and recipient safety and providing a sufficient supply of blood.

In Islamabad, blood transfusion authority was made functional by the Ministry of National Health Services in 2013.[4] The Islamabad Blood Transfusion Authority (IBTA) acts as a regulatory body to register and license blood banks in its jurisdiction. One of the key functions of the authority is the collection and analysis of data pertaining to blood transfusion services. There are currently 19 licensed blood banks operational in the Islamabad Capital Territory. Except for one blood bank, all remaining blood banks are hospital-based and dependent on family replacement donations.[4]

The blood banks have the responsibility to collect blood from the low-risk population. A laborious process to evaluate the suitability of potential donor is, therefore, necessary to safeguard the safety and sufficiency of the blood supply while making sure that suitable blood donors are not deferred needlessly. The blood donors are deferred from donating blood for numerous reasons, either permanently or temporarily. The permanent deferrals are mostly due to reactivity to either one of the transfusion-transmitted infections (TTIs), namely, hepatitis C and hepatitis B viruses (HCV and HBV), human immunodeficiency virus (HIV), syphilis, and malaria and are well established while the deferrals due to other causes are not studied in detail. The criteria for selection and deferral of blood donor are based on the National Standards and Guidelines [5] developed by the Safe Blood Transfusion Programme, Government of Pakistan.

There is a dearth of literature on blood donor deferrals in Pakistan and a possible cause of this is the lack of sensitization to these deferral criteria. The annual data collection practices do not include information on donor deferrals and are more inclined toward the collection of basic blood safety data, for example, number and type of donations, screening practices. Currently, the efforts are aimed at recruiting new donors while overlooking the retention of those enrolled but deferred because of numerous causes. Knowledge of the causes for donor deferral can help in planning more effective recruitment and retention campaigns aiming at the availability of safe donors.

There are, however, a couple of single-center studies [6],[7] conducted in Pakistan over the past few years and provided insight into the causes of donor deferral pattern. The present study was conducted to analyze the prevalence of deferral pattern among blood donors in all the blood banks of Islamabad through the IBTA. The current study will be informative and valuable for studying and altering existing local donor selection and deferral criteria.


  Materials and Methods Top


This retrospective study was conducted through the data collected by the IBTA from the 19 licensed blood banks of Islamabad from January to December 2015. The blood banks were provided a structured pretested questionnaire to submit the data and the response was 100%. All blood banks collected the complete demographic information and conducted behavioral screening and physical examination. Hemoglobin (Hb) screening was performed by three processes in the blood banks: one is the copper sulfate specific gravity method, the second is the HemoCue Hb 201 (HemoCue AB, Angelholm, Sweden) and the third is the automated hematology analyzer method. The acceptable limit for Hb was 12.5 g/dl.

Data were entered into SPSS (IBM SPSS Statistics for Windows, version 20.0. IBM Corp., Armonk, NY, USA) and frequencies of each cause of deferral were calculated. As per licensing requirement, the procedure of donor selection and deferral is centered on the national standards based on blood safety legislation of the Islamabad Capital Territory.[8] The significance limit was set at 0.05 and Chi-square test was employed to assess statistical significance. Odds ratio (OR) was calculated to measure the probability of deferral between male and female donors.


  Results Top


Among the 19 IBTA-licensed blood banks functioning in the Islamabad Capital Territory, eleven are in public sector and eight in the private sector. Data of 68,317 blood donors who came to donate at the 19 licensed blood banks or the camps organized by these blood establishments of Islamabad were analyzed. Among these donors, 65,376 (95.7%) were selected for the whole blood donation after the physical and behavioral screening. Of a total of 65,376 whole blood donations collected in Islamabad in 2015, 59,986 (91.75%) were replacement donors and 5390 (8.25%) were voluntary donors. Breakdown of one-time voluntary donors and regular voluntary donors was not available. Blood from professional/paid donors was not collected by any blood bank in Islamabad.

Totally, 2941/68,317 (4.3%) blood donors were deferred in the predonation step (temporary n = 2692/permanent n = 249) from blood donation. 3988/65,376 (6.1%) blood donors were deferred permanently after postdonation serological screening on the basis of TTI reactivity. The predonation deferral rate was considerably higher (P ≤ 0.0001) among females (60.5%) compared to (39.5%) males and had higher OR for deferral (15.1). The rate of deferral of voluntary nonremunerated blood donors was not significantly different from that of family replacement donors (P = 0.25).

The total percentage of deferred donors (pre- and post-donation) was 10.14%, with majority of them (57.6%) being permanently deferred.

The causes of predonation deferral are shown in [Table 1].
Table 1: Causes of deferral

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The causes of permanent predonation deferral included hypertension in 30 donors (1.0%), diabetes in 8 donors (0.3%), and history of jaundice in 193 donors (6.6%). The causes of postdonation permanent deferral included HCV-positive 69.4% (n = 2765), HBV-positive 27.1% (n = 1083), HIV-positive 1.1% (n = 45), syphilis-positive 1.8% (n = 71), and malaria-positive 0.6% (n = 24).


  Discussion Top


The deferral of blood donors is essential to protect the donor from the harms of blood donation, or protection of recipient from TTIs or protection of both the donor and recipient. The donor deferral rate has been reported from 5.19% to >30% in different countries,[9],[10],[11],[12],[13],[14],[15],[16] and it was 10.4% in our study. These variations in different countries regarding the donor deferral pattern may be attributed to diverse donor selection criteria such as weight, age, Hb levels, blood donation interval, and incidence of transmittable diseases. However, the results of our study are comparable earlier studies from Pakistan which have reported 8.7% and 13. 5%, respectively.[6],[7]

The most common cause of deferral in our study was anemia (41%). This is in agreement with earlier studies.[17],[18] The majority of these were females. As reported in other studies, up to 95% of the deferrals for anemia occur in females.[19],[20] The blood donors deferred due to anemia are much less likely to reappear for future donations than donors who are not deferred. A study reported that only 21% first-time donors having anemia came back to donate within 3 years while 70% of those not deferred returned. Similarly, only 64% of repeat donors returned within 3 years after low Hb deferral while 91% of those not deferred returned.[21]

The second major cause of deferral was underweight as many donors had a weight below 50 kg. A high blood pressure was another common cause for deferral and is due to nervousness and anxiety of the first-time donors. Low blood pressure, on the other hand, is mostly due to fear of the donation and was prevalent in our donor population. Another deferral cause was fasting and age restrictions. The donors below the age of 18 years and above 60 years are not allowed to donate. However, there is relaxation in case of regular donors and they can donate up to 65 years.

Hypertension leads to permanent deferral of a substantial number of potential blood donors as obvious in our study and another study by Bahadur et al.[11] As the country is endemic for hepatitis viruses, any history of jaundice was considered permanent deferral and a high number of donors were deferred due to this history.

The donor deferral is related to the loss of key resources for both the donor and the blood bank staff. Some of these deferrals can be preventable and could escalate the blood supply without having to recruit new donors. The staff should effort to prevent any negative impression that might stop the donors from visiting again. Deferring a potential donor frequently leaves the individual with a bad feeling about themselves as well as about the blood bank and may have adverse psychological effects.[22]


  Conclusion Top


Credible scientific data of an important urban center, Islamabad, generated by a regulatory authority, indicate that about 10% of the blood donors who presented for blood donations were unfit for donations temporarily or permanently. This study, therefore, underlines the need to focus on retention of suitable voluntary as well as replacement donors in addition to further strengthening donor management systems. Studies on a much larger scale are needed to have detailed understanding of the deferral pattern. Donor sensitization on the criteria of recruitment needs to be addressed on priority basis through the public/donor awareness campaigns.

Acknowledgment

We would like to acknowledge all blood banks' in-charges who reported their data to IBTA. The assistance of IBTA staff, namely, Irfan Shabber Kayani, Akhlaaq Wazeer, and Rehan Hafeez in data acquisition is much appreciated.

Financial support and sponsorship

Islamabad Blood Transfusion Authority, Ministry of National Health Services, Government of Pakistan.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Zou S, Musavi F, Notari EP 4th, Fujii KE, Dodd RY; ARCNET Study Group. Prevalence of selected viral infections among temporarily deferred donors who returned to donate blood: American Red Cross blood donor study. Transfusion 2005;45:1593-600.  Back to cited text no. 1
    
2.
Cable R, Musavi F, Notari E, Zou S; ARCNET Research Group. Limited effectiveness of donor deferral registries for transfusion-transmitted disease markers. Transfusion 2008;48:34-42.  Back to cited text no. 2
[PUBMED]    
3.
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. 3
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4.
Zaheer HA, Waheed U. Impact of regulation of blood transfusion services in Islamabad, Pakistan. Glob J Transfus Med 2016;1:29-31.  Back to cited text no. 4
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5.
Safe Blood Transfusion Programme, Government of Pakistan. National Standards and Guidelines; 2012. Available from: http://www.sbtp.gov.pk/wp-content/uploads/2016/01/5-Standards-and-Guidelines-for-Blood-Banks-and-Transfusion-Services1.pdf. [Last accessed on 2016 Jun 20].  Back to cited text no. 5
    
6.
Tufail S, Babar F, Ikram N, Raza M, Shakoor HA. Blood donors deferral – Causes. J Rawalpindi Med Coll 2013;17:119-2.  Back to cited text no. 6
    
7.
Khan S, Rehman N, Raziq F. Donor deferral: Evaluation of causes of causes on pre donor screening. Gomal J Med Sci 2012;10:23-6.  Back to cited text no. 7
    
8.
The Gazette of Pakistan. Islamabad Transfusion of Safe Blood Rules, 2005. SR0 307 (1) 12005, Ministry of Health, Government of Pakistan; 2005.  Back to cited text no. 8
    
9.
Custer B, Chinn A, Hirschler NV, Busch MP, Murphy EL. The consequences of temporary deferral on future whole blood donation. Transfusion 2007;47:1514-23.  Back to cited text no. 9
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10.
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. 10
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11.
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. 11
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12.
Gonçalez TT, Sabino EC, Schlumpf KS, Wright DJ, Mendrone A, Lopes M 1st, et al. Analysis of donor deferral at three blood centers in Brazil. Transfusion 2013;53:531-8.  Back to cited text no. 12
    
13.
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. 13
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14.
Ekwere TA, Ino-Ekanem M, Motilewa OO, Ibanga IA. Pattern of blood donor deferral in a tertiary hospital, South-South, Nigeria: A three-year study review. Int J Blood Transfus Immunohematol 2014;4:7-13.  Back to cited text no. 14
    
15.
Ngoma AM, Goto A, Nollet KE, Sawamura Y, Ohto H, Yasumura S. Blood donor deferral among students in Northern Japan: Challenges ahead. Transfus Med Hemother 2014;41:251-6.  Back to cited text no. 15
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16.
Girish CJ, Chandrashekhar TN, Ramesh BK, Kanitkar SM. Pre-donation deferral of whole blood donors. J Clin Diagn Res 2012;6:47-50.  Back to cited text no. 16
    
17.
Prados Madrona D, Fernández Herrera MD, Prados Jiménez D, Gómez Giraldo S, Robles Campos R. Women as whole blood donors: Offers, donations and deferrals in the province of Huelva, South-Western Spain. Blood Transfus 2014;12 Suppl 1:s11-20.  Back to cited text no. 17
    
18.
Patil RS, Mhetre S, Rayate M, Karache AG. Analysis of blood donor deferral causes in Solapur district. Int J Biol Med Res 2014;5:4227-30.  Back to cited text no. 18
    
19.
Wood EM, Kim DM, Miller JP. Accuracy of predonation HCT sampling affects donor safety, eligibility, and deferral rates. Transfusion 2001;41:353-9.  Back to cited text no. 19
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20.
Halperin D, Baetens J, Newman B. The effect of short-term, temporary deferral on future blood donation. Transfusion 1998;38:181-3.  Back to cited text no. 20
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21.
Hillgrove T, Moore V, Doherty K, Ryan P. The impact of temporary deferral due to low hemoglobin: Future return, time to return, and frequency of subsequent donation. Transfusion 2011;51:539-47.  Back to cited text no. 21
    
22.
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. 22
[PUBMED]    



 
 
    Tables

  [Table 1]


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