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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 3  |  Issue : 1  |  Page : 13-16

Response to postdonation counseling is still a challenge in voluntary blood donation: A survey from tertiary care blood center


Department of Pathology, C. U. Shah Medical College and Hospital, Surendranagar, Gujarat, India

Date of Web Publication5-Apr-2018

Correspondence Address:
Dr. Nisha G Raval
Department of Pathology, C. U. Shah Medical College and Hospital, Surendranagar, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GJTM.GJTM_56_17

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  Abstract 


Background: Blood transfusion carries the risk of transmission of several infectious agents. The latest method for blood screening such as nucleic acid testing is not affordable in developing countries. Hence, the importance of pre- and postdonation counseling for transfusion transmission infections is paramount. Aim: The study was aimed to find response to postdonation counseling for reactive markers among the voluntary blood donors donating in blood bank. Materials and Methods: This 2-year study was conducted from May 2015 to June 2017. Transfusion-transmitted infections' testing was performed by routine enzyme-linked immunosorbent assay method. The initial human immunodeficiency virus (HIV) reactive donors who return back to the blood bank were confidentially counseled and referred to the Integrated Counseling Cum Testing Centre. The hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) reactive donors were referred to General Medicine Department for confirmation by qualitative polymerase chain reaction and follow-up. Venereal disease research laboratory (VDRL) reactive donors were referred to sexually transmitted infections clinic. Results: During the survey, 17,306 units of blood were collected. Among which 7 were reactive for HIV, 117 were reactive for HBsAg, 10 were reactive for HCV, and 101 were reactive for VDRL. Out of 235 donors who were reactive and called for counseling postdonation, only 28.94% responded.

Keywords: Hepatitis B surface antigen, hepatitis C virus, human immunodeficiency virus, postdonation counseling, venereal disease research laboratory


How to cite this article:
Thaker SS, Raval NG, Agnihotri A S. Response to postdonation counseling is still a challenge in voluntary blood donation: A survey from tertiary care blood center. Glob J Transfus Med 2018;3:13-6

How to cite this URL:
Thaker SS, Raval NG, Agnihotri A S. Response to postdonation counseling is still a challenge in voluntary blood donation: A survey from tertiary care blood center. Glob J Transfus Med [serial online] 2018 [cited 2018 Sep 26];3:13-6. Available from: http://www.gjtmonline.com/text.asp?2018/3/1/13/229339




  Introduction Top


Blood transfusion is a lifesaving procedure, but at the same time, it carries the risk of transmission of several infectious agents. In developing countries, nonremunerated voluntary blood donors play a major role in safe blood supply as most of the blood banks in these countries cannot afford to use the latest nucleic acid testing (NAT) for blood screening. Although NAT screening decreases the window period of viral infections, in India, the conventional enzyme-linked immunosorbent assay (ELISA) remains the most commonly used screening test for transfusion-transmitted infections (TTIs). The risk of TTIs is estimated to be 1 in 2,000,000 units for human immunodeficiency virus (HIV) and 1 in 2,000,000 for hepatitis C virus (HCV) and for hepatitis B virus (HBV), many times more as compared to HCV.[1] Hence the importance of donor counseling should not be underestimated.

As a fundamental part of preventing TTIs, the role of notification/counseling donors about their seroreactivity is of major importance in blood safety. As per objective given in 4.16 of the Indian action plan for blood safety, blood donors are counseled about TTIs prior donation and are offered the option of knowing their seroreactivity status provided they give consent.[2]

This survey was aimed to find awareness among voluntary blood donors in Surendranagar District, Gujarat, for safe blood donation practices and their response towards. postdonation counseling. This will help in formulating strategies to inform donors about their seroreactive status and take necessary medical interventions at the earliest before considering next blood donation. This will also help in spreading the importance of self-deferral.

In the long term, this may help in creating a pool of safe repeat, nonremunerated voluntary donors across the district and at some level across the state.


  Materials and Methods Top


This 2-year survey was conducted by C. U. Shah Blood Bank, Department of Pathology, C. U. Shah Medical College and Hospital, Surendranagar, Gujarat, from time period of June 1, 2015 to May 31, 2017. All the blood donors who registered were requested to fill donor screening cum registration card formulated as per national guidelines.[1] The blood donors were from both rural and urban areas within and around the district of Surendranagar. All donors had given the consent to be informed of their serological screening status of TTIs during predonation screening and were communicated by blood bank about their reactive status. Five mandatory TTI screening tests for HIV, hepatitis B surface antigen (HBsAg), HCV, venereal disease reasearch laboratory (VDRL), and malaria antigen were performed on 5 ml clotted blood and 3 ml ethylenediaminetetraacetic acid blood collected in pilot tubes from postdonation samples.

The blood donors who were initially reactive to HIV (ERBA Diagnostics Mannheim GmbH with Transasia Bio Medical Ltd., Ringanwada, Daman), HBsAg (ERBA diagnostics Mannheim GmbH with Transasia Bio Medical Ltd., Ringanwada, Daman), and HCV (ERBA Diagnostics Mannheim GmbH with Transasia Bio Medical Ltd., Ringanwada, Daman) by semiautomated ELISA method (Benesphera-ELISA microplate reader E21) and donors reactive to VDRL (ASPEN – Syphilis rapid test) were notified. The donor records were verified by the counselor to call back the donors (over phone or by personal letters) maintaining the confidentiality of all test records. In every case, the notifications over phone or letters were provided three times at the interval of 2 weeks. The donors who did not respond even after third notification were considered nonresponders. Postdonation counseling was done by blood bank counselor provided by government authority, Integrated Council Cum Testing Center (ICTC).

The donors who returned back to the blood bank were recounseled of their health status and high-risk behavior and referred to ICTC, if their units were initially HIV reactive. The ICTC testing protocol was followed as per operational guidelines for ICTC. The donors who were reactive to HBsAg and HCV were counseled about the same and directly referred to the Department of General Medicine of C. U. Shah Medical College and Hospital for confirmation of their viral status by qualitative polymerase chain reaction (PCR, Roche diagnostics, German) and further management.


  Results Top


There were 17,306 voluntary blood donors who were surveyed from June 2015 to May 2017 at C. U. Shah blood bank including blood donation camps held throughout the district of Surendranagar. Of them, 7 units were reactive for HIV 1 and 2 (0.04%), 10 were reactive for HCV (0.06%), 117 for HBV (0.68%), and 101 for VDRL (0.58%) making a total of 235 units (1.36%) which were initially reactive to TTIs.

Among these 235 initially reactive donors, 5 were female donors and remaining 230 were male donors. Reactivity status of these 235 donors is given below in [Table 1]. Out of these 235 reactive donors, 68 of them returned to the blood bank for postdonation counseling and were considered responders and 167 donors did not turn up. The data of notified donors versus responders are given in [Figure 1].
Table 1: Reactivity status of 235 donors

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Figure 1: The data of notified donors versus responders in following figure

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Of 68 voluntary blood donors who returned for postdonation counseling for their seroreactive status, 55 were repeat blood donors. They were well aware of TTIs and high-risk behavior. Rest 13 of 68 volunteers were donating blood for the first time. Only four of them were aware of TTIs, whereas nine of them mentioned donating blood due to peer pressure during postdonation counseling and were not aware of TTIs or high-risk behavior. Of 235 reactive donors, 167 (71.06%) did not return to the blood bank after being informed thrice. Of these, 58 had given initial positive response (34.73%) for postdonation counseling and advice but could not attend due to their busy schedule. The rest 118 of 167 (70.66%) donors simply refused to return back either due to a personal reason or expressing their unwillingness. Out of 68 donors who returned for counseling, 5 were initially reactive for HIV 1 and 2, 31 for HBsAg, 9 for anti HCV, and 23 for VDRL.


  Discussion Top


Overall seroreactivity observed in our study was 1.36% (235/17306) which is comparable with other studies from India and other developing nations.[3],[4] The demand for blood and blood products has been increasing day by day with the advancement of health-care superspeciality and organ transplant biology. However, availability of reasonably safe blood still remains a debatable issue, especially in developing countries as they cannot afford to perform universal NAT screening for blood-borne viruses.

The rate of response among initial seroreactive donors on notifications in our study was only 28.94% which is quite low as compared to other studies from North India.[5] The possible explanation of our result could be a lack of proper donor education and lack of privacy during predonation counseling in crowded voluntary out donation camps. The importance of donor education and predonation counseling should not be ignored. Predonation screening of donor's health should be given more importance as a part of blood safety. Counselor should be well trained and competent. Written matter in the registration cum counseling form should be clear, understandable, and most importantly privacy and confidentiality should be maintained. One study revealed that 41% of HIV-reactive donors felt lack of privacy during health interview, whereas 20% of the donors said that they would have provided different answers if they had more private situations.[6]

Seroreactivity in donors is compared in [Table 2] as well as responders among reactive donors are compared with Mukherjee et al.'s study which shows 34% responders, and in our study, we have 28.94% responders after postdonation counseling. It was observed that 55 of 68 donors who responded to postdonation counseling were repeat blood donors and also aware of TTIs and high-risk behavior. More interestingly, the donors who were reactive for HIV responded in a maximum number for postdonation counseling (5/7). This may be because of increasing awareness of HIV in our society in recent years.[7] A study of Sharma et al.[9] found that very few of the donors have information about the “window period.” The donors who had “high-risk behavior” continued to donate blood thinking that their blood will be tested for infections and if their test results will be negative, then they are safe. A similar low response rate (20%) in postdonation counseling has also been observed in another study.[10] The authors have considered that disclosure of TTIs status by telephone is a very challenging task as it may result in serious complication for some donors. There is also a need to create more awareness among the voluntary donors to achieve the goal of “Safe Blood Starts with Me” by the World Health Organization.[11]
Table 2: A comparative study of our study with other similar studies

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  Conclusion Top


The response to the postdonation counseling among seroreactive blood donors was only 28.94% (68/235). A majority of our voluntary blood donors (167/235) are still having a reluctant approach to provide relevant information about their sociodemographic profile while registering them for blood donation. Proper predonation counseling is still a challenge and even bigger challenge is postdonation counseling for TTIs among the voluntary donors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jeffery SD, Kenneth CA. Transfusion biology and therapy. In: Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J. Harrison's Principles of Internal Medicine. 19th ed. New York: McGraw-Hill Education; 2015. p. 138e-6.  Back to cited text no. 1
    
2.
An Action Plan for Blood Safety. National AIDS Control Organization. Ministry of Health and Family Welfare, Government of India, New Delhi; 2007. p. 33-4.  Back to cited text no. 2
    
3.
Singh B, Kataria SP, Gupta R. Infectious markers in blood donors of East Delhi: Prevalence and trends. Indian J Pathol Microbiol 2004;47:477-9.  Back to cited text no. 3
    
4.
Fessehaye N, Naik D, Fessehaye T. Transfusion transmitted infections – A retrospective analysis from the national blood transfusion service in Eritrea. Pan Afr Med J 2011;9:40.  Back to cited text no. 4
    
5.
Agarwal N. Response rate of blood donors in the Uttarakhand region of India after notification of reactive test results on their blood samples. Blood Transfus 2014;12 Suppl 1:s51-3.  Back to cited text no. 5
    
6.
Choudhury LP, Tetali S. Ethical challenges in voluntary blood donation in Kerala, India. J Med Ethics 2007;33:140-2.  Back to cited text no. 6
    
7.
Arora D, Arora B, Khetarpal A. Seroprevalence of HIV, HBV, HCV and syphilis in blood donors in Southern Haryana. Indian J Pathol Microbiol 2010;53:308-9.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Mukherjee S, Bhattacharya P, Bose A, Talukder B, Datta SS, Mukherjee K,et al. Response to post-donation counseling is still a challenge in outdoor voluntary blood donation camps: A survey from a tertiary care regional blood center in Eastern India. Asian J Transfus Sci 2014;8:80-3.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Sharma UK, Schreiber GB, Glynn SA, Nass CC, Higgins MJ, Tu Y,et al. Knowledge of HIV/AIDS transmission and screening in United States blood donors. Transfusion 2001;41:1341-50.  Back to cited text no. 9
    
10.
Doll LS, Petersen LR, White CR, Ward JW. Human immunodeficiency virus type 1-infected blood donors: Behavioral characteristics and reasons for donation. The HIV blood donor study group. Transfusion 1991;31:704-9.  Back to cited text no. 10
    
11.
World Health Organization. Safe Blood Starts With Me! Geneva: World Health Organization; 2000.  Back to cited text no. 11
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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