Understanding deferral rate and reason among voluntary blood donors at a tertiary care center��JOURNAL WAS DONE IN GOVERNMENT MEDICAL COLLEGE, INDIA YEAR 2021�

SN SHAMLAH NAGAIAH

JURURAWAT U29

UNIT PERKHIDMATAN KAUNTER

PUSAT DARAH NEGARA

INTRODUCTION

• A healthy donor is chosen by a screening process for blood donation that uses a questionnaire and a short physical exam based on national guidelines.

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• Those who don't meet the selection criteria are not allowed to give blood.

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• A proper donor screening procedure reduces the risk of transfusion-transmitted infection (TTI) as well as blood and blood product waste.

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• Replacement donors give blood when a patient or the patient's family asks for it. Voluntary donors give blood because they want to, not because they have to.

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• Literature has shown that a lot of blood donors are stopped from giving blood for one or more reasons, either temporarily or permanently. This is terrible for blood banks and creates a shortage of healthy blood donors.

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OBJECTIVE

• finding out the different reasons for deferral.

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• Care for donors and make sure patients get safe blood.

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• Figure out the most common reasons for permanent and temporary deferrals.

STUDY DESIGN AND METHODS

• The study was done in the blood bank of a tertiary care hospital from January 2015 to December 2017.
• Donors who gave blood at outdoor voluntary blood donation camps and at the blood bank were included in this study.
• Donor questionnaire form was used for screening.
• Donors were screened based on their past and present health, medications, vaccinations, alcohol use, sexual behaviour, history of jaundice, surgical history, menstrual history, etc.
• Before taking blood, physical and vital examinations were done. Blood pressure was measured,the axillary temperature was taken and haemoglobin was estimated using the Hemocue and Copper sulphate method.
• Deferred donors are put into groups based on their age, gender, and the reason for deferral.
• All deferral form was registered to get the information about donors who were turned away.
• Based on Indian medical association (IMA) blood bank rules, all deferred blood donors were put into one of two categories either temporary or permanent.

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RESULTS

• Total 10000 donors was registered for a donation during this study which is 8224 males and 1776 were females donors
• Out of the 10,000 donors who signed up during the study period, 598 were turned away. Of those, 467 were men and 131 were women.

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TEMPORARY DEFER

• The reasons for men are anaemia, pharmaceuticals, and alcohol consumption within the previous 24 hours, in that order. Anemia is the most common cause for females, followed by menstruation history within one week and underweight.

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PERMANENT DEFER

• Hypertension (8%), diabetes (7%), and chronic diseases like epilepsy, cardiac dysfunction, recent surgery, kidney dysfunction, and recent hepatitis or hep B vaccination in the last 6 months were the main reasons for permanent deferral for both men and women (3 percent ) [Table 3]

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• Most of the deferred donors (65%) were between the ages of 18 and 30. [Table 2]. Analysis showed that temporary deferrals were more common than permanent deferrals.

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CONCLUSION

• Our study found that donor deferral rates were very similar across populations, with varying reasons in different studies.
• Hypertension was the main reason for permanent deferral, and anaemia was the main reason for temporary deferral. Most of the time, neither is found because there isn't a regular screening programme in the community.
• Having an awareness session at a pre-donation camp, putting up an IEC display, and clearing up myths and misunderstandings will help donors pre-screen themselves and cut down on temporary deferrals.
• People who have been temporarily put on hold must be told and followed up on to encourage them to donate again in the future.
• Analysis of deferral patterns helps to strengthen or improve strategy, which will help to get more people to donate blood.
• It is also important for the safety of blood transfusions and to help guide donor recruitment efforts so that valuable blood don't get wasted at the local, national, and international levels.

STUDY DISCUSSION

• There were a total of 10,000 individuals who volunteered to donate blood, of which 598 were deferred for various reasons.
• This difference in deferral could be caused by many things, such as differences in health problems based on location, socioeconomic status, donor selection criteria, and gender.
• Most blood donors are male, according to an analysis. 82% of blood donors were men and only 17.8% of women volunteered to donate.
• This is due to incorrect beliefs about blood donation in society and a lack of blood donation knowledge among women.
• In the present study, 7.4 percent of female donors were deferred, compared to 5.4 percent of male donors.
• This may be because female donors are more likely to be anaemic and underweight.However, proper predonation counselling and improving nutritional status will help to reduce female deferral due to physiological factors.
• Another study show that more women could be eligible if the standard levels of haemoglobin were lowered and pre-menopausal women were offered iron treatment.

STUDY DISCUSSION

CONT…..

• The other causes of temporary deferral included alcohol intake, underweight, history of malaria, dengue or typhoid
• within 6 months and menstrual history within one week.
• It is also a huge concern that most of the temporary deferred donors may think that they have been deferred for life. . In order to re-enter the donor pool, deferred donors must be told of the reasons for their deferral and the period of deferral with proper counseling that can help donor to back to donor pool and allow donor to donate as usual.
• In our study, high blood pressure, diabetes, and high-risk behaviour among donors who had more than one sexual partner were the main reasons for permanent deferral.
• Analysis of age of deferral showed that most deferrals were made by people between the ages of 18 and 30.
• To get more people to donate blood on their own, a lot of programmes will be held to raise awareness about how important it is, why people might not want to donate, common myths about blood donation, pre-donation self-screening, and IEC activities.
• Additionally, pre-donation medical check-ups and free blood investigations could encourage and motivated people to donate blood.

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PDN OVERVIEW

PERMANENT DEFERRAL LIST MAY 2022

PDN CONCLUSION

• Total 23374 donors was registered for a donation in MAY 2022 which is including donors who was donated at centre,blood donation drive and mobile static
• Total defferal was 5045 donor,which is 3559 were females and 1486 is male donors.
• The highest defferal in PDN was the low haemoglobin level which is 2840 donors
• High blood pressure is our second highest rate for deferred which is total 507 and followed by low blood pressure 197 donors.
• Medical illness was the main reason for permanent deferral and followed by family history of hepatitis.
• In this study,they suggest to lowered the standard level of haemoglobin to make many people to eligible to donate especially female donor,but is may probably can increased adversed donor reaction.
• we can give the donor an appointment date (TCA) so they know when they can donate again after deferral period.(FOR TEMPORARY DEFER)

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COMPARISON WITH ARTICLE AND PDN

• All pre screening that we done for donor before they eligible to donate are most likely same like the article such as check haemoglobine level,ABO and blood pressure.

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• women are the highest group that is not eligible for blood donation

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• The highest temporary deferred in PDN and the article is low haemoglobin level.

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• Here we also have a campaign related to blood donation awareness so people can get a lot of knowledge about blood donation.

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PDN SUGGESTIONS

For temporary defer:

1. Low Hb

-Advise donors especially female donors to maintain a time period between 3 months donation so that iron in blood sufficient

- need to educate donor about iron tablet (timing,action & myths)

2. High BP

-Advise donor to compliance on medication

-donor have to rest well and sleep more then 5 hours before donation

iii. To advice all temporary deferred donor to come again after deferral period ends

PDN SUGGESTIONS

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For permanent defer

1. Medical illness:

- To spread education among donors about the types of medical illness that are prohibited for donation(social media,roadshow)

- Pre donation medical check up for new donor and lapsed donor to reduce permanent deferral rate thus giving assurance on the safety of the blood product

2. Family history hepatitis

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- New donor to do screening before donation

-Regular donor can get free hep b vaccination and complete vaccine

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-regular donor will advice to do hepatitis screening

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iii. To key in all the data for permanent deferral in bbis system to avoid donor to try to donate at other place

Have a nice day �