Validating a blood donation awareness tool created using general practitioner and patient acceptability and preferences.

BACKGROUND: There is a need to develop an awareness raising tool for GPs to reach out their patients in order to increase blood donation. The main objective was to create and validate a tool to raise awareness about blood donation that meets acceptability and preference criteria and is applicable in general practice. MATERIAL AND METHODS: This cross-sectional study was conducted in three phases. 1. Tool creation: A stakeholder meeting co-developed three potential tools to raise awareness about blood donation: a consulting room poster, a waiting room poster and a lapel badge for the doctor. Three GPs pilot-tested each tool for one day during their regular consultations. Then, once the pilot was completed each GP assessed acceptability and preference using a semi-structured interview, and patients were also interviewed. 2. Consensual tool selection: An appropriate tool was selected based on pilot data using nominal group technique and expert review. 3. The tool was validated for its acceptability in practice via a quantitative questionnaire distributed electronically to GPs. RESULTS: The consensual tool selected by the nominal group was a combination of elements from all three tools trialled in the pilot, reported to be non-intrusive and convenient for both GPs and patients. Patient responses indicated a high level of acceptability and indicated a strong preference for self-generated discussion of the topic with their GP. In the validation step, 217 responses to the quantitative questionnaire were received: 74.5% of responses fulfilled the acceptability criteria for using this combined tool in general practice. Furthermore, 93.1% of GPs indicated they would use the tool in the proposed format for the purpose of raising awareness. DISCUSSION: The validation of our blood donation awareness tool for use in general practice justifies its evaluation on a larger scale as part of a wider blood donation awareness campaign.

Deferral from donating blood of men who have sex with men: impact on the risk of HIV transmission by transfusion in France.

BACKGROUND: In France, men who have sex with men (MSM) are permanently excluded from blood donation. This policy is felt to be discriminatory by MSM activists. Furthermore, the policy is not fully respected because some MSM do not report their sexual behaviour before donating. METHODS: We estimated the fraction of the current risk of HIV attributed to MSM. We then constructed a model based on data obtained from behavioural and epidemiological surveys to assess the impact of a new strategy in which MSM would only be deferred if they report more than one sexual partner in the last 12 months. RESULTS: Thirty-one HIV seroconversions occurred among repeat donors between 2006 and 2008, giving a risk of one in 2 440 000 donations. Fifteen of these seroconversions (48%) were MSM. If all MSM had abstained from donating blood, the risk would have been 1 in 4 700 000 donations, half the current risk. The new strategy would result in an overall HIV risk of between 1 in 3 000 000 (close to the current risk) to 1 in 650 000 donations (3·7 times higher than the current risk). CONCLUSIONS: Changing the current MSM deferral policy may increase the risk of transfusion-transmission of HIV. However, this does not take into account a possible better compliance with MSM with a less stringent policy that would be perceived as more equitable. Conversely, relaxing the policy could encourage some MSM to seek an HIV test in blood centres. Thus, further qualitative study is needed to assess possible changes in compliance linked to a new policy.

[The contraindications in blood donation. Impact of the decree of January 12, 2009]. / Les contre-indications au don du sang. Impact de l'arrêté du 12 janvier 2009.

The ministerial decree of 12 January 2009 fixing the criteria for the selection of blood donors establishes the list of contraindications for blood donation according to the appendix to the European directive 2004/33/EC. This text regroups the preexisting guidelines and reinforces their regulatory status, which illustrates the importance attributed to the selection of donors within the dispositions ensuring transfusion safety. It introduces more flexibility with respect to the preexisting criteria taking into account the improvement in life expectancy and the continual increase in transfusion requirements. Thus, the rules for donation authorize up to 24 donations annually and one may give whole blood up to six times per year for men and four times for women, up to the age of 70, the risk of anaemia now being well controlled. The medical rules are more flexible in the areas of haemochromatosis, allergies and autoimmune diseases and for the collection of plasma for fractionation. Some expected changes were not approved in certain cases due to the preeminence of the corresponding criteria in the European directive, like for cured cancers, in other cases in view of an analysis of the available epidemiological data or potential risks like for sexual relations between men and the risks linked to prions or emerging agents (transfusion antecedents). These selection criteria will be revised every year, which should permit their adaptation to the current state of knowledge, although the extent of the revisions will be limited by the updating of the European text on which they are based.

Psychosocial and cognitive engineering contributions to blood transfusion.

Among the research developed in social psychology, there is a field of study questioning the mechanisms that explain prosocial behaviors. In 1956, the first links between transfusion medicine and social psychology were formed, with the study of underlying motivations to blood donation behavior. Sixty years later, the number of "fundamental" and "applied" research has widely increased, and we now have a theoretical understanding of blood donation engagement's levers, as well as experimental demonstrations of methods to activate these levers. Thus, the literature offers several strategies experimentally verified to improve the recruitment and retaining of blood donors. These methods can go from specific speeches when soliciting donors, to changes in the blood donation environment, etc. They aim either at impacting the donation experience, at obtaining a change in the donor's behavior, or at changing the determinants of blood donation. Yet, it is clear that the knowledge from the research in social psychology is not really deployed on the field by the organizations that could benefit from it. In this article, we will try to develop the difficulty regarding the application of fundamental and experimental knowledge, and to underline the implications for the blood transfusion establishments. We will then present the psychosocial and cognitive engineering method, and argue its relevance to answer this problematic.

Overview of revised measures to prevent malaria transmission by blood transfusion in France.

Plasmodial transmission by blood donation is rare in non-endemic countries, but a very serious complication of blood transfusion. The French national blood service (Etablissement Français du Sang and Centre de Transfusion sanguine des Armees) intended to revise the measures to strengthen blood safety with regard to Plasmodiae as transmissible pathogens. To limit the risk of transmission during infusion, serious additive measures have been taken for more than a decade in France, which is the European country with the highest rate of exposure to imported plasmodial infections or malaria. These measures were revised and strengthened after the occurrence of a lethal transfusion-transmitted infection in 2002, but did not prevent another occurrence in 2006. This report examines the weaknesses of the systems and aims at emphasizing the safety measures already taken and addresses issues to best respond to that risk.

Determinants of plasma donation: A review of the literature.

The major contribution of Human Sciences in the understanding of the whole blood donation behavior has been through the study of individuals' motivations and deterrents to donate. However, if whole blood donation has been very widely studied in the last sixty years, we still know very little about plasma donation in voluntary non-remunerated environments. Yet, the need for plasma-derived products has been strongly increasing for some years, and blood collection agencies have to adapt if they want to meet this demand. This article aims to review the main motivations and deterrents to whole blood donation, and to compare them with those that we already know concerning plasma donation. Current evidence shows similarities between both behaviors, but also differences that indicate a need for further research regarding plasma donation.

[Commitment in plasmapheresis donation: A study of determinants among regular donors in plasmapheresis]. / L'engagement dans le don de plasma : étude des déterminants chez des donneurs réguliers en plasmaphérèse.

The purpose of this study, based on the Theory of planned behavior, is to identify and ultimately better understand what determines the fidelity and the regularity of donors committed in plasmapheresis donation. This qualitative study is a primary stage to establish a classification of donors in a French socio-cultural context. For this reason, we have carried out a survey among 16 regular plasmapheresis donors, by way of semi-structured individual interviews at the Établissement français du sang - Brittany. The level of commitment of these regular donors is considered as a level of appropriation. If subjective norms have initially influenced their decision to donate blood, no specific motivation has been highlighted for them to donate plasma except a generally favourable attitude towards the voluntary donation process. The perception of control over their environment is a variable which played a decisive role in the donor's intention to give, with little cost associated to plasmapheresis donation and recourse to internal causal explanations. A better comprehension of the plasmapheresis donors' determinants should lead us to a more efficient awareness of new potential donors, thereby enhancing recruitment and retention. Due to the increasing need for plasma-derived products, this study's ultimate issue is closely correlated both with ethical and socio-economic aspects. Following which, after analysing the results, a certain number of recommendations will be made.

[Not-for-profit: A report from the fourth annual symposium of ethics held by the National Institute for Blood Transfusion (France)]. / À propos du non-profit : rapport du quatrième symposium annuel d'éthique transfusionnelle de l'Institut national de la transfusion sanguine.

The not-for-profit issue has been debated in November 2016 in Paris; this issue is one of the four canonical pillars of ethical blood donation. It is intimately bound to benevolence though it is distinct, as not-for-profit calls for institutions while benevolence calls for individuals. It is indeed intended that voluntary blood donors do not benefit from their donation and are thus non-remunerated. Not-for-profit is essential since it refers to the public character of blood as a putative public resource aimed at being shared as a tribute of solidarity. A central question however is linked to the capacity- or not -of public sectors to ensure that blood components are universally available, with special mention to plasma derived drugs, without the contribution of the for profit, private sector.

[Ethical issues in transfusion medicine]. / Dimensions éthiques en transfusion sanguine.

Ethics is on the cross road of off values that are present along the ways of transfusion medicine. This is an important tool to afford opinions as well as debates that always emerge when discussing transfusion medicine. The wording is particularly important; this was one among several others that characterized the soul of Jean-Jacques Lefrère when he opened the doors of the ethical issues of transfusion medicine.

[Voluntariness and blood donation: Proceedings of an ethics seminar held at the National Institute for Blood Transfusion]. / Volontariat et don de sang : compte rendu d'un séminaire de l'Institut national de transfusion sanguine.

Voluntariness stands for one of the four pillars of ethics in blood donation; it is, however, more related to tradition than to legislation. Because it seems necessary to apply "marketing" techniques to blood collection in order to meet the needs in blood components, both in terms of quantity and quality, one wonders if this may be at the expense of this principle of voluntariness. This seminar-belonging actually to a series of seminars in Ethics in Transfusion Medicine-aimed at questioning the possible weakness of voluntariness in the field of blood donation. To achieve this goal, specialists of numerous disciplines in medical sciences, law and humanities gathered to discuss all related issues to voluntariness in blood donation.

[Stating technical requirements and deferral criteria for whole blood donation]. / Enoncer les conditions d'un don du sang standard et les motifs d'exclusion.

Blood donation is framed by regulations whose finality is to guarantee the safety of blood transfusions and to preserve the health of the donors. Each blood donation is preceded by a medical interview which evaluates the aptitude of the donor to support a 400 to 600 mL collection of blood or its components, and checks the absence of exposure to blood-borne diseases. The criteria of exclusion of blood donation are defined on clinical and epidemiologic arguments. The aim of blood donors selection is consisting in managing the residual infectious risk caused by known pathogens, risk related to the window period due to recent contaminations, the absence of technique of pathogens inactivation available for the cellular blood products, and the risk inherent in any production process. Blood donors selection proved to be the only means of reducing the risk of transmission of an emergent agent by blood transfusion.

[Incidents of blood donation]. / Les incidents du prélèvement.

In France, more than two million blood donations are needed for transfusion each year. The rules and requirements for blood donors selection are strict and aim to protect the donors' health as well as the patients'security. However, the review of the literature shows that adverse effects of blood withdrawal occur quite frequently. They can be classified in immediate or delayed events, or local (hematoma, nerve injury, arterial puncture injury, allergy, veinitis, thrombosis) and general reactions (vasovagal reaction, citrate toxicity, cardiovascular failure, allergy to ethylene oxide, adverse effects of drugs used for some types of donation). This article reviews the principal adverse events described in the literature and concludes with the necessity to set up hemovigilance for donors, as defined in directive 2002/98/EC of the European parliament and of the council.

[Geomatics in the service of blood collection]. / La géomatique au service de la collecte de sang.

UNLABELLED: To achieve blood supply, EFS organizes mobile blood collection sessions (80% of whole blood supply), close to target blood donors. Mobile sessions planning is usually developed in partnership with organizations of voluntary blood donors, based on the experience of previous sessions. However, population moving to urban areas and lifestyles changing force to focus on objective demographic analysis to determine a prospective vision of potentialities to ensure blood supply. METHOD: For blood supply management, EFS recently implemented innovative methods of mapping, through Geographic Information System software (GIS) that allow a spatial representation of different indicators. Geomatics engineering gathers and processes spatially referenced information about blood collections and blood donors, combining data from EFS and data from IGN or INSEE. RESULTS AND CONCLUSION: The authors present some examples of geomatics applied to blood supply and a feedback on the implementation of these tools in a French region. These innovative tools enhance expertise and increase the mastery of analysis for blood supply strategies.

[Organization for the coverage of the transfusional needs of patients with hemoglobinopathy at the Établissement français du sang Bretagne]. / Organisation de la prise en charge des besoins transfusionnels des patients atteints d'hémoglobinopathie à l'Établissement français du sang Bretagne.

UNLABELLED: Brittany is a low prevalence region for hemoglobinopathies. Despite of that, the number of patients is increasing each year. In 2013, 140 patients were known at the EFS Bretagne, and medical consultations are growing for 50% each year since 2011. The consequence is an increase of needs of 22% of compatible packed red blood cells. To anticipate the announced progress, various actions were implemented as study groups, creation of a new informatic prescription for red blood cells phenotyping, promotion of donation, transfusion organisation. RESULTS: Fifthty-nine percent of the 400 ABO RH-KELL, FY, JK, MNS 3, 4, red blood cells were realised on the basis of this new informatic prescription, as the 99% of the packed red blood cells identified Fy (a- b-). So, 92% of the compatible transfused packed red blood cells were already in stock when the patients needed them. CONCLUSIONS: In Brittany, that organisation leads to assume qualitative and quantitative transfusion for sickle cell disease in more than 90% of cases, with fast distribution. In the same time promotion of donation is done to increase the diversity of donors.

Alkaline single-cell gel electrophoresis (comet assay): a simple technique to show genomic instability in sporadic breast cancer.

The alkaline comet assay was used to study the genomic instability of lymphocytes derived from untreated sporadic breast cancer patients (50 cases), and also following their in vitro irradiation up to 5 Gy. We compared the results (mean tail moment (MTM)) with a control population of 25 patients and with breast cancer patients who had been 'cured' of their disease, with a follow-up of 10 years or more (25 cases). At the basal level, 77.5% (P<0.01) of the untreated patients and 73.7% (P<0.05) of the 'cured' women had values higher than the basal cut-off level of 5.3, compared with only 44% of the controls. After in vitro irradiation, 83% of the untreated patients were above the cut-off value of 10.8 at the 5-Gy dose compared with only 48% of the controls (P<0.01). These results support the hypothesis that women affected by sporadic breast cancer have a constitutional genomic instability. The assessment of the prognostic value of this test could be of interest, particularly in women without axillary nodal involvement.

Genomic instability and breast cancer.

The loss of genomic stability is accepted as being one of the most important aspects of cancer. The correlation between genomic instability and cancer proneness in cases of known genetic syndromes (e.g. ataxia telengectasia, Fanconi anemia) is well established. This study was conducted to assess genomic instability in 19 patients with sporadic breast cancer. We used the comet assay on the lymphocytes of patients before radiotherapy and/or chemotherapy. The alkaline comet assay (single-cell gel electrophoresis) is a sensitive and rapid method for detecting DNA damage (single strand breaks and alkali-labile sites) in G(0) cells, at a single-cell level. This assay was achieved in vitro without irradiation and after exposure (dose ranging from 50 cGy to 5 Gy). The results show that the patients have higher baseline values than controls. At 2 Gy, the mean tail moment, score and the percentage of DNA in the tail increase for both groups but these values are much higher for patients. Our results show that the lymphocyte DNA of cancer patients is more damaged than that of controls with or without irradiation. Our hypothesis is that this baseline DNA damage reflect a genomic instability in sporadic breast cancer. This instability seems to increase after in vitro irradiation.

[How human sciences can help to understand blood donation?]. / Comprendre le don: l'apport des sciences humaines à l'activité de prélèvement.

In France, the necessity of managing sanitary risks associated with blood transfusion has induced a strong medicalization of blood collection. Practicing this activity of transfusion medicine confronts the professional with problems which the medical science is not sufficient to answer: curbs and motivations for donating, seasonal and geographic fluctuations in blood collection, sense of pre-donation interview, individual or collective contestings of guidelines for blood collection. From recent sociological works on donation in France, especially on blood donation, this paper suggests reporting the complexity of blood donation thought process and the necessity to refer to human and social sciences to approach it in a best way. Understanding the gift should help professionals to communicate not only on the promotion of blood donation, but also on the risk and its management.

[Clinical selection of blood donors]. / La sélection clinique des candidats à un don du sang.

For 20 years, the organization set up to insure the blood transfusion safety has never stopped strengthening. It is based on clinical and epidemiological selection of the blood donation candidates, biologic selection of blood donations and different physico-chemical techniques for pathogens reduction or inactivation in blood products. In France, this organization is optimized by the assertion of the voluntary and non-remunerated character of blood donation registered in the law of January 4th, 1993. The blood donors selection is structured in three successive stages. The first stage is the pre-donation information. The second stage begins with reading and filling out an info-questionnaire which prepare for an interview with a physician. This interview is specially directed to prevention of transfusion-transmitted infections and the prevention of adverse reactions after a 400 to 600 mL collection of whole blood or components. Finally, the third stage is the delivery of a post-donation information which invites the donor to contact the "établissement français du sang" (EFS) in case of a new event arisen after the donation or in case of reviewing of its own answers during the medical interview.

[The physician's role in blood donation]. / Rôle du médecin du don.

In France, proper transfusion practices impose that the medical pre-donation interview be done by a physician. In Anglo-Saxon countries, it is more often performed by a nurse. The physician's job is not limited to the clinical selection of blood donation volunteers. In the production process, the physician is implicated in the safety and supply of labile blood products. The practice of the profession requires educational and communication skills. As the manager of a medical team working in mobile sites, the physician must ensure the respect of ethics and professional regulations by the staff he or she trains and supervises.