Variations in hemoglobin measurement and eligibility criteria across blood donation services are associated with differing low-hemoglobin deferral rates: a BEST Collaborative study.

BACKGROUND: Determination of blood donor hemoglobin (Hb) levels is a pre-requisite to ensure donor safety and blood product quality. We aimed to identify Hb measurement practices across blood donation services and to what extent differences associate with low-Hb deferral rates. METHODS: An online survey was performed among Biomedical Excellence for Safer Transfusion (BEST) Collaborative members, extended with published data. Multivariable negative-binomial regression models were built to estimate adjusted associations of minimum donation intervals, Hb cut-offs (high, ≥13.5 g/dL in men or ≥ 12.5 g/dL in women, vs. lower values), iron monitoring (yes/no), providing or prescribing iron supplementation (yes/no), post-versus pre-donation Hb measurement and geographical location (Asian vs. rest), with low-Hb deferral rates. RESULTS: Data were included from 38 blood services. Low-Hb deferral rates varied from 0.11% to 8.81% among men and 0.84% to 31.85% among women. Services with longer minimum donation intervals had significantly lower deferral rates among both women (rate ratio, RR 0.53, 95%CI 0.33-0.84) and men (RR 0.53, 95%CI 0.31-0.90). In women, iron supplementation was associated with lower Hb deferral rates (RR 0.47, 95%CI 0.23-0.94). Finally, being located in Asia was associated with higher low-Hb deferral rates; RR 9.10 (95%CI 3.89-21.27) for women and 6.76 (95%CI 2.45-18.68) for men. CONCLUSION: Differences in Hb measurement and eligibility criteria, particularly longer donation intervals and iron supplementation in women, are associated with variations in low-Hb deferral rates. These insights could help improve both blood donation service efficiency and donor care.

Can we prevent vasovagal reactions in young inexperienced whole blood donors? A placebo controlled study comparing effects of a 330 vs 500 mL water drink prior to donation.

BACKGROUND: Complications of donation reduce donor return. Younger and less experienced donors are more likely to experience vasovagal-type reactions (VVR). A water drink of approximately 500 mL shortly before donation may reduce VVR, but the effect of a smaller volume of water has not been investigated. STUDY DESIGN AND METHODS: A placebo-controlled comparative study was conducted among donors < 30 years who attended for a 1st-4th whole blood (WB) donation. Collection centers were assigned to offer one of three interventions: 500 mL water drink, 330 mL water drink, or a placebo intervention consisting of pre-donation arm exercise. Within 7 days after attending, participants received an electronic questionnaire about possible symptoms during and after donation. In additional centers, control donors were recruited, who only received standard care and were also sent the questionnaire. Self-reported VVR and other complications were evaluated in all groups. RESULTS: Out of 8,300 participating donors, 6,921 (83%) returned the questionnaire. Overall, 18.5% of responding donors reported moderate or worse VVR symptoms. In 2nd-4th time donors, both water volumes decreased the odds of a VVR compared to standard care controls (OR500ml 0.75, 95% CI 0.59-0.94; OR330ml 0.73, 0.58-0.91; adjusted combined OR 0.77, 0.64-0.94). There was no effect in new donors or the placebo group compared to controls. CONCLUSION: In young donors making their 2nd-4th WB donation, drinking water was associated with 23% fewer VVR with no difference between 330 and 500 mL. This decrease was not found in the placebo group. The findings support advocating drinking water for the prevention of VVR.

Eligibility and willingness to donate blood in men who have (had) sex with men.

BACKGROUND: Several countries have changed, or are reevaluating, their blood donor policies for men who have had sex with men (MSM). Changing policies has consequences for donor recruitment and the donor pool. In this study, we investigated whether MSM are eligible and willing to donate blood. STUDY DESIGN AND METHODS: Members of a research panel (n = 4422) in the Netherlands were invited to participate in an online survey. We asked questions about male-to-male sex and risk behavior that are also asked during the predonation screening of a blood donor. Furthermore, we asked questions about willingness to donate. RESULTS: The total response rate was 60% (n = 2654). Of MSM nondonors (n = 230), 32.2% would be eligible to donate under a 12-month deferral policy, according to their reported risk history and last male-to-male sex. In other scenarios, 42.6% (4-month deferral), 38.7% (6-month deferral), and 18.7% (5-year deferral) would be eligible to donate. When not taking their last male-to-male sex into account (n = 203), 47.8% of MSM reported a moderate or high willingness to donate. CONCLUSION: A 12-month deferral after last male-to-male sex is a commonly used criterion by blood services. Approximately one-third of the MSM in our study would be eligible to donate under this deferral policy. Higher proportions of MSM would be eligible to donate in shorter deferral scenarios. Almost half of MSM are willing to donate blood. Targeting MSM by donor recruitment campaigns could therefore prove fruitful.

Reasons for noncompliance in donor risk reporting regarding male-to-male sex.

BACKGROUND: In the Netherlands men who have had sex with men were permanently excluded from donating blood or blood products. This study aimed to determine the rate of not disclosing male-to-male sex (noncompliance) among Dutch donors and reasons for noncompliance. STUDY DESIGN AND METHODS: Invitations to participate in an anonymous online survey were sent out to a sample of the Dutch donor population (50,000 male and 5000 female donors). Male donors were asked if they ever had sex with a man. Second, a definition of male-to-male sex was given, followed by the same question. Donors who reported to have had male-to-male sex on the second question were defined as noncompliant and were asked what reasons they had for not reporting. We asked all donors questions regarding the Dutch donor policy. RESULTS: A total of 18,137 male donors responded to the questionnaire. Of male donors, 1.4% reported to have had sex with a man, and 0.7% reported to have donated after their first male-to-male sex. Discrepancies were found in male donors' interpretation of male-to-male sex. The most frequently reported reasons for noncompliance had to do with the timing and/or frequency of male-to-male sex, perceived privacy, perceived risk status, and knowledge about the policy. Compliers, noncompliers, and female donors had different opinions on a number of policy issues. CONCLUSION: The percentage found for noncompliance is similar to percentages in other compliance studies worldwide. Based on reported reasons, a substantial amount of noncompliers would become eligible for donating under a revised policy, possibly without jeopardizing blood safety.