Towards total voluntary non-remunerated blood donation in Trinidad and Tobago

Objective: Investigate the historical origins of voluntary nonremunerated blood donation (VNRD) and describe a UWI-led initiative. Design and Methodology: Historical review was performed using internet searches, documents, books, journals, interviews. Data from blood donor cards and Microsoft Excel spreadsheets was collected prospectively and analysed retrospectively. Donors were classified by age, gender, donation status (first-time or repeat) and donation outcome (accepted or deferred). The prevalence of transfusion transmissible infections and deferrals in donors was compared to the national donor pool using Chi square analysis to compare proportions and a p value < 0.05 to assign statistical significance. Results: Human to human blood transfusion and voluntary non-remunerated blood donation were first practised in metropolitan countries and amplified in large scale community blood donation programmes during World War II. Blood donation systems based on individual, transactional donations emerged in most developing countries, including Trinidad and Tobago, causing low donation rates, chronic blood shortage, unequal access, high donor infections and high donor deferrals. A voluntary non-remunerated blood donation programme started by the UWI Blood Donor Foundation and the North Central Health Authority has collected 660 units of blood in its first three years, the majority from persons aged 16 -25 age (52%), females (52%) and repeat donors (51%). Deferrals were < 10% and total transfusion transmissible infections in donors 0.9% compared with 43.6% and 2.4 % respectively (p < 0.05 for both) for the involuntary national donor pool. Conclusion: This model could be extended to all blood donation centres and the community to achieve 100% VNRD.

A national survey of independent living donor advocates: the need for practice guidelines.

In 2000, representatives of the transplant community convened for a meeting on living donation in an effort to provide recommendations to promote the welfare of living donors. One key recommendation included in the consensus statement was that all transplant centers which have performed living donor surgeries have an independent living donor advocate (ILDA) "whose only focus is on the best interest of the donor." The aims of this study were to begin to understand the sociodemographic characteristics, selection and training, and clinical practices of ILDAs. All US transplant centers performing living donor surgeries were contacted to identify the ILDA at their center. One hundred and twenty ILDAs completed an anonymous survey. Results indicated considerable variability with regard to the sociodemographic characteristics of ILDAs, how the ILDA was selected and trained, and the ILDAs' clinical practices, particularly ethical challenges encountered by ILDAs. The variability observed may result in differential selection of donors and could have a potential negative impact on the lives of both donors and transplant candidates. The variability in the background, training, and practice of ILDAs suggests the need for strategies, such as practice guidelines, to standardize the interaction between ILDAs and living donors.

Epidemiology of multiple myeloma and the role of M-band detection on serum electrophoresis in a small developing country. A retrospective study.

OBJECTIVE: The objective of the study was to determine the role of M-band component on serum protein electrophoresis and bone marrow biopsy in the diagnosis. METHODS: Data was collected on 34 patients with MM diagnosed and/or treated. RESULTS: There were equal numbers of men 17 (50%) and women 17 (50%). All patients were first screened for the presence of M-Band using serum protein electrophoresis (SPE) followed by bone marrow biopsy as the confirmatory test. Only two patients screened negative by SPE. On the other hand six patients who tested positive by SPE were negative on biopsy. Thus the sensitivity of the SPE was 96% and specificity 71%. This means that 29 patients had an established diagnosis of MM. There was a slight male predominance when compared to females. CONCLUSION: The data showed that the SPE and bone biopsy are the important tools in the diagnosis of multiple myeloma in a small developing country.

Calcium, magnesium, and zinc status of young adult females on an adequate protein and calorie intake.

Calcium, magnesium, and zinc balances were determined in eleven young adult college females (mean age, 24.9±2.35) during a 39-d metabolic study when the subjects were fed an adequate calorie and protein diet based on habitually consumed foods. Analysis showed that the dietary contribution of calcium, magnesium, and zinc to the RDA were 53.6, 26.4, and 57.9%, respectively. Mean fecal losses of calcium and magnesium were low, while fecal zinc losses were higher than the daily intake. Mean urinary excretion of calcium was within the normal range, but was low for magnesium whereas urinary zinc was higher than normal. Mean daily apparent retentions of calcium and magnesium were positive, whereas positive apparent retention for zinc were observed in four of the subjects. Plasma calcium and magnesium remained normal, but mean plasma zinc declined at the end of the study. Significant correlations were observed between the fecal losses of calcium and magnesium and calcium and zinc. Urinary calcium also correlated significantly (P<0.05) with urinary magnesium, but not with zinc. It appears that adequate protein and calorie intake in the presence of low dietary intake of calcium, magnesium, and zinc has no significant effect on calcium and magnesium status whereas a lowering effect on plasma zinc and apparent zinc retention was observed in the subjects studied.