Iron deficiency-related symptoms in non-anemic whole blood donors.

INTRODUCTION: Whole blood donors are at increased risk for iron deficiency (ID). ID anemia is associated with several symptoms, such as fatigue, cognitive dysfunction, pica, and restless leg syndrome (RLS). However, it is unclear if these symptoms also occur when a donor has developed ID without anemia. This study aims to determine whether non-anemic ID (NAID) is associated with the occurrence of ID-related symptoms. STUDY DESIGNS AND METHODS: We combined data from three studies in whole blood donors (i.e., Donor Insight-III, FIND'EM, and FORTE) to create a substantial sample size (N = 12,143). The self-reported occurrence and severity of ID-related symptoms, such as physical and mental health, fatigue, cognitive functioning, pica, and RLS, was measured using validated questionnaires. Associations were studied using logistic regression modeling with ID-related symptoms derived from the questionnaires as the dependent variable and ferritin level group (0-15 µg/L, 15-30 µg/L, and >30 µg/L) as explanatory variable. RESULTS: After applying inclusion and exclusion criteria, 9829 donors were eligible for analysis. In the models corrected for age, body mass index, Hb level, and cohort, only fatigue was shown to be associated with ferritin levels in men, showing lower odds (OR 1.41, 95% CI 1.11-1.79) for fatigue with higher ferritin levels. CONCLUSION: In these studies, NAID was only associated with self-reported fatigue in male donors. Although selection bias may have led to underestimated associations, ferritin measurements in donors should be primarily considered as a measure to prevent anemia, rather than to prevent or mitigate NAID-related symptoms.

Iron deficiency among Japanese whole-blood donors measured by serum ferritin.

BACKGROUND AND OBJECTIVES: A more restrictive blood donation criterion has been applied in Japan, with a maximum volume of whole blood (WB) donation of 400 mL, allowing twice a year for female donors and thrice a year for male donors. However, iron deficiency was as high as 20.5% among female donors prior to donation, increasing to 37.7% after blood donation. More than 20 years have passed since then, so we set out to investigate the present situation. MATERIALS AND METHODS: A total of 2659 (male/female: 1496/1163) donors of 400 mL WB who gave informed consent to join the study were enrolled. Serum ferritin (sFer) of first-time/reactivated (FT/RA) donors were compared with those of repeat donors, according to gender and age; those who returned for subsequent donations during the study period were also followed up. RESULTS: About one-third of FT/RA female donors had iron deficiency, possibly reflecting its high incidence among the general population. Interestingly, although sFer levels were low among pre-menopausal FT/RA female donors, these values were not much different in repeat donors, whereas significant differences were observed between FT/RA and repeat donors among post-menopausal females and in most age groups among males. As expected, donors with a normal initial sFer (≥26 ng/mL) recovered faster than those with a low initial sFer. CONCLUSION: Female donors, especially, have iron deficiency even before donation, and the rate increased compared to what was found previously. Measures to prevent iron deficiency of blood donors is required, and studies are going on in Japan.

Donor knowledge and perceptions regarding donation-induced iron depletion and iron supplementation as a blood service policy.

BACKGROUND AND OBJECTIVES: Regular whole blood donations are associated with an increased risk of iron deficiency. Iron supplementation is an effective strategy to prevent donation-induced iron deficiency. However, research on donor perceptions towards such a policy is limited. Therefore, we aim to evaluate donors' knowledge on donation-induced iron depletion and their perceptions regarding iron supplementation as a blood service policy. MATERIALS AND METHODS: Three thousand Dutch whole blood donors were invited to complete a survey assessing their knowledge of donation-induced iron depletion and attitudes and perceptions towards iron supplementation as a policy. Linear regression modelling was used to evaluate associations between explanatory variables and perceptions. RESULTS: In total, 1093 (77.1%) donors were included in the analysis. Donors had poor knowledge of current iron management policies, but a better understanding of iron metabolism and supplementation. Iron supplementation as a policy was perceived mainly positive by donors, and the majority were willing to use iron supplements if provided. Iron supplementation was not perceived as invasive or negatively affecting donors' motivation to continue donating. Additional iron monitoring, information and donor physician involvement were regarded as important conditions for implementation. Male sex, trust in the blood service, prior experience with iron supplements and openness towards dietary supplements were strongly positively associated with willingness to use iron supplementation. CONCLUSION: Donors' knowledge regarding donation-induced iron depletion is limited, but not associated with their perceptions regarding iron supplementation. Donors do not consider iron supplementation as invasive, deterring or demotivating, and a majority are willing to take supplements if offered.

Development and validation of a scoring system to predict vasovagal reaction upon whole-blood donation.

BACKGROUND AND OBJECTIVES: Risk factors for vasovagal reaction (VVR) have been extensively studied. With knowledge of the relative importance of these risk factors for VVR, collection staff could take care of blood donors from the same standpoint, leading to improved donor safety. We therefore developed a scoring system to predict VVR, which incorporates registration information. MATERIALS AND METHODS: Pre-syncopal and syncopal symptoms, as well as on- and off-site reactions, are included in this analysis as VVR. We defined the donor status as follows: first-time donors, repeat donors with no history of reaction and repeat donors with a history of reaction. We prepared two datasets: whole-blood donations at a blood donation site in Tokyo between January 2019 and December 2019 were included in training data (n = 361,114), and whole-blood donations between January 2020 and August 2020 were included in testing data (n = 216,211). RESULTS: The most important variable was the donor status, followed by age, estimated blood volume and height. We integrated them into a scoring system. Training and testing datasets were combined (n = 577,325), and VVR rates in groups with scores of 0, 1, 2, 3, 4 and 5 or more were 0.09% (95% CI: 0.081%-0.10%), 0.33% (95% CI: 0.31%-0.36%), 0.87% (95% CI: 0.78%-0.96%), 1.17% (95% CI: 1.05%-1.30%), 2.15% (95% CI: 1.98%-2.32%) and 3.11% (95% CI: 2.90%-3.34%), respectively. CONCLUSION: The scoring system enables staff to significantly predict VVR and may help them to identify donors at increased risk of experiencing syncope, thereby mitigating the negative impact of VVR on donor safety and return by paying close attention to high-risk donors.

Mass spectrometry-based analysis on the impact of whole blood donation on the global plasma proteome.

BACKGROUND: Biomonitoring may provide important insights into the impact of a whole blood donation for individual blood donors. STUDY DESIGN AND METHODS: Here, we used unbiased mass spectrometry (MS)-based proteomics to assess longitudinal changes in the global plasma proteome, after a single blood donation for new and regular donors. Subsequently, we compared plasma proteomes of 76 male and female whole blood donors, that were grouped based on their ferritin and hemoglobin (Hb) levels. RESULTS: The longitudinal analysis showed limited changes in the plasma proteomes of new and regular donors after a whole blood donation during a 180-day follow-up period, apart from a significant short-term decrease in fibronectin. No differences were observed in the plasma proteomes of donors with high versus low Hb and/or ferritin levels. Plasma proteins with the highest variation between and within donors included pregnancy zone protein, which was associated with sex, Alfa 1-antitrypsin which was associated with the allelic variation, and Immunoglobulin D. Coexpression analysis revealed clustering of proteins that are associated with platelet, red cell, and neutrophil signatures as well as with the complement system and immune responses, including a prominent correlating cluster of immunoglobulin M (IgM), immunoglobulin J chain (JCHAIN), and CD5 antigen-like (CD5L). DISCUSSION: Overall, our proteomic approach shows that whole blood donation has a limited impact on the plasma proteins measured. Our findings suggest that plasma profiling can be successfully employed to consistently detect proteins and protein complexes that reflect the functionality and integrity of platelets, red blood cells, and immune cells in blood donors and thus highlights its potential use for donor health monitoring.

What would it take to convince you to donate? A survey study of the relationship between motivators, barriers, and payment for whole blood, plasma, and platelet donation.

BACKGROUND: With growing discussion about blood donor remuneration, the present study examined the level of payment that may be required to convince individuals to engage in whole blood, plasma, and platelet donations. STUDY DESIGN AND METHODS: Anonymous online surveys were completed by a college sample [n = 490; 76.9% female; Mean Age = 20.3 (SD = 4.9) years; 32.9% whole blood donors] and a ResearchMatch sample [n = 323; 70.6% female; Mean Age = 50.7 (SD = 16.6) years; 82.7% whole blood donors]. Level of payment needed to motivate whole blood, plasma, and platelet donation was examined as a function of donation history, sample, and gender. In addition, path analyses examined associations between donation motivators, barriers, and payment level. RESULTS: Across all types of donation, history of whole blood donation was related to a greater willingness to donate without payment. At the same time, however, sizeable portions of prior donors indicated that monetary payment would convince them to donate whole blood (24%), plasma (51%), or platelets (57%). Across all types of donation, donation-related barriers (i.e., anxiety, fear) were indirectly related to higher payment levels via lower self-efficacy and more negative donation attitudes. Donation-related motivators (i.e., warm glow, regret, and altruism) were indirectly related to lower payment levels via higher self-efficacy and more positive donation attitudes. CONCLUSION: Despite reporting a strong commitment to nonremunerated blood donation, many respondents with and without a history of blood donation indicated that money would convince them to engage in whole blood, plasma, and platelet donation.

The impact of blood donation on blood counts and ferritin levels: A multi-center study from the Eastern Mediterranean region.

Regular donation of whole blood may lead to iron deficiency. In this study, we aimed to assess the impact of frequent whole blood donation on hematological parameters. Whole blood donors were enrolled from four blood banks located in Saudi Arabia, United Arab Emirates (UAE), Libya and Oman, between 2016 and 2017. SPSS version 21.0 was used to generate descriptive and inferential statistics. A total number of 3096 blood donors were screened (males 93.8 %, females; 6.2 %), with a mean donor age of 35.29 ± 9.31 years. For male blood donors, the majority (1073) had 1-3 previous donations. Increased frequency of donations was significantly associated with increases in age and weight, decreases in Hemoglobin (Hb) and ferritin measures, and increases in Red Blood Cells (RBC) counts. A General Linear Model (GLM) adjusted for age and weight indicated negative impacts on White Blood Cells (WBC) counts and ferritin. A weak correlation between the Hb and ferritin levels was observed (r = 0.160, P > 0.001). For female donors, the majority (63 out of 114) were first time donors. Increased frequency of donations was significantly associated with an increase in age and a decrease in HCT readings. A GLM adjusted for age and weight indicated a negative impact on ferritin. A strong correlation was observed between the Hb and ferritin levels for the most frequent female donors (r = 0.636, P > 0.001). In conclusion, regular whole blood donation impacts hematological parameters in particular the levels of ferritin in the serum.

Why some donors are more willing to donate platelets? ----a qualitative study on 25 regular platelet donors in Guangzhou, China.

BACKGROUND: Since 1998, China has gradually moved toward voluntary uncompensated blood donation. In some cities, the shortage of platelets has been noticeably severe. Mutual assistance that collects blood from one's family and social networks is a potential solution. The measure, however, turned out problematic. There are donors who choose to donate platelets over whole blood without compensations, and donate platelets directly to blood banks instead of via the mutual assistance system. This study explores reasons behind their choices qualitatively. METHODS: This report is based on data conducted from January to February 2018; 25 uncompensated regular platelet donors were interviewed. The blood component donation service team in Guangzhou facilitated the data collection process and referred prospectively eligible blood donors to our research team. The interviews took about 30 min to two hours to complete. The qualitative data were analyzed by using the software ATLAS.ti 8. RESULTS: Platelet donation takes a much long time than whole blood donation and requires complicated processes. It may also cause discomfort as the other blood components are returned to the body, causing physical and psychological distress due to worries about contamination. Thus, platelet donation tends to involve higher time and psychological costs than whole blood donation. Yet, it has short collection intervals that allows for more frequent donations, and urgency of a severer shortage than whole blood. Hence, regular platelet donors may feel higher significance in platelet donation than whole blood donation, with the belief that more lives would be saved. Some whole blood donors thus switched to become platelet donors. Mutual assistance blood donation was not chosen by the participants for platelet donation, because such donations may exert moral pressure to both the donors and recipients. Furthermore, "acquaintance" has been loosely defined; the system has sometimes been manipulated to become profit-making monetary transactions. It hence failed. CONCLUSIONS: The practice of platelet donation reinforces the understanding that blood donation is a gift giving process performed among strangers. A safe and sustainable voluntary blood supply can only be secured in the absence of monetary transactions and moral pressure.

Pattern of care of blood donors with early-uncomplicated hereditary haemochromatosis in a Swiss blood donation centre.

BACKGROUND AND OBJECTIVES: We describe the recognition and pattern of care of voluntary blood donors with early-uncomplicated genetic haemochromatosis in our blood donation centre. MATERIALS AND METHODS: Asymptomatic volunteers with suspicion of hereditary haemochromatosis (HH) due to an elevated ferritin level on routine screening were referred for further investigation. Alternatively, we accepted subjects with prediagnosed HH on referral. In the case of early-uncomplicated genetic haemochromatosis, either standard whole blood donation (WBD) or double-erythrocytapheresis (DEC) was offered. RESULTS: A median of six procedures was needed to achieve a ferritin value below 100 ng/ml in the WBD group and of four in the DEC group (P = 0·5). The rate of donation side-effects was higher in the DEC group, while the costs it generated were equivalent to WBD. CONCLUSION: Compared with WBD, DEC had no beneficial effect on treatment number, length of treatment, side-effects or treatment budget in early-uncomplicated HH. Integrating donors with uncomplicated genetic haemochromatosis to blood donation programmes can supplement blood stores and provide the donors with a cost-effective and altruistic purpose of treatment.

Blood Donor Incentives across 63 Countries: The BEST Collaborative Study.

Incentives for blood donors are a much-debated strategy intended to ensure a sufficient supply of blood. Yet, there is a fundamental lack of knowledge about which incentives are offered by different blood collectors. We provide a comprehensive description of incentive policies for whole blood donors across 63 countries and 50 states of the United States. We collected data on incentive policies by conducting 2 surveys among representatives of blood collection establishments. Additionally, we integrated incentive data from an existing study and the World Health Organization (WHO). Lastly, we performed a web content analysis of blood collector websites and news releases to extend incentive data for the United States as well as underrepresented regions. We present descriptive analyses illustrating the type and value of incentives and their geographical distribution around the globe. Approximately half of the countries in our sample employ financial incentives, which include cash and tax benefits, but also less conventional incentives, such as healthcare supplements and raffles. Time off work is also commonly offered to blood donors and varies across blood collection establishments in duration and whether it is granted to all donors or only to those whose employer allows it. There is a geographical clustering of incentives, such that neighboring countries are more likely to employ similar incentives. This study provides insights into the strategies used for incentivizing blood donation and highlights the global diversity of incentive policies for whole blood donors. In stark contrast to WHO guidelines, half of the countries surveyed employ some kind of high-value incentive for blood donors. More realistic guidelines that are adapted to the local cultural and institutional context may be needed to maintain an adequate blood supply.

Era of blood component therapy: time for mandatory pre-donation platelet count for maximizing donor safety and optimizing quality of platelets.

Blood bank regulatory agencies including the Drug and Cosmetics Act (DCA) of India do not mandate a predonation platelet count in whole blood donation. Mandating such practice will definitely optimize the quality of random donor platelets (RDP) in terms of platelet yield and patient therapeutic benefit. We observed poor platelet yield in RDP concentrates prepared at our center with a significant number not meeting the DCA guideline of ≥ 4.5 × 10(10) per bag processed from 450 ml of whole blood. Therefore we planned this study to evaluate the pre-donation hematological values in our blood donor population and effect of these values on the quality of platelet concentrates. The prospective study included 221 blood donors eligible for donating 450 ml of whole blood (WB). Following the departmental standard operating procedure (SOP) RDPs were prepared using the 'Top & Bottom' quadruple bag system and automated component extractor. Quality of RDP was assessed as per departmental protocol. All results were recorded and subsequently transcribed to SPSS working sheet. A significant (p<0.001) decrement of donor blood counts has been observed after WB donation. Mean donor Hb and platelets reduced by 0.72 g/dl and 22.1 × 10(6)/ml respectively. Quality of RDPs in terms of platelet yield was significantly better (p<0.001) when donor platelet count was >200 × 10(6)/ml. Although platelet yield significantly correlated with the donor platelet count however quality of RDPs in terms of red cell contamination showed no correlation with the donor hematocrit. Platelet yield in random donor platelets is a concern in Eastern India. A platelet yield of 4.5 × 10(10) per bag as mandated by the DCA of India was only achieved when the donor platelet count was >200 × 10(6)/ml. Posttransfusion platelet recovery (PPR) was unsatisfactory in the transfused patient. Introduction of pre-donation platelet count in whole blood donation will maximize donor safety and optimize patient platelet transfusion management.

Does Air Pollution Affect Prosocial Behaviour?

Air pollution has become a serious issue that affects billions of people worldwide. The relationship between air pollution and social behaviour has become one of the most widely discussed topics in the academic community. While the link between air pollution and risk-averse and unethical behaviours has been explored extensively, the relationship between air pollution and prosocial behaviour has been examined less thoroughly. Individual blood donation is a typical form of prosocial behaviour. We examined the effect of air pollution on prosocial behaviour using the Poisson regression quasi-maximum likelihood (PQML) based on the panel data related to air pollution and blood donations. We also employed a set of control variables and robustness checks. The findings indicate that air pollution does not affect whole blood donation, although it does affect component blood donation. We also find that the effect of air pollution on blood donation is heterogeneous in terms of gender, age, and other factors. These results show that the relationship between air pollution and prosocial behaviour is limited. Not all types of prosocial behaviour are affected by air pollution, perhaps because air pollution affects only specific psychological motivations and because different types of prosocial behaviour have different motivations.

Zeroing in on the root cause of the clots in a blood bag: Reinforcing improvement in blood collection practices.

Blood clots in the packed red blood cell [PRBC] unit can sometimes go unrecognized and could eventually give rise to flow problems while administering the same. We herein report our observation of a moderately elongated threadlike clot in a PRBC unit prepared from a whole blood donated by a young Indian male donor. The PRBC unit was returned to us from the ward by the nursing staff citing "flow issues". In fact, this warranted the initiation of root-cause analysis of the entire event led by two faculty members, one post-graduate student and the technical supervisor at our blood centre.

Indian blood donor selection guidelines: Review in the context of the ongoing COVID-19 pandemic.

The National Blood Transfusion Services under the aegis of the ministry of health and family welfare, India has recently issued guidelines regarding the blood donor selection criteria and the processing of blood. Care has been taken to make the blood transfusions safer. However, COVID-19 has disrupted the organization of the voluntary blood donation drives, whole blood donations [WBD] and restricted the donors' movement to the blood transfusion centres all across the world. While sickness and the need for transfusions are very much in place, the gap of demand against blood collection has widened. Additionally, with the monsoon season at hand, and the categorical challenges of a dengue outbreak, the subsequent need for blood components especially the platelet concentrates is going to rise. Some of the criteria laid for deferring a blood donor from his or her WBD need a categorical revision, considering these unprecedented times. We, therefore, critically analyzed the blood donor selection criteria and hereby, suggest an updating regarding the pre-donation haemoglobin, sexually transmitted diseases, lactation, pregnancy and many such subheadings. We also suggest collecting smaller blood volumes in the blood bags for the optimal benefit of the recipients both for now and also as a measure of pandemic preparedness for future use.

Demographic difference and influencing factors of motivations between whole blood and plasmapheresis donors: a comparative study / 中国输血杂志

【Objective】 To explore the difference of demographics and influencing factors of motivations between whole blood donors and plasmapheresis donors, so as to provide scientific reference for effective recruitment strategy. 【Methods】 A total of 200 whole blood donors from Guangyuan Blood Center and 200 plasmapheresis donors from Jiange Plasmapheresis Station were selected in August 2021 for on-site questionnaire survey using the method of cross-sectional survey. Statistical analysis was performed by chi-square test, univariate and multivariate logistic regression. 【Results】 There were significant differences in gender, age, occupation, education level and annual family income between whole blood donors and plasmapheresis donors (P<0.05). Males accounted for a large proportion of whole blood donors(124/196, 63.3%), whereas females accounted for a large proportion of plasmapheresis donors(117/198, 59.1%). There was little difference in the number of whole blood donors in different age groups, while the age of plasmapheresis donors was concentrated in 40~59 years old (167/198, 84.3%). In terms of occupation, civil servants (including public institutions) accounted the highest proportion in whole blood donors (41/196, 20.9%), and farmers accounted the highest proportion (152/198, 76.8%) in plasmapheresis donors. The number of whole blood donors increased with the education level, and donors with college/university and above degree accounted the largest proportion (80/196, 40.8%). Plasmapheresis donors with junior middle school education and college/university and above accounted the largest and smallest proportion (49.5% vs 4.5%). The annual family income of whole blood donors ranged from 30 000 to 80 000 yuan accounted the largest proportion (109/196, 55.6%), and the annual family income of plasmapheresis donors less than 30 000 yuan accounted the largest proportion (132/198, 66.7%). 【Conclusion】 There were significant statistical differences in gender, age, education level, occupation and annual family income between whole blood and plasmapheresis donors. Therefore, targeted recruitment strategies should be formulated.

Prevalence of blood donation related vasovagal reactions in China: a systematic review and Meta-analysis / 中国输血杂志

【Objective】 To systematically evaluate the incidence of donation related vasovagal reactions (DRVR) in China by Meta-analysis method and discuss the risk factors of DRVR, so as to provide scientific basis for the prevention and control of DRVR. 【Methods】 Cochrane Library, PubMed, WanFang Data CNKI and other electronic databases were retrieved to collect research literature concerning the incidence and risk factors of DRVR among whole blood donors in mainland China, with the publishing duration setting from 1998 to 2020. Two reviewers independently screened the literature, extracted the data, and evaluated the methodological quality of the included studies according to the inclusion and exclusion criteria. Then Stata was used for Meta-analysis. 【Results】 A total of 63 studies involving 6 043 945 donors were included. The prevalence of DRVR was 1.0% (95% confidence interval [CI], 0.9%~1.1%, I2=99.7%, P<0.01). The prevalence of DRVR in females (1.4%, 95% CI: 1.0-1.8%, I2=99.6%, P<0.01) was higher than that in males (1.1%, 95 % CI: 0.8-1.4%, I2=99.6%, P<0.01). The incidence of DRVR was 1.3% (95%CI: 0.8-1.8, I2=97.9%, P<0.01), 0.8% (95%CI: 0.5-1.0, I2=95.0%, P<0.01), 0.4% (95%CI: 0.3-0.5, I2=88.5%, P<0.01) and 0.3% (95%CI: 0.1-0.6, I2=96.1%, P<0.01) in the age groups of 18-25, 26-35, 36-45 and 46-55, respectively, and the incidence of DRVR decreased with age(P<0.01). From 1998 to 2020, the incidence of DRVR decreased year by year (P<0.01). The prevalence in first-time donors (1.5%, 95% CI: 1.3-1.8, I2=98.6%, P<0.01) was higher than that of regular donors (0.6%, 95% CI: 0.5-0.7%, I2=97.2%, P<0.01). Anxiety was the major risk factor for DRVR. 【Conclusion】 Our results indicate that blood centers should strengthen the monitoring of DRVR. More attention should be paid to young women, more comfort given to first-time blood donors, and a more perfect system developed to reduce the occurrence of DRVR.

How Can We Improve Retention of the First-Time Donor? A Systematic Review of the Current Evidence.

Blood products are critical to health systems and donations by voluntary nonremunerated donors are recommended. Worldwide, however, only around 5% of those eligible to donate do so and around half of those never return to donate again. This review focuses on what deters first-time donors, what predicts their retention, and what interventions may promote retention of this group. A comprehensive search of relevant databases identified 9 studies investigating motives and deterrents of first-time donors, 14 studies investigating predictors for first-time donors (13 whole blood [WB] and 2 plasmapheresis), and 15 studies (in 14 published articles) detailing interventions conducted on first-time donors. Drawing on an established blood donation taxonomy, studies were classified by 2 independent raters. Interventions were also classified into traditional, behavioral, or social science interventions. With only 2 eligible studies among first-time plasmapheresis donors, analyses focused on WB donors. First-time WB donors reported benevolent and collectivistic motivations, as well as personal benefits to commence WB donation. Self-reported deterrents have typically not been examined. Intention predicted first-time donor retention with intention determined by attitudes and a sense of (perceived behavioral) control. However, anxiety, adverse events, and deferrals all deterred retention. Traditional interventions, such as reminders and incentives, are widespread yet had only a small effect on return of first-time donors. Although behavioral science interventions such as fluid loading are effective, the strongest effect for the return of first-time donors was found when individual psychological support was provided. The purpose of this analysis was to identify the factors associated with the commencement and continuation of first WB donations. The current review revealed that self-reported motivators are typically not effective, and most successful predictive factors identified have not been translated into interventions. Future work would do well to identify, manage, and meet donors' expectations along with developing more individualized donation experiences. Blood donor research should delineate donor career stages; addressing first-time donor retention will support stable panels for blood collection agencies.

The effect of pre-donation hypotension on whole blood donor adverse reactions: a systematic review.

Blood services are reliant upon healthy blood donors to provide a safe and adequate supply of blood products. Inappropriate variables contained within blood donor exclusion criteria can defer potentially appropriate donors. The aim of this systematic review was to examine the effect of low pre-donation blood pressure, as compared with normal blood pressure, on adverse events in allogeneic whole blood donors. A systematic review was performed using highly sensitive search strategies within five databases (Cochrane Central Register of Controlled Trials, CINAHL, Embase, MEDLINE, and Web of Science) from inception date until April 12, 2013. Out of 8305 records, 10 observational studies were identified that addressed the question. Five of these studies (with a combined total of 1,482,020 donations and 2903 donors) included either a statistical analysis or an appropriate study design that controlled for possible confounding factors. Based on the currently available evidence, hypotension has not been shown to be an independent predictive factor for donor complications. However, the overall quality of evidence was rather limited and rated 'low,' using the GRADE approach. In conclusion there is currently no evidence that hypotensive blood donors have a greater risk for donor adverse events compared with their normotensive counterparts.

Ready-made allogeneic ABO-specific serum eye drops: production from regular male blood donors, clinical routine, safety and efficacy.

PURPOSE: To overcome problems and delays of the preparation of autologous serum eye drops, a production line of ABO-specific allogeneic serum eye drops from male blood donors was set up in a blood bank. Feasibility, clinical routine, safety and efficacy were evaluated in a cohort of patients with severe ocular surface disorders. METHODS: Serum was derived from 450 ml whole-blood donations from regular male blood donors, produced and tested according to good manufacturing practice and legislation regulating blood products in Denmark. Serum was diluted to 20% (v/v) with NaCl 0.9%, filtered, bottled, registered and stored at -30°C in the blood bank. Upon request, frozen ABO-identical serum drops in lots of 14 bottles could be provided immediately. Safety and efficacy were evaluated in 34 patients with severe ocular surface disease refractory to conventional medical therapy. Patients were treated six times daily for minimum 2-4 weeks. Objective findings and subjective symptoms were compared between day 0 and after 4 weeks of treatment using the Wilcoxon signed-rank test. RESULTS: Clinically, no side-effects were observed. In total, 59% of the patients with ocular surface changes improved objectively (slit-lamp examination). Partial or full healing of corneal changes, as well as subjective relief of symptoms, was observed in 16 of 20 patients with keratoconjunctivitis sicca (p < 0.001). The 14 patients with persistent epithelial defect experienced neither objective nor subjective improvements during serum treatment. CONCLUSION: Ready-made ABO-identical allogeneic serum eye drops were straightforwardly produced, quality-assured and registered as a safe standard blood product for the treatment of certain cases of severe dry eye disease. Therapeutic efficacy was comparable to previous reports on autologous serum drops.