Kermanshah earthquake blood supply experience: Turning the risk into opportunity

Background: A declining need for red blood cells coupled with strengthening demand for plasma-derived medicines has led to a strong focus on moving whole blood donors to plasmapheresis. The purpose of this study was to evaluate the four-year policies of the Iranian Blood Transfusion Organization (IBTO) in terms of plasmapheresis recruitment of first-time donors and its effect on plasmapheresis outcome. Materials and Methods: Plasmapheresis data related to 16 centers from 2016 to 2019 was obtained from IBTO software. This information includes; (1) blood donation number, (2) plasmapheresis donation number, (3) number of plasmapheresis donors, (4) plasmapheresis donor demographic data, (5) plasmapheresis donor status, (6) frequency of plasma donation for each donor, (7) volume of plasma and (8) the prevalence of transfusion-transmissible infections (TTIs) in plasmapheresis donors.Results: The result of this study demonstrated that plasmapheresis collection centers have recruited 85,515 (91%) first-time and 8,595(9%) regular and repeated donors from 2016 to 2019 years. Plasmapheresis to blood donation index was increased from 0.2% in 2016 to 4.9% in 2019. The mean donation number was 2 times per year. The trend of the yearly Whole Blood Donation (WBD) Index decreased from 26.69 to 24.11/1000 for the general population. The total volume of collected source plasma was 49,203 liters during this period. However, 46,000 liters of recovered plasma were decreased due to less WBD. Furthermore, the results indicated that the prevalence of HCV was significantly higher in first-time donors compared to repeated and regular donors (P = 0.000).Conclusion: It is concluded that during four years, the net volume of plasma did not increase and plasmapheresis led to reducing WBD in our country. Moreover, first-time plasmapheresis donors can be associated with challenges such as increasing screening costs and compromising the safety of plasma resources. Therefore IBTO decided to stop the project and focus on its main role to prepare safe and sufficient blood components through WB collection and also single donor platelet and concurrent plasma by plateletpheresis.

International application of the incidence rate/window period model.

See article on page 1471–1478, in this issue

Summary Background: The lack of correct blood grouping practices can lead to missing of the rare Bombay Oh phenotype and subjecting patients to the risk of severe hemolytic transfusion reaction. In the absence of blood donor registry, transfusion management of patients is a challenge. We performed this study in order to estimate the prevalence of the Bombay blood group (Oh) in Iran and to determine whether consanguinity plays a role in the prevalence of Oh group. Methods: This is a descriptive study in the Immunohematology Reference Laboratory of the Iranian Blood Transfusion Organization (IBTO) Tehran, Iran, over a period of 7 years. All donor blood samples showing blood group O and a strong initial reaction with blood group O RBC control cells were tested with anti-H lectin. Also blood samples from blood group O patients were tested with anti-H lectin if all cells on both antibody screening tests and antibody identification panels were reactive with negative auto control test. Specialized tests like adsorption/elution technique and inhibition assay for determination of secretor status were performed on Oh cases. Any history of consanguineous marriages were recorded. All variables were categorical variables, and percentage and proportions were calculated manually. Results: Analysis of the results of over 7 million first-time blood donors in Iran showed that the most common ABO blood group was O, with 2,520,000 (36%) subjects. 56 Oh individuals' (donors and patients) phenotypes (0.0008%) were detected. Consanguinity was observed in 50 cases (89%). Conclusions: This study shows that the prevalence of Bombay blood group in the general population of Iran is relatively high (0.0008%) and associated with consanguineous marriage. Thus, consanguinity is still an important risk factor present.

The COVID-19 pandemic has affected blood inventory and donation worldwide. The Islamic Republic of Iran was among the first countries to report the COVID-19 pandemic and it faced a significant blood shortage during the first weeks of the pandemic. We aimed to evaluate the impact of COVID-19 pandemic on the number, type, and safety of blood donations, comparing the periods before and during the pandemic. This retrospective study evaluated data from all volunteers who attended the blood transfusion centres in the Islamic Republic of Iran from March to December 2020 (during the COVID-19 pandemic) and during the same period in 2019, i.e. pre-pandemic. Data on the number of blood collections, confirmed transfusion transmissible infection marker test results, and donor demographic information were collected from the Iranian Blood Transfusion Organization integrated donor database. Total blood donations decreased by 8.38%. The number of first-time, lapsed, and female blood donors increased by 4.41%, 0.17%, and 0.90% respectively. Regular blood donation decreased by 4.58%. The distribution of the 3 main blood products, red cell concentrate, frozen fresh plasma and platelets, decreased by 7.86%. All changes were statistically significant. The prevalence rates of hepatitis C virus and hepatitis B surface antigen increased significantly during the pandemic. COVID-19 had a negative effect on blood safety and availability in the Islamic Republic of Iran. To improve blood supply and enhance regular blood donation, the Iranian Blood Transfusion Organization needs to reassure blood donors of the safety and hygiene measures being observed at blood collection sites.

In this issue of TRANSFUSION, Zou and colleagues1 of the American Red Cross (ARC) report the marker prevalence and derive the incidence of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) for donations of approximately 66 million units of allogeneic whole blood collected between January 1999 and December 2008, encompassing the 10-year period since introduction of nucleic acid tests (NATs). The authors estimated the residual risk of these infections in donated blood as the product of incidence multiplied by the NAT window period for HIV and HCV. They provide an analysis of the temporal trends in risk and the underlying donor demographics. This article complements a previous publication by investigators at ARC and Abbott Laboratories in which the incidence and residual risk of hepatitis B virus (HBV) infection in whole blood donors was estimated by two independent methods for November 2006 through July 2008 and compared with a similarly derived result for November 1997 through July 1999.2 In a separate article in this issue, Zou and colleagues3 report on the marker rates, incidence, and residual risk of HIV, HCV, HBV, and human T-lymphotropic (HTLV) for apheresis donations of blood components from January 2004 through December 2008. They provide comparisons among these variables by apheresis component compared with whole blood collections. This report updates the findings of a previous investigation that was conducted under the first Retrovirus Epidemiology Donor Study (REDS-I) at five U.S. blood collection centers between 1991 and 1994.4 These studies represent the most current estimates of incidence and residual risk for the major blood-transmissible viruses affecting the U.S. blood supply. Moreover, the analyses of temporal trends and demographics related to marker-positive donations provide insights into the sources of risk in the blood system and how they are changing over time. A few limitations warrant mention, however. First, it should be noted that the incidence estimates depend strongly on the number of NAT yield (RNA-positive, but antibody-negative) cases, which could have been affected by changes over time in the sensitivity of the NAT and serologic assays, as well as by current estimates for the marker-negative infectious window periods. Second, inferences of trends based on small numerators (number of incident cases) with very large denominators (total number of collections) can be misleading as to level of both statistical significance and public health importance. Third, it is possible that the data obtained solely within the ARC system might not be nationally representative. Nevertheless, these data provide us with a unique and very rich source of information that directs our attention appropriately to a number of issues and concerns. The role of NAT in enabling accurate assessments of donor incidence (number per 100,000 person-years) of HIV and HCV infection is central to these analyses. NAT-yield cases represent recently acquired and thus incident cases of infection, although estimation of the incidence rate in first-time donors still requires an extrapolation from the directly observed rate in repeat donors. In an examination of transfusion risk in the NAT era, it is perhaps also worth remembering that the introduction of NAT as a donor screening method for HIV resolved an otherwise vexing concern about disparate blood safety due to differences in sensitivity (and hence window period risk) of the available licensed screening tests for antibodies.5 The authors' results are summarized in Table 1 as rounded values of the reported point estimates for incidence and residual risk of HIV, HCV, and HBV. The infectious window periods for HIV and HCV were based on donor testing by minipool NAT, while that for HBV was based on estimated time to detection of hepatitis B surface antigen (HBsAg). The authors make several important observations based on more detailed analyses of the multiyear data. These include the following: HCV prevalence appears to have decreased steadily over 10 years in first-time donors. While significant as evidence of a favorable change in the donor base (new donors have less cumulative HCV risk than in the past), this finding may reflect a cohort effect (higher risk in a historic group of donors) or an overall change in the epidemiology of HCV in the United States rather than any temporal improvement in donor selection. Cases of acute hepatitis reported to the Centers for Disease Control and Prevention (CDC) under the CDC's National Notifiable Disease Surveillance System indicate that annual incidence of HCV has declined markedly from 5.2 cases per 100,000 population in 1995 to 0.5 per 100,000 population in 2007 among persons aged 25 to 39 years, the age group with the current and historically highest incidence.6 This general decline may result from a decreased number of HCV incidence in injection drug users. The authors estimated that residual risk of HBV in blood donation has decreased approximately threefold comparing the periods of 2006 to 2008 to 1997 to 1999.2 Regardless of cause (such as a general increase in vaccination against HBV), this represents good progress in blood safety. However, the risk for transmission of HBV is approximately three to five times higher than for HIV or HCV. As discussed recently at a meeting of the FDA's Blood Products Advisory Committee, widespread implementation of licensed donor screening tests for HBV DNA by NAT, and the further development of more sensitive NAT assays should further reduce this risk.7 In contrast to HBV, and of concern, is a progressive increase in the incidence of HIV and HCV over a 10-year period. An apparent decrease in the incidence of HIV and HCV in 2005 to 2006 compared with 2003 to 2004 is an unexplained exception to the general trend. Comparing 2007-2008 to 2005-2006, increased incidence of HCV in repeat donors was due to an increased rate of seroconversions rather than any observed increased number of NAT-yield cases, perhaps suggesting a bias against donations by repeat donors who have had more recent high-risk exposures. If a bias against donation soon after risk exposure actually exists, then the true HCV risk might be lower than has been estimated. In the case of HIV, the increased incidence was attributed primarily to young (age 16-19 years) male African American donors. More generally, HIV incidence and prevalence are higher in African American males and females compared to Caucasians of comparable age.8 Donations by African Americans are critical to the availability of red blood cells (RBCs) with antigenic characteristics compatible with those of African American recipients, especially for chronically transfused patients with sickle cell disease.9 The authors noted a consistently higher incidence of HIV among donors in the South compared with other geographic areas. In the case of HCV, the increased incidence in repeat donors was attributed primarily to Caucasian males and females over age 50 years. The authors note that HCV transmission from nonhospital procedures, and specifically endoscopies, could be a risk factor in this age group based on recognized outbreaks in the United States. However, other possible medical and nonmedical parenteral exposures in this age group cannot be ruled out. The authors did not comment on an apparent sharp increase in HCV incidence for the Western ARC regions comparing 2007-2008 to all previous years that can be seen in Fig. 5B of the article.1 The increased incidence of HIV and HCV in donors should prompt renewed efforts to investigate incident cases of HIV, HCV, and HBV to determine the donors' underlying risk factors. This is especially important for NAT-yield cases because such donors might well have transmitted their infections to recipients had they presented to donate even just a few days earlier. Detection of HIV or HCV in such cases can be thought of as “near-miss” events in questionnaire screening. Risk factor investigations in these cases might point to areas where donor questions could be improved. As noted above, ARC investigators have also reported on the relative risks of apheresis compared with whole blood donations.3 The importance of this study lies in the fact that use of apheresis collections including at mobile sites has increased rapidly in recent years, especially for RBCs, with likely changes in donor demographics compared with collections of whole blood. The most recent data from the 2007 National Blood Collection and Utilization Survey indicated that apheresis RBCs now constitute 10% of all transfused allogeneic whole blood or RBCs and 88% of all transfused platelet (PLT) equivalent units (one apheresis PLT collection was considered equivalent to six whole blood–derived PLT units).10 Although marker rates for HIV, HCV, HBV (as indicated by HBsAg screening), and HTLV in apheresis donors as a whole were much lower than for whole blood donors, the authors noted that this observation largely reflects the much higher frequency of apheresis donations (other than RBCs) compared with whole blood, preventing any direct implication for relative incidence. However, of more basic significance was the finding that first-time male donors of double RBCs, who provided only 1% to 5% of apheresis collections, accounted for 25% to 100% of the various marker test–positive units. In particular, first-time male donors aged 30+ years who donated double RBCs represented only 3% of donors, but accounted for more than 50% of all HCV positives. A severalfold increase in such male donations between 2004 and 2008 has resulted in an increase in marker prevalence rates for apheresis collections overall and especially for HCV. The marker rates (and interdonation intervals) in this subgroup were comparable to those of whole blood donors, but higher than those for donors of non–double-RBC units (mainly PLT donors). Once again, the finding of a higher risk cohort of donors should underline the importance of further studies to examine the risk factors in this group of donors as a basis to develop improved donor selection procedures. This is especially important in light of the movement toward predominant use of male donors to make large-volume plasma products (including apheresis PLTs and plasma) as a preventive measure against transfusion-related acute lung injury.11 Table 2 provides a summary of the authors' study on incidence of major transfusion-transmissible viral infections in apheresis donors compared with whole blood donors.3 The incidence of HTLV was not estimated due to the absence of any seroconverting donor in the period of study, consistent with the very low rate of HTLV positivity that was found in apheresis donors. Unlike the findings summarized in Table 1, which are based on data including first-time and repeat donors, those summarized in Table 2 pertain only to repeat donors. An overall comparison of residual risks for apheresis versus whole blood collections would require inclusion of data on infection incidence in first-time donations. The authors' main conclusion is that, within the limits of statistical significance, all the donor groups have similar incidence for HIV, HCV, and HBV resulting in comparable per unit risks. Biovigilance endeavors are expected to shape blood safety monitoring in the future. A robust discussion of biovigilance is beyond the scope of this editorial. However, the following brief discussion outlines the direction that national hemovigilance is taking in the United States. Hemovigilance, a subset of biovigilance, is the state or attitude of watchfulness (monitoring) of the entire blood system from donor recruitment, donor health, and infectious disease markers to transfusion practices and recipient adverse events through the lens of a quality system. In some countries such as those in the European Union, the European Directive requires quality systems as well as hemovigilance “from vein to vein” and also requires its member states to develop periodic reports of the progress.12,13 In 2009, the Department of Health and Human Services (HHS) and its public health agencies released a white paper, “Biovigilance in the United States: Efforts to Bridge a Critical Gap in Patient Safety and Donor Health,” that was presented to the Secretary's Advisory Committee for Blood Safety and Availability.14 The gaps that were identified relevant to blood safety include: Gap 1: Patchwork and sometimes fragmented system of various adverse event reporting; Gap 2: Likely underreporting of transfusion adverse events; Gap 3: Challenges with FDA-required reporting; Gap 4: Need for accurate recipient denominator data, precise definitions, and training; Gap 5: No national surveillance of donor serious adverse events other than fatalities; Gap 6: Need for accurate donor denominator data, precise definitions, and training; Gap 7: Need for accurate tracking of all donor infectious disease test data; Gap 8: Need for timely analysis of reported data. Pertinent to the articles by Zou and colleagues, Gap 7, the need for accurate tracking of all donor infectious disease test data, is extremely important to identify trends and identify risk factors in donor groups. While NAT of small pools of donor specimens (“minipools”) has narrowed the window period to an estimated 9.0 ± 0.6 days for HIV, breakthrough cases still can occur.15-17 To address this risk, proactive national donor surveillance is needed to understand the circumstances, behaviors, or mode of transmission underlying transfusion-transmitted disease (TTD) infections in donors, especially those with recent infections. A standardized post-TTD conversion interview presently under development by several major blood collecting organizations could provide information useful to improving the donor selection process. The authors make a compelling case for proactive monitoring of TTD markers by large blood establishments. It is important to note that surveillance of TTD markers is critical not only for large establishments but for all establishments that collect and process blood. This point is further emphasized by the review of the 2008 FDA Biological Product Deviation (BPD) reports, which also encouraged establishments to evaluate TTD seroconversion rates among their donor populations.181, 2 illustrate BPD reports from 2007 and 2008 for which a unit of blood or plasma was distributed from a marker-negative donor who subsequently tested confirmed positive for a viral marker. BPD reports are individually filed with the FDA and are not associated with a denominator. However, it is noteworthy that the number of BPD reports rose 18% for blood establishments and 60% for plasma establishments between 2007 and 2008. These observations, which encompass reports from all blood and plasma establishments, may reflect more complete reporting under a recently established Web-based system. However, they are consistent with the apparent increases in HIV and HCV incidence in ARC donors reported by Zou and colleagues. Blood establishment BPD reports of a unit of blood distributed from a marker-negative donor who subsequently tested confirmed positive. Plasma establishment BPD reports of a unit of blood distributed from a marker-negative donor who subsequently tested confirmed positive. The increase in FDA BPD reports of donors who subsequently confirm positive for TTD markers suggests an ongoing need for postinterview follow-up to investigate underlying risk factors including high-risk behavior. Assessment and analysis of prevalence and incidence data (Gap 8) along with understanding of the characteristics of those donors could help in policy decisions, recruitment strategies, and screening practices to strengthen donor selection and maintain the safety of the blood supply. As the authors point out, understanding of independent associations with demographic characteristics such as age, sex, high-risk behavior, geographic location, and medical procedures can help to improve donor selection and screening. One example of the use of hemovigilance data has been reported from Germany. Germany with its federal system has 29 competent authorities to ensure compliance with European Directives such as hemovigilance. Through analysis of hemovigilance data, the Paul-Ehrlich-Institut made a decision to mandate minipool NAT screening for TTD markers of not only blood products for transfusion but also therapeutic plasma.19 After several years of planning, nationwide tools to collect donor and recipient adverse events have been developed in the United States to improve patient safety and donor health.20 This year the CDC National Healthcare Safety Network has released its hemovigilance module for national participation, which allows health care facilities to report both infectious and noninfectious transfusion-related adverse events among recipients.21 Enrollment is voluntary, and aggregated data will be analyzed periodically. Additionally, AABB has developed a blood donor hemovigilance tool through support from HHS. This system has been piloted and now is ready to be launched nationwide for tracking adverse donor events. The studies by Zou and colleagues demonstrate the power of large-scale data collection to permit analysis of trends in blood safety. However, routine, national hemovigilance systems to collect and analyze data from all blood establishments would provide the most robust strategy for blood safety monitoring. Ideally, this system should include standardized protocol and definitions, reporting of denominators (number of collections, released units, and transfusions), adverse events in donors and recipients, and product deviations. Routine ongoing monitoring of TTD marker rates coupled with post-TTD conversion interviews of donors would help to form a composite picture of the current safety of the blood supply and the sources of potential threats from known agents. Comprehensive hemovigilance is an important goal both nationally and globally. It is clear that hemovigilance data and its appropriate analysis can be a vital tool to improve blood safety by identifying opportunities for advancements in prevention and control. Zou and colleagues at ARC are commended for their illuminating work in this area of transfusion-transmissible disease. None. The opinions expressed in this editorial are not necessarily those of the Department of Health and Human Services or its Operating Divisions.

It is important to understand donor return behavior to maintain sufficient numbers of blood donors in developing countries where blood supplies are often inadequate. A total of 54,267 whole blood (WB) donors who donated between January 1 and March 31, 2008, at the five blood centers in China were followed for 2.5 years. Logistic regression was conducted to identify factors associated with their return behavior. A recurrent-event Cox proportional-hazard model was used to evaluate the overall effect of demographic variables and return behavior among first-time donors. Donors with previous donation history were more likely to return and the number of previous returns was positively associated with future return (odds ratios, 3.31, 4.82, and 8.16 for one, two to three, and more than three times compared to none). Thirty-four percent of donors (first-time donor, 21%; repeat donor, 54%) made at least one return donation, with 14% returning in the first 9 months. The multivariable logistic regression model for all WB donors and the Cox proportional hazard model for first-time donors showed consistent predictors for return: female sex, older age (≥ 25 years), larger volume (300 or 400 mL), and donating in satellite collection site. Encouraging first-time donors to make multiple donations is important for keeping adequate blood supply. The finding that first-time and repeat donors shared the same predictors for return indicates that retention strategies on repeat donors may be effective on first-time donors. Studies on motivators and barriers to return are needed, so that successful retention strategies can be tailored.

Iranian Blood Transfusion Organization (IBTO) is the only nationally accredited organization in Iran that performs blood transfusion procedures ranging from blood donor recruitment as well as blood distribution. IBTO was established in May 1974. This government-based organization provides its services free of charge. Before its establishment, blood services were provided through hospital-based systems. IBTO is managed by the Supreme Council, which consists of five experts in hematology and related fields appointed by the Minister of Health. The Managing Director of IBTO, elected by the Supreme Council, ensures proper implementation of the decisions adopted. The financial resources of IBTO are covered by a government-approved budget.[1] The mission of IBTO is to provide and ensure a safe and adequate blood supply in Iran. IBTO fulfils its goals through 30 regional blood centers, which are located in 30 different provinces with more than 200 blood donation sites throughout the country to meet the demands of the Iranian community for blood. It also aims at promoting transfusion medicine in Iran.

This study examined the impact of age and sex of first-time donors who had not experienced an adverse event or deferral on their likelihood of and time to return. On behalf of the Biomedical Excellence for Safer Transfusion (BEST) Collaborative, international blood collection agencies (BCAs) were invited to provide data on first-time whole blood donors in 2014, including initial presentation date, collection site type, age, sex, blood type, return to donate within 24 months (yes/no), and subsequent presentation date. Eight BCAs contributed 706,789 records. The overall odds of returning to donate were slightly lower in female versus male donors, and the overall age trend was U-shaped with younger and older donors having higher odds for returning relative to middle-aged donors. However, variations by BCA were observed. Specifically, in three BCAs, women had higher odds of returning to donate than men. Further, while across seven BCAs the smallest cohort of older first-time donors returned at a higher rate and returned more quickly than middle-aged first-time donors, the behavior of younger donors varied substantially between BCAs. While older first-time donors are more likely to return and return more quickly than middle-aged donors they make up only a small proportion of first-time donors, whereas the larger group of younger donors exhibits less clear patterns of return compared to middle-aged donors. Further research is needed to determine whether targeting the recruitment of older donors or bolstering retention of middle-aged donors would be most effective in maintaining the blood supply.

This study aims to compare the changes and progress made to Iranian Blood Transfusion Organization (IBTO) during 1974-2014 in order to identify the shortcomings. The History of Blood transfusion in Iran can be traced back to the 1940s. IBTO was established in 1974 as a national centralised organisation, supported by Iranian government for its budget and supplies and provides its products free of charge to both public and private hospitals. The statistics have been derived from IBTO Statistical Center. Also related literature has been reviewed. From 1974 to 2014, donation per population has been increased about eight times. IBTO reached 100% voluntary blood donation in 2007, but the number of female blood donors in Iran is six times lower than average global rate. On one hand, the prevalence rate of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) in blood donors was dropped in to one fifth and one third, respectively during past 8 years. On the other hand, irrational blood usage and lack of integrated blood stock management systems and non self-sufficiency on plasma-derivedmedicines are considered as main challenges of IBTO. Forty years since the establishment, IBTO managed to achieve considerable improvements in different fields but many challenges still remain, which need to be addressed urgently. Great gap between the number of male and female blood donors in Iran has to be filled. The improvement of knowledge and practice on patient blood management and use of alternatives are on the agenda of IBTO in next coming years.

Iranian Blood Transfusion Organization (IBTO) established in 1975 has been the sole responsible entity for blood adequacy and safety in Iran. It has been the same in case of providing recovered plasma. At the same time, the first commercial plasma center was authorized by IBTO to operate in the capital Tehran to contribute to the main purpose that was the investment of the private sector in fulfilling fractionation purposes and the construction of a fractionation plant. The goal that unfortunately did not materialize. To make remedies based on a well-calculated plasma document, in 2015, a plasma program developed in Iran by IBTO by which new donor centers were opened or already blood center were equipped to allow for the collection of voluntary nonremunerated source plasma. It had in it capacities of plasma collection for IBTO recovered, commercial source, and IBTO voluntary source. The latter third was a gradually growing program that lasted just 3 years and showed progress but the managerial changes and invalid arbitrary and sudden decisions brought it to the end. Whilst the paid private centers grew and ruined the voluntary nonremunerated sense that IBTO always pursued and was against the Ministry of Health requirements for what the commercial private sectors should have abided by. Safe voluntary nonremunerated source plasma collection that almost all countries pursue to grow along with existing recovered plasma share was terminated with consequences that are detailed in the present article.

n Iranian Journal of Parasitology Vol. 9, No. 1, Jan -Mar 2014, a paper entitled Anti-Toxoplasma gondii Antibody Levels in Blood Supply of Shiraz Blood Transfusion Institute, Iran by Shaddel et al. was published and prevalence of toxoplasmosis was reported as 23.6% in blood products. In this regard, following notes should be considered. Blood transfusion is an important lifesaving medical intervention throughout health care systems. Sufficient and safe blood supply is ongoing challenges for Blood Transfusion Organizations. In Iran, national blood supply has been established on 100% voluntary blood donation, blood donor selection, according to the standards of the Iranian Blood Transfusion Organization (IBTO), which are implemented based on donors and or recipients safety measures. Laboratory screening for known transfusion transmitted infections, including HBV, HCV, HIV, syphilis and HTLV1-2 (In certain geographic areas) are carried out entirely. By which, prevalence of above mentioned agents decline dramatically. However it is not possible to achieve zero risk of transfusion transmitted infections, neither in Iran nor in any other part of the world yet. Seroprevalence rates for Toxoplasma gondii in the general population vary worldwide and increased by age. Approximately 25% to 30% of the world populations are infected and more than 80% of primary infections are subclinical. The higher prevalence is observed in tropical areas (1). Seroprevalence rates in Iran estimated in range from 18% to 70% (2). Toxoplasma is an obligate intracellular parasite, which can infect human by different modes mostly by ingestion and inhalation of contaminated products. Occasionally T. gondii could be transmitted from person to person by modes of mother-to-child transmission, organ transplantation and or rarely by blood transfusion. In context of transmission by blood transfusion, although the risk is theoretically possible but there are rare reports in the literature (3), so that there is no recommendation to screen the blood products for T. gondii in WHO, American Association of Blood Banks (AABB), European Council and so on. I Iranian Society of Parasitology http:// isp.tums.ac.ir Iranian J Parasitol

It is important to understand donor return behavior. Converting first-time donors to become repeat donors is essential for maintaining an adequate blood supply. Characteristics of 241,552 whole blood (WB) donations from first-time and repeat donors who donated in 2008 at the five blood centers in China were compared. A subset of 54,394 WB donors who donated between January 1 and March 31, 2008, were analyzed for their return behavior in 2008 after the index donation using logistic regression. Of all donations, 64% were from first-time donors. Donors with self-reported previous donations tended to be male, older, and married; donated larger volume (≥ 300 mL); and were heavier in weight. Among donors who donated from January to March 2008, 14% returned for subsequent WB donations by the end of 2008. The number of previous donations and blood collection location were the two strongest predictors for making subsequent donations. Donors with one, two to three, and more than three previous donations were 3.7, 5.7, and 11.0 times more likely to return than first-time donors. Those who donated in a blood collection vehicle were four times more likely to return than those who donated at a blood center. Being female, younger, and of a lower education level (middle school or less) were positively associated with subsequent return blood donation during the follow-up period observed in this study. Most of the Chinese blood supply is from first-time donors. Strategies aimed at encouraging current donors to become repeat donors are needed.

Trend of blood donation including coronavirus pandemic: A nationwide cross-sectional study during 2017-2022 in Iran.

Background: In the recent past, the discrepancy between blood supply and future demand may have been overestimated. As medical progress develops rapidly, it will be essential to monitor ongoing demographic changes in the donor population regularly and to re-evaluate retention and recruiting strategies. The aim of the current study was to compare first-time donor (FTD) characteristics and their return rates. We therefore compared whole blood (WB) donations in total and the annual donation frequencies in 2010 and in 2015/2016. Furthermore, we evaluated whether over the same observation period, medical reasons for deferral underwent a change (2010 vs. 2015). Methods: The return probability of FTD within 12 months was analysed in 2010 and 2015 with respect to successful donation versus deferral and with regard to age. The total number of WB donations was investigated, and age distribution was compared between 2010, 2013 and 2016. WB donation frequencies were calculated with respect to age and gender in 2010 and 2016. In a second analysis, medical reasons for deferral were differentiated into 14 categories and a possible impact of time (2010 vs. 2015) on the respective percentage was studied. Results: We observed a significant decline of the FTD return rate from 42.5% to 38.8% in donors that successfully donated WB while the rate remained unchanged in deferred FTD. At the same time the mean FTD age decreased from 29.1 ± 11.6 to 28.5 ± 11.7 years in 2016. Analysis of total WB donations revealed an increase of all donations from donors ≥60 years, a constant percentage from donors <30 years but a declining proportion of donors aged 30-59 years from 2010 to 2013 to 2016. In parallel, annual mean WB donation frequencies decreased over time. Deferrals due to travel history increased significantly from 2010 to 2015 both in FTD and repeat donors. Conclusion: There is ongoing demographic change in our WB donor population. Our data prove a need for a re-evaluation of retention and recruitment strategies since previous marketing campaigns seem to have neglected the age group 30-59 years. This must be addressed in further studies as this age group will be highly relevant for assuring future blood supplies since donor recruitment from adolescents will be limited due to declining birth rates. Furthermore, deferral due to travel history is increasing significantly. Thus we will require further studies on the possible impact on donor retention.