Deferral Rate Research Articles

Whole Blood Donor Iron Management Across Europe: Experiences and Challenges in Four Blood Establishments

Whole blood donors lose iron while donating and frequent blood donation is therefore known to induce a risk of iron deficiency and/or anemia. In this review we present, compare and discuss the pros and cons of 4 distinctive donor iron management strategies in England, Finland, the Netherlands, and Denmark. Donor iron management policies in the countries concerned are described for the year 2021, and data on donor and donation numbers, low hemoglobin (Hb) deferral rates and Hb levels are presented. In England Hb levels were only measured in donors failing a copper sulphate test, while in the other 3 countries Hb is measured at every donation. In Finland, donors considered at risk of iron deficiency receive iron supplements, while in the Netherlands, ferritin-guided donation intervals without iron supplementation are in place. In Denmark, iron supplementation is provided to donors with low ferritin levels. Low-Hb deferral rates and average Hb levels are quite similar across the included countries, with the exception of higher deferral rates in England. To conclude, despite significant diversity in donor iron management approaches, low Hb deferral rates and average Hb levels are similar among the included countries except for England, where higher deferral rates were observed that are likely attributed to the absence of iron supplementation or ferritin-guided deferral. Achieving an optimal, more tailored iron management strategy requires further research and a nuanced understanding of both donor demographics and physiological responses to optimize the effectiveness and safety of blood donation practices.

Analysis of Rates and Reasons of Whole Blood Donor Deferral at a Tertiary Care Hospital

Background: Safe blood donors form the backbone of safe blood transfusion services. Donor eligibility policies are a critical layer of blood safety designed to ensure selection of healthy donors and to protect recipients from any harm. Aim: Analysis of rates and reasons of blood donor deferral at a tertiary care hospital in north India. Methodology: The present study is a retrospective study done in a tertiary care centre in Jammu region. The data was collected over a period of 2 years from January 2018 to December 2019.The various causes for deferral of the donor from donation were collected from donor deferral register which was recorded using regular questionnaire- based interview in the registration card followed by thorough medical history elicitation and minimal physical examination. Result: The total number of potential donors screened during the study period were 4728, out of which 532 were deferred because of various reasons. The deferral rate was calculated to be 11.25%.The mean age of deferred donors was 31.2±8.4 years. Most common cause for deferral both among males and females was low Haemoglobin level (less than 12.5gm %) i.e., 28.58%, followed by alcohol intake in last 24 hrs i.e., 11.09%, history of medication (6.2%); medical causes (5.83%); and Jaundice 5.26%. Deferral rate was found to be more among replacement donors (18.98%) than voluntary donors (6.62%). The permanent deferral was 16.65%. Conclusion: The deferral rate in this study is comparable to the deferral rates in other centres. The data will be very essential and helpful in testing the applicability of donor selection criteria. By identification of the causes for temporary deferrals, appropriate measures can be put in place to motivate and inform these potential donors to return for blood donation at a later date after the underlying cause has been rectified. Keywords: Blood donor deferral, permanent deferral, temporary deferral

Causes of pre and post-donation deferrals among blood donors, at Kwale Satellite Blood Transfusion Center, Kwale County, Kenya, 2018–2022

BackgroundBoth pre-donation and post-donation deferrals pose challenges to blood safety and availability. This study delved into the deferral rates before donations and their underlying reasons, as, transfusion transmissible infections (TTIs) leading to post-donation deferrals among potential blood donors at the Kwale Satellite Blood Transfusion Centre (KSBTC) in Kenya.MethodsWe performed a retrospective electronic record review of pre- and post-donation deferrals among blood donors at KSBTC, 2018–2022. The pre-donations deferral rate and reasons for deferral were analyzed. Accepted donations were analyzed to determine the prevalence of HIV, hepatitis B (HBV), hepatitis C (HCV), and syphilis. Descriptive statistics were calculated and both crude odds ratio (COR) and adjusted odds ratio (AOR), and their 95% confidence intervals (CI) were calculated. Variables with p < 0.05 were considered statistically significant.ResultsA review was conducted on 12,633 blood donation records. Among these, individuals 2,729/12,633 (21.60%) were deferred from donating with the primary reason being low hemoglobin levels, constituting 51.86% of deferrals. Around 773/9,904 (7.80%) of blood units, were discarded due to at least one TTI. Among these, HBV accounted for 4.73%, HIV for 2.01%, HCV for 1.21%, and Syphilis for 0.59% of cases. The adjusted odds ratio for male donors were, (aOR = 1.3, 95% CI 1.01–1.57), donors with none or primary education level (aOR = 1.4 95% CI 1.11–1.68), first-timer donors (aOR = 1.2, 95% CI 1.01–1.44), and static strategy for blood collection (aOR = 1.4, 95%CI 1.12–1.63) were independently potentially associated with testing positive for at least one TTI.ConclusionThe study indicates that TTIs continue to pose a risk to the safety of Kenya’s bloodstock, with a notable prevalence of HBV infections. Male donors, individuals with limited education, first-time donors, and utilizing a fixed strategy for blood collection were identified as potential risk factors independently associated with TTIs.

Analysis of Blood Donor Deferral Pattern at a Tertiary Care Hospital in Chennai: A Cross-Sectional Retrospective Study.

Background Blood is essential for saving lives, particularly in emergencies. However, many patients, especially in developing countries face delays in accessing safe blood due to inadequate infrastructure, insufficient blood banks, poorly equipped laboratories, unreliable transportation systems, low donation rates driven by cultural beliefs, fear, and misconceptions, poor blood donor recruitment and retention, economic constraints, and a general lack of awareness and education about blood donation. Ensuring safe transfusions requires advanced technology and promoting healthy, voluntary donations. Donor selection is crucial for safety, preventing adverse reactions through proper criteria and infection screenings. Donor deferrals can discourage donors and hinder recruitment, so identifying and addressing deferral causes is vital. Blood centers must balance quality and quantity by using thorough donor assessments. Efforts should focus on both recruiting new donors and retaining deferred ones to ensure a stable blood supply. Aim The aim of the study is to evaluate and analyze the patterns and causes of blood donor deferrals in a tertiary care hospital. The objectives are to determine the incidence and reasons for blood donor deferrals. Materials and methods A cross-sectional retrospective study was conducted for 36 months fromMay 2021 to May 2024.A simple random sampling method was used to select the blood donors who reported for donation. Data was obtained from records maintained by the blood center. Descriptive statistics were utilized to summarize the demographics of the blood donors, including deferral rates among males and females, and the frequency of temporary and permanent deferrals. A Chi-square test was done to find the association between gender and deferral rates in blood donation. This analysis aimed to explore gender variations and underlying health status differences between male and female donors, as these can influence deferral rates. Results From May 2021 to May 2024, 17,082 people registered to donate blood at the Blood Centre, Department of Transfusion Medicine. Out of these, 1,000 donors, or 5.85%, were deferred. The majority of donors were males 16,638, with only 444 females. Most deferrals (76.4%) were temporary, often due to low hemoglobin levels or recent alcohol intake. Permanent deferrals (23.6%) were usually due to uncontrolled hypertension and diabetes. A significant association was found between gender and type of deferral among participants (p < 0.05). Conclusion This cross-sectional retrospective study on blood donor deferral patterns in a tertiary care hospital highlights key reasons such as low hemoglobin, recent alcohol intake, hypertension, and diabetes. To improve donor eligibility and retention, targeted strategies including enhanced education and community engagement are essential. These efforts will strengthen blood transfusion services and support critical healthcare needs effectively.

In-person versus virtual heart transplantation selection committee meetings: Longer-term impact on committee member perceptions and patient selection outcomes

The COVID-19 pandemic led to changes in heart transplantation, including transitioning from in-person to virtual selection committee meetings. The longer-term impact of this transition on committee perceptions and patient selection outcomes has not been described. An anonymous survey was administered to our institution’s selection committee. Among 58 regular attendees, there were 21 physician and 21 non-physician respondents. Selection outcomes were compared for patients discussed during in-person meetings (March 1, 2017 – March 14, 2020) with those of virtual meetings (March 15, 2020 – March 31, 2023). Though a virtual format was generally preferred, respondents highlighted a lack of accountability and spontaneous discussion. Among the 529 patients evaluated during the study period, there was a significant difference in selection outcomes between the virtual and in-person cohorts owing to lower rates of deferral and higher rates of approval in the virtual era overall (p=0.009) and notably among men, but not women (p=0.022).

Analysis of trends in radiofrequency ablation in a tertiary care center practice.

Radiofrequency ablation (RFA) for thyroid nodules has recently been introduced into the United States healthcare system landscape. Little is known about the process of incorporating this procedure into existing clinical practice. A retrospective chart review of a single institution was conducted to examine referral patterns and decision-making after the introduction of RFA into an endocrine surgery-focused practice. Patient demographics and thyroid-specific data were recorded. Two reviewers abstracted and coded reasons for the noncompletion of RFA. Two-sample t tests were used to compare groups; linear regression was used to assess trends and practice patterns. Chart review identified 451 patients referred for consideration of RFA from January 2020 to December 2022. Only 255 (56.5%) went on to receive the treatment. There was no significant difference in nodule volume between treated and nontreated groups (18.5 vs. 14.9 cm3, p = 0.07). Concern for malignancy on genetic testing, size (too large/too small), recommendation for Ethanol ablation, and multinodular disease without target nodules were the most common reasons for physician deferral. Of patients who declined to proceed, 46% opted to undergo surgical excision. Linear regression showed that referral numbers significantly increased with time; however, the proportion of patients receiving treatment decreased yearly, primarily because of higher rates of physician deferral. This study reflects the complex decision-making in offering minimally invasive thyroid nodule ablation. Despite a greater number of referrals over time, physician criteria became increasingly selective. Optimal candidacy in RFA is an evolving determination requiring patient and physician input to guide ideal practice patterns.

Implementation of sexual risk behavior donor screening in Canada.

The two Canadian blood suppliers, Canadian Blood Services and Héma-Québec, removed the time-based deferral for men who have sex with men and adopted criteria assessing sexual risk behaviors. We report the impact of these changes on the safety and adequacy of the Canadian blood supply. Since 2022, all donors are asked if (1) they have had a new partner and (2) more than one sexual partner in the last 3 months. Donors answering yes to either question are asked if they had anal sex in the last 3 months; if yes, they are deferred for 3 months. We followed HIV rates for the 18 months before and 14 (Héma-Québec) or 18 months (Canadian Blood Services) post-implementation and interviewed HIV-positive whole blood donors. We assessed the number and characteristics of whole blood donors answering yes to the two first questions with or without deferral. There were four HIV-positive donations out of 1,492,355 donations pre-implementation and four out of 1,447,772 post-implementation (0.27/100,000 vs. 0.28/100,000, p = 1.00). Post-implementation, one HIV-positive donor was non-compliant with multiple criteria, no risk factors were identified in the others. 3.2% of donors answered yes to questions (1) and/or (2); 0.17% were deferred for a new partner and/or more than one partner and anal sex. Deferral rates were highest in first time, younger donors, and similar in males and females. Implementation of sexual risk behavior donor screening resulted in unchanged HIV rates to date and a manageable deferral rate.

Frequency of Blood Donor Deferrals in Urban Population among Random Voluntary Donors and Evaluation of Gross Differences in Various Study Groups

Introduction: The most important aspect of the blood donor selection criteria is the selection of Healthy donors for donating blood to safeguard the health of the donor as well as the patient. Based on the selection criteria donors are considered either fit or unfit (deferred) to donate blood. Aim: Primary aim of the study is to analyze and evaluate the various causes of donor deferrals in comparison to different regional studies with special emphasis on temporary donor deferrals, in order to retain them as potential future donors. Materials &amp; Methods: A retrospective study was conducted with available data of all donors registered between May 2022 and Dec 2023. Donor deferral data was analyzed for various causes of deferral patterns. Results: A total of 2003 donors registered for voluntary blood donation out of which 244(80.79%) were accepted for donation and 302(15.07 %.) were deferred for various reasons. Total number of temporary deferrals were 244(80.79%) and permanent deferrals were 58(19.20%). Discussion: The overall deferral rate in this study was 15.48%. Low Hemoglobin (36.09%) was the commonest cause for temporary deferral and the commonest age group which had maximum deferrals was 18---25 yrs. Hypertension was the main cause of permanent deferral. Conclusion: The incidence of donor deferral can be reduced by furnishing the appropriate information related to blood donations and educating the general public and blood donors through awareness programs. Follow up of the donors must be encouraged to remove the negative feeling in deferred donors to make them potential future donors.

Predicting haemoglobin deferral using machine learning models: Can we use the same prediction model across countries?

Personalized donation strategies based on haemoglobin (Hb) prediction models may reduce Hb deferrals and hence costs of donation, meanwhile improving commitment of donors. We previously found that prediction models perform better in validation data with a high Hb deferral rate. We therefore investigate how Hb deferral prediction models perform when exchanged with other blood establishments. Donation data from the past 5 years from random samples of 10,000 donors from Australia, Belgium, Finland, the Netherlands and South Africa were used to fit random forest models for Hb deferral prediction. Trained models were exchanged between blood establishments. Model performance was evaluated using the area under the precision-recall curve (AUPR). Variable importance was assessed using SHapley Additive exPlanations (SHAP) values. Across the validation datasets and exchanged models, the AUPR ranged from 0.05 to 0.43. Exchanged models performed similarly within validation datasets, irrespective of the origin of the training data. Apart from subtle differences, the importance of most predictor variables was similar in all trained models. Our results suggest that Hb deferral prediction models trained in different blood establishments perform similarly within different validation datasets, regardless of the deferral rate of their training data. Models learn similar associations in different blood establishments.

Effect of COVID-19 Vaccine on Blood Donor Deferral Patterns in PIMS, Islamabad

Objective: To evaluate the effect of COVID-19 vaccine on overall donor deferral patterns in PIMS, Islamabad. Study Design: Cross-sectional descriptive study. Settings: This study was carried out at Blood Bank of Pakistan Institute of Medical Sciences (PIMS), Islamabad Pakistan. Duration: January 2019 to December 2021. Methods: The participants for donation were included in this cross-sectional study on the basis of certain criteria by taking their previous medical history physical examination, COVID-19 vaccination status, and transfusion-transmissible infections (TTI) screening results. All those donors who don’t meet these criteria were deferred. On the basis of causes, deferrals were categorized into temporary or permanent. Results: This study included a total of 84,669 potential donors during a period of three years (January 2019- December 2021), out of which 82,072 donors met inclusion criteria and donated blood during this period whereas 2597 donors were deferred. The overall deferred rate was 3.2% (n=2,717), out of which 13% (n=342) were deferred permanently and87% (n=2375) were deferred temporarily. The leading cause of permanent deferral includes hepatitis C (n=142), hepatitis B (n=106) and cardiac diseases (n=94). On the other hand, leading causes of temporary deferrals include COVID-19 vaccination, being under weight, underage, low HB, short gap, fatty veins and fever. Conclusion: The identification of deferrals is an important step for safe transfusions and helps to formulate criteria for efficient donor selection. The current study indicates a 3.2% deferral rate for blood donors and demands preventive steps for both donor and patient safety against HBV, HCV and AIDS.

The Blood Donor Deferral Rate and the Reasons for Deferral at a Tertiary Care Teaching Institute in Northeastern Malaysia.

A deferral takes place when donors fail to meet the eligibility criteria for donating blood during their visit to a blood collection site. Deferral periods, which can be either permanent or temporary, are implemented to protect the well-being of both the donor and the recipient.This study aimed to investigate the frequency of deferrals and the various factors contributing to them.A retrospective analysis was conducted at the Transfusion Medicine Unit of Hospital Universiti Sains Malaysia (USM), utilizing data obtained from blood donors during the period from January 2022 to June 2023. The research included a cohort of 18,751 donors who visited our transfusion unit for blood donation. Data, including gender, age, and reasons for deferral, were collected by reviewing the records of donors who were deferred. Descriptive statistics were employed to analyze the data of deferral blood donors.Out of 18,751 blood donors, 3,533 (18.84%) were deferred, consisting of 1,267 males (35.86%) and 2,266 females (64.14%). The age group of 18-25 years accounted for the highest number, comprising 1,875 donors (53.07%). Among the deferred cases, 53.33% were first-time donors, followed by 25.28% regular donors and 21.40% lapsed donors. The deferral of blood donors resulted from various reasons. The most common cause of overall deferral among blood donors was low hemoglobin (38.33%), followed by upper respiratory tract infections (8.38%), chronic medical illness (7.08%), and high blood pressure (7.02%). Temporary deferrals were more prevalent than permanent deferrals, accounting for 91.57% of cases compared to 8.43% for permanent deferrals.Voluntary non-remunerative blood donors constitute the backbone for a safe and reliable blood supply in transfusion services. Utilizing a comprehensive database will enable effective counseling of temporarily deferred donors, providing insights into the reasons for their deferral, the expected duration, and the appropriate treatments. This information is crucial for motivating these donors to recruit again in the donor pool. Public education initiatives aimed at raising awareness about the causes of deferral and promoting regular health check-ups can play a pivotal role in minimizing these deferrals.

Analysis of Blood Donor Deferral Pattern during COVID-19 Pandemic at a Tertiary Care Hospital-based Blood Centre, Jammu and Kashmir, India: A Cross-sectional Study

Introduction: Blood donor deferral is vital for ensuring safe blood transfusion. However, with the unfolding Coronavirus Disease-2019 (COVID-19) pandemic, significant changes were made in donor screening and blood donation criteria, resulting in a shift in the pattern of donor deferrals. Aim: To estimate the blood donor deferral patterns during the COVID-19 pandemic. Materials and Methods: A retrospective cross-sectional study was conducted in the Department of Transfusion Medicine at SMHS Hospital/GMC Srinagar, Jammu and Kashmir, India. The study spanned two years, from March 2020 to February 2022. All blood donors were screened in accordance with the Ministry of Health and Family Welfare (MOHFW), National Acquired Immune Deficiency Syndrome (AIDS) control organisation (National blood transfusion services) 2017 guidelines. The data was analysed in Microsoft Excel, considering factors such as age, gender, type of deferral, and reasons for deferral. Results: Deferred blood donors were most common in the age group of 18-33 years. During the study period, a total of 19,895 blood donors (19493 males and 402 females) were registered for blood donation. Out of these, 3441 donors (17.30%) were deferred, with a male donor deferral rate of 3258/19493 (16.71%) and a female donor deferral rate of 183/402 (45.52%). Temporary blood donor deferrals accounted for 3272 (95.09%) cases, while permanent deferrals were 169 (4.91%). The most common cause of deferral was low haemoglobin, accounting for 991/3441 (28.80%) cases, followed by deferrals due to reasons attributable to the COVID-19 pandemic (786/3441, 22.84%) and hypertension (653/3441, 18.98%). Conclusion: The study observed a substantial increase in the total donor deferral rate, as well as a change in the donor deferral pattern during the COVID-19 pandemic.

ANALYSIS OF CAUSES FOR PRE-DONATION DEFERRAL AMONG VOLUNTARY BLOOD DONORS AT A TERTIARY CARE HOSPITAL

Objectives: Pre-donation screening of potential blood donors is critical for ensuring the safety of the blood collected, and donor deferral as a result of risk factors is practiced worldwide. It is important to study the pattern of deferrals to reduce unnecessary deferrals and encourage continuous blood donation. The aim of the present study was to determine the rate and reasons for pre-donation donor deferral among voluntary blood donors. Methods: This was a single-center, retrospective cross-sectional study conducted by analyzing 3 years of data, from January 2020 to December 2022, over a period of 2 months (December 2022 and January 2023) retrieved from the donor deferral register. The data was entered in Microsoft Excel and analyzed using the Statistical Package for the Social Sciences software. Descriptive statistical measures were utilized to present the data. Results: Among 29,847 voluntary donors, 13.81% (4123/29,847) were deferred, of whom 84.2% (3472/4123) were males. The deferral rate among males was 12.19% (3472/28,480), while it was 47.62% (651/1367) in females. 53.04% of the deferred donors were in the age group of 18–30 years (2187/4123). 98.73% (4071/4123) of the deferrals were temporary. Hypothyroidism on treatment (42.30%, 22/52), uncontrolled diabetes on insulin (34.62%, 18/52), and epilepsy on treatment (11.54%, 6/52) were the common reasons for permanent deferral, while low hemoglobin (13.07%, 532/4,123), medications (11.67%, 475/4,071), and body piercing (9.85%, 406/4,123) were the most common reasons for temporary deferral. Low hemoglobin was the common reason for deferral among repeat donors (55.45%, 295/532) compared to first-time donors. Conclusion: The current findings suggest that it is important to increase awareness of voluntary, non-remunerated blood donation among young people and educate people about the common criteria for a healthy donor to minimize the loss of blood donors.

The influence of demographic and lifestyle factors on blood donation delay among student population: a retrospective study.

This study analysed blood donation deferral trends, reasons and demographic/lifestyle characteristics among students in Huzhou City. The aim was to understand the health status of students and reduce the deferral rate. Data on blood donation deferral among students in Huzhou City from 2018 to 2022 were collected and analysed. Deferral trends and main reasons were investigated. Using demographic and lifestyle data from 2,619 cases in 2022, a risk prediction model for deferral was constructed. The deferral rate among students in Huzhou City from 2018 to 2022 was 12.60% (p = 0.000, 95%CI: 12.14-13.06%), showing a significant increasing trend. Temporary deferral was the main reason, with alanine aminotransferase (ALT), blood pressure (BP) and haemoglobin (Hb) as the main deferral factors. ALT had a deferral rate of 5.23% (4.92-5.53%), BP 3.30% (3.06-3.55%), and Hb 2.92% (2.68-3.15%). Demographic and lifestyle characteristics in 2022 showed no significant differences between education level, household registration and deferral rate (p > 0.05). However, age, sex, blood donation history, sleep quality, diet and mental state had variable effects on ALT, BP, and Hb deferrals (p < 0.05). Logistic regression showed that sex, blood donation history, sleep quality, diet and mental status were independent risk factors for ALT deferral (p < 0.05), with odds ratios (ORs) of 5.057, 2.735, 1.594, 3.679, and 1.957, respectively. Age, blood donation history, sleep quality and mental state were independent risk factors for BP deferral (p < 0.05), with ORs of 0.256, 3.658, 6.042, and 1.812, respectively. Gender, blood donation history and diet were independent risk factors for Hb deferral (p < 0.05), with ORs of 0.244, 0.542, and 3.103, respectively. Students' health problems require attention. Effective health education should improve self-health management and pre-donation health behaviour to encourage regular blood donation.

Investigating Deferral Rates in Cochlear Implantation: How Often Do Candidates Defer and Why?

Evaluate the rate at which cochlear implant (CI) candidates decline surgery and identify associated factors. Retrospective cohort study. Tertiary referral center. Four hundred ninety-three CI candidates from July 1989 to December 2020 with complete demographic and socioeconomic data. Diagnostic. Age, sex, race, marital and employment status, median household income percentile, distance-to-CI-center, and residence in a medically underserved county. Of the 493 CI candidates included, 80 patients (16.2%) declined surgery. Based on chart checking, the most common reason patients did not receive the implant was due to loss of follow-up (38%). African American patients were 73% less likely to undergo implantation compared with White patients (odds ratio [OR], 0.27 [0.11-0.68]; p = 0.005). Asian patients were 95% less likely to undergo implantation (OR, 0.05 [0.009-0.25]; p = 0.0003) compared with White patients. For every 1-year age increase, patients were 4% less likely to undergo implantation (OR, 0.96 [0.94-0.98]; p < 0.0001) and for every 10-year age increase, the patients were 33% less likely. Compared with their single counterparts, married patients were more likely to undergo implantation (OR, 1.87 [1.12-3.15]; p = 0.02). No differences were observed when comparing implanted and nonimplanted CI candidates in sex, employment status, distance-to-CI-center, or median family income percentile. A χ2 test of independence showed no association between receiving CIs and living in medically underserved counties ( χ2 = 2; N = 493; 0.3891; p = 0.53). Not infrequently, CI candidates decline surgery. Although demographic factors (race, age, and marital status) were associated with the cochlear implantation decision, socioeconomic factors (median family income and residence in a medically underserved community) were not. Perhaps cultural components of a patient's race have a larger impact on whether or not the patients get implanted.

Donor Health Questionnaire and Physical Examination as a Tool for Re-Examination of Causes for Donor Deferral in a Tertiary Care Hospital

Objective: To reassess the reasons for blood donor deferrals as per donor history questionnaire and physical examination findings. Study Design: Cross-sectional study. Place and Duration of Study: Blood Bank, Dr. Ziauddin Hospital, Karachi Pakistan, from Jan 2017 to Dec 2020. Methodology: After approval from the Ethical Review Committee, all donors reporting at the blood bank were included. All donors were interrogated via a detailed donor health questionnaire. Data for donor history and physical examination findings were retrieved from the Blood Bank Information Software System (BBIS). Results: During the study period, 33,095 donors reported at the.Blood Bank. Of the total donors, 25,531(77.1%) were accepted and donated blood, while 7564(22.9%) were deferred for different reasons. The majority of donations were from males (32773,99.0%), and female donations accounted for 1%, while females accounted for more deferrals as compared to males. Most deferrals were due to low Hemoglobin (2722,36%), followed by injection/needle stick injuries (1994,26.4%).Less common causes observed were donors not feeling fit for donations, medications, etc. Conclusion: In our study, the deferral rate was 22.9%, with low haemoglobin being the most common cause, followed by injections/needle stick injuries.

Infectious etiologies among post-donation deferrals in a military blood donation center.

The burden of transfusion-transmitted infections among blood recipients remains low due to extensive pre- and post-donation screening. However, the military has the unique challenge of providing blood in austere environments with limited testing capabilities. This study evaluates the infectious etiologies of deferred blood donors at a large military blood donation center. All blood donors at the Armed Service Blood Bank Center, San Antonio, between 2017 and 2022 with positive post-donation screening for hepatitis C (HCV), hepatitis B (HBV), human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV-I/II), Zika (2018-2021), West Nile virus, Trypanosoma cruzi, Treponema pallidum, or Babesia microti (2020-2022) were evaluated. Donors were deferred based on Food and Drug Administration (FDA) guidance. Two-hundred and thirteen (213) donors met FDA criteria for deferral. T. pallidum (n = 45, 50.3 per 100,000), HCV (n = 34, 38.0 per 100,000), and HBV (n = 19, 21.2 per 100,000) were the most common pathogens among those with both positive screening and confirmatory testing. The majority of HIV (95%), Chagas (78%), HTLV-I/II (50%) deferrals were due to indeterminate confirmatory tests following initial positive screens. The majority of deferrals for HBV were for a second occurrence of a positive screen despite negative confirmatory testing. The rates of post-donation deferral for transfusion-transmissible infections were low in this military cohort. Our findings suggest that donor testing in deployed service members should focus on HBV, HCV, and T. pallidum and highlight the need for better diagnostics for HIV, Chagas, and HTLV-I/II.

Intraoperative assessment of axillary sentinel lymph nodes by telepathology.

Although axillary dissection is no longer indicated for many breast cancer patients with 1-2 positive axillary sentinel lymph nodes (ASLN), intraoperative ASLN assessment is still performed in many institutions for patients undergoing mastectomy or neoadjuvant therapy. With recent advancements in digital pathology, pathologists increasingly evaluate ASLN via remote telepathology. We aimed to compare the performance characteristics of remote telepathology and conventional on-site intraoperative ASLN assessment. Data from ASLN evaluation for breast cancer patients performed at two sites between April 2021 and October 2022 was collated. Remote telepathology consultation was conducted via the Aperio eSlideManager system. A total of 385 patients were identified during the study period (83 telepathology, 302 on-site evaluations). Although not statistically significant (P = 0.20), the overall discrepancy rate between intraoperative and final diagnoses was slightly higher at 9.6% (8/83) for telepathology compared with 5.3% (16/302) for on-site assessment. Further comparison of performance characteristics of ASLN assessment between telepathology and conventional on-site evaluation revealed no statistically significant differences between deferral rates, discrepancy rates, interpretive or sampling errors, major or minor disagreements, false negative or false positive results as well as clinical impact and turn-around time (P ≥ 0.12). ASLN assessment via telepathology is not significantly different from conventional on-site evaluation, although it shows a slightly higher overall discrepancy rate between intraoperative and final diagnoses (9.6% vs. 5.3%). Further studies are warranted to ensure accuracy of ASLN assessment via telepathology.

Abstract 9 Identification of Effective Changes to Workflow Triaging Criteria and Production Planning

Abstract Introduction The Cleveland Cord Blood Center (CCBC) analyzes fresh incoming cord blood units for the total nucleated cell (TNC) count. Units that meet the TNC criteria are processed for clinical banking and units not meeting the defined criteria are made available for research collaborations. CCBC sought to understand if adding additional pre-screening criteria would reduce post-manufacturing deferral rates and increase production of licensed units. Objectives To identify the main failure modes resulting in cord blood unit deferral for clinical banking post-manufacturing. To identify key factors resulting in unlicensed status of processed cord blood units. To implement changes to pre-screening strategies to reduce deferral rates and increase production of licensed units. Methods CCBC created four cross-departmental teams to evaluate the main reasons for deferrals post-manufacturing and to evaluate travel-risk history. Each committee had representation from collections, quality, and laboratory staff. Data was evaluated that was collected between January and June 2022. Results The committees identified that 19% of all deferrals post-manufacturing were related to low CD34 count and/or viability and that 17% of all processed units were unlicensed due to travel to Zika related areas. In March 2023, pre-screening criteria was updated to include a pre-processed CD34 count and viability and a pre-screening of the donating mother for travel history after consenting and prior to manufacturing. Units that fulfilled both the TNC and CD34 cut offs and did not have a high-risk travel history were processed for clinical banking. Data evaluated from March and April 2023 indicated that the deferral rates for low viable CD34 counts post-manufacturing went from 19% down to 0% and the percentage of high-risk travel units manufactured was reduced from 17% to 7%. Discussion Review of failure modes identified two main factors to guide improved triage efficiency. By implementing a pre-processing CD34 count, the larger TNC and CD34 cord blood units were identified for banking for clinical use. By using a pre-screening process at collection sites, high-risk travel donations were identified prior to processing. In the two-month timeframe evaluated, the overall deferral rates were reduced by roughly 7% and post-manufacturing licensure status increased from 83% to 93%.

"Why don't you want my poop?" Willing stool donor's experiences of being ineligible to donate intestinal microbiota.

Blood collection agencies (BCAs) hosting stool (fecal or poo) donor programs report high rates of donor deferral. However, the impact of deferral on willing donors, in terms of personal well-being and future engagement with BCAs, remains unexplored. Accordingly, we surveyed those attempting to donate intestinal microbiota about their experience of being ineligible. A total of 196 potential stool donors from Australia's BCA (>90% blood/blood product donors) completed the first stage of eligibility screening and then an online survey once notified of their ineligibility. Respondents reported motives for donating, perceptions of screening and improvements needed, experience of being told they are ineligible, and their feelings about this. Over 80% of participants were ineligible to donate. Of those ineligible, 58% did not know why they were ineligible resulting in potentially future eligible donors being permanently lost. Motives (>5%) included helping others, being a human substance donor, understanding benefits, curiosity/novelty, and helping science/research. Participants identified they needed clear and timely information during screening and a specific reason for their ineligibility. Participants commonly experienced disappointment, confusion, and calm in response to being ineligible. BCAs need strategies to mitigate the disappointment of ineligible donors, maintain satisfaction with BCAs, and preserve donor identity since many ineligible donors give multiple human substances. BCAs should provide more information about eligibility criteria during early screening stages to reduce disappointment and give personalized information about ineligibility to resolve the confusion. Offering alternative opportunities to give may reduce disappointment and increase ineligible donor engagement.