Permanent Deferral Research Articles

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

THE EVALUATION OF PATTERN OF WHOLE BLOOD DONOR DEFERRALS IN A TERTIARY CARE CENTER OF NORTH INDIA

Objectives: Donor recruitment is critical to the supply of safe and adequate blood/blood components to meet patient’s need; the first and most crucial step to provide safe blood is proper selection of blood donors. Blood donor selection criteria are designed to ensure the donor as well as the recipient’s health. The objective of this study is to analyze the various causes of donor deferral, study their frequency pattern and to suggest changes to retain and retrieve donors in future. Methods: A retrospective study on analysis of deferred donors of whole blood was conducted in a blood center at tertiary care hospital in North India. The study included blood donors deferred from January 2022 to December 2022. Results: A total of 27,121 donors were registered for whole blood donation and 4534 (16.71%) were deferred. Female deferral (41.67%) was more as compared to male deferral (15.11%). Temporary deferrals (n=4238 [93.47%]) were significantly higher than permanent deferrals (n=296 [6.5%]). The most common reason for temporary deferral was anemia (n = 940 [20.7%]) while that for permanent deferral was jaundice (n=179 [3.94%]). Conclusion: Analyzing the causes, frequency and deferral pattern of blood donors will help to guide the recruitment and retention efforts to maintain a healthy donor pool at large.

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 & 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.

'Then We Build a System to Deal with It': Waste and the Technological Sublime in Don DeLillo’s "Underworld"

Over twenty-five years after the publication of Don DeLillo’s magnum opus Underworld (1997), which depicts the shift from a naïve belief in technological progress at the beginning of the Cold War to disillusionment as it ended, the novel is more topical than ever, faced as we are with the growing recognition of the failure of both technorationality and capitalism to address humanity’s depredation and despoilment of the biosphere. This article argues that Underworld deploys David Nye’s notion of the technological sublime to depict the attempt to master recalcitrant nature, only to ironically reveal the impossibility of the endeavor. Underworld’s use of waste as a catalyst for the sublime is interesting precisely because waste connotes something valueless, whereas the sublime is occasioned by ‘great’, ostensibly valuable, things. Seen within its own logic, the technological sublime is a project of liberation, a vision of impending omniscience, a permanent deferral of human limitation. Yet when waste becomes sublime, the progression toward mastery does not proceed smoothly. Although the technological sublime “undermines all notions of limitation, instead presupposing the ability to continually innovate and to transform the world” (Nye 60), Underworld’s aestheticization represents it at its limit, when it can no longer regulate the abject threat of waste. Ultimately, I argue that DeLillo asks readers to grapple with abjection by dramatizing the failure of the technological sublime as an aesthetic strategy, which inadvertently reinscribes the boundaries that it seeks to override: the finitude of the embodied human, our relative powerlessness amongst the world within which we are enmeshed.

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.

Establishing a screening strategy for non-discriminatory reactive blood donors by constructing a predictive model of hepatitis B virus infection status from a single blood center in China.

When employing the transcription-mediated amplification method for screening blood donors, there are some non-discriminatory reactive results which are screening assay reactive but HBV-DNA discriminatory assay negative. This raises concerns regarding the possibility of false positives among donors, which may lead to permanent deferral of blood donors and affect blood supply. This study aimed to elucidate the infection status of these non-discriminatory reactive blood donors and develop and validate a model to predict individualized hepatitis B status to establish an optimal screening strategy. Supplementary tests were conducted on initial non-discriminating reactive donations to determine their HBV infection status, including repeat testing, viral load, serological marker detection, and follow-up. Primary clinical variables of the donors were recorded. Based on the Akaike information criterion, a stepwise forward algorithm was used to identify the predictive factors for information and construct a predictive model. The optimal screening strategy was determined through cost-effectiveness analysis. At the Blood Center of Zhejiang Province, 435 cases of initial non-discriminatory reactive donations were collected over two successive periods and sub-categorized through repeated testing into the following three groups: non-repeated positive group, non-discriminated positive group, and non-repeated HBV-DNA positive group. The HBV discriminatory rate increased after repeated testing (110/435, 25.29%). According to supplementary tests, the HBV-DNA positivity rate was 65.52% (285/435), and occult HBV infection was a significantly different among groups (χ2 = 93.22, p < 0.01). The HBV serological markers and viral load in the non-repeated positive group differed from those in the other two groups, with a lower viral load and a higher proportion of false positives. The predictive model constructed using a stepwise forward algorithm exhibited high discrimination, good fit, high calibration, and effectiveness. A cost-effectiveness analysis indicated that utilizing repeated discriminatory testing and the predictive model is an extremely beneficial screening approach for non-discriminatory reactive blood donors. Nearly two-third (65.52%) of the non-discriminatory reactive blood donors were HBV-DNA positive. Our innovative approach of constructing a predictive model as a supplementary screening strategy, combined with repeated discriminatory experiments, can effectively identify the infection status of non-discriminatory reactive blood donors, thereby increasing the safety of blood transfusions.

MSM and blood donation: shifting to individualized risk assessment.

Deferring donors at higher risk for transfusion transmissible infections is an important part of ensuring blood safety. The deferral for gay, bisexual, and other men who have sex with men (gbMSM) was implemented in the 1980s in many countries, since they were identified as a high-risk group for AIDS/HIV. With the introduction of increasingly sensitive HIV antibody testing, augmented by nucleic acid testing, the window period for HIV infection-when a donor may be infectious but have negative test results-has shrunk dramatically. In Canada, this has led to progressively shorter deferral periods for gbMSM, decreasing from a permanent deferral for sex with another male since 1977 to a 5-year, 12-month, and eventually 3-month deferral period. These time-based deferrals maintained safety; however, they are seen as stigmatizing by many and still result in the deferral of sexually active gbMSM. More recently, several countries have moved to a donor screening approach based on assessing sexual risk behaviors in all donors. This article outlines research supporting changes in policy, current eligibility screening policies in several countries, and preliminary results postimplementation of new eligibility policies in Canada in September 2022.

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.

BLOOD DONOR DEFERRAL PATTERN AS A KEY TOOL FOR SAFE BLOOD TRANSFUSION PRACTICE: A RETROSPECTIVE STUDY FROM NORTH EAST INDIA.

Background: Safe blood transfusion practice starts with meticulous selection of blood donors. Recruitment and retention of healthy safe donor is crucial to maintain adequate supply of blood units available for transfusion. The present study was undertaken with the aim to analyze the rate as well as the causes of pre-donation deferral and blood units discarded following screening test for Transfusion Transmitted Infection (TTI). Material and methods: This retrospective hospital-based study was conducted in the Blood Centre, Jorhat Medical College and Hospital, Jorhat, Assam over a period of one year i.e., from 1st October, 2021 to 30th September, 2022. All donors who attended the Blood Centre as well as outdoor voluntary blood donation camps were included in the study. Each and every blood donor was screened as per the guidelines of Drugs and Cosmetics (Second Amendment) Rules, 2020. Transfusion Transmitted Infection (TTI) screening tests were done on the collected blood units and those found to be positive were discarded. The donor records were reviewed and analyzed according to sex, donor type (voluntary or replacement) and reason for deferral. Results: Out of 17030 prospective donors, 14372 (84.39%) donors were accepted for blood donation while 2658 (15.61%) donors were deferred. The deferral rate was higher in females i.e., 35.63% (88 out of 247) compared to males i.e., 15.31% (2570 out of 16783). Deferral percentage of voluntary donors was 19% (2563 out of 13485) and that of replacement donor was 2.68% (95 out of 3545). The rate of temporary and permanent deferral was 99.17% (2636 out of 2658) and 0.83% (22 out of 2658) respectively. The most common cause of temporary deferral was found to be low hemoglobin (41.81%) whereas in case of permanent deferral high risk behaviour (50%) was found to be the leading cause. 3.21% (462 out of 14372) blood units were discarded following screening tests for Transfusion Transmitted Infection (TTI). Hepatitis C was the most common cause of blood units discarded. Conclusion:Asystematic and well organised approach to selection of blood donors is the mainstay of safe blood transfusion practice. Analysis of donor deferral pattern guides us to recruit safe healthy donors and to maintain an adequate pool of blood units available for transfusion

Donor notification of permanent deferral: a qualitative study on the perceptions and practices of notifier and blood donor in Mexico

BackgroundInforming about permanent deferral requires a process that links the notifier with the donor in a particular way. Little is known about the type of information and how it is disclosed to the donors. The current study aimed to examine perceptions and practices of notifier and blood donor within the framework of the notification process of permanent deferral and from the perspective of the notifier―blood donor relationship.MethodsA qualitative study with in-depth interviews. The participants were 13 notifiers and 25 permanently deferred donors. Participants were recruited from a national blood bank and a state’s blood bank. The entire dataset/narratives were analysed using the method of thematic analysis.ResultsThe disclosure of permanent deferral was understood as a matter of disclosing the serological test results and their medical meaning along with a concise explanation of the deferral status with regard to future blood donation and the plan to be followed. The notifiers preferred to act in accordance with the standard protocol despite acknowledging the adverse psychological and social effects to which donors are exposed when they are informed of the possible disease and the consequent permanent deferral. Donors described a variety of psychological and social affectations. They valued honesty in the communication, the clarity of the information provided and a greater involvement of the notifier.ConclusionEven though the notification process does not imply that medical care is being offered to donors, the notifier is the administrator of the well-being of the donor. Notification must not be considered as something apart from care, since it is intimately related to the health of each of the donors and their medical care.

Study of donor deferral during blood donation: A single centre teaching hospital study

Background: Safe blood transfusion can be a crucial lifesaving intervention in many clinical situations.For safe blood products donor selection is the first and foremost measure of blood donation. Objective:Aim of the study to determine the incidence and causes for deferral in blood donors. Materials and Methods: This cross-sectional retrospective study was done at Transfusion medicine department in Delta Medical College and Hospital, Bangladesh during 6 months period. In current study data were extracted from the register book and analyzed. Prospective donors were confidentially interviewed and examined and screened for causes of temporary and permanent deferral of blood donation. Data were presented as charts, table and analyzed with Microsoft Excel. Result: A total of 2215 directed donors were studied,of them, 1555 (73.52%) were male and 560 (26.48%) females. Predominantly blood donors belonged to 31–40 years of age group (38.01%). Out of 2115 directed donors, 423 (20%) were deferred. Deferral was significantly more likely in female. The most common cause for deferralwere history of anemia (27.66%). Other causes were antibiotic &amp; medications, high blood pressure, low blood pressure, frequent donation, Positive HBsAg, HCV markers, suspected addiction, and vaccination. Conclusion: Effective measures are required for documenting the deferred donors and appropriate preventive intervention program should be undertaken for prevalent causes of deferrals, like low Hb, Infections with HBV etc. Anemia is the most prevalent reason of temporary deferral for blood donation in this region of Bangladesh. Other reasons were hypertension, hypotension,suspected addiction, vaccination etc. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 645-647

Understanding deferral rate and reason among voluntary blood donors at a tertiary care center

Healthy Donor selection is necessary for procurement of safe blood in addition to the screenings of blood bags for infectious diseases. Deferrals lead to loss of precious blood/components available for transfusion in emergency situation. To avoid such problems, we should be aware about its reasons and frequency. To find the incidence of donors who were deferred from donating blood and to determine the causes for same.The study was conducted in the blood bank of tertiary health care center, from January 2015 to December 2017 to find the incidence of deferral and reason behind it. Criteria for deferral was decided as per guidelines given by national health authority.A total of 10,000 donors were screened of which 99% were voluntary donors (VD). The total 598 donors were deferred among 10000 registered during study period. The total donor deferral rate was 6%. The percentage of deferral amongst males was 5.7% and females 7.4%. A majority (65%) of the deferred donors were between 18 to 30 years. The major causes of deferral were anemia and hypertension.Analysis of the deferrals showed that the proportion of temporary deferral was more common than the permanent deferral. Conducting pre-donation camp awareness session can reduce the deferral rate. Temporarily deferred individuals must be informed and followed up to encourage donation in future.

Alternative hepatitis B virus DNA confirmatory algorithm identified occult hepatitis B virus infection in Chinese blood donors with non-discriminatory nucleic acid testing.

Multiplex viral nucleic acid testing (NAT) and a discriminatory testing algorithm have been used to detect viral infections in blood donors. Non-discriminated reactive (NDR) results may arise from low hepatitis B virus (HBV) DNA levels and are challenging for donor management by blood services. The aim of this study was to evaluate the performance and feasibility of alternative viral particle concentration methods to confirm and to characterise HBV infection status in NDR donors from Dalian, China, in order to improve routine donor management according to the potential residual risk estimate. Individual donations were tested with ULTRIO Plus, and discriminated when reactive. Virions were concentrated from 12 and 6 mL plasma samples by ultracentrifugation (UC) and polyethylene glycol (PEG) precipitation, respectively. HBV DNA was detected with four nested polymerase chain reactions (95% limit of detection: 5-25 IU/mL). Amplified products were sequenced for definitive confirmation. Anti-HBc and anti-HBs were tested. Of 77,556 donors, 79 (0.1%) were NAT NDR. After viral particle concentration by UC and PEG precipitation, HBV DNA was detected in 46 (58.2%) and 34 (43.0%) NDR donors, respectively, including 61.7% of samples that were repeatedly non-reactive with multiple NAT testing. Anti-HBc and anti-HBs (median titre: 37 mIU/mL) were detected in 87.3% and 46.8% of NDR donors, respectively. Sequencing confirmed HBV DNA in 65.8% of NDR donors, of whom 96.2% were occult HBV carriers with rare mutations in S and core proteins. A HBV DNA confirmatory procedure with limited technical constraints was implemented successfully. The majority of NDR donors had occult HBV infections with extremely low viral DNA levels, which may constitute a potential residual threat for blood safety. Only a minority of anti-HBc+ NDR donors had anti-HBs levels high enough to consider their reinstatement as donors. The data support the permanent deferral of NDR donors to ensure maximum blood safety in areas of high HBV endemicity.

Profile of Blood Donor Deferrals in a Tertiary Care Centre-Our Institutional Experience

Background: It is the prime duty of transfusion services to provide safe, adequate and timely need of blood and the blood products. Understanding the reasons for donor deferral can help in planning more efficient recruitment strategies and educate and motivate temporarily deferred donors in order to maintain a safe and adequate supply of blood products.&#x0D; Aims of the Study: To evaluate and analyze the blood donor deferral pattern in a tertiary care hospital blood bank and to review its influence on blood safety.&#x0D; Methodology: This retrospective study was conducted in the blood bank, CHRI from the year January 2015 to December 2018. Data like demographic data, clinical history, physical examination, haematological examination, stored in the blood bank was retrived. The donors will be deferred based on standard WHO guidelines. The collected deferral data was analyzed using SPSS software 2011version 20.&#x0D; Results: During the study period there were 7010 registered blood donors. The deferral rate was 5.19%. Among the donor deferrals, females were more commonly deferred ie 31.66%. The deferral rate among voluntary and replacement donors are 4.71% and 11.62% respectively. The rate of permanent deferral (17.86%) was less compared to temporary deferral (82.14%). Among temporary deferral anaemia is the most common cause (27.75%). Seropositive for Hepatitis B is the most common cause for permenant deferral (52.30%).&#x0D; Conclusion: In our study temporary deferral is higher this necessities the need of education, motivation of these donors for future donation to maintain a healthy and safe donor pool.

HIV incidence and compliance with deferral criteria over three progressively shorter time deferrals for men who have sex with men in Canada.

In Canada, the deferral for men who have sex with men (MSM) has been progressively reduced from a permanent deferral for MSM since 1977, to 5 years, 1 year, and, most recently, 3 months. We estimated human immunodeficiency virus (HIV) residual risk and compliance with the MSM time deferral after each change. Four anonymous online compliance surveys were carried out before and after each change. HIV incidence and prevalence were monitored from 2010 to 2021. Residual risk was estimated using the incidence-window period model. Human immunodeficiency virus prevalence, incidence, and residual risk did not change with incrementally shorter MSM deferrals. The residual risk per million donations post 3-month deferral was 0.05 (0.001-0.371). Men with temporally remote MSM history became eligible and, therefore, compliant as the deferral periods decreased (Cochran-Armitage p value=<.0001). However, the percentage of men with MSM history in the last 3 months with the indefinite deferral in place was similar to the percentage noncompliant, while the 3-month deferral was in place. MSM donors did not report high-risk behaviors for which they would otherwise be deferred in any survey. Following the change, an estimated 4467 MSM per year were eligible to donate, an increase from 2501 estimated eligible MSM donors following the change to the 1-year deferral. With progressively shorter MSM deferral periods, HIV residual risk was unchanged. The proportion of male donors with deferrable MSM history remained low, while those with temporally remote MSM history became eligible, increasing the number of eligible MSM donors.

PREVALENCE OF BLOOD DONOR DEFERRAL AND ITS DISTRIBUTION BY SEX, TYPE OF DEFERRAL AND CAUSES IN POPULATION OF KARACHI, PAKISTAN

Background: Donor selection is an important step for safe blood transfusion. The objectives of this study were to determine prevalence of blood donor deferral and its distribution by sex, type of deferral and causes in population of Karachi, Pakistan.Materials Methods: This cross-sectional study was conducted at Department of Pathology, Hamdard University, Karachi, Pakistan from July 1, 2019 to June 30, 2020. Hamdard University Hospital, Karachi is assumed to cater 1.5 million population. With 1% donors, population at risk was 15,000. With 10% donor deferral, 1.073% margin of error and 95% confidence interval, sample size was calculated as 2,503. The technique was consecutive non-probability. Sex, age in years, weight, temperature, blood pressure and pulse were noted. Tests for CBC, blood grouping, hepatitis B, Hepatitis C, HIV, malaria and syphilis were done. Donor selection criteria included age range 18-60 years, weight ≥50 kg, pulse rate 60-100/ min, systolic blood pressure 101-150 mmHg, diastolic blood pressure 60-100 mmHg, temperature ≤99◦F, hemoglobin ≥13.0 g/dl for men and ≥12.5g/dl for women. All categorical variables were analyzed by count and percentage with 80%CI.Results: Out of 2,503 donors, 2,493 (99.7%) were men and 10 (0.3%) women. Frequency of deferral was 139 (5.5533%), including 129 (5.1538%) men and 10 (0.3995%) women and 58 (2.3172%) temporary and 81 (3.2361%) permanent. Causes of temporary deferral were; anemia 33 (1.3184%), low weight 8 (0.3196%), acute infection and on medication each 5 (0.1998%), donation of blood in last 8 weeks 4 (0.1598%) and hypotension 3 (0.1198%) cases. Causes of permanent deferral were; HCV 32 (1.2784%), HBV 30 (1.1985%), syphilis 17 (0.6792%), HIV and diabetes mellitus each one (0.04%) case.Conclusion: Prevalence of blood donor deferral was 5.55% in our study, which is almost half of all the cited studies here from global, regional, national and local populations. Prevalence in men was many times higher than women and prevalence of permanent causes was higher than temporary causes. Anemia and HCV were the two major causes of deferral in our study. Proper donor selection is a key of safe blood transfusion. Appropriate measures are needed to prevent causes of deferral.

Donor Selection and Deferral Pattern in Convalescent Plasma Donor in Plasmapheresis Unit of a Tertiary Care Hospital

Context: The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China, in December 2019. The management plan is supportive care with oxygen supplementation and mechanical ventilation. US FDA approved convalescent plasma (CP) for COVID-19 for clinical trials and as an emergency investigational new drug. Although numerous trials are currently investigating the safety and efficacy of CP in COVID-19 patients, there is a paucity of ongoing and published studies evaluating the CP donors' side. This retrospective study reports the CP donors' selection and deferrals. Aim: To evaluate and analyze the donor deferral pattern and its causes among CP donors in a tertiary care hospital blood bank apheresis unit. Settings and Design: Hospital-based retrospective analysis. Subjects and Methods: Donors aged 18–65 years who had recovered from COVID-19 at least 4 weeks previously coming for plasma donation were retrospectively analyzed from July 25, 2020 to January 24, 2021 for a period of 6 months at blood bank apheresis unit, Assam Medical College and Hospital. Results: A total of 396 potential plasma donors were screened during the study period. The donor deferral rate was 39.1%. The permanent deferral was 36.8%, and the temporary deferral was 63.2%. The maximum number of donors deferred because of low antibody (18.7%) followed by low hemoglobin (14.8%). Associated comorbidities, low platelet count, repeat reverse transcription-polymerase chain reaction positivity, transfusion transmitted infection reactivity, intake of medicines, infections, vaccination, and underweight were other causes identified. Conclusion: The pattern of donor deferral is an important tool for blood safety and also provides key areas to focus on a demographic region or policy formulation for donor selection as well as to ensure donor safety.

Perianal Plasmablastic Lymphoma Masquerading as a Buschke-Löwenstein-like Tumour in an HIV-infected Patient with Recurrent Anal Condyloma

Plasmablastic lymphoma (PBL) commonly presents as a primary (de novo) oral or extraoral mucocutaneous or nodal mass lesion in patients with HIV/AIDS. PBL developing as a secondary malignancy at the same location as a pre-existing tumour is extremely rare and has never been reported in association with longstanding or recurrent anal condyloma. A Buschke-Löwenstein tumour is a rare gigantic, locally destructive condyloma that is usually located in the anogenital region. We report a case of a diagnostically and therapeutically challenging PBL that presented as a rapidly enlarging mass underlying a giant condyloma, thereby mimicking a benign Buschke-Löwenstein tumour. Clinical suspicion was further masked by the co-presence of fistulae in ano and adjacent abscess pockets at the time of diagnosis. By the time of final diagnosis, the lymphoma had disseminated to regional lymph nodes, a month later to pleural cavities and 4 months later to the leptomeninges and bilateral kidneys, leading to permanent deferral of chemotherapeutic intervention.LEARNING POINTSPlasmablastic lymphoma presenting as a secondary tumour in a patient with pre-existing giant anal condyloma has not been reported previously in the literature.Unusual clinical presentation of a recurrent giant condyloma, especially rapid growth and significant change in physical appearance, should kindle a high index of suspicion for a secondary aggressive tumour.Plasmablastic lymphoma disseminates early and rapidly, which complicates its response to treatment.

What are blood donors telling us about injecting drug use?

Injecting drug use (IDU), a permanent deferral for blood donors, was included in a review of donor selection criteria completed in 2017. Here, we describe what is known about IDU in blood donors in the United Kingdom (UK). Data were obtained from routine surveillance of donation testing and confirmed positive donors and a 2013/2014 UK survey of behaviour and compliance in screen-negative donors. Between 2009 and 2018, of 22 UK million donations screened, IDU was self-reported at the post-test discussion in 5% (86/1777) of donors with confirmed positive donations. Recent injecting within 12months was reported in 8 HCV-positive donors, but only in 1/14 donors where it was clear HCV infection had been acquired in the previous 12months. Of 65439 survey responders, 25 reported IDU, which when weighted to the donor population gave 99·95% compliance. Most of the 111 donors reporting IDU felt it was not important to their donation, mainly because their injecting was in the past, while three HCV-positive recent injectors reported not sharing needles so presumably felt safe to donate. Compliance with the permanent deferral appeared extremely high with low levels of injecting reported by donors, mainly in the past. This agreed with the low-incident HCV infection observed in UK donors. These data contributed to a recommendation to reduce the deferral to 1year. Ways of improving compliance in those few donors at current increased risk of infection need to be investigated.

An Evaluation of Donor Deferrals in A Blood Bank of a Tertiary Care Hospital A 3½-Year Study

Background: Blood transfusion is a crucial life-saving procedure that has become an integral component of modern medicine. It is therefore, imperative that the supply chain of blood to blood banks be optimized so as to meet the minimum demand of patients. This goal can be readily achieved by forming a safe reduction policy in the deferral rate of potential donors. The aim of this study was to explore the various causes for donor deferrals and to assess their frequency over the past 3½ years in a blood bank of a tertiary care hospital in Bangalore city. Methods: The data for the current retrospective study was collected over a period of 3 years 6 months from October 2015 to March 2019. Donors were asked to fill in a questionnaire followed by physical examination and blood screening tests. Results: Out of 2942 potential blood donors, only 2781 were accepted while the remaining 161 were deferred, the deferral rate being 5.5%. The age group of the deferred donors ranged from 18 to 49 years old, the highest being between 21-30 years old. There was a total of 119 temporary deferrals and 42 permanent deferrals. The most common cause for temporary and permanent deferral was found to be hypertension and sero-positivity for HBV antigen, respectively. Conclusion: In descending order of frequency, the most common causes for permanent deferrals were transfusion transmitted infection, hepatitis-B, Hepatitis-C and HIV and that for temporary deferrals were hypertension, alcohol consumption and anaemia. By identification of the causes for temporary deferrals, appropriate measures can be put in place to motivate these potential donors to return for blood donation at a later date after the underlying cause has been rectified.