Reasons For Deferral Research Articles

Vaccination deferral among children with seizures in Zhejiang: influence, recommendation, safety and implications

Objectives Delayed vaccination in children with seizures was common in China. This study aims to describe the vaccination status, reasons for vaccination deferral, vaccination recommendations and the safety for these patients in Zhejiang. Methods 1539 children included were divided into febrile seizure (FS) group, epilepsy (EP) group, unclassified seizure group and other symptomatic seizure group. The medical records and reasons for the vaccination deferral were collected by questionnaire. Vaccination data and Adverse Event Following Immunization (AEFI) were retrieved from the vaccination booklets. Results The main diseases of the children enrolled were FS (756, 49.1%) and EP (443, 28.8%). Most of them (95.6%) were vaccinated on time before the onset of seizure, but their vaccination was delayed after seizure occurred. 76.1% were recommended to receive vaccines normally, of which the FS group accounted for the highest proportion (90.3%). 88.73% of them were vaccinated as recommended, and there were no serious side effects or seizure reoccurrence. The main reason for vaccination deferral was providers’ and parents’ hesitation to have these children vaccinated. Conclusion Seizures were overestimated as a contraindication for vaccination in China. Routine vaccination was safe in most circumstances. It is essential to educate providers and parents about the benefits and contraindications of vaccination in children with seizures.

Individualized AML Induction with Venetoclax Based Therapy in Unfit Treatment Naïve Patients Aged ≤ 60 Years: A Real World Perspective from India

Introduction:Although AML outcomes have reportedly improved in the developed world, outcomes continue to be poor in low middle income countries (LMIC). Apart from financial constraints, presence of baseline infections is one of the major reasons for early mortality and treatment deferral. According to an Indian study of 268 patients acute leukemia, more than 54% patients had baseline infections out of which only 40% received induction versus 93 % patients who did not have baseline infections.(Ragesh R et al EHA23 abstract book: Hemasphere; 2018)Venetoclax has improved outcomes in AML and has been approved in elderly population. There is an unmet need for protocols for younger patients who are unfit for 3+7 due to multi drug resistant baseline infections or ECOG ≥2 or organ dysfunction.Methods:This is a single centre prospective observational study of AML patients who received either Azacytidine+Venetoclax or modified 3+7 regimen with Venetoclax.We recruited 26 AML patients aged 60 or younger who had clinico-radiological evidence of infection or ECOG PS ≥2 or comorbidities from July'19 to March'21. Therapy was individualized based on the nature of infections, ECOG PS and co morbidities into two cohorts by the treating panel.Cohort A (n=12) received Azacytidine @75mg/m 2 x 7 days with Venetoclax 100mg on day1, 200mg on day 2 and 100mg from day 3 with Voriconazole from day 3 onwards as antifungal prophylaxis and to reduce the cost. This regimen was preferred in patients who were unfit to receive modified 3+7 regimen.Cohort B (n=14) received modified 3+7. This included backbone of Cytarabine (Ara C) infusion @100mg/m 2 with Venetoclax. Daunorubicin @60mg/m 2 was added based on the clinical status of the patient.Venetoclax was added from day one in the similar ramp up manner as in cohort A. Day 14 bone marrow examination and cytopenias were used to guide the duration of Venetoclax(range 7-14 days).Daunorubicin doses were individualized as follows: Two doses of Daunorubicin were given to hemodynamically stable patients who showed recovery following antimicrobial therapy. Single dose of Daunorubicin was given to patients with multiple foci of infections or those who required ICU stay either before or during the initiation of therapy. Daunorubicin was omitted in patients on ventilatory support.Ara C infusion was limited to 5 days with 2 doses of Daunorubicin.Patients who achieved CR and had their infections resolved received standard consolidation like High dose Ara C or HSCT as per ELN risk.Results:Baseline data is presented in table 1. Induction mortality was 2/26 (7.6%) till day 56. Median follow up was 6 months. At Day 28 composite CR (CR+CRi) was achieved in 8/12 (66%) in cohort A and 10/14 (71.4%) in cohort B. At day 56 composite CR (CR+CRi) was achieved in 9/12 (75%) in cohort A and 12/14 (85.7%) in cohort B. Overall CR rates at day 28 & day 56 were 69.2% and 80%.One year OS was 62.8 % for the entire study population. It was 76.2% cohort A and 74 % in cohort B as per Kaplan Meier Curve estimates. RFS was 78.6% at 1 year for entire cohort. RFS was 66.7 % in cohort A and 100 % in cohort B.In Cohort A, all patients were continued on Azacytidine and Venetoclax as they were not fit for standard consolidation.At the time of analysis 33% patients experienced relapse, 25% patients had refractory disease and 42% patients continue to be in CR. 33% patients were dead at the time of analysis due to disease.In Cohort B, all patients who achieved CR were consolidated using Ara C @ 9 gm/m 2x 3 cycles. 2 patients underwent HSCT. No relapses were seen in this cohort. At the time of analysis, 3 non relapse mortalities were noted in Cohort B.Adverse events:Hematological toxicities were the most common adverse effects in both the arms. Most common infection was colitis. Sepsis due to carbapenem resistant organisms was the most common cause of grade ≥ 3 febrile neutropenia.On Univariate analysis the outcome was not affected by ICU stay. We report that AML induction using Ara C infusion and Venetoclax backbone with individualized Daunorubicin dose yields non inferior CR rates and durable responses. No patient in cohort B relapsed.We found that by modulating the intensity of induction using Venetoclax we can salvage heavily infected or co-morbid patients.Conclusion:Ara C infusion and Venetoclax based AML induction with individualized Daunorubicin dosing is a promising strategy in unfit younger patients. However, it needs to be validated in a larger prospective trial. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Pattern Of Blood Donation And Reasons For Deferral Of Blood Donors In A Tertiary Health Facility In Northeastern Nigeria

Bbackground: Blood transfusion is an essential lifesaving procedure in medical practice. The source of blood for donation can be from Voluntary Non-remunerated Donors (VNRDs), Family Replacement Donors, Commercial/Paid donors and Autologous Donors. The VNRD has been recommended by the World Health Organization (WHO). The situation in developing countries like Nigeria is different as there is scarcity of VNRDs which can be attributed to ignorance, fear, misconceptions regarding blood and blood products donation and transfusion. Objective: This study aimed to determine the pattern of blood donations and reasons for deferral in Abubakar Tafawa Balewa University Teaching Hospital Bauchi. Materials and Methods: This was a retrospective study where records of blood donors that presented to the Blood Bank of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi from January, 2018 to December 2019 were collected. Data was analyzed using Microsoft excel 2016. Ethical approval for the study was obtained from the Research and Ethics committee of ATBUTH Bauchi. Results: There were 19,406 prospective donors who presented for donation during the period under review. Of the 19,406 prospective donors, 24.7% (4,786/19406) were deferred from donation for various reasons including seropositivity to transfusion transmissible pathogens (70.3%), low blood level (anaemia) (20.5%), low weight (1.3%), among others. Females constituted only 2.4% (354/14,620) of the blood donors. Ninety eight percent (14,423/14,620) were family replacement donors while no commercial donors were seen during the period under review. Conclusion and Recommendations: There is a low rate of voluntary and female blood donation as well as a high donor deferral rate in our environment. We therefore recommend increased advocacy for regular voluntary non-remunerated blood donation by the community as well as encouraging more female participation in blood donation.

Laboratory monitoring during treatment of onychomycosis in pediatric patients: A survey of provider perspectives and practices.

Literature regarding the cost and necessity of laboratory monitoring during oral antifungal treatment in adults has recently been published. However, consensus guidelines for the treatment and monitoring of pediatric patients with systemic antifungals for onychomycosis are lacking. We sought to evaluate both the practice trends and perspectives of pediatric dermatology providers who treat pediatric onychomycosis. An electronic survey was administered to providers belonging to the Society for Pediatric Dermatology (SPD) and/or Pediatric Dermatology Research Alliance (PeDRA) regarding their clinical practice and reasoning for laboratory monitoring during the treatment of pediatric onychomycosis. One hundred and twenty-one providers completed the survey (12.5%). 77% identified themselves as pediatric dermatologists. A majority practice in the academic setting (51%), and 54% were primarily only pediatric providers. All respondents prescribe oral terbinafine for onychomycosis. 88% of respondents always or almost always confirm the diagnosis of onychomycosis prior to prescribing oral terbinafine for onychomycosis. 39% always or almost always routinely order baseline laboratory tests while 40% never or almost never do. 41% never or almost never order monitoring laboratory tests during treatment while 32% always or almost always do. 91.5% have never discovered a significant reaction to terbinafine with routine monitoring. Pediatric dermatology providers are very likely to confirm the diagnosis of onychomycosis prior to systemic treatment. Significant variability was found in pretreatment and treatment laboratory monitoring, reasons for laboratory monitoring or deferral of testing, and timing of testing among providers. Knowledge of current practice trends as well as provider perspectives may be useful in the future development of consensus guidelines.

Intraoperative Frozen Section Biopsy of Uterine Smooth Muscle Tumors: A Clinicopathologic Analysis of 112 Cases With Emphasis on Potential Diagnostic Pitfalls.

Frozen sections of uterine smooth muscle tumors are infrequently required, and related diagnostic difficulties are seldom discussed. We analyzed the clinicopathologic features of 112 frozen sections of uterine smooth muscle tumors and determined the accuracy, reasons for deferrals, and causes of interpretational errors. Most patients (median age, 45 y) presented with pelvic mass symptoms (53%). The main reasons for a frozen section examination were an abnormal gross appearance including loss of the usual whorled pattern of leiomyoma (36 cases, 32.1%), and intraoperative discovery of an abnormal growth pattern and extrauterine extension of a uterine tumor (28 cases, 25%). There were 9 leiomyosarcomas and 103 leiomyomas, including 18 benign histologic variants. An accurate diagnosis of malignancy was achieved in all leiomyosarcomas, with the exception of a myxoid leiomyosarcoma. In 99 cases (88%), the frozen section diagnosis concurred with the permanent section diagnosis (false positives, 0.9%; false negatives, 0%). Misinterpretation of stromal hyalinization as tumor cell necrosis in a leiomyoma with amianthoid-like fibers was a major discrepancy. Two minor discrepancies did not lead to a change in management. The diagnosis was deferred in 10 cases (8.9%) because of stromal alterations, unusual cellular morphology, uncertain type of necrosis, and abnormal growth patterns. Thus, although various stromal and cellular alterations can cause diagnostic uncertainty, leading to deferrals, frozen section diagnosis of uterine smooth muscle tumors has a high accuracy rate. While a definitive frozen section diagnosis of malignancy may be made when there is unequivocal atypia, indisputable mitotic figures, and tumor cell necrosis, it is important to remember that nonmyogenic mesenchymal tumors may also mimic uterine smooth muscle tumors. In a frozen section setting, it would be sufficient to issue a diagnosis of "malignant mesenchymal tumor." For tumors that do not meet the criteria for malignancy, issuing a frozen section diagnosis of "atypical mesenchymal tumor and defer the histologic subtyping to the permanent sections" is appropriate.

Understanding the Reasons for Deferring ART Among Patients Diagnosed Under the Same-Day-ART Policy in Johannesburg, South Africa

We aimed to examine the correlates of antiretroviral therapy (ART) deferral to inform ART demand creation and retention interventions for patients diagnosed with HIV during the Universal Test and Treat (UTT) policy in South Africa. We conducted a cohort study enrolling newly diagnosed HIV-positive adults (≥ 18 years), at four primary healthcare clinics in Johannesburg between October 2017 and August 2018. Patients were interviewed immediately after HIV diagnosis, and ART initiation was determined through medical record review up to six-months post-test. ART deferral was defined as not starting ART six months after HIV diagnosis. Participants who were not on ART six-months post-test were traced and interviewed telephonically to determine reasons for ART deferral. Modified Poisson regression was used to evaluate correlates of six-months ART deferral. We adjusted for baseline demographic and clinical factors. We present crude and adjusted risk ratios (aRR) associated with ART deferral. Overall, 99/652 (15.2%) had deferred ART by six months, 20.5% men and 12.2% women. Baseline predictors of ART deferral were older age at diagnosis (adjusted risk ratio (aRR) 1.5 for 30–39.9 vs 18–29.9 years, 95% confidence intervals (CI): 1.0–2.2), disclosure of intentions to test for HIV (aRR 2.2 non-disclosure vs disclosure to a partner/spouse, 95% CI: 1.4–3.6) and HIV testing history (aRR 1.7 for > 12 months vs < 12 months/no prior test, 95% CI: 1.0–2.8). Additionally, having a primary house in another country (aRR 2.1 vs current house, 95% CI: 1.4–3.1) and testing alone (RR 4.6 vs partner/spouse support, 95% CI: 1.2–18.3) predicted ART deferral among men. Among the 43/99 six-months interviews, women (71.4%) were more likely to self-report ART initiation than men (RR 0.4, 95% CI: 0.2–0.8) and participants who relocated within SA (RR 2.1 vs not relocated, 95% CI: 1.2–3.5) were more likely to still not be on ART. Under the treat-all ART policy, nearly 15.2% of study participants deferred ART initiation up to six months after the HIV diagnosis. Our analysis highlighted the need to pay particular attention to patients who show little social preparation for HIV testing and mobile populations.

Analysis of blood donors’ characteristics and deferrals related to COVID-19 in Iran

BackgroundWith the outbreak of the coronavirus disease in 2019, called COVID-19, Iranian Blood Transfusion Organization (IBTO) implemented the new deferrals. This study analyzed the COVID-19 deferrals of blood volunteers and compared the demographics, deferrals, and the donor status during the COVID-19 outbreak in 2019. Study design and methodsData were collected from the integrated blood donor database between Feb-Apr 2019 and 2020. Deferral reasons of COVID-19 were categorized as: those who have symptoms or live with a symptomatic family member, have direct exposure with a confirmed case, have travelled from the outbreak affected areas, and have fully recovered from confirmed COVID-19. The z-test analysis was used, and 95 % confidence intervals were calculated to compare the sample proportions. ResultsThe blood donations dropped to 26.09 % in 2020. The percent change of first-time blood donors, female donors, and donors within the age group of 45−54 years old was significantly greater in 2020 than the same time frame in 2019 (p < 0.05). The results showed that 0.58 % of volunteers were deferred from blood donation to avoid transmission of SARS-CoV-2. The rate of COVID-19 deferrals in all types except travelling to affected areas has increased in the second 30-day of the study (p < 0.05). ConclusionThe blood shortage that occurred during the COVID-19 outbreak was not due to increased deferral for COVID-19, but it was mostly due to a decrease in the number of volunteers who referred to BTCs.

Impact of COVID-19 pandemic on the pattern of blood donation and blood safety: Experience from a hospital-based blood center in North India.

INTRODUCTION:Although coronavirus disease-2019 (COVID-19) pandemic does not result in increased blood needs, blood supply can be considerably compromised due to the unavailability of blood donors. The objective was to share our experience about blood donation patterns and concerns on blood safety during COVID-19 pandemic in India.METHODS:This was a retrospective study of approximately 4.5 months of data including both lockdown period (LD) and LD phases. LD phase was further subdivided into four phases of varying durations. Data of blood collected and various reasons for deferral of prospective donors were analyzed. The effectiveness of mitigation strategies adopted to maintain adequate blood inventory was also assessed. Events in transfusion services during the LD were compared with the pre-LD (P-LD) phase.RESULTS:The mean collection per day for WB and SDP was reduced by 70% and 50%, respectively, compared to pre-LD. Approximately 23% of WB and 27% of SDPs were collected on an appointment basis during LD. The proportion of indoor voluntary blood donation was increased by 7–8 times during LD compared to P-LD. Approximately 2% of total prospective donors screened were deferred after thermal scanning and due to risk of being infected with COVID-19. Donor deferrals due to high-risk behavior increased significantly in the LD phase compared to P-LD period.CONCLUSION:COVID-19 pandemic has a significant impact on the pattern of blood donation and blood safety. Transfusion services must develop appropriate plans to respond efficiently to various challenges posed by such pandemics.

Improving Pneumococcal Vaccination Rates in Rheumatology Patients by Using Best Practice Alerts in the Electronic Health Records

To improve pneumococcal vaccination (PV) rates among rheumatology clinic patients on immunosuppressive therapy in the outpatient settings. This quality improvement project was based on the pre-post intervention design. Phase I of the project targeted patients with rheumatoid arthritis from 13 rheumatology clinics (January 2013-July 2015) on immunosuppressive therapy to receive the pneumococcal polysaccharide vaccine (PPSV23). In the Phase II study (January 2016-October 2017), all patients on immunosuppressive medications regardless of diagnosis were targeted to receive PPSV23 and the pneumococcal conjugate vaccine (PCV13). The best practice alerts (BPAs) for both PVs were developed based on the Centers for Disease Control and Prevention guidelines, which appeared on electronic medical records for eligible patients at the time of assessment by the medical assistant. The BPA was designed to inform the vaccination status and enable the physician to order the PV, or to document refusal or deferral reasons. Education regarding vaccine guidelines, BPAs, vaccination process, and regular feedback of results were important project interventions. The vaccination rates during pre-post intervention for each study phase were compared using chi-square test. During phase I, PPSV23 vaccination rates improved from a 28% preintervention rate to 61.5% (P < 0.0001). During phase II, 77.4% of patients had received either PPSV23, PCV13, or both, compared to 49.6% of patients in the preintervention period (P < 0.0001). The documentation rates (vaccine received, ordered, patient refusal and deferral reasons) increased significantly in both phases. Electronic identification of vaccine eligibility and implementation of BPAs with capabilities to order and document resulted in significantly improved PV rates. The process has potential for self-sustainability and generalizability.

A cross sectional study of the reasons for deferral of voluntary blood donors at a district blood bank attached to a medical college hospital in southern Karnataka

Introduction: The study objectives were to determine the demographic profile of voluntary donors who were deferred from donating blood and the different reasons for deferral of those donors who intended to donate blood to the hospital blood bank. Materials and Methods: A cross sectional, record based study was done from March 2014 to February 2015 at the blood bank. The data was entered into Microsoft® ExcelTM Spreadsheet and was analysed using the same. Descriptive statistics were obtained. Result: A total of 7,319 potential donors were screened by the blood bank of whom, 7000 (95.64%) were selected for donating blood and 319 (4.36%) were found ineligible for blood donation for various reasons. Of all the potential blood donors, male donors were 6991, of whom 6783 (97.02%) were selected and 208 (2.98%) were deferred from donating blood. While out of 328 registered female donors, 217 (66.15%) were selected and 111(33.84%) were deferred. Permanent deferral rates were comparatively higher for males than females and temporary deferrals, were higher among female donors. A major proportion of the deferred donors were between the age group of 18-30 years. Anemia, medication intake, being underweight and underage were predominant reasons for deferral among temporary deferrals. Conclusion: A significant number of potential blood donors are deferred for various preventable and treatable reasons. The deferred donors need to be actively pursued, so that they can contribute by donating blood and saving lives as they may get de-motivated, when they are deferred from donating blood. Keywords: Voluntary blood donors, Deferral.

Evaluation of blood donor pre-donation deferral causes in ESIC Medical College Hospital, Chennai, Tamilnadu

Systematic analysis of pre-donation deferral reasons guides the transfusion society to undertake necessary steps towards the retention and re-entry of the temporary deferrals. Aim of our centre’s study is to find out the causes for deferral in detail and to reduce the pre-donation deferrals to an extent that give appreciable results. One year donor details from January 2019 to December 2019, collected from the properly maintained registers, grouped and studied with respect to age, gender and reason for deferral.Deferred donors were 184 out of 2083 registered volunteersThe number of males deferred were higher (139/184; 75.54%) than females (45/184; 24.46%), but the deferral rate was higher in females (45/109; 41.28%). Temporary deferral (84.23%) accounted more than 4/5 of the total deferrals.As our study, most of the studies in literature indicate higher percentage of donor deferrals due to temporary causes. Suitable temporary deferrals can be brought back into the donor pool after completion of the treatment by giving proper counselling about the reason and period of deferral.

&lt;p&gt;Blood Donor Deferral Analysis in Relation to the Screening Process: A Single-Center Study from Southern India with Emphasis on High Hemoglobin Prevalence&lt;/p&gt;

PurposeDonor deferral results in loss of potential, motivated blood donors, and thereby, availability of blood for needy patients. This study analyses the frequency and reasons for donor deferral, including high hemoglobin deferral, which is underreported in India.MethodsRetrospective analysis of the deferral record of whole blood donors from January 2014 to December 2018 was performed with respect to the pre-donation screening process at our center. Accordingly, the deferrals are categorized as stage1 – evaluation of Donor History Questionnaire (DHQ), stage 2 – medical examination, stage 3 – hemoglobin (Hb) check using copper sulfate method or a gradually implemented quantitative hemoglobin analyzer, and stage 4 – before phlebotomy. Donor demographic details, donation frequency, and deferral reasons were noted. Descriptive statistical analysis was performed using SPSS version 20 (IBM, USA).ResultsOf 99,680 pre-donation screenings, 10.6% was deferred. The highest deferral (56.02%) was at stage 3 (based on hemoglobin level) contributed by low (52.45%) and high (3.75%) hemoglobin deferrals against cut-off of 12.5 to 18 g/dl. High Hb was noted only in male donors when screened by hemoglobin analyzer. Further, a steady fall in low hemoglobin but a rise in high hemoglobin deferral rate owing to the gradual implementation of hemoglobin analyzer over the study period was noted. The deferrals in stage 1, 2, and 4 were 29.64%, 13.97%, and 0.36%, respectively. Overall, the deferral rate was higher in females (49.88%), and in first-time (13.63%), and 18 to 25 yrs age-group (4.25%) donors for low Hb, underweight, and tattooing/ear piercing.ConclusionInsights on donor deferral reasons promote proactive measures towards donor recruitment and retention. Further, donor hemoglobin screening by quantitative method, if followed uniformly by all blood centers across the country, will help identify the true prevalence of high hemoglobin in Indian blood donors and ensures donor safety.

Demographical Pattern of Blood Donors and Pre-Donation Deferral Causes in Dhahran, Saudi Arabia.

BackgroundUnderstanding the demographic features of blood donors is important for identifying the donor structure and guiding the recruitment and retention strategies of donors. This study was aimed to determine the demographic characteristics of blood donors, the types of donation drives, and the frequency and reasons for pre-donation deferral in our population.MethodsThis cross-sectional study included data analysis of all prospective blood donors presenting themselves for donation at the Blood Bank of the King Fahad Military Medical Complex, Dhahran, Saudi Arabia between January 2010 and December 2018. Eligibility of blood donation was assessed using a standardized history questionnaire, physical examination, hemoglobin estimation, pulse rate, blood pressure, and temperature. The questionnaire included the demographic features of the donor such as age, gender, and the reason for donation and other specific risk factors that potentially affect the safety of the donor or the recipient. Data analyzed using the analysis of SPSS version 20 (SPSS Inc., Chicago, IL, USA) were used to calculate the unadjusted odds ratios (OR) and the respective 95% confidence interval for the association between the various demographic parameters.ResultsA total of 28,189 potential donations were recorded during the study period; of these, 77.4% were family replacements with females accounting for only 1.8% of all donations. Most of the donors were Saudi nationals (92.1%) of whom donors between 18 and 34 years old constituted 87.9%, while those over 40 years old represented only 7.9% of the donations. Pre-donation temporary deferral occurred in 3300 (11.7%) of all potential donation attempts. The most common causes being the recent intake of medication (24.4%) followed by low hemoglobin (14.8%), low or high blood pressure (14.6%), low or high pulse rate (13.6%), and low weight (11.6%).ConclusionA profile of blood donors consisting mainly of young male citizens who mostly donated for family replacement was detected. Deferral rate was found to be average when compared to other countries; the causes being similar to those detected in other developed countries. Simple descriptive statistics has shown no marked difference was noted over the 9 years of the study in neither the profile of blood donors nor the cause for temporary deferral of prospective blood donors.

Effective methods for reactivating inactive blood donors: a stratified randomised\xa0controlled study

BackgroundRecruiting of sufficient numbers of donors of blood products is vital worldwide. In this study we assessed the efficacy and cost-effectiveness of telephone calls and SMS reminders for re-recruitment of inactive blood donors.MethodsThis single-centre, non-blinded, parallel randomised controlled trial in Guangzhou, China included 11,880 inactive blood donors whose last donation was between January 1 and June 30, 2014. The donors were randomly assigned to one of two intervention groups (telephone call or short message service [SMS] communications) or to a control group without intervention. SMS messages with altruistic appeal were adopted in the SMS group; in addition to altruistic appeal, reasons for deferral of blood donation were also asked in the telephone group. All participants were followed up for 1 year. The primary outcome was re-donation rate, and rates in different groups were compared by intention-to-treat (ITT) analysis and estimation of the average treatment effect on the treated (ATT). Secondary outcomes were the self-reported deterrents. Other outcomes included the re-donation interval, and the incremental cost-effectiveness ratio (ICER) of telephone calls and SMS reminders on re-recruitment.ResultsITT analysis revealed no significant differences in the re-donation rate among the three groups. ATT estimations indicated that among compliers, telephone calls significantly increased re-donation compared to both SMS reminders and no intervention. Donor return behaviour was positively associated with receiving reminders successfully, being male, older age, and previous donation history. The SMS reminder prompted donors to return sooner than no reminder within 6 months, and according to ICER calculations, SMS reminders were more cost-effective than telephone calls. Donors reported time constraints as the most main causes of self-deferral in the telephone group, and altruistic appeal had a positive effect on these donors.ConclusionsInterventions to reactivate inactive blood donors can be effective, with telephone calls prompting more donors to return but at a greater cost than SMS messages. SMS reminder with altruistic appeal can urge donors to re-donate sooner within 6 months than no reminder.Trial registrationNCT03366441 (Reactivation of Inactive Blood Donors). Retrospectively registered 4 December 2017.

Analysis of Blood Donor Deferral in a Tertiary Care Hospital

Introduction: Selection of proper donor according to stringent selection criteria is the prerequisite for safe blood transfusion practice. It is widely known that a large number of blood donors are deferred for different reasons.&#x0D; Objective: The aim of present study is to evaluate the incidence and different reasons of blood donor deferral in atertiary care hospital.&#x0D; Methodology: This retrospective cross-sectional study was carried out in Transfusion Medicine and Clinical Haematology Department of BIRDEM General Hospital, Dhaka, during the period from July 2016 to June 2017.The blood donor of either sex attending the mentioned department were selected purposively and categorized into four groups according to their age for this study. Donors were selected and deferred by medical officer according to national guideline. Deferred blood donors were recorded in register book and were analyzed retrospectively.&#x0D; Results: In current study, 1152 blood donor (8.8%) were deferred attending for allogeneic blood donation during the study period. Out of 13082 registered blood donor 11961were male (91.43%) and 1121 were female (8.57%) and deferral rate was 2.37 times more in female. Majority of the deferred donors (55.38%) were under the age of 40 where 26.82% were in between 40-49 years and 17.8% were in the range of 50 years and above. Age range of highest deferred donors (32.20%) was between 30-39 years. The number of temporary and permanent deferral were 836 (72.57 %) and 316 (27.43%) respectively. Anaemia (33.01%), underweight (21.53%) and hypotension (17.34%) were the most common reason of temporary deferral. Chronic uncontrolled hypertension (42.4%), donors with medication (16.77%) and asthma (15.18%) was the most common cause of permanent deferral.&#x0D; Conclusion: The deferral rate was low and most of the deferred donors were young adult. Temporary deferred donors were higher than permanent deferred donors. The most common reasons for temporary deferral were anemia, underweight and hypotension. Permanent deferral causes were chronic uncontrolled hypertension, donors on medication for various reason and asthma. Donors should be informed with a clear message on their deferral status. It is important to determine the rate and causes of donor deferral for the safety of blood transfusion and to guide the recruitment efforts for safe blood transfusion and to avoid the permanent loss of blood donors.&#x0D; Northern International Medical College Journal Vol.10 (2) Jan 2019: 373-376

Impact of a Related Donor Pre-Screening Questionnaire on Donor Deferrals

Background Match related donors (MRDs) have long been a critical source of stem cells for patients needing an allogeneic transplant. In both our center and across the country, approximately 30% of patients needing an allogeneic transplant will have a matched family member who can serve as their donor. In our center these donors are, on average, over a decade older (median age = 40) than unrelated donors (median age = 27) at the time of donation. Additionally, 21% of our potential donors live outside the northeastern (New England and New York) region, and thus make significant travel time investments to come to our center. This makes it critical that any disqualifying medical issues be caught as early in the process as possible, preferably prior to the donor coming on site. Methods A donor pre-screen questionnaire was designed to be administered to potential donors by phone prior to typing. A pilot program was implemented with a subset of patients in December 2016 and expanded to all patients in June of 2017. If any potentially disqualifying conditions or other concerning information was noted on the donor pre-screen, it was given to a member of the Donor Services clinical team for review and follow-up. Donors not meeting medical suitability criteria were deferred either prior to typing or after a physical exam (PE). Results In the first two years after full implementation, 1073 potential related donors were referred to the Donor Services group. All but 40 (3.7%) of these were able to be pre-screened. Those who were not pre-screened were primarily international potential donors or non-responsive to phone contact. Of the remaining 1033 donors, 441 (42.6%) had prescreens requiring clinical review. After this review, 112 donors (11%) were deferred prior to typing. An additional 30 (3%) were preemptively disqualified from donating one product type (either PBSC or marrow) at time of pre-screen, and 15 (1.5%) were noted to have issues that may defer them if they were selected. The most common reasons for deferral were multiple complex medical issues (25%), severe cardiac issues and/or treatment with blood thinners (23%), and recent cancer history (13%). The rate of deferral after PE dropped from 11% to 5% (p Conclusion The donor pre-screening process has been beneficial for our center. Fewer HLA kits were sent out to donors not meeting medical criteria for clearance, and more donors were deferred prior to coming on site. Additionally, donor PE visits were streamlined as medical record requests and additional testing could be ordered prior to the visit allowing us to see greater donor volume (18% increase) without expanding resources. Finally, important information about the donor was able to be communicated to the recipient team prior to donor selection, helping them optimize donor selection.

Assessment of blood donor selection and deferral pattern in a tertiary care hospital in Central India

Introduction:Safety and efficacy of blood donations depends on selection of suitable donors. Understanding the prevalent reasons of non-suitability of donors can help understanding the donor pool demographics to develop better donor recruitment and screening strategies. Material and Methods: This is across sectional retrospective study conducted in a tertiary care hospital in central India over a period of two years from January 2017 to December 2018. The donor registry from in hospital donation as well as the blood donation camps were analyzed for the pattern of deferral. Results: Total 18,025 people donated blood during the study period. During this period the number of deferrals was 681. The overall deferral rate was 3.77%.Males constituted the majority of donors (17586, 97.56%), and expectedly majority of deferrals were in males (626, 3.47%). The most common reason of temporary deferral in donors was recent alcohol intake is 197(28.93%) potential donors which was exclusively in the males. The most common reason of permanent deferral was hypertension (59, 8.66%). The common reason for deferral among deferred females was low hemoglobin (26, 47.27%) and that in deferred males was alcohol intake (197, 31.46%). Conclusion: Donor deferral is essential to ensure the safety of both the donor and recipient of the blood; however, it can also lead to non-return of temporarily deferred donors. A pattern and trend in donor deferral could be used as a reference for developing policy and future initiatives in donor education, encouragement and retention.

Challenges in the collection of convalescent plasma for COVID-19 patients at a plasma therapy trial site

Background and Objectives: With no proven treatment guidelines for COVID-19, human convalescent plasma is an option and has been under trial worldwide. In India, Indian Council for Medical Research (ICMR), started a Mulicentric Trial for the use of convalescent plasma in the treatment of COVID patients. The purpose of this paper is to analyse the challenges encountered in the collection of convalescent plasma from COVID recovered patients at a trial site. Methods: The current prospective study was carried out in a tertiary care hospital based blood centre catering to COVID patients and a trial site for Plasma therapy by ICMR. For analysing the challenges in the collection of convalescent plasma, the discharged patients were contacted telephonically. After applying eligibility criteria, the reasons of deferral were assessed. Data was collected and analysed. Results: The current prospective study was carried out during the period of 1st April 2020 to 15th May 2020. During this period, a total of 496 patients got discharged. After applying deferral criteria, 113 were eligible, out of which only 13 (11.5%) consented to come to donate plasma. Conclusion: In a global ongoing pandemic, the “Fear Factor” is a constraint and a major challenge to motivate and convince a COVID recovered patient for plasma donation. The challenge for the medical professionals is to motivate, convince and educate the potential donors and society about the likely benefits of COVID Convalescent Plasma.

Considerations for Referral: What Happens to Patients After Being Turned Down for Left Ventricular Assist Device Therapy

BackgroundLeft ventricular assist device (LVAD) therapy has revolutionized the treatment options for patients with advanced heart failure. Patient selection is essential for obtaining successful results. However, few data exist concerning the outcomes of patients evaluated for LVAD therapy but subsequently rejected or deferred. Methods and ResultsThis is a retrospective review of all patients referred for LVAD therapy at our institution between January 2009 and December 2016. Baseline demographics and Interagency Registry for Mechanically Assisted Circulatory Support profiles were collected, and reasons for rejection or deferral for LVAD placement were investigated. A total of 669 patients were referred for LVAD therapy, and 228 patients (34%) were turned down. The yearly acceptance rate ranged between 57% and 75%. The average age of the turned-down cohort was 60.8 ± 12.5 years; 83% were men. Reasons for rejection included: patient being too sick (34%); psychosocial concerns (25%); patient declined (16%); decision was deferred for medical optimization (15%); or patient being too well (10%). The percentage of patients who were rejected due to psychosocial concerns has increased over time (P = 0.02), whereas the rate of deferral for medical optimization has remained stable (P = 0.10). One-year survival after initial LVAD consultation was 42% in those who were too sick, 64% in those with psychosocial concerns, 68% in patients who declined, 86% in those deferred for medical optimization; and 100% in those too well (P < 0.01). ConclusionsOne-year survival is reduced among patients who were initially turned down for LVAD therapy, except for those in whom this decision was deferred for medical optimization or because the patient was too well. Psychosocial concerns have become a significant barrier to LVAD therapy.

Do deferred donors continue their donations? A large-scale register study on whole blood donor return in the Netherlands.

BACKGROUNDTemporary deferral of whole blood donors is essential for a safe blood supply, yet deferral may impact donor return. Different deferral reasons may differently affect return, and donor experience may interfere with this. Therefore, we studied the joint effect of deferral reason and donor experience on return.STUDY DESIGN AND METHODSWe used a large‐scale retrospective cohort design including all Dutch donors with a whole blood donation attempt in 2013 to 2015 (n = 343,825). We established details of the target donation (including deferral reason if applicable), details of attendances in the 2 years after the target donation, donor characteristics (blood type, sex, age), and donor experience (first‐time, novice, experienced, reactivated). Descriptive statistics as well as time‐to‐events methods were used.RESULTSExperienced donors were most likely to return, even after deferral (nondeferred 96% vs. deferred 92%). First‐time and reactivated donors were less likely to return after deferral (69 and 61%, respectively) compared to their nondeferred counterparts (82 and 76%, respectively). First‐time hemoglobin (Hb)‐deferred donors were less likely to return and slower to return than other donors. Similar results were found for reactivated donors deferred for short‐term medical reasons.CONCLUSIONDeferral reason and donor experience individually as well as jointly impacted donor return. Particularly first‐time and reactivated donors were at risk of nonreturn, especially when deferred for Hb or short‐term medical reasons, respectively. Blood banks designing and implementing donor retention strategies should thus not only take successful but also unsuccessful donation experiences and different experience levels into account.