Donor Return Research Articles

Factors associated with first-time and repeat blood donation: Adverse reactions and effects on donor behavior.

Blood centers have a dual mission to protect donors and patients; donor safety is paramount to maintaining an adequate blood supply. Elucidating donor factors associated with adverse reactions (AR) is critical to this mission. A retrospective cohort analysis of whole blood donors from 2003 to 2020 was conducted at a single blood center in northern California. Adjusted odds ratios (AORs) with 95% CIs for ARs were estimated via multivariable logistic regression on demographics, donation history, and physical examination data. Where appropriate, Wilcoxon-Rank Sum and chi-squared tests were used to determine significance. First-time blood donors (FTD) exhibited a higher AR rate than repeat donors (4.4% vs. 1.9% p< .0001). When compared with FTDs without AR, FTDs with ARs (FT-AR) were less likely to return (30.0% vs. 47.3%, p< .0001), and, of those who returned, had a higher rate of reaction 20.2% versus 2.8% (p< .001). Factors found to be associated with FT-AR (younger age, increased heart rate, and higher diastolic blood pressure) still correlated positively with AR on return donation, but to a lower degree. FTD who potentially witnessed an AR had a lower return rate (44.6% vs. 47.3%, p= <.001) and donated fewer units (2.38 vs. 3.37, p< .001) when compared to FTD who did not witness an AR. The AR on FTD increases the AR likelihood of return donation. Longitudinal analysis shows that a time-based deferral policy targeted at FT-AR young donors can reduce the number of ARs while not dramatically impacting the blood supply.

Is high hemoglobin a hindrance factor for blood donation? A pilot observational study from the coastal region of India.

Blood donors with high Hb are often deferred for the presumed risk of polycythemia vera (PV). However, adequate data to substantiate or refute this hypothesis is lacking. We conducted an observational study on blood donors found to have high hemoglobin (Hb≥18g/dL) during the pre-donation screening process using a portable hemoglobinometer at our blood center for four months. We adopted a cost effective methodology wherein a questionnaire was used to elicit the secondary causative factors of high hemoglobin and a complete blood count test to observe the blood cell parameters and JAK2V617F mutation test was performed in a subset of donors lacking secondary erythrocytosis (SE) history. Of the total 7076 donors enrolled, 112 male donors (1.58%) had high hemoglobin. The majority (70.4%) were repeat donors with mean age of 31.4 years. About 61% of the donors had attributable factors for SE like smoking, occupational exposure to carbon monoxide. The mean hemoglobin value of capillary and venous hemoglobin demonstrated a statistically significant difference (P<0.05) where 2.7% of donors had venous Hb<18g/dL. The hematological profile of all the donors showed increased RBC but normal platelet and WBC count. Of 24 donors included for the JAK2V617F test, none had a positive report. This study suggests high hemoglobin in blood donors is less likely due to PV. Hence, re-considering their deferral may help alleviate donor anxiety and allow donor return. However, multi-centric studies are required to develop consensus statements on PV risk status and blood donation eligibility.

Ferritin-guided iron supplementation in whole blood donors: optimal dosage, donor response, return and efficacy (FORTE)—a randomised controlled trial protocol

BackgroundFrequent whole blood donors have an increased risk of developing iron deficiency. Iron deficiency can have detrimental health effects when left untreated. Donation intervals are commonly too short to replenish...

INVESTIGATION OF NATURAL EXTRACTS AS GREEN CORROSION INHIBITORS IN STEEL USING DENSITY FUNCTIONAL THEORY

One of the materials with low corrosion resistance is steel when it interacts with a corrosive environment. The use of green inhibitors is able to provide good corrosion inhibition performance with high inhibition efficiency on steel. Green inhibitors which in their compound structure contain heteroatom groups (such as O, N, S, P) and aromatic rings are efficiently used as corrosion inhibitors in steel. This paper provides an important comparative overview for the development of green inhibitors of natural extracts in steel. The study of DFT at the atomic level based on molecular orbitals, chemical quantum parameters, and adsorption characteristics showed results that were in accordance with experimental results. The distribution of electron density through the Frontier Molecular Orbitals (FMO) plot illustrates the prediction of active sites through the distribution of the HOMO-LUMO region of inhibitor molecules that interact with the steel surface. To get the correlation between the electronic properties of the inhibitor molecule and the corrosion inhibition potential, calculate the quantum chemical parameters such as ionization potential (I), electron affinity (A), global hardness (η), absolute electronegativity (χ), global softness (σ) , the transferred electron fraction (ΔN), global electrophilicity (ɷ) and electron return donation (ΔEback-donation) indicate the reactivity of inhibitor molecules which have excellent potential to interact and bind strongly to metal surfaces, thus potentially producing high inhibitory efficiency. The mechanism of corrosion inhibition can be through chemical adsorption and/or physical adsorption by forming a complex compound between the inhibitor molecule and the steel surface to protect it from the corrosive environment. The development of future studies should be able to display the mechanism of interaction and inhibition of inhibitor molecules in more detail and systematically at the atomic level on several metal surfaces such as Fe, Al, Cu, and others .

Ramadan favors first blood donation, but not frequent donation: Results of 10,145 blood donors from Algeria.

Frequent blood donors contribute to an important share of blood donations in many countries. In Algeria, frequent donation and its determinants, notably the place of the month of Ramadan, which plays an important role in blood donation in Muslim countries, have not been studied. This was a retrospective cohort study of n = 10145 Algerians who donated blood to the blood transfusion post (BTP) of Boufarik between January 2, 2008, and December 31, 2019. Donors were assessed at each donation for general clinical information, demographic information, and dates and times of donation. Donor return, defined as two or more donations to Boufarik BTP, and frequent donation, defined as three or more blood donations to Boufarik BTP, were the outcomes of interest and were analyzed using groups comparison and logistic and Cox regression analyses. 2.2% of donors were frequent donors and donated 9.6% of all donated blood. The volume of donated blood during Ramadan was twice the monthly volume during the rest of the year, but donation in Ramadan was associated with lower odds of return (odds ratio [OR]: 0.54, 95% confidence interval [CI]: 0.40-0.71) and frequent donation (OR: 0.41, 95% CI: 0.24-0.73). Women were underrepresented (10.9%), but they were more likely to be frequent donors (male vs. female OR: 0.55, 95% CI: 0.31-0.96; hazard ratio: 0.64, 95% CI: 0.41-0.98). Reducing the gender gap and promoting return could significantly improve the volume of blood donations in Algeria.

Petogodišnja studija preseka incidence neželjenih reakcija kod dobrovoljnih davalaca cele krvi u Vojvodini

Introduction: Blood donors (BDs), in most cases, tolerate the whole blood donation procedure well. However, occasionally adverse reactions (ARs) may occur. ARs often have a negative impact on donors return. Therefore, the staff of transfusion institutions must be educated and properly trained to recognize and take care of BDs who experience ARs before, during or after the procedure. The incidence of ARs is about 1,4%. Aim: To determine the frequency and severity of ARs that occurred among BDs on the territory of Vojvodina, analyze the age and profile of donors in whom they were recognized, indicate possible prevention of ARs. Material and methods: In a retrospective study, the records of ARs among whole BDs at the Blood Transfusion Institute Vojvodina, from January 1 2017, until December 31, 2021 were analyzed. Demographic data of the donors were obtained from the Institute's information system. The data were analyzed according to the time and manner of occurrence and the severity of ARs. Results: During the study period there were 194 425 blood donations. The ARs were identified in 2722 (1,4%) donations. The incidence was 14 in every 1000 donations. BDs who suffered ARs were 28,0 ± 8,3 years old, 1881 (69,1%) were male, 841 (30,9%) were female, while 1908 (70,1%) donated blood for the first time. In 2396 (88,03%) BDs vasovagal reaction occurred, 737 (27,08%) experienced nausea, 363 (13,33%) suffered syncope, 221 (8,13%) developed hyperventilation, 64 (2,34%) gained hematoma. Severe ARs in the form of collapse with convulsions were experienced by 12 (0.44%) donors. In multiple BDs, ARs were significantly less frequent (p&lt;0,05). Conclusion: Although the number of donors with ARs in institution is low, it is necessary to monitor them, react promptly in case of their occurrence and minimize the risks of occurrence, primarily through education and preparation of donors for the whole blood donation procedure.

Factors Affecting Blood Donation Intervals And Patterns Of Return Based On A Sample In Southern Iran: A Follow-Up Design

Objectives — The main goal of blood transfusion centers is to recruit and retain more qualified blood donors. This study aimed to identify the factors influencing the return of volunteer blood donors. Material and Methods — A cohort study was conducted on all blood donors who donated blood for the first time, from March 21, 2013, to March 20, 2014. They were followed up for five years (up to March 20, 2018). Demographic characteristics, type of blood donation and time interval between two blood donations were recorded as recurrent events. Data were then analyzed using Logit Model for Multinomial Responses and Cox's shared frailty model. Results — Of the 2010 blood donors, 33.7% as the repeated donor and 16.2% as the regular donor had regular donations. The frequency of blood donation was in the range of 1 to 20 with a mean of 4.54±3.29. There was a significant reverse relationship between the number of donations and the time interval between two donations. The variables of gender, marital status and occupation had a significant effect on the blood donation of the repeated and regular donors. Genders, age at the time of the first donation, marital status and occupation had a significant effect on the intervals between blood donations. Conclusions — Most of blood supply of Iran is provided by men and first-time donors. Since the decision to donate and keep donating blood involves many complex issues applied programs are require to convert women and first-time donors into regular donors.

Serial monitoring of ionised calcium levels in plateletpheresis donors: A study from tertiary care oncology centre in India

BackgroundPlateletpheresis is a safe procedure, and the most common reaction is hypocalcemia which is transient and self-limiting, but it can have an impact on donor experience and donor return rate. AimTo serially monitor the ionized calcium levels of the plateletpheresis donors and to correlate with symptoms of hypocalcemia if any. MethodsIt was a prospective observational study in 126 healthy voluntary donors eligible for plateletpheresis as per the Departmental SOP and after taking written informed consent. Procedures were conducted on continuous flow centrifugation (CFC) and intermittent flow centrifugation (IFC) cell separators. Donor blood samples were collected in pre-heparinized syringes at different intervals to measure ionized calcium levels (iCa++) by venous blood gas analysis (Cobas 221). ResultsThere was a continuous and gradual decrease in iCa++ from start to 30–45 minutes during the procedure; while the levels showed a gradual increase at end of the procedure and reached near the baseline values after 15−30 min of completion of the procedure. The change in iCa++ was statistically significant at 30 min and 45 min (p < 0.05), which was correlated with symptoms of hypocalcemia observed in 32.5 % (41/126) of the donors. Females experienced more symptoms of hypocalcemia as compared to males (p < 0.01). Donors who underwent plateletpheresis on the IFC machine experienced more symptoms of hypocalcemia as compared to the CFC machine (p < 0.05). ConclusionFor donors with persistent symptoms of hypocalcemia which are unrelieved by procedural modifications (reducing blood return rate, citrate infusion rate, etc.) measurement of iCa++ and administration of oral calcium tablets may be considered.

Role of motivation in the return of blood donors: mediating roles of the socio-cognitive variables of the theory of planned behavior

The starting point of this study is based on a ground observation in Tunisia: The unsustainable blood donations and the shortage of clinical blood in some periods of the year (i.e. holidays; covid-19). This observation is also avowed in over the world. The present study extends the theory of planned behavior (TPB) by incorporating relevant variables from Self-determination Theory (SDT). The latter suggests that individuals persist with a behavior when they are internally motivated than externally motivated. Online survey was administrated to assess TPB constructs (attitudes, social norms, perceived behavioral control (PBC), personal moral) and two of SDT factors (autonomous and controlled). 321 donors responded to the questionnaire. Results revealed that effects of autonomous and controlled motivation on behavioral intention were mediated by attitude, PBC as well as moral norms. This paper proposes practical recommendations to social marketing designers to better retain blood donors.

The vasovagal reaction experience among blood donors: A qualitative study of factors that affect donor return

RationaleBlood collection agencies face ongoing challenges in retaining voluntary donors to meet the demand for blood and blood-related products by healthcare services. A known deterrent to continued blood donation is the experience of a vasovagal reaction (VVR). However, there has been little research into donors’ experiences of these reactions and the factors that influence their decision to return, which is essential information to inform strategies to improve donor return. ObjectiveThe aim of this paper was to explore blood donor views and experiences of a VVR, with a particular interest in how the reaction influenced their return behaviour, using the Transactional Model of Stress and Coping. MethodsWe conducted 34 semi-structured in-depth interviews between February and April 2018 with a sample of Australian donors who had experienced a VVR in the last seven days. Transcripts were analysed using the Framework Method. ResultsThe VVR elicited various emotional responses, which appeared to be influenced by social support, being aware of the possibility of experiencing a VVR, or the donation outcome. In turn, the VVR experience affected intentions to return, with those who reported more positive experiences expressing stronger intentions. Further, donors felt more likely to return if they perceived their risk of a recurrent event as low and if they were able to identify appropriate problem and emotion-focused coping strategies. ConclusionThis article provides novel insights into possible ways to encourage blood donor return following a VVR.

Incentives and limitations of Greek blood donors: Application of the Health Belief Model in the design of recruiting strategies.

Studies of the behavior of blood donors suggest that the examination of their incentives and reported barriers could be utilized in designing targeted recruiting strategies and awareness-raising campaigns. Data was collected via a questionnaire based on the Health Belief Model (HBM), aimed to examine reported incentives, limitations, benefits, and self-efficacy of 261 blood donors at Thriasio General Hospital from January 1 to March 1, 2020, after required permission provided. The analysis was performed by the use of the SPSS statistical software. In addition, a Greek translation of the K6+ distress scale was provided. Our sample consisted of 261 blood donors, the majority of which were men (88.5%), 40-50 years old (36.4%), high school graduates (49.4%), and married (53.3%). Heightened awareness of increased blood needs and blood shortages was mentioned. 92.8% of respondents believe that blood donation is an act of contribution to society or beneficial for their health (86.6%). The limited working hours of blood donation services are the main obstacle mentioned by the participants (32.8%), while 80.7% emphasized the need for public information campaigns. Based on the K6 scale answers score, most participants are classified in the intermediate-risk category for Serious Mental Illness (SMI). The study of beliefs and incentives of blood donors is a critical factor in developing an effective recruiting strategy in a volunteering frame. Public information campaigns regarding the blood donation process and reminders aiming at the return of blood donors after the necessary time interval could facilitate this effort.

Post-donation telephonic interview: A tool for active follow-up of voluntary whole blood donors for analysis of frequency and predisposing factors of adverse reactions

Objectives: Blood donation experience by most donors is satisfactory; however, a few may encounter adverse reactions. Healthy, altruistic, voluntary blood donors ensure adequate blood supply despite the potential risk of adverse reactions. Post-donation follow-up is crucial to get information about these adverse reactions. This study aimed to evaluate the frequency and type of adverse donor reactions and their correlation with contributory factors if any among the blood donors in a tertiary care oncology center. Material and Methods: It was a prospective observational study of 1000 consecutive voluntary whole blood donors who consented to participate in the study. Donors were followed up telephonically on two instances (first after 24 h of donation and second after 2 weeks of donation) and were asked a self-structured donor questionnaire to collect information regarding the adverse donor reactions if any. An appropriate statistical tool was used for analysis (IBM, SPSS software). Results: Of the 1000 voluntary whole blood donors, 92.6% (926/1000) responded to telephonic calls on both occasions. Of these 926, 8.5% (79/926) donors experienced adverse reactions. All these donors experienced immediate reactions, that is, within 24 h of donation while none reported fresh adverse reactions beyond 24 h–2 weeks. Of the 79 donors, 60% (49/79) experienced vasovagal reactions (VVR) and 40% (32/79) experienced hematoma including two donors who experienced both. A total of 86% (68/79) of reactions occurred in outdoor blood donation camps while 14% (11/79) occurred in-house (indoor). First time donors, female donors, and donors with weight on the lower side were more prone to immediate VVR (P &lt; 0.05). Of the 49 VVR, 76% (37/49) were mild, 18% (9/49) were moderate, and 6% (3/49) were severe. Most of the hematomas, that is, 90% (29/32) occurred at outdoor blood donation camps while 10% (3/32) occurred indoor. Most hematomas (53%) took more than 7 days to recover. Conclusion: Post-donation interview proves to be an efficient tool to acquire information about adverse donor reactions. This will help in improving donor safety and satisfaction and will have a positive impact on the national blood supply by improving the donor return rate. Blood transfusion services (BTSs) staff must be trained to promptly identify the donor reactions onsite and manage them to enhance the donation experience of voluntary donors. Post-donation follow-up will aid in getting the donation experience and BTS can develop strategies to enhance it. This will also help in donor hemovigilance in the future for the betterment of donor safety.

Analysis of factors affecting return of first‐time blood donors in Japan: The role of small volume whole blood collection

Acquiring and maintaining a repeat donor population is essential to keep a sufficient blood supply in Japan. To understand the factors associated with the return of first‐time blood donors, we conducted a retrospective analysis of first‐time blood donors who donated blood to the Japanese Red Cross Blood Services in the year 2017, by following them up for 2 years and then statistically analysing the returning donors in comparison with the non‐returning donors. The blood donors’ features were obtained from the Donor Management System and statistically analysed according to whether they returned or not to make another blood donation during the 2‐year period. Data from 421 415 first‐time donors were analysed, and the return rate was 39·6%. In a univariate analysis including all donors, the factors significantly associated with return donation were male gender, younger age, higher BW, 200 ml whole blood collection (200 WB) and higher Hb. In the subgroup analysis, we analysed student donors aged less than 23 years (157 847 donors) and found younger age, higher BW, 200 WB and female gender as factors significantly associated with returning. Among non‐students in the same age group (n = 42 623), younger age, higher BW, 400 WB and male gender were the factors associated with higher returning. The median age and BW of the non‐student group were higher compared with the students. Although 200 WB donation is not cost‐effective, from our results it seems to play a role in the acquisition of donors who are potential repeat blood donors, essential for maintaining the blood supply in Japan.

Donor deferral and return patterns – a South African perspective

AbstractBackgroundDonor eligibility assessment and subsequent return after deferral are key in maintaining an adequate and safe blood supply. Eligibility criteria should be reviewed regularly to ensure regional relevance and impact on donor deferral and return. Large‐scale studies investigating donor deferral and return in Africa are currently lacking.Study design and methodsOperationally collected blood donation data on whole blood donations at the South African National Blood Service during the five years from January 2015 to December 2019 were extracted and analysed. Separate multivariable logistic regression models for factors associated with donor deferral and donor return were developed.ResultsOf the 5 068 638 donor presentations, 869 840 (17·2%) resulted in deferral of which out of range haemoglobin was most common (45·9%). New (aOR 3·99; 95% CI 3·97–4·01), female (aOR 2·51; 95% CI 2·50–2·53) and Black African (aOR 1·90; 95% CI 1·89–1·91) donors had greater odds of being deferred compared to Repeat, male and White donors, respectively. Of the donors deferred during 2015–2018, 328 306 (47·2%) returned within 12 months. Odds of returning increased with increasing age. Lower odds of return were noted among female (aOR 0·82; 95% CI 0·81–0·83) and Black African (aOR 0·75; 95% CI 0·74–0·76) donors.ConclusionWe confirmed high proportions of deferral among SANBS donors with almost half returning within 12 month. Donor deferral and return patterns differed significantly by donor characteristics, the latter also by deferral indication. Further understanding the interaction between haemoglobin deferral and changing donor demographics may assist in refining eligibility criteria and recruitment efforts.

Whole blood donors' post-donation symptoms diminish quickly but are discouraging: Results from 6-day symptom diaries.

Whole blood donors may experience post-donation symptoms such as fatigue, dizziness, or headache after blood donation, which could influence donor retention. We aimed to examine post-donation symptoms during 1 week after whole blood donation, investigate donor characteristics associated with symptoms, and evaluate associations between symptoms and donor return. During 1 week, whole blood donors who donated successfully at one of the collection centers in The Netherlands were invited to participate. Three thousand seventy six donors filled in a diary, assessing post-donation symptoms during days 1 to 6 after donation. We used linear mixed models analyses to determine the change in post-donation symptoms after donation for male and female donors separately. Furthermore, we investigated associations between post-donation symptoms and donors' physical characteristics using multivariable regression and determined associations between symptoms and donor return. Donors reported fatigue as the most common symptom, with approximately 3% of donors experiencing severe problems at the first day after donation. Multiple symptoms improved significantly up to day 3 after whole blood donation. Age, BMI, blood pressure (male donors), and blood volume (female donors) were significantly associated with post-donation symptoms. Donors with less fatigue after whole blood donation were more likely to return for their next donation within 31 days after receiving an invitation. Post-symptoms improve up to 3 days after whole blood donation. Our results may help blood collection centers to identify donors more prone to post-donation symptoms and provide personalized information about the presence and course of post-donation symptoms, possibly increasing donor return rates.

Assessing the impact of an automated Web-based motivational interview on the intention and return behavior of Australian O-negative donors.

O-negative donors are a critical resource for blood collection agencies, and their recruitment and retention provides an ongoing challenge. Motivational interviewing shows promise as a tool to promote donor retention, although concerns about scalability remain. The current study examined the effect of an automated Web-based interview drawing on motivational interviewing and self-determination theory on O-negative donors' motivation, intention, and behavior. Within 13 days of donating, 2820 O-negative donors completed baseline measures of motivation and intention before being randomly assigned to complete either a motivational interview (MI) or active control interview (ACI). Motivation and intention were assessed at 2 days and at 7 weeks after participation in the MI or ACI, with return behavior tracked for 6 months following trial completion. Changes in donor motivation and intention, rate, and time to return did not vary by participation in the MI or ACI. When compared with O-negative donors who experienced business-as-usual practices, donors completing the MI or ACI returned to donate more, and they returned more quickly. However, subsequent exploratory analyses considering the behavior of those who did not accept the invitation to participate and those who completed only baseline measures showed that the improved return behavior of donors in the MI or ACI conditions was likely not due to any specific properties of the MI or ACI activities. Australian O-negative donors were highly internally motivated and committed to donating. An automated Web-based motivational interview appears to be of limited effectiveness in promoting the return of such donors.

Educating donors about deferrals through the provision of tailored materials: Findings from a survey of deferred donors.

Receiving a temporary deferral has been shown to negatively affect donor retention. One contributing factor for low donor return may be poor understanding of why the deferral has occurred. The aim of this study was to determine whether new educational materials-a brochure, guided conversation, and follow-up email-increased deferred donors' knowledge about their donation eligibility, satisfaction with the deferral process, intention to return, and odds of rebooking another appointment. A three-arm cluster randomised controlled trial was conducted to evaluate the impact of the educational materials compared to business as usual deferral procedures: (a) In-center brochure and follow-up email; (b) Email only; (c) Control. A survey was administered to a random sample of trial participants (n = 847). Compared with the control condition, donors in the in-center brochure and email condition were more knowledgeable about the end date of their deferral, and reported higher satisfaction with the deferral information provided, and had fewer questions and/or concerns about the deferral. Similar findings were observed when comparing the email only condition to the in-center brochure and email condition. No differences were found in intention to return. Donors in the in-center brochure plus email condition had increased odds (OR:1.385) of rebooking their next appointment compared to the combined email only and control conditions. The application of a deferral is often misunderstood by donors. Providing educational materials to donors can increase their understanding and may lead to increased retention of donors through rebooking of subsequent donations.

Long-term return and donation pattern of those who begin donating at different ages: A retrospective cohort analysis of blood donors in Australia.

This study compared the likelihood of return to donate and donation rate ratio by age of donors at their first donation when followed up to 12 years. Donation history of two cohorts of first-time donors (those donating in 2007 and 2013) was extracted until March 2019 from Australian Red Cross Lifeblood's national database. Poisson regression analyses compared donor return and negative-binomial regression estimated the rate ratio of donations. A total of 120 469 and 95 381 donors were included in the 2007 and 2013 cohorts, respectively. Compared to donors aged 20-24 years, the likelihood of return in both cohorts increased consistently as age at first donation increased from 30-years and above. Average number of whole-blood and plasmapheresis donations increased as the age at first donation increased from 30-years onward. The whole-blood donation rate was highest for donors ≥60 years, while plasmapheresis donation rate was highest for donors aged 50-59 years. These patterns were largely consistent when stratified by sex. To continuously ensure the short- to mid-term sufficiency of blood supply in Australia, targeted recruitment of donors aged 30-years and above may be considered, however its feasibility and impact should be explored further given relatively smaller proportion of new donors are middle-aged and older under current policies. Future studies with a longer follow-up period are needed to examine whether the frequency of donation among those who start donating at a younger age increases later in their life when they are 30-years or over.

Ferritin measurement IN Donors\u2014Effectiveness of iron Monitoring to diminish iron deficiency and low haemoglobin in whole blood donors (FIND\u2019EM): study protocol for a stepped wedge cluster randomised trial

BackgroundBlood donors are at risk for reduced iron stores, because of which donor iron monitoring received increased attention in the last decade. Despite the importance for donor health, international consensus on an appropriate policy for iron monitoring is lacking. Therefore, we conduct a trial to evaluate to what extent ferritin-guided donation intervals are effective in increasing haemoglobin and ferritin levels, decreasing low-haemoglobin deferral, increasing donor return and improving the health of whole blood donors in the Netherlands.MethodsSanquin Blood Bank is implementing ferritin-guided donation intervals to prevent donors from increasing iron loss at repeated donations. Using a stepped wedge cluster randomised trial approach, the design involves a random crossover of 29 clusters of blood collection centres from the existing policy without ferritin measurements to a ferritin-guided donation interval policy. This new policy includes ferritin measurements for all new donors and at every 5th whole blood donation, extending donation intervals to 6 months if ferritin is 15–≤ 30 ng/mL and to 12 months if ferritin is < 15 ng/mL. We measure ferritin levels of whole blood donors from stored plasma samples and collect haemoglobin levels and information on low-haemoglobin deferral and donor return from the donor database before, during and after the implementation period. We measure donor health during and after the implementation period using questionnaires, assessing physical and mental wellbeing and iron deficiency- and donation-related symptoms. We use multilevel analyses to investigate differences in ferritin and haemoglobin levels, low-haemoglobin deferral rates, donor return and donor health from whole blood donors, between blood collection centres that have versus those that have not yet implemented the ferritin-guided donation interval policy.DiscussionThis stepped wedge cluster randomised trial will provide insight into the effectiveness of ferritin-guided donation intervals in lowering iron deficiency, decreasing donor deferrals due to low haemoglobin and improving donor health. We will evaluate a policy that is implemented nationwide in a real-life setting. Our study is therefore not limited to a small experimental setting and the results will guide policymakers seeking an appropriate policy for iron monitoring.Trial registrationThe Dutch trial registry NTR6738. Registered on 29 September 2017. Retrospectively registered.

Donation related fears predict vasovagal reactions and donor attrition among high school donors.

This longitudinal study of high school whole blood donors examined relationships among donation-related fears assessed prior to donation, vasovagal reactions to donation, and the proportion of donors who attempted another donation over the subsequent 60 weeks. Data regarding vasovagal reactions and attempted donation were obtained from donor records of 530 female and 342 male high school donors who answered questions about five types of fear (ie, of blood draw, needles, seeing blood, feeling pain, or fainting) prior to their index donation. Each type of fear was associated with an increased risk of vasovagal reactions (all P < .001) and a smaller percentage of attempted donations was seen among those who reported at least one type of fear (53%) as compared to those who did not report any fear (62.1%); P = .022; β = -0.374, OR = 0.69; 95% CI, 0.50-0.94. Path analyses of the relationships among fear, vasovagal reaction, and attempted donation revealed significant indirect effects for each type of fear. Specifically, donors who reported fear were at increased odds of experiencing a vasovagal reaction, which, in turn, was associated with decreased odds of attempting a repeat donation. Donation-related fears are associated with reduced donor return rates, and this effect is mediated through an increased risk for vasovagal reactions. For both practical and ethical reasons, blood collectors are encouraged to identify and intervene with fearful donors to reduce the likelihood of negative donation-related symptoms and enhance donor retention.