1
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Kim LG, Bolton T, Sweeting MJ, Bell S, Fahle S, McMahon A, Walker M, Ferguson E, Miflin G, Roberts DJ, Di Angelantonio E, Wood AM. Impact of a post-donation hemoglobin testing strategy on efficiency and safety of whole blood donation in England: A modeling study. Transfusion 2023; 63:541-551. [PMID: 36794597 PMCID: PMC10952564 DOI: 10.1111/trf.17277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Deferrals due to low hemoglobin are time-consuming and costly for blood donors and donation services. Furthermore, accepting donations from those with low hemoglobin could represent a significant safety issue. One approach to reduce them is to use hemoglobin concentration alongside donor characteristics to inform personalized inter-donation intervals. STUDY DESIGN AND METHODS We used data from 17,308 donors to inform a discrete event simulation model comparing personalized inter-donation intervals using "post-donation" testing (i.e., estimating current hemoglobin from that measured by a hematology analyzer at last donation) versus the current approach in England (i.e., pre-donation testing with fixed intervals of 12-weeks for men and 16-weeks for women). We reported the impact on total donations, low hemoglobin deferrals, inappropriate bleeds, and blood service costs. Personalized inter-donation intervals were defined using mixed-effects modeling to estimate hemoglobin trajectories and probability of crossing hemoglobin donation thresholds. RESULTS The model had generally good internal validation, with predicted events similar to those observed. Over 1 year, a personalized strategy requiring ≥90% probability of being over the hemoglobin threshold, minimized adverse events (low hemoglobin deferrals and inappropriate bleeds) in both sexes and costs in women. Donations per adverse event improved from 3.4 (95% uncertainty interval 2.8, 3.7) under the current strategy to 14.8 (11.6, 19.2) in women, and from 7.1 (6.1, 8.5) to 26.9 (20.8, 42.6) in men. In comparison, a strategy incorporating early returns for those with high certainty of being over the threshold maximized total donations in both men and women, but was less favorable in terms of adverse events, with 8.4 donations per adverse event in women (7.0, 10,1) and 14.8 (12.1, 21.0) in men. DISCUSSION Personalized inter-donation intervals using post-donation testing combined with modeling of hemoglobin trajectories can help reduce deferrals, inappropriate bleeds, and costs.
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Affiliation(s)
- Lois G. Kim
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Thomas Bolton
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
- BHF Data Science CentreHealth Data ResearchUK
| | | | - Steven Bell
- Dept of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
| | - Sarah Fahle
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Amy McMahon
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Matthew Walker
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Eamonn Ferguson
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- School of PsychologyUniversity of NottinghamNottinghamUK
| | | | - David J. Roberts
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- NHS Blood & TransplantJohn Radcliffe HospitalOxfordUK
- Radcliffe Dept of MedicineUniversity of OxfordOxfordUK
| | - Emanuele Di Angelantonio
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of CambridgeCambridgeUK
- Health Data Science Research CentreHuman TechnopoleMilanItaly
| | - Angela M. Wood
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of CambridgeCambridgeUK
- Cambridge Centre of Artificial Intelligence in MedicineCambridgeUK
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2
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Baart AM, van den Hurk K, de Kort WLAM, Huis In 't Veld EMJ. Impact of risk-dependent interventions on low haemoglobin deferral rates in whole blood donors. Vox Sang 2020; 115:171-181. [PMID: 31912518 DOI: 10.1111/vox.12885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Blood donors with a relatively low haemoglobin (Hb) level at their previous donation attempt have an increased risk of Hb deferral at the subsequent donation attempt. The aim of this study was to investigate whether the interventions prolongation of donation interval and/or a dietary advice decrease the Hb deferral rate. METHODS 11 897 whole blood donors with Hb levels from below to 0·2 mmol/l above the cut-off level for donation received either no intervention, a prolongation of the donation interval to six or twelve months, a dietary advice, or both. Deferral rates for low Hb levels at the subsequent donation attempt were compared in the different intervention groups. Additionally, the effects of the interventions on Hb deferral risk and donor return for a subsequent donation attempt were analysed using generalized estimating equations. RESULTS The Hb deferral rate was substantially lower in the group that received a prolongation of the donation interval to six months than in the Control Group (12·9% vs. 6·3% in men and 20·4% vs. 13·4% in women). However, the additional benefit of twelve over 6-month interval prolongation was small, and no benefit of a dietary advice showed up. On the other hand, receiving a dietary advice increased the likelihood of donor return for a subsequent donation attempt. CONCLUSION Implementation of a protocol for the prolongation of donation intervals to six months for donors with Hb levels from below to slightly above the cut-off level for donation may reduce the deferral rate for low Hb levels while keeping donor lapse at a minimum.
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Affiliation(s)
- A Mireille Baart
- Donor Medicine Research Group, Sanquin Research, Amsterdam, the Netherlands
| | - Katja van den Hurk
- Donor Medicine Research Group, Sanquin Research, Amsterdam, the Netherlands
| | - Wim L A M de Kort
- Donor Medicine Research Group, Sanquin Research, Amsterdam, the Netherlands
| | - Elisabeth M J Huis In 't Veld
- Donor Medicine Research Group, Sanquin Research, Amsterdam, the Netherlands.,Department of Cognitive Science & Artificial Intelligence, Tilburg University, Tilburg, the Netherlands
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3
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Browne A, Fisher SA, Masconi K, Smith G, Doree C, Chung R, Rahimzadeh M, Shah A, Rodriguez SA, Bolton T, Kaptoge S, Wood A, Sweeting M, Roberts DJ. Donor Deferral Due to Low Hemoglobin-An Updated Systematic Review. Transfus Med Rev 2020; 34:10-22. [PMID: 31806414 DOI: 10.1016/j.tmrv.2019.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/30/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
Blood donors attending a donation session may be deferred from donating blood due to a failure to meet low hemoglobin (Hb) thresholds. This costs the blood donor service and donors valuable time and resources. In addition, donors who are deferred may have more symptoms, and as a direct and/or indirect effect of their experience, return rates of donors deferred for low Hb are reduced, even in repeat donors. It is therefore vital that low Hb deferral (LHD) is minimized. The aim of this updated systematic review is to expand the evidence base for factors which affect a donor's risk of deferral due to low Hb. Studies were identified by searching MEDLINE, Embase, The Cochrane Library, and the WHO International Clinical Trials Registry to March 2019. Demographic data, donor history, hematological/biological factors, and the primary outcome of deferral due to low Hb were extracted. Our primary outcome was deferral due to low Hb. Analyses were descriptive and quantitative; pooled odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by meta-analysis using random-effects models. A total of 116 studies met the inclusion criteria. Meta-analysis showed a significantly greater risk of LHD in females compared with males in studies applying universal Hb thresholds for males and females (OR 14.62 95% CI 12.43-17.19) and in those which used sex-specific thresholds (OR 5.73, 95% CI 4.36-7.53). Higher rates of LHD were also associated with increasing age in men, low body weight, shorter interdonation interval, donors of Hispanic or African descent, higher ambient temperature, donors with low ferritin levels, and donation in a fixed donor center. There was conflicting evidence on the effect of new and repeat donor status, and blood group. This work has strengthened the evidence of the previous review in identifying factors that should be considered in studies of donor deferral and highlighting areas in need of further study, including ABO and Rh blood groups, previous platelet donation, diet, smoking, time of day, and genetic data. These factors may lead to individually tailored donation criteria for safe and efficient donation in the future.
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Affiliation(s)
- Andrew Browne
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Sheila A Fisher
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK; BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
| | - Katya Masconi
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Graham Smith
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK; BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK; BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ryan Chung
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Mana Rahimzadeh
- Oxford University Medical School, John Radcliffe Hospital, Oxford, UK
| | - Akshay Shah
- BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Silvia Alonso Rodriguez
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Thomas Bolton
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Stephen Kaptoge
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Michael Sweeting
- Department of Health Sciences, University of Leicester, University Road, Leicester
| | - David J Roberts
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK; BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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4
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Goldman M, Yi Q, Steed T, O'Brien SF. Changes in minimum hemoglobin and interdonation interval: impact on donor hemoglobin and donation frequency. Transfusion 2019; 59:1734-1741. [DOI: 10.1111/trf.15155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Mindy Goldman
- Donor & Clinical ServicesCanadian Blood Services Ottawa Ontario Canada
| | - Qi‐Long Yi
- Donor & Clinical ServicesCanadian Blood Services Ottawa Ontario Canada
| | - Tony Steed
- Donor RelationsCanadian Blood Services Ottawa Ontario Canada
| | - Sheila F O'Brien
- Donor & Clinical ServicesCanadian Blood Services Ottawa Ontario Canada
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5
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Malard L, Richard P, Maire F, Djoudi R, Gross S, Fillet A. Factors associated with recovery of haemoglobin levels after whole‐blood donation in the French West Indies in 2015. Transfus Med 2018; 29 Suppl 1:72-75. [DOI: 10.1111/tme.12563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/21/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- L. Malard
- Medical DepartmentEFS Siège La Plaine Saint‐Denis France
| | | | - F. Maire
- ETS Guadeloupe‐Guyane Pointe à Pitre France
| | | | - S. Gross
- Medical DepartmentEFS Siège La Plaine Saint‐Denis France
| | - A.‐M. Fillet
- Medical DepartmentEFS Siège La Plaine Saint‐Denis France
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6
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Fillet AM, Gross S. [Prevention of anemia in blood donors]. Transfus Clin Biol 2017; 24:143-147. [PMID: 28687193 DOI: 10.1016/j.tracli.2017.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 12/01/2022]
Abstract
The prevention of anemia of blood donor is a main issue for donor safety and self-supplying. This prevention is done in one hand by donor deferral whose haemoglobin level is under defined threshold and in other hand by preventing iron deficiency. Some subgroups of donors are at increased risk for developing iron deficiency and adverse effects of iron deficiency: premenopausal females; donors with haemoglobin values near the minimum for eligibility and frequent donors. Different interventions could be used: lengthening the inter-donational interval and/or decreasing the number of donations per year; donor ferritin testing to evaluate iron store and at least donor iron supplementation.
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Affiliation(s)
- A-M Fillet
- EFS siège, direction médicale, 20, avenue du Stade-de-France, 93218 La Plaine Saint-Denis, France.
| | - S Gross
- EFS siège, direction médicale, 20, avenue du Stade-de-France, 93218 La Plaine Saint-Denis, France
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7
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Retrospective analysis of capillary hemoglobin recovery in nearly 1 200 000 blood donor returns. Blood Adv 2017; 1:961-967. [PMID: 29296737 DOI: 10.1182/bloodadvances.2016004218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/20/2017] [Indexed: 12/27/2022] Open
Abstract
Measuring the concentration of capillary hemoglobin (cHb) is a standard procedure before blood donation. To further assess the time period needed for cHb recovery after blood donation and to have a more in-depth understanding of features of recovery, we used data-mining tools in a large, retrospective data pool containing all 1 163 524 donor returns that took place in Finland in 2010 to 2015. The results show that the average recovery times for cHb to return back to the level preceding donation were substantially longer, over 200 days in all age groups, than were the minimum allowed donation intervals. cHb recovery was especially poor in women under the age of 30 who returned to donate soon after the minimum allowed donation interval. It was of interest that frequent donors recovered substantially faster, with the average recovery times of ∼100 days in men and ∼200 days in women, than did infrequent donors, suggesting that there is a subpopulation of donors who can donate frequently without fear of iron deficiency. Return interval in fact explained only 1% of the variation in cHb recovery, which points to unknown, individual features, such as genetic or lifestyle factors, warranting further studies and suggesting that simply extending the allowed donation intervals may not suffice to improve cHb recovery. The study demonstrates that data mining of blood bank records is a powerful tool for depicting features of blood donor population.
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8
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Gemelli CN, Hayman J, Waller D. Frequent whole blood donors: understanding this population and predictors of lapse. Transfusion 2016; 57:108-114. [DOI: 10.1111/trf.13874] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jane Hayman
- Clinical Services and Research, Australian Red Cross Blood Service
- School of Clinical SciencesMonash UniversityMelbourne Australia
| | - Daniel Waller
- Clinical Services and ResearchAustralian Red Cross Blood ServiceSydney Australia
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9
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Goldman M, Magnussen K, Gorlin J, Lozano M, Speedy J, Keller A, Pink J, Leung JNS, Chu CCY, Lee CK, Faed J, Chay J, Tan HH, Teo D, Djoudi R, Woimant G, Fillet AM, Castrén J, Miflin G, Vandewalle GC, Compernolle V, Cardenas JM, Infanti L, Holbro A, Buser A, van den Hurk K, Yahalom VJ, Gendelman V, Shinar E, Eder AF, Steele WR, O'Neill EM, Kamel H, Vassallo R, Delage G, Lebrun A, Robillard P, Germain M, Gandhi M, West KA, Klein HG. International Forum regarding practices related to donor haemoglobin and iron. Vox Sang 2016; 111:449-455. [DOI: 10.1111/vox.12431] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Goldman
- Medical Services and Innovation; Canadian Blood Services; Ottawa ON Canada
| | - K. Magnussen
- Clinical Immunology/Blood Centre; Copenhagen University Hospital; Hvidovre Denmark
| | - J. Gorlin
- Physician Services; Innovative Blood Centers; St. Paul MN USA
| | - M. Lozano
- Hospital Clinic; Department of Hemotherapy and Hemostasis; Barcelona Spain
| | - J. Speedy
- Australian Red Cross Blood Service; Adelaide South Australia Australia
| | - A. Keller
- Australian Red Cross; Perth Western Australia Australia
| | - J. Pink
- Australian Red Cross Blood Service; Stafford Queensland Australia
| | - J. N. S. Leung
- Blood Collection and Donor Recruitment Department; Hong Kong Red Cross Blood Transfusion Service; Kowloon Hong Kong
| | - C. C. Y. Chu
- Blood Collection and Donor Recruitment Department; Hong Kong Red Cross Blood Transfusion Service; Kowloon Hong Kong
| | - C.-K. Lee
- Blood Collection and Donor Recruitment Department; Hong Kong Red Cross Blood Transfusion Service; Kowloon Hong Kong
| | - J. Faed
- Otago Site, New Zealand Blood Service; Department of Haematology; University of Otago; Dunedin New Zealand
| | - J. Chay
- Blood Services Group; Health Sciences Authority; 11 Outram Road Singapore City 169078 Singapore
| | - H. H. Tan
- Blood Services Group; Health Sciences Authority; 11 Outram Road Singapore City 169078 Singapore
| | - D. Teo
- Centre for Transfusion Medicine; Singapore City Singapore
| | - R. Djoudi
- Qualification Biologique du Don; Etablissement Français du Sang; St. Denis France
| | - G. Woimant
- EFS, Médecine, la Recherche et l'Innovation; La Plaine Saint-Denis France
| | - A.-M. Fillet
- Medical Department; Etablisement Français du Sang; 20 Avenue du Stade de France La Plaine Saint-Denis 93218 France
| | - J. Castrén
- Medical Support in Blood Donation; Finnish Red Cross Blood Service; Kivihaantie 7 Helsinki FI-00310 Finland
| | - G. Miflin
- NHS Blood and Transplant; Watford UK
| | | | - V. Compernolle
- Blood Services; Belgian Red Cross; Ottergemsesteenweg 413 Ghent B-9000 Belgium
| | - J. M. Cardenas
- Tejidos Humanos; Centro Vasco de Transfusion y Tejidos Humanos; Labeaga s/n Galdakao 48960 Spain
| | - L. Infanti
- Blood Donation Center; Swiss Red Cross; Hebelstrasse 10 Basel CH-4031 Switzerland
| | - A. Holbro
- Blood Transfusion Centre; Swiss Red Cross; Hebelstrasse 10 Basel CH-4031 Switzerland
- Department of Hematology; University Hospital Basel; Basel Switzerland
| | - A. Buser
- Blood Transfusion Centre; Swiss Red Cross; Hebelstrasse 10 Basel CH-4031 Switzerland
- Department of Hematology; University Hospital Basel; Basel Switzerland
| | - K. van den Hurk
- Donor Studies; Sanquin Research; Plesmanlaan 125 Amsterdam 1066 CX The Netherlands
| | - V. J. Yahalom
- National Blood Services; Magen David Adom-National Blood Services; Ramat Gan 5262100 Israel
| | - V. Gendelman
- National Blood Services; Magen David Adom-National Blood Services; Ramat Gan 5262100 Israel
| | - E. Shinar
- National Blood Services; Magen David Adom-National Blood Services; Ramat Gan 5262100 Israel
| | - A. F. Eder
- Biomedical Headquarters; American Red Cross; 15601 Crabbs Branch Way Rockville MD 20855 USA
| | - W. R. Steele
- Transmissible Disease Department; American Red Cross; 15601 Crabbs Branch Way Rockville MD 20855 USA
| | - E. M. O'Neill
- National Headquarters; Biomedical Services; American Red Cross; 15601 Crabbs Branch Way Rockville MD 20855 USA
| | - H. Kamel
- Medical Affairs; Blood Systems, Inc.; 6210 E. Oak Street Scottsdale AZ 85257 USA
| | - R. Vassallo
- Blood Systems, Inc.; 6210 E. Oak Street Scottsdale AZ 85257 USA
| | - G. Delage
- Medical Affairs; Héma-Quebec; 4045 boul. Cote-Vertu, Ville Saint-Laurent Montreal QC Canada
| | - A. Lebrun
- Medical Affairs; Héma-Quebec; 4045 boul. Cote-Vertu, Ville Saint-Laurent Montreal QC Canada
| | - P. Robillard
- Medical Affairs; Héma-Quebec; 4045 boul. Cote-Vertu, Ville Saint-Laurent Montreal QC Canada
| | - M. Germain
- Medical Affairs; Héma-Quebec; 4045 boul. Cote-Vertu, Ville Saint-Laurent Montreal QC Canada
| | - M. Gandhi
- Laboratory of Medicine and Pathology; Mayo Clinic Minnesota; 200 1st Street SW Rochester MN 55905 USA
| | - K. A. West
- Department of Transfusion Medicine; National Institutes of Health Clinical Center; 10 Center Drive, Room 1N226 Bethesda MD 20892 USA
| | - H. G. Klein
- Department of Transfusion Medicine; National Institute of Health; Warren G. Magnuson Clinical Center; 10 Center Drive, Room IC711 Bethesda MD 20892 USA
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10
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O'Brien SF. Donor iron policy: from research to practice. Transfusion 2016; 56:1496-8. [PMID: 27295024 DOI: 10.1111/trf.13555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Sheila F O'Brien
- Canadian Blood Services.,School of Epidemiology, Public Health and Preventive Medicine Canadian Blood Services, University of Ottawa, Ottawa, ON, Canada
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11
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Spencer BR, Johnson B, Wright DJ, Kleinman S, Glynn SA, Cable RG. Potential impact on blood availability and donor iron status of changes to donor hemoglobin cutoff and interdonation intervals. Transfusion 2016; 56:1994-2004. [PMID: 27237451 DOI: 10.1111/trf.13663] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/07/2016] [Accepted: 04/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND A minimum male hemoglobin (Hb) level of 13.0 g/dL becomes a Food and Drug Administration requirement effective May 2016. In addition, extending whole blood (WB) interdonation intervals (IDIs) beyond 8 weeks has been considered to reduce iron depletion in repeat blood donors. This study estimates the impact these changes might have on blood availability and donor iron status. STUDY DESIGN AND METHODS Six blood centers participating in Retrovirus Epidemiology Donor Study-II (REDS-II) collected information on all donation visits from 2006 to 2009. Simulations were developed from these data using a multistage approach that first sought to adequately reproduce the patterns of donor return, Hb and ferritin levels, and outcomes of a donor's visit (successful single- or double-red blood cell donation, deferral for low Hb) observed in REDS-II data sets. Modified simulations were used to predict the potential impact on the blood supply and donor iron status under different Hb cutoff and IDI qualification criteria. RESULTS More than 10% of WB donations might require replacement under many simulated scenarios. Longer IDIs would reduce the proportion of donors with iron depletion, but 80% of these donors may remain iron-depleted if minimal IDIs increased to 12 or 16 weeks. CONCLUSION Higher Hb cutoffs and longer IDIs are predicted to have a potentially large impact on collections but only a modest impact on donor iron depletion. Efforts to address iron depletion should be targeted to at-risk donors, such as iron supplementation programs for frequent donors, and policy makers should try to avoid broadly restrictive donation requirements that could substantially reduce blood availability.
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Affiliation(s)
- Bryan R Spencer
- American Red Cross Blood Services, Massachusetts Region, Dedham, Massachusetts
| | | | | | | | - Simone A Glynn
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Ritchard G Cable
- American Red Cross Blood Services, Connecticut Region, Farmington, Connecticut
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12
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Bäckman S, Larjo A, Soikkeli J, Castrén J, Ihalainen J, Syrjälä M. Season and time of day affect capillary blood hemoglobin level and low hemoglobin deferral in blood donors: analysis in a national blood bank. Transfusion 2016; 56:1287-94. [DOI: 10.1111/trf.13578] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 02/12/2016] [Accepted: 02/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Sari Bäckman
- Finnish Red Cross Blood Service; Helsinki Finland
| | - Antti Larjo
- Finnish Red Cross Blood Service; Helsinki Finland
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13
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Nasserinejad K, van Rosmalen J, de Kort W, Rizopoulos D, Lesaffre E. Prediction of hemoglobin in blood donors using a latent class mixed-effects transition model. Stat Med 2015; 35:581-94. [PMID: 26467774 DOI: 10.1002/sim.6759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/26/2015] [Accepted: 09/24/2015] [Indexed: 11/10/2022]
Abstract
Blood donors experience a temporary reduction in their hemoglobin (Hb) value after donation. At each visit, the Hb value is measured, and a too low Hb value leads to a deferral for donation. Because of the recovery process after each donation as well as state dependence and unobserved heterogeneity, longitudinal data of Hb values of blood donors provide unique statistical challenges. To estimate the shape and duration of the recovery process and to predict future Hb values, we employed three models for the Hb value: (i) a mixed-effects models; (ii) a latent-class mixed-effects model; and (iii) a latent-class mixed-effects transition model. In each model, a flexible function was used to model the recovery process after donation. The latent classes identify groups of donors with fast or slow recovery times and donors whose recovery time increases with the number of donations. The transition effect accounts for possible state dependence in the observed data. All models were estimated in a Bayesian way, using data of new entrant donors from the Donor InSight study. Informative priors were used for parameters of the recovery process that were not identified using the observed data, based on results from the clinical literature. The results show that the latent-class mixed-effects transition model fits the data best, which illustrates the importance of modeling state dependence, unobserved heterogeneity, and the recovery process after donation. The estimated recovery time is much longer than the current minimum interval between donations, suggesting that an increase of this interval may be warranted.
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Affiliation(s)
| | | | - Wim de Kort
- Department of Donor Studies, Sanquin Research, Amsterdam, the Netherlands.,Department of Public Health, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Emmanuel Lesaffre
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands.,L-Biostat, KU Leuven, Leuven, Belgium
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14
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Kleinman S, Glynn SA. Database research in transfusion medicine: The power of large numbers. Transfusion 2015; 55:1591-5. [DOI: 10.1111/trf.13139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 01/03/2023]
Affiliation(s)
| | - Simone A. Glynn
- Blood Epidemiology and Clinical Therapeutics Branch, Division of Blood Diseases and Resources; National Heart, Lung, and Blood Institute, National Institutes of Health; Bethesda MD
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