重复献血对血液安全的影响

目的分析献血者在初次和重复献血时检验结果不合格的情况,了解重复献血对血液安全的影响,为开展献血人群的市场细分、组建固定献血者队伍提供科学依据。方法以2004～2010年无偿献血者为对象,对献血者初次和重复献血时的ALT、HBsAg、Anti-HCV、梅毒（SYP）、Anti-HIV5项指标的检验结果不合格情况和同期203 423人次献血情况进行分析。结果 5项指标不合格率随献血次数增多呈逐步降低的趋势,第1次献血人群中不合格率最高。第3次和第4次献血人群ALT不合格率比较：χ2=16.82,P〈0.05;第1次和第2次献血人群HBsAg不合格率比较χ2=19.46,P〈0.05,第3次和≥第4次献血人群比较χ2=14.61,P〈0.05;第1次和第2次献血人群SYP不合格率比较χ2=62.55,P〈0.05,第3次和≥第4次献血人群比较：χ2=22.24,P〈0.05。ALT、HBsAg、SYP不合格多见于≤3次献血人群。第1次和第2次献血人群Anti-HCV不合格率比较χ2=51.30,P〈0.05;第2次和第3次献血人群比较χ2=13.35,P〈0.05。≤2次献血人群中Anti-HCV不合格率高。结论献血次数越多的重复献血者血液更安全,以献血≥4次的重复献血者组成固定献血者队伍,有利于保障血液安全。     

浙江省血液中心低危固定无偿成分献血者队伍建设策略与评价

目的对浙江省低危固定成分献血者队伍建设策略进行系统性评价。方法建立固定成分献血者队伍建设策略,包括成分献血者精准招募、献血环境改善、献血流程优化、成分献血服务规范提升、成分全过程整体护理、个性化机采方案制定、成分献血全过程宣教、关爱激励机制建立等措施,对2012-2015年固定成分献血者人数、人次、年献血频次(年献血频次=人次/人数)和血液检测结果使用SPSS 19.0统计软件包进行数据分析。结果固定成分献血者人数由2012年1 278人增加至2015年1 922人,构成比由16.0%上升至29.7%(P0.001),固定献血人次由7112人次增加至14440人次,构成比从48.2%上升至72.8%(P0.001);成分献血者年均献血次数由2.22次/年上升至3.06次/年,固定献血者由6.46次/年上升至7.51次/年;2012-2015年固定、重复和初次献血者的血液检测阳性率分别为0.234%、0.672%和1.48%(P0.001)。结论固定成分献血者队伍建设策略是成分献血长效机制的重要组成部分,是保障机采血小板稳定、充足、安全供应的基石。     

服务营销理念在无偿献血中应用的效果评价

目的探讨服务营销理念在无偿献血中的应用方法及效果。方法将服务营销的理念引入无偿献血护理工作中,包括无偿献血的宣传招募、献血全过程护理、献血后回访等方面,创新和优化献血服务。观察应用此理念后2006年1-10月无偿献血者献血反应发生情况、固定献血者人数以及一次性献血400m1人数,并与2005年同期进行比较,观察服务营销理念应用的效果。结果在无偿献血护理中引入服务营销理念后献血反应发生率由开展前的1．798％下降至0．499％;一次性献血400ml人数占献血者比例由14．878％增加至57．055％;固定献血者比例由3．448％增加到10．758％：两组比较差异均有统计学意义（P〈0．05或P〈0．01）。结论将服务营销的基本原理和方法运用于无偿献血护理工作中,可减少献血反应的发生率和降低献血反应的严重程度,并提高一次性献血400ml的人数,稳定和扩大固定无偿献血者队伍。     

无偿献血者谷丙转氨酶检测结果及其分布特征调查

目的了解无偿献血者谷丙转氨酶（ALT）不合格率及人群分布情况。方法应用速率法对2009-2012年无偿献血者的248 164份血液标本进行ALT含量检测。结果 2009-2012年保定市无偿献血者ALT的总不合格率为0.97%,ALT不合格数占总不合格数的比例逐年增加（χ2=59 968.04,P〈0.01）。不同献血人群ALT不合格率比较,男性高于女性（χ2=653.71,P〈0.01）;随着年龄的增加ALT不合格率增高（χ2=196.88,P〈0.01）;学生是ALT不合格率最低的献血人群,其次为农民,最高的是职员。结论加强献血前宣传和献血队伍管理,以及制定适合我国国情的ALT检测合格标准是降低血液不合格率、减少血液浪费的有效措施。     

多举措推进固定无偿成分献血者队伍建设

目的 对固定无偿成分献血者队伍建设成效进行系统性评价。方法 固定无偿成分献血者队伍建设举措包括工作人员多角色扮演机制建立、献血流程优化无缝对接、献血服务规范专人整体护理、人性化的献血后延伸服务机制建设、精准招募和预约献血实施、多种关爱激励保留机制建立、量化的绩效考核方案实施及开展多项目的创新和研究等,对2012-2016年固定成分献血者人数、人次、献血量,新增成分献血人数、人次,当年重复献血人数、人次,流失成分献血人数、流失比例和血液检测结果使用SPSS 19.0统计软件包进行数据分析。结果 2012-2016年固定成分献血者人数由3 333人增加至4 268人,构成比由41.7%上升至67.5%(P0.001),固定献血人次由9 798人次增加至18 641人次,构成比由66.5%上升至89.4%(P0.001),固定献血量由13 605.8 U增加至28 195.6 U,构成比由69.0%上升至91.6%(P0.001);新增成分献血者固定献血人次由1 178人次增加至2 578人次,构成比由17.6%上升至45.0%(P0.001);1年内献血3次以上的成分献血人次由7 112人次增加至15 599人次,构成比由48.2%上升至74.8%(P0.001);成分献血流失人数由4 767人下降至3 348人,构成比由64.3%下降至51.7%(P0.001);成分献血初筛合格率由71.1%上升至85.5%(P0.001),血液检测合格率由99.11%上升至99.64%(P0.001)。结论 多措并举的固定无偿成分献血者队伍建设策略实施是保障机采血小板稳步增长,提供安全、充足血液的基础。     

济南市无偿献血者抗-HCV流行情况调查研究

目的：了解济南市无偿献血者抗-HCV流行情况．确定低危献血群体，为安全输血提供保障。方法：选择2002～2004年济南市无偿献血者163854人，应用ELISA法检测其抗-HCV。统计学方法采用χ^2检验。结果：济南市无偿献血者抗-HCV阳性率0．52％（847／163854），2002～2004年阳性率分别为0．75％、0．43％、0．36％．（χ^2=94．08，P〈0．001）；男性阳性率为0．37％、女性阳性率为0．35％，差异无显著性（χ^2=0．17，P〉0.05）；初次献血者阳性率为0．53％，多次献血者阳性率为0．27％，差异有显著性（χ^2=23．45，P〈0．001）；18～30岁、31～40岁、41～55岁不同年龄段阳性率分别为0．37％、0．39％、0．23％，差异无显著性（χ^2=2．93，P〉0．05）；不同职业间（学生、现役军人和其他职业）阳性率分别为0．33％、0．41％，差异有显著性（χ^2=3．85，P〈0．05）。结论：多次献血者或学生、现役军人是安全输血的低危人群．应作为主要选择对象。     

护理心理学在无偿献血中的应用

目的 为满足自愿无偿献血者奉献爱心给社会的心理需求。提高无偿献血服务工作质量,扩展自愿无偿献血人群,发展固定自愿无偿献血者。方法 于献血过程前、中、后期运用护理心理学知识为献血者开展全方位服务。结果 实现了组织献血向街头自愿无偿献血、一次献血200ml向400ml的过渡;献血者满意度稳定在98％以上;献血反应减少到0．69％以下,实现了服务的零投诉;固定献血队伍逐年增加。目前已建立3万多人。结论 护理心理学在无偿献血中的应用效果较好,使无偿献血事业呈现良性持续发展的趋势。     

龙岩地区无偿献血人群乙肝DNA阳性情况分析

目的分析2012~2016年龙岩市中心血站不同无偿献血者乙型肝炎病毒(HBV)DNA阳性分布情况,为发动低危无偿献血者献血提供理论参考。方法对5年来龙岩市中心血站不同无偿献血者HBV DNA阳性进行统计分析。结果自愿献血人群和团体献血人群HBV DNA阳性率分别为0.22%和0.44%,差异有统计学意义(χ~2=10.19,P0.05),团体是自愿的2倍,团体献血人群HBV DNA阳性率逐年上升,从2012年的0.12%上升到2016年的0.87%。女性和男性献血者HBV DNA阳性率分别为0.15%和0.30%,差异有统计学意义(χ~2=10.11,P0.05),男性是女性的2倍。不同年龄分布的献血者HBV DNA阳性率也存在差异(χ~2=19.42,P0.05),41岁以上献血者阳性率较高,18~30岁献血者阳性率较低。不同献血次数献血者HBV DNA阳性率的差异亦有统计学意义(F=5.87,P0.05),初次比2次及≥3次献血人群HBV DNA阳性率高,LSD-t值分别为2.16和3.08P0.05,但2次和≥3次献血人群HBV DNA阳性率的差异无统计学意义(LSD-t=0.93,P0.05)。结论自愿献血、女性、18~30岁、重复献血者是HBV DNA阳性率较低的人群,且随着献血者HBV DNA检测应用于血液规范化筛查,多次献血人群HBV DNA阳性率逐渐下降。     

山东省血液中心2006～2010年机采成分血和献血者队伍分析

目的对山东省血液中,心2006。2010年机采成分血和机采献血者队伍状况进行分析,为今后的机采成分血采集及其献血者招募提供指导与参考。方法用唐山计算机软件中的统计模块统计2006．2010年的机采成分血和献血者资料．用EXCEL、SPSSl7．0进行数据分析。结果机采血小板的采集量逐年增长,机采粒细胞的采集量逐年减少;机采血小板血型比例A型、B型、O型和AB型之间基本保持在3：3：3：l;除2006～2007年外,2007—2010年单次捐献双份成分血的比例逐年升高,各年问差异有统计学意义（P〈0．05）;2006年有机采成分献血者1512名,2007年达到2329名,2008—2009年献血者均在2100名以上。2010年又降为1624名;每年多次（≥3次）献成分血的献血者比例由2009年的31．75％（723／2277）上升到2010年46．06％（748／1624）。有统计学意义（P〈0．05）,2006—2009年问无统计学意义（P〉0．05）。结论济南市省级医院临床机采成分血需求明显增加;机采无偿献血者队伍建设取得了部分成效,多次献血及单次双份献血比例增加,因而献血者队伍需求趋势明显．今后工作形势不容乐观。     

中等城市捐献机采血小板招募 保留 采集和质控模式研究

目的探讨建立中等城市自愿捐献机采血小板献血者的招募、采集、质控模式,确保机采血小板质量和临床用血安全与及时。方法固定献血者作为自愿者实行一对一动员,并计自愿服务小时,实行星级管理;争取市政府支持,对献血次数达20次以上者进行表彰;根据献血者采血前血常规检查和献血者体质量、体质量指数（BMI）,判断能否捐献两个治疗量。以2010年1月至2011年6月的原招募模式和2011年7月与2012年12月实施新的招募模式的捐献机采血小板固定献血者队伍、自愿捐献双份的比例和成品机采血小板作对照,分别对2组数据进行统计学分析。结果实行新的招募模式后,捐献机采血小板固定献血者队伍、自愿捐献双份的比例（χ2=413.48,P〈0.01）、机采血小板捐献成功率和成品机采血小板质量均大幅度提高,差异均有统计学意义（均P〈0.05）。结论实行新的招募模式、采集、质控模式能够更好地巩固和发展捐献机采血小板固定献血者队伍,保障机采血小板质量和临床用血安全及时。     

Prevalence of selected viral infections among temporarily deferred donors who returned to donate blood: American Red Cross blood donor study

BACKGROUND: Health history questions are introduced into the predonation interview to identify blood donors believed to pose a higher risk of infectious diseases to recipients. This study assesses the current impact of some of those questions. STUDY DESIGN AND METHODS: Donor deferral and donation data were extracted from a research database of the American Red Cross. The prevalence of hepatitis B surface antigen or antibodies to human immunodeficiency virus, hepatitis C virus, or human T-lymphotropic virus was obtained for different groups of donors who were temporarily deferred in 2000 through 2001 and later returned to donate blood in 2000 through 2003. The results were compared with either first-time or repeat donors in 2000 through 2003, while controlling for differences in sex, age, and year of donation. RESULTS: Of donors temporarily deferred in 2000 through 2001 who had had no donation or deferral during the previous 2 years, only 22.08 percent subsequently returned to donate blood in 2000 through 2003. Donations from returning donors who had been deferred for potential infectious disease risk did not show a higher prevalence for any of the viral markers when those with no donation or deferral during the previous two years were compared with first-time donations, and those with prior donation were compared with repeat donations. CONCLUSION: Blood donors temporarily deferred in 2000 through 2001 for potential risk of viral infection who later returned to donate blood did not appear to pose a higher risk compared to first-time or repeat donors. The effectiveness of some of the currently used deferral questions in reducing viral risks warrants further study.     

Incidence rates of viral infections among repeat donors:are frequent donors safer?

BACKGROUND: Incidence rates (IRs) for viral infections may vary with the frequency of donation among repeat, community, whole-blood (WB) donors, with IRs thought to be lower among donors with higher frequency of donation. STUDY DESIGN AND METHODS: IRs for HIV, HTLV, HCV, and HBV infection were stratified by frequency of donation among 868,403 repeat WB donors who gave approximately 4 million donations at five United States blood centers from 1991 through 96. All donors had given at least 2 donations during those years, with the first donation being nonreactive on confirmatory testing. Frequency of donation was measured in three ways: by the number of donations per year; at the time of donation, by the number of donations given within the preceding 2-year period; and by the number of donations given from 1991 through 1993. RESULTS: The IRs for HIV, HCV, and HBV infection did not appear to differ among donors with lower or higher numbers of donation per year. However, the IR for HTLV infection decreased as the number of donations per year increased (p = 0.0004). IRs for all viral markers remained stable, regardless of the number of donations given within the 2-year period before the donation. Although IRs for HIV, HTLV, and HCV infection did not vary by the number of donations given in 1991 through 1993, the IR for HBV infection appeared to be lower in donors who gave more donations in that period (p = 0.01). CONCLUSION: These findings do not provide evidence of a lower IR for transfusion-transmissible viral infections among repeat WB donors who give more frequently. Abbreviated screening histories for frequent repeat donors might not be advisable.     

Analysis of Chinese donors' return behavior

BACKGROUND: It is important to understand donor return behavior. Converting first‐time donors to become repeat donors is essential for maintaining an adequate blood supply. STUDY DESIGN AND METHODS: Characteristics of 241,552 whole blood (WB) donations from first‐time and repeat donors who donated in 2008 at the five blood centers in China were compared. A subset of 54,394 WB donors who donated between January 1 and March 31, 2008, were analyzed for their return behavior in 2008 after the index donation using logistic regression. RESULTS: Of all donations, 64% were from first‐time donors. Donors with self‐reported previous donations tended to be male, older, and married; donated larger volume (≥300 mL); and were heavier in weight. Among donors who donated from January to March 2008, 14% returned for subsequent WB donations by the end of 2008. The number of previous donations and blood collection location were the two strongest predictors for making subsequent donations. Donors with one, two to three, and more than three previous donations were 3.7, 5.7, and 11.0 times more likely to return than first‐time donors. Those who donated in a blood collection vehicle were four times more likely to return than those who donated at a blood center. Being female, younger, and of a lower education level (middle school or less) were positively associated with subsequent return blood donation during the follow‐up period observed in this study. CONCLUSION: Most of the Chinese blood supply is from first‐time donors. Strategies aimed at encouraging current donors to become repeat donors are needed.     

The risk of posterior subcapsular cataracts in granulocyte donors

BACKGROUND: Therapeutic use of adrenal corticosteroids is a risk factor for the development of posterior subcapsular cataract (PSC). Because corticosteroids are given to donors of apheresis granulocytes (PMNs) to improve yield, this study was performed to determine the prevalence of PSCs in PMN donors relative to a matched control group of apheresis platelet (PLT) donors. STUDY DESIGN AND METHODS: This study was a cross-sectional study stratified by age, sex, and lifetime apheresis experience at three sites. Individuals who had made at least five PMN donations preceded by corticosteroids were eligible. The presence of PSC was ascertained by grading digital retroillumination images of both lenses. A random subset of participants underwent clinical eye examinations by ophthalmologists masked as to study group. A logistic regression model was used to compute odds ratios (ORs). RESULTS: Granulocyte donors had given a mean of 13 donations (range, 5-39 donations) over a mean period of 8.5 years (range, 0.3-25.2 years). The mean corticosteroid exposure, in cortisol equivalents, was 2840 mg (range, 1067-9040 mg). Six of 89 PMN donors had photographic evidence of PSCs versus 4 of 89 controls. This difference was not significant (OR, 1.54; 95% confidence interval [CI], 0.46-5.08). Five of 33 PMN donors and 3 of 30 PLT donors had evidence of PSC by clinical examination. This difference was also not significant (OR, 1.61; 95% CI, 0.35-7.39). CONCLUSION: This study does not support the hypothesis that corticosteroid stimulation of PMN donors is associated with an increased risk of developing a PSC.     

Cataracts in neutrophil donors stimulated with adrenal corticosteroids

BACKGROUND: A relatively young man (43 years old) was found to have a cataract after receiving prednisone before each of 35 neutrophil (PMN) donations over several years. Because corticosteroids are known to induce posterior subcapsular cataracts (PSCs), additional repeat PMN donors were examined ophthalmologically. STUDY DESIGN AND METHODS: A controlled, blinded study was performed in 11 PMN donors who received prednisone with or without G-CSF before 17 to 46 leukapheresis donations over an average of 8.5 years. Control subjects were nine plateletpheresis donors of comparable age and donation experience, but they had never donated PMNs. A complete eye examination was performed by an ophthalmologist who was unaware of the donor's status (PMN vs. platelet). RESULTS: Mild PSCs were found in 36 percent (4/11) of PMN donors versus 0 of 9 platelet donors (p = 0.068). Five of the 22 PMN donor eyes involved versus 0 of the 18 platelet donor eyes involved exhibited PSCs (p = 0.040). Cortical and nuclear cataracts were found similarly in both groups of donors (82% PMN vs. 56% platelet donors; p = 0.217); this indicated that lifestyle factors, independent of corticosteroids, that might predispose to cataract formation probably were comparable. CONCLUSION: Corticosteroids given before PMN donations by leukapheresis might increase the risk of PSCs. Because of widespread renewed interest in PMN transfusions, this potential risk factor--if confirmed by studies of additional PMN donors--is of great international importance. Other centers are urged to perform ophthalmologic examinations on repeat PMN donors to clarify this issue.     

Donation reactions among autologous donors

Studies of risk factors associated with reactions among autologous blood donors have been limited. Therefore, 2091 autologous and 4737 homologous donations were examined. Donors at greatest risk for reaction were autologous donors who had reactions at first donation; among 45 who made repeat donations for the same surgery, 17 (38%) had repeat reactions. The group least likely to experience reactions were the autologous donors greater than or equal to 66 years old; they experienced a 1.9 greater than or equal to percent (6/310) incidence of reactions. More reactions were seen in both autologous and homologous donors in the categories of first-time donor, female gender, decreasing age, and lower weight. Multiple logistic regression analysis showed that all of these variables were independent predictors of donor reaction, with first-time donation (odds ratio, 2.4) and female gender (odds ratio, 1.9) being the strongest predictors of reaction. Donor room personnel should be alerted that autologous donors who react at first donation are very likely to react at subsequent donations. Contrary to common concern, elderly autologous donors are least likely to have reactions.     

Long-term serologic follow-up of blood donors with biologic false reactivity on an anti-human T-cell lymphotropic virus Types I and II chemiluminescent immunoassay and implications for donor management

BACKGROUND: This study reports the results of the long‐term serologic follow‐up of blood donors who gave an index biologic false‐reactive (BFR) result on an anti‐human T‐lymphotropic virus Types I and II (HTLV‐I and ‐II) chemiluminescent immunoassay (ChLIA). STUDY DESIGN AND METHODS: All allogeneic whole‐blood and apheresis donors who gave an index BFR result on a HTLV‐I and ‐II ChLIA between May 10, 1997, and December 31, 2004, were included in the study. Donors were followed up for an additional 2 years until December 31, 2006. RESULTS: A total of 332 donors gave an index BFR donation during the study period. Donors were divided into five groups based on results of donations subsequent to the index BFR donation: 89 (26.8%) donors gave only nonreactive donations subsequent to the index BFR result, 56 (16.9%) donors gave only BFR donations, 43 (13.0%) gave one or more subsequent BFR donations before giving only nonreactive donations, 59 (17.8%) donors gave intermittent BFR and nonreactive donations, and 85 (25.6%) donors gave no further donations during the study period. The estimated mean duration of biologic false reactivity from the time of the index BFR donation in donors who gave only a single BFR result was 7.0 (1.4‐42.75) months and 23.3 (4.1‐92.25) months in those donors who gave several BFR results before giving nonreactive donations. Modeling of the data indicated that notification and deferral of donors after two consecutive BFR donations would result in the deferral of 143 of 332 (43.1%) of donors with an index BFR result while allowing donors to give three BFR results would reduce the number of deferred donors to 74 of 332 (22.3%). CONCLUSION: The results of this study indicate that although biologic false reactivity is usually transient, the time for resolution is variable. Allowing donors to give two or three BFR results before notification and deferral is one strategy that would substantially reduce the number of donors requiring deferral.     

Who donates blood at five ethnically and geographically diverse blood centers in China in 2008

BACKGROUND: In China recruitment and retention of sufficient numbers of safe blood donors continues to be a challenge. Understanding who donates blood, particularly those who donate larger (>200 mL) whole blood (WB) units, will help blood centers to target more effective recruitment and retention strategies. STUDY DESIGN AND METHODS: Demographic characteristics of 226,489 allogeneic WB donors from January to December 2008 at five geographically and ethnically diverse, urban blood centers were analyzed. RESULTS: The typical Chinese WB donor can be characterized as first‐time volunteer (67.9%), male (56.9%), less than 45 years old (93.8%), and Han ethnicity (86.1%). Most donors had some college or below educational level (77.5%), donated at a mobile collection site (97.6%), and donated 300‐ or 400‐mL units (76.0%). Differences in WB volume donations and donor demographics exist among the five centers. CONCLUSION: In China compared to the United States, donations are made by younger donors and donors give infrequently and make smaller WB donations. To help ensure supply adequacy, continued efforts are needed to have donors give larger volumes of WB in China.     

Analysis of donor return behavior

BACKGROUND: Efforts to provide a safe, adequate blood supply have been inhibited by persistent shortages attributed to a lack of motivation on the part of the general public and inefficiency in recruiting processes. This study examined whether frequency of donations and/or timing of subsequent donations by first-time donors related to donor demographics. STUDY DESIGN AND METHODS: Characteristics of 879,816 first-time donors making at least one whole-blood donation were analyzed. Cox proportional-hazards regression models evaluated the first 10 return times separately, and a recurrent-event Cox model was applied to simultaneously evaluate the first five returns. RESULTS: The shorter the donation interval between the first two donations, the more likely the donor was to make subsequent donations. The proportion of repeat donors increased with education level. Rate of donation increased with age and education. The recurrent-event Cox regression model showed that Rh-negative donors, older donors, and donors who had completed college had higher donation return rates. CONCLUSION: Time to return for second donation was associated with total number of donations made and with return rate for subsequent returns. Age was the strongest predictor of high donation frequency and early-return rate. Relationships between interdonation interval and the number of future donations may prove useful in understanding return behavior and developing donor recruitment and retention strategies.     

Lapsed donors: an untapped resource

BACKGROUND: There is a clear need for methods to recruit and retain donors without compromising blood safety. Although prior studies report lower viral prevalence rates in repeat donors than those in first-time donors, it is unknown if this relationship holds after a lapse of several years between donations. STUDY DESIGN AND METHODS: A total of 6.4 million allogeneic donations collected at five US blood centers from 1991 through 1998 were classified by donation history (first-time vs. repeat) and by length of time between donations (lapsed interval length). The prevalence of HCV, HIV, and HBsAg was compared by donation history and lapsed interval length. The relationship between lapsed interval length and donor demographics was explored. RESULTS: Repeat donors who delayed their return for over 5 years were significantly less likely to test positive for a viral infection than were first-time donors. The likelihood of a positive test result appeared to increase steadily with lapsed interval length for HCV and HBsAg, but not for HIV. Younger, less educated, and nonwhite donors were less likely to return than others. CONCLUSIONS: Recruitment of donors who have not returned for several years could be an effective way to increase the blood supply while preserving blood safety. Understanding the relationship of donor demographics to return behavior is important for recruitment efforts.