Measures to decrease the risk of acquired immunodeficiency syndrome transmission by blood transfusion. Evidence of volunteer blood donor cooperation

We studied whether volunteers giving blood to the Greater New York Blood Program (GNYBP) cooperated with procedures implementing public health recommendations intended to decrease the risk of acquired immunodeficiency syndrome (AIDS) transmission by blood transfusion. Predonation medical screening was expanded to exclude donors who might be ill with AIDS. To exclude possible asymptomatic carriers of the disease, members of groups at increased risk of AIDS were asked either not to give blood or to give it for laboratory studies. A confidential questionnaire, administered to all donors after medical screening, provided the vehicle for donors to advise the GNYBP whether their donation was for laboratory studies or for patient transfusion. We found that the number of male donors decreased; AIDS-related questions in medical history led to a 2 percent increase in donor rejections; 97 percent of donors said their blood could be used for transfusions; 1.4 percent said their blood could be used for laboratory studies only; and 1.6 percent did not respond. Only units designated for transfusion were released to hospitals. People who indicated that their donation was for laboratory studies had a higher prevalence of markers for hepatitis B virus and of antibodies to cytomegalovirus. White cell counts and helper/suppressor T lymphocyte ratios were not significantly different in the two groups. We conclude that volunteer donors have cooperated with the established procedures. None of the laboratory assays identified blood units donated by individuals who, based on information about AIDS high-risk groups, designated their donation for laboratory studies.     

Blood-donor perceptions of health history screening with a computer-assisted self-administered interview

BACKGROUND: Computer-assisted self-interviewing (CASI) has been shown to promote disclosures of sensitive information. Using CASI to screen blood-donor candidates might encourage reports of deferrable risks without discouraging eligible donors. STUDY DESIGN AND METHODS: In 1998, an anonymous mail survey was sent to donors from eight blood centers. The relationship of donor demographics, donation history, and infectious risks (HIV test-seeking behavior, unreported deferrable risk, or reactive donor-screening test result) on attitudes toward CASI were assessed. RESULTS: Of 92,581 blood donors surveyed, 52,650 (57%) responded; of these, 4713 (7%) had an infectious risk. Among donors with risks, 29 percent felt they would be encouraged to reveal personal data, and 7 percent reported they would be discouraged from donating by CASI. Young, minority, female, and first-time donors were the most likely to report that CASI would encourage personal disclosures. Among donors without risks, 5 percent felt CASI would discourage them from donating. CONCLUSIONS: Although most donors felt their donation practices would not be influenced, CASI might reduce the proportion of donors with infectious risks by fostering personal disclosures and self-deferrals. The potential for CASI to improve donor screening and increase appropriate self-deferrals should be balanced against the possible loss of reluctant safe donors.     

Directed-donor programs may adversely affect autologous donor participation

One hundred autologous whole blood donors (11 men, 89 women; 49 preoperative, 51 prenatal) completed a questionnaire concerning their motivations as autologous donors, their perceptions of the relative safety of blood donor options, and their interest in directed donations. Concern about acquiring AIDS from transfusion was the most prevalent reason for autologous donation. Nearly all participants knew that autologous blood was safer than volunteer blood, and most also believed that directed-donor blood was safer than volunteer blood. Most would have used a directed-donor program if available, particularly if they were ineligible as autologous donors. Furthermore, their interest in directed donations was unaffected by written material, provided pathway through the questionnaire, that included a statement that no scientific evidence exists to support directed donations' being safer than volunteer blood. One donor in five believed that autologous and directed donations were equivalent in safety, and 19 (15 of whom were prenatal donors) indicated that they probably or surely would not have participated in the autologous program if directed donations had been available. This study demonstrates that a sizable proportion of autologous donor candidates might not participate if a directed donation program were available. The unrestricted availability of directed donations may thus contribute to suboptimal use of autologous donor programs.     

Second fingerstick: a simple method to increase the blood supply

Before blood donors are deferred because of a low hemoglobin determination by the copper sulfate procedure, they are routinely retested with a microhematocrit. The copper sulfate test and the microhematocrit usually are performed on blood samples taken from the same finger (or earlobe) puncture. We studied 201 male and female volunteer blood donors who failed the copper sulfate test to determine if more donors would be accepted for donation if blood from a second fingerpuncture, instead of the original fingerstick, was used for the microhematocrit determination. Venous blood samples were obtained to evaluate complete blood count and measures of iron status. The results indicated that the deferral rate was reduced by 46% using a fresh fingerpuncture for the microhematocrit determination. The iron status of the additional donors accepted on the basis of the second puncture was not significantly different from that of the donors accepted by the original fingerstick. We conclude that using a second fresh fingerpuncture for the microhematocrit determination after failing the copper sulfate test decreases the number of hematocrit deferrals and does not compromise the iron status of the additional donors.     

Community blood donors' knowledge of anemia and design of a literacy-appropriate educational intervention

BACKGROUND: The purpose of this project is to improve the health of blood donors by educating and motivating them to seek medical attention for anemia. The National Anemia Action Council, BloodCenter of Wisconsin, and the Medical College of Wisconsin formed a partnership to engage volunteer blood donors and develop an educational intervention to motivate donors with anemia to seek appropriate medical care.
STUDY DESIGN AND METHODS: Partners developed an educational pamphlet and conducted two focus groups with volunteer blood donors for feedback. Participants were recruited from volunteer donors at BloodCenter of Wisconsin found to have anemia (men age, 18 years and older with a hematocrit [Hct] level of <38%; women age 50 years and older with a Hct level of <36%) at blood screening before donation.
RESULTS: Participants (n = 25) addressed their understanding of anemia, information they received after being deferred, their reactions about the deferral, and comments on the educational material. The educational pamphlet was revised based on focus group comments.
CONCLUSION: Volunteer donors are extremely dedicated and interested in increasing their understanding of anemia and the ability to continue donation. Community members' feedback on educational material is a valuable resource to improve the literacy level of information.     

Development and operation of a program to obtain volunteer bone marrow donors unrelated to the patient

Because of recent increases in bone marrow transplantation, the lack of available matched sibling donors has become a problem. This study investigated the feasibility of obtaining volunteer bone marrow donors unrelated to the patient. A program was developed to inform potential donors and obtain their consent for listing in a bone marrow donor registry. Sixty-six percent of whole blood or apheresis donors agreed to participate in the program. There were no demographic differences between those who accepted or declined to participate. Religion, experiences with medical practices, and the attitude of the potential donor's spouse were important factors in the decision to participate. A search for donors was initiated for 127 patients. Thirty searches were not completed, primarily because of patient-related problems. A total of 713 HLA-A and -B antigen-identical donors was located for 63 of the 97 (65%) patients. A total of 40 HLA-A, -B, and -DR antigen-identical donors was located for 18 of these 63 patients. Six of these 18 patients then had one or more donors (total, 9) whose lymphocytes did not react in mixed lymphocyte culture. Thus, using the file of 2147 donors, an HLA-identical donor was located for 6 percent of the 97 patients. None of these patients has yet received a transplant; in four cases this was due to patient-related and in two cases donor-related reasons. The cost to establish the donor program averaged $33.46 (1984) per donor for donors already typed for HLA-A and -B antigens. This experience indicated that, given thorough information about bone marrow donation and transplantation, a majority of blood and apheresis donors will volunteer to donate bone marrow, without feeling pressure to do so. A relatively small donor file provided donors for 6 percent of patients. The long-term value of bone marrow transplantation using unrelated donors and the optimum size of the donor file remain to be established.     

Biospecimen repositories: are blood donors willing to participate?

BACKGROUND: Sponsored by the National Heart, Lung, and Blood Institute, the Retrovirus Epidemiology Donor Studies (REDS‐I/‐II) have conducted epidemiologic, laboratory, and survey research on volunteer blood donors. Some studies request additional permission to store biospecimens for future studies. The representativeness and applicability of studies performed using repositories may be reduced by low participation rates. STUDY DESIGN AND METHODS: Demographics from subjects consenting to participate in the 2007 REDS‐II Leukocyte Antibodies Prevalence Study (LAPS) repository were compared to “study‐only” subjects. Data from the 1998 REDS‐I survey of donor opinion regarding storage and use of biospecimens were also explored. RESULTS: Overall, 91% of LAPS subjects agreed to participate in the repository. Odds of repository participation were lower among African American and Hispanic donors, 35‐ to 44‐year‐olds, donors who had not completed high school, and donors from one geographic location, regardless of other variables. Survey data from 1998 revealed that 97% of respondents approved of long‐term storage of biospecimens, although only 87% indicated that they would personally participate. Many respondents would require notification or their permission be obtained before participation. Minority respondents would require permission or notification more often and were less certain they would personally participate in a repository. CONCLUSION: Blood donors are quite willing to participate in biospecimen repositories. Regional differences and lower odds of participation in the minority blood donor population may result in a reduced number of biospecimens available for study and a decreased ability to definitely answer specific research questions in these populations.     

Evaluation of technical and behavioral issues in predonation alanine aminotransferase testing

To evaluate the technical and behavioral impact of predonation alanine aminotransferase (ALT) testing, one group of 2914 donors (Reflotron group) were tested with the Boehringer Mannheim Reflotron instrument; 3042 control group donors had no predonation test. Mobile blood collection sites in three regional blood centers were studied. More Reflotron group donors than control group donors thought that predonation testing did not add time and was a good idea. Both groups were equally satisfied with the donation process and indicated they would donate again even if testing added time. Comparison of the Reflotron and standard laboratory tests showed excellent correlation with low variability. The mean r value was 0.934, with a mean sensitivity of 94.4 percent and a specificity of 99.8 percent. The staff working with the Reflotron group found predonation testing easy to incorporate into donor screening. They observed that donors were pleased with testing and accepting of deferral counseling for elevated ALT. The control group staff was concerned that predonation testing would require more time and would have a negative effect on the donor return rate. This did not appear to be the case as judged by donor response and the 6-month return rates of 50 percent for Reflotron group and 54 percent for control group donors.     

A pool of repeat blood donors can be generated with little expense to the blood center in sub-Saharan Africa

BACKGROUND: In sub-Saharan Africa, most collected blood originates from accessible and cheaper replacement donors while recruiting and retaining volunteers requires considerable costs not all countries can afford. The Kumasi Teaching Hospital Blood Center and a local FM radio station developed a partnership calling three times a year for donation at the radio station where music, entertainment, and token gifts were available. STUDY DESIGN AND METHODS: To assess the program's impact, attendance, deferral, age, sex, identification, and viral test results of donors attending 12 consecutive sessions in 2003 through 2006 were analyzed, and this donor population was compared to other types of donors in Kumasi, Ghana. RESULTS: A total of 3801 donors attended the program and 92 percent of the potential FM donors were eligible to donate compared to 85.5 and 70.3 percent of other volunteer and replacement donors, respectively. Ninety percent of donors were male (median, 25 years) and 4.9 percent were hepatitis B surface antigen-positive compared to 11 and 15 percent in other volunteer and replacement donors. This reflected 63.6 percent spontaneous repeat donations from donors responding to the radio appeal compared to 15 to 30 percent in other volunteer donors. CONCLUSIONS: It has been demonstrated that the use of a culturally and socially adapted environment to make the gift of blood a pleasurable and festive experience generated a new pool of blood donors spontaneously repeating donations. This program indicates that retaining Ghanaian blood donors is possible at little extra cost to the blood center and that such an approach may represent a substantial help in the efforts of sub-Saharan Africa to collect volunteer blood.     

The motivations of blood donors and nondonors: a community survey

Telephone interviews elicited information on motivational responses of blood donors and nondonors from a completely random sample of an entire community. Results indicated that more males than females are current donors and that 63 per cent of the males and 89 per cent of the females who have donated previously have become nondonors. Most donors express no fears before donating and state direct appeal, convenience, and peer pressure as the motivational aspects that caused them to donate in the first place, and altruism as the major reason for continuing to donate. The two largest categories mentioned by nondonors for inhibiting their donating were medical disqualification and fear. When both donors and nondonors made suggestions for improving blood donor recruitment, they tended to mention publicity (including education), emergency appeal, and personal solicitation. The first two were not mentioned by actual donors as to what motivated them to give blood initially. Blood procurement agencies should, therefore, be aware of a distinction between actual motivating factors and those that are only hypothetical.     

The potential impact of incentives on future blood donation behavior

BACKGROUND: It is important to assess the potential efficacy and safety of offering donation incentives as part of recruitment and retention programs. STUDY DESIGN AND METHODS: In 1995, 7489 allogeneic donors responded to an anonymous mail survey that inquired about demographics, donation history, infectious disease risks, and the potential appeal of incentives. RESULTS: The projected net effect of offering blood credits and medical testing would be to motivate, respectively, 58 percent and 46 percent of donors to return, whereas offering an item of limited value would motivate 20 percent to do so. First-time and younger donors reported more frequently than repeat or older donors that incentives would appeal to them. Donors attracted by cash were 60 percent more likely to have a risk for transfusion-transmissible infections (p = 0.03). Although not statistically significant, the odds of being an at-risk donor were higher among individuals attracted by tickets to events (OR 1.5) and extra time off work (OR 1.2). CONCLUSION: These findings suggest that offering blood credits and (though to a lesser extent) items of limited value could be safe and effective strategies for retaining donors. Although medical tests were found to have broad appeal, studies are needed to identify tests in which donors would be most interested.     

Serum alanine aminotransferase in blood donors: activity distribution and effect of phenotype

Alanine aminotransferase (ALT) phenotype and serum activities were determined in 200 random volunteer blood donors. Serum enzyme activities were not significantly affected by the ALT phenotype (p greater than 0.1). Studies on 500 random volunteer blood donors showed significant differences in serum ALT levels between male and female donors (p less than 0.001). Elevated serum ALT levels were more commonly found in male donors; the frequency of male donors with levels of 45 IU/l or higher was 2.5 percent compared with 0.9 percent in female donors. The frequency of donors with serum ALT levels of 80 IU/l or higher was 0.6 percent of the total donor population sampled.     

Computer-assisted audiovisual health history self-interviewing Results of the pilot study of the Hoxworth Quality Donor System

BACKGROUND: The safety of blood for transfusion depends, in part, on the reliability of the health history given by volunteer blood donors. To improve reliability, a pilot study evaluated the use of an interactive computer-based audiovisual donor interviewing system at a typical midwestern blood center in the United States. STUDY DESIGN AND METHODS: An interactive video screening system was tested in a community donor center environment on 395 volunteer blood donors. Of the donors using the system, 277 completed surveys regarding their acceptance of and opinions about the system. RESULTS: The study showed that an interactive computer-based audiovisual donor screening system was an effective means of conducting the donor health history. The majority of donors found the system understandable and favored the system over a face-to-face interview. Further, most donors indicated that they would be more likely to return if they were to be screened by such a system. CONCLUSION: Interactive computer-based audiovisual blood donor screening is useful and well accepted by donors; it may prevent a majority of errors and accidents that are reportable to the FDA; and it may contribute to increased safety and availability of the blood supply.     

Critical evaluation of informed consent forms for adult and minor aged whole blood donation used by United States blood centers

BACKGROUND: Blood donation is a medical procedure with attendant risks, and thus blood donors should undergo acceptable informed consent. There are no guidelines for the informed consent forms (ICFs) for whole blood donors or for parental consent forms (PCFs) for minor age blood donors. The goal of the study was to determine if the majority of the generally accepted elements of informed consent are provided to volunteer allogeneic whole blood donors in the United States.
STUDY DESIGN AND METHODS: ICFs and PCFs along with their accompanying general information forms (GIFs) from nonmilitary blood collection establishments for allogeneic whole blood donation were collected throughout the United States and scored using a system based on the essential elements of informed consent derived from guidelines of consent for research subjects. The overall score for each ICF and PCF was obtained.
RESULTS: Twenty-one ICFs and 37 PCFs from 48 states representing major collection centers within the United States were scored. The mean score for the common essential elements ICFs was 35 percent (range, 10%-80%) and for PCFs was 46 percent (range, 10%-90%).
CONCLUSION: None of the whole blood allogeneic donation informed consents surveyed contained all the common essential or specific blood donation information desired. There is a need for national guidelines for the informed consent process for both the donor and the parent of a minor to ensure adequate information is specified.     

A pilot study of surrogate tests to prevent transmission of acquired immune deficiency syndrome by transfusion

Because of reports that acquired immune deficiency syndrome (AIDS) might be transmissible by blood transfusion, we studied potential surrogate tests that could be used for screening donors. Male donors at one volunteer blood center and two plasma centers were screened for total lymphocyte count, OKT3, OKT4, OKT8, OKT11, LEU-7, LEU-M2, antibodies to hepatitis B core (anti-HBc), cytomegalovirus (CMV), and herpes and circulating immune complexes. Total lymphocyte counts and the OKT11 were significantly lower in one plasma center. No significant differences were found for the other lymphocyte or monocyte tests. Low T4/T8 ratios, found in 20 percent of donors, did not correlate with other abnormalities. A small percentage (3.3%) of volunteer donors, 15.4 percent at one plasma center and 20.8 percent at a second plasma center, and 38.5 percent of the male homosexual donors were positive for anti-HBc (significant when comparing the male homosexuals to the volunteers at p = 0.032). Positive CMV and herpes titers were similar in the groups. Circulating immune complex levels greater than two standard deviations above the mean were found in 20 percent of the volunteer donors, 7.7 percent at one plasma center and 8.3 percent at the second plasma center, and none in the male homosexual population. Pearson product moment correlations showed reasonably good agreement among the lymphocyte tests. However, the anti-HBc, CMV, and herpes antibodies and circulating immune complex levels did not correlate with any of the other tests. Surrogate tests for AIDS are nonspecific and unlikely to be helpful in screening blood donor units.     

Attitudes and physical condition of unrelated bone marrow donors immediately after donation

Annually, over 3000 bone marrow transplants are performed worldwide involving HLA-identical sibling donors. However, only 30 percent of those patients who need a bone marrow transplant have a matched sibling donor. Programs have been developed to provide volunteer unrelated bone marrow donors for patients without sibling donors. Because bone marrow donation requires a high level of altruism, especially on the part of a donor unrelated to the patient, it is important to determine the effect of donation on the donor. Serious medical complications during the collection of marrow from related donors have been reported only rarely, but there have been no reports on the psychosocial and physical effects of the bone marrow donation process on volunteer unrelated bone marrow donors. The first 20 unrelated volunteers who donated bone marrow through the authors' volunteer bone marrow donor program were surveyed. They suffered no serious emotional or physical aftereffects. Seventeen of 20 donors reported that making the decision to donate was easy, and 16 reported making the decision to donate right away. Nine of 20 donors, however, stated that a friend or family member discouraged them from donating. All 20 donors thought that they were well prepared for the donation process. Four donors thought that the donation process required more time than they expected, but four donors thought the reverse. One person thought the process was more painful than they expected; however, 12 found the process to be less painful than expected.(ABSTRACT TRUNCATED AT 250 WORDS)     

Characteristics of a donor population in western Venezuela

To determine the characteristics of blood donors in western Venezuela, we collected data from 1983 to 1985 on 31,320 volunteer donors at the Blood Bank of the State of Zulia in Maracaibo. Fifty-nine percent of the donors were blood group O, 30 percent were group A, 9 percent were group B, and 2 percent were group AB. Most of the donors (93%) were Rh positive. One percent of donors had positive reactions to hepatitis B surface antigen, 3.15 percent for syphilis, 1.43 percent for antibodies to Trypanosoma cruzi, and 0.32 percent to human immunodeficiency virus antibodies. About one-half of the donors were between 18 and 30 years old, and only 10 percent were women. To determine if iron deficiency anemia was a cause for the small size of the female donor pool, we measured serum ferritin in 50 first-time female donors. Ten of these (20%) had serum ferritin values below normal, and the distribution of serum ferritin levels of all 50 was very similar to that reported for frequent donors in Europe and the United States, with a clustering of ferritin values between 10 and 70 ng per ml. The data indicate that blood donors in western Venezuela are markedly different from those in the United States and that iron supplementation may be indicated for female Venezuelan donors.     

Notes on East Anglian blood donors

The record cards of 10,000 donors were examined. Of these, 44.5 per cent were women, and women formed the majority of rhesus (Rh)-negative donors. In addition, 500 donor cards each of male and female donors were examined to obtain information regarding the age of donors when their first donation was given, how many donations were given by each donor, and how long they remained on the panel. The average number of donations per donor was six, given on the average over a four-year period. The age limits for blood donors are 18 to 64 years. Within these limits, only 5 per cent of the population will be blood donors. Responses to a questionnaire indicated three main reasons for not being current blood donors: lack of time, disqualification on health grounds, and lack of information regarding the time and place of blood donor sessions. The study indicates that publicity to recruit donors should be aimed to appeal to both sexes and that the most desirable age range for new donors is from 20 to 45 years of age. If the present policy of not encouraging individuals 60 years of age or older to be donors were changed to limit new donors to individuals less than 54 years old, the number of donations would be initially decreased by only 4.6 per cent. Any advertising campaign should give more information concerning exact places and times of sessions, and should aim to overcome general disinterest in the need for blood donors and the conviction that a personal donation is not really necessary. It might emphasize that giving up at most, an hour every six months is usually possible.     

Prevalence of viral markers among first-time Arab blood donors in Kuwait

BACKGROUND: The aim of this study was to assess the effect of blood donation modes on the prevalence of viral markers among Arab first-time blood donors in Kuwait. STUDY DESIGN AND METHODS: Donor ethnic background was classified as Kuwaiti nationals and non-Kuwaiti Arabs. A total of 26,874 donors were screened in 2002 for the following viral markers: hepatitis C virus antibody (anti-HCV), hepatitis B surface antigen (HBsAg), anti-hepatitis B core antigen (HBc), human immunodeficiency virus-1 and -2 antibody (anti-HIV-1 and -2), HIV p24, and human T lymphotropic virus-I and -II antibody (anti-HTLVI/II). All samples positive for the presence of anti-HBc were tested for anti-HBs. Among these donors, 12,798 were first-time donors of which 74 percent were replacement and 26 percent were volunteers. RESULTS: The prevalence of HCV among replacement donors was significantly higher than the volunteer group. The difference between the two modes of blood donations, however, was not significant for HBsAg. The prevalence of anti-HCV among Kuwaiti national and non-Kuwaiti Arab first-time donors was 0.8 and 5.4 percent, respectively, whereas the prevalence of HBsAg was 1.1 and 3.5 percent, respectively, with the difference being significant at a p level of <0.0001. The difference observed for prevalence of anti-HBc among Kuwaiti national and non-Kuwaiti Arab donors (17 and 33.3%, respectively) was significant (p < 0.0001). Among first-time donors, 13.7 percent were positive for the presence of anti-HBs, indicating that 13.7 percent of the total Arab donor population might have had a previous infection and possible immunity to hepatitis B virus (HBV). CONCLUSION: A high prevalence of HBV and HCV was found among non-Kuwaiti Arab donors. The prevalence of anti-HCV was only significantly higher among replacement versus volunteer first-time donors. Therefore, there is a need to develop a strategic plan that incorporates the diverse background of the blood donors living in Kuwait.