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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 7  |  Issue : 1  |  Page : 23-27

Blood donors and their deferral pattern in a university hospital, Nepal


1 Department of Pathology, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
2 Department of Biochemistry, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal

Date of Submission07-Feb-2022
Date of Decision05-Apr-2022
Date of Acceptance07-Apr-2022
Date of Web Publication29-Apr-2022

Correspondence Address:
Dr. Surendra Koju
Department of Pathology, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/gjtm.gjtm_11_22

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  Abstract 


Background and Objectives: Blood transfusion is a life-saving procedure and the selection of healthy blood donors is essential steps for safe blood transfusion. Proper selection of blood donors is needed for the safety of both blood donors and recipients. The aim of this study was to assess the demographic profile of blood donors and determine the frequency and reason of donor deferral in a university hospital of Nepal. Methods: This hospital-based retrospective study was carried out in the Blood Bank Unit of the tertiary care center of Nepal. Data were collected from the record book maintained in the blood bank from January 2016 to December 2020. Data were analyzed using Microsoft Office Excel 2010 for descriptive analysis. Results: A total of 3697 individuals came for blood donation during the study period; among them, 2802 (75.8%) were male and 895 (24.2%) were female. Total number of voluntary donation were 2175 (58.8%), while 1522 (41.2%) were family/replacement donation. Among all donors, 351 (9.5%) donors were deferred for different reasons. The most common cause of donor deferral was hypertension (15.0%), followed by medication (14.0%), while anemia (32.8%) was the leading cause of deferral in female donors. Out of total deferral cases, 92.6% of donors were temporary deferral, while 7.4% were deferred permanently. Conclusion: Most deferrals were temporarily due to hypertension, medication, and anemia. Awareness about these causes of deferral can increases the donor pool.

Keywords: Blood donors, deferral, Nepal


How to cite this article:
Koju S, Bhatt RD, Shankhadev R, Twitwi R. Blood donors and their deferral pattern in a university hospital, Nepal. Glob J Transfus Med 2022;7:23-7

How to cite this URL:
Koju S, Bhatt RD, Shankhadev R, Twitwi R. Blood donors and their deferral pattern in a university hospital, Nepal. Glob J Transfus Med [serial online] 2022 [cited 2022 Sep 26];7:23-7. Available from: https://www.gjtmonline.com/text.asp?2022/7/1/23/344327




  Introduction Top


Blood transfusion service is a crucial component of the health-care system where its major goal is to ensure the supply of safe and adequate blood products from blood donors.[1] Hence, careful assessment of donor selection through structured questionnaires is an important and effective aspect for ensuring blood safety and to protect donor as well as recipient health.[2],[3]

According to the World Health Organization (WHO), blood donation by 1% of the population in a country will help to fulfill the demand of blood products for safe transfusion;[4] however, a limited number of healthy donors for safe donation are a major public health issue.[5],[6] Stringent blood donor criteria are an important tool for the safety of blood donors and recipients.[7] However, such rigid criteria for donor selection cause a large number of donor deferrals, either temporary or permanent, leading to the loss of precious blood donors.[8] In addition, deferring blood donors has a negative impact on blood donors and the blood donation process and they are less likely to return for blood donation in future.[9]

The WHO report (2011–2015) for the South-East Asian region showed on an average of 88.7% voluntary donors in Nepal and around 21% deferrals were recorded on an average.[4].We could not find any study giving the demographic profile and deferral pattern of donors in Nepal. The exact causes of deferral are essential not only to make strategies to increase donor pool but also for recruiting temporarily deferred donors.

Aim and objectives

The aim of this study was to assess the demographic profile of blood donors and determine the frequency and reason for donor deferraol at our centre.


  Materials and Methods Top


This was a retrospective hospital-based study where demographic data were collected from the record book of blood bank. Registered information and cause of deferral in the study period of 4 years from January 2016 to December 2020 were analyzed. Demographic profile, sex, age, occupation, and number of blood donation by donors were studied. Along with that, information about blood pressure, predonation hemoglobin level, history of diseases and medication, alcohol consumption, past transfusion history, pregnancy status, and breastfeeding were also analyzed. Frequency and causes for temporary and permanent deferral were analyzed.

Statistics

Data were analyzed using Microsoft excel spreadsheet version 2010. (Microsoft Corporation, Washington, USA).

Ethical clearance

Ethical approval was obtained from the institutional review committee. Our blood bank has policy to screen every blood donor by a predesigned questionnaire prepared according to national guidelines for blood transfusion by the National Bureau for Blood Transfusion Service, Nepal.[10]


  Results Top


A total of 3697 blood donors were registered for blood donation in the blood bank record book during the study period. Out of total donors, 2802 (75.8%) were male and the remaining 895 (24.2%) were female. Majority of blood donors belong to the age group of 18–25 years and this contributed 1640 (44.4%) of total donations, followed by 26–35 years and 36–45 years with a contribution of 1458 (39.5%) and 479 (13.0%), respectively. In this study, more than half of the blood donors 2175 (58.8%) were voluntary nonremunerated donors (VNRD), while family/replacement donors accounted for 1522 (41.2%). Majority of the donors were employed, accounting for 1220 (32.3%), followed by students who contributed to 1155 (31.2%) of the donor pool. There were 30.5% and 5.3% self-employed and unemployed, respectively. More than half of donors 2156 (58.3%) had previous experience of blood donation, while 1541 (41.7%) were first-time donors [Table 1].
Table 1: Demographic profile of registered, selected, and deferred blood donors

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Out of total 3697 blood donors, 351 (9.5%) were deferred. Among 351 deferred cases, 220 (62.7%) were male and 131 (37.3%) were female participants. However, in total, the deferral frequency for males and females was 220/2,802 (7.8%) and 131/895 (14.6%), respectively.

Out of the total deferrals, 325 (92.6%) were deferred temporarily, while 26 (7.4%) only were permanently deferred [Figure 1]. Overall, hypertension (15.0%) was major cause of blood donor deferral [Figure 2], followed by medication (14.0%), anemia (12.2%), hypotension (10.3%), and alcoholism (9.1%). However, in female donors, anemia was the major reason of deferral and accounted for 43/131 (32.8%). Different reasons for permanent deferral were diabetes, asthma, cardiovascular disease, transfusion-transmitted infection, epilepsy, and bleeding disorder [Figure 3].
Figure 1: Frequency of temporary and permanent deferral

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Figure 2: Reasons with number of temporary donor deferrals

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Figure 3: Reasons with number of permanent donor deferral

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  Discussion Top


This is the first research of its kind in Nepal revealed that 9.5% of donors were deferred in the blood bank of a university hospital for 4-year due to different reasons. A few studies from some Asian countries showed that the prevalence of deferral was 6.85% to 11.7%.[11],[12],[13],[14] The total deferral rate varies among different countries from 1% to 37%, with a median of 12%.[15]

This study indicated that around 93% of donors were deferred temporarily and 7% permanently. In a study, Vasudev and Kaur reported 66.6% temporary deferral and 33.3% of permanent deferral.[9] It might be due to differences in guidelines for temporary and permanent deferral in different countries.[2],[10],[16]

Hypertension was the most prominent (15%) cause of donor deferral in this study. Few other studies in Asian countries showed donor deferral due to hypertension ranges from 1.8% to 29.4%.[6],[11],[17],[18] The variation in the frequency of the donors' rejection based on blood pressure may be due to variations among countries' guidelines. Other probable reasons for the high blood pressure may be the fears, anxiety, and stress of phlebotomy needle and blood at the time of donation.[17]

In females, anemia was the leading cause of deferral, accounting for 32.8%. A study[11] advocated that low hemoglobin is the noticeable cause of deferral in females, while a study conducted in Malaysia, 69% of deferral among females was due to anemia.[18] This is possibly due to the rigid and different levels of hemoglobin requirements in different countries. Low hemoglobin level is a leading cause, accounting for 13.3% to 60.7% deferrals among male and female donors in different countries of South-East Asia with a mean value of 35.84% ± 12.79% standard deviation.[4]

Predonation hemoglobin estimation is mandatory to screen for eligibility of blood donation.[2],[10] One of the major drawbacks in blood donation is unnecessary deferral of donors due to inconvenience, anxiety, and fear of needle.[19]

In Nepal, the prevalence of anemia in women of the age group 15–49 years was 41%,[20] while there is no reported data on anemia prevalence in the male population of Nepal. It was reported that majority of deferral due to anemia were female, where some studies reported that 95% of deferral for anemia occur in females.[11] Hence, only female donors were properly informed on the high prevalence of anemia in women and counseled on the benefit of predonation hemoglobin screening. However, some studies have showed that anemic male donors were very high compared to female donors.[12] Hence, it is recommended to check predonation hemoglobin levels in all gender of blood donors.

The second-most common cause for overall donor deferral was the recent intake of medication, that accounts for 14.0%. The highest deferral rate was due to use of therapeutic drugs, which was also reported in other studies done in Saudi Arabia and India with the rate of 24.4% and 15.1%, respectively.[14],[17]

Out of 131 deferred female donors, 12 (8.4%) were deferred due to their menstrual period. However, this is not a reason to defer blood donors unless they report discomfort or pain in the menstrual period.[21] Proper awareness and guidelines on the eligibility of blood donation during the menstrual period can increase the pool of female donors. There is no information in the national guideline of Nepal regarding blood donor rejection or acceptance during menstruation; however, blood centers in Nepal are rejecting female donors during menstruation. The WHO guideline of donor selection has clear information that menstruation itself should not be cause of donor deferral.

Major causes of permanent deferral in this study were diabetes, asthma, and cardiovascular disease, contributing 8 (2.3%), 6 (1.7%), and 5 (1.4%), respectively.

In our study, 83.9% of donors were under 35 years of age, with 44.4% and 39.5% of donors from the age group 18–25 years and 26–35 years, respectively, which is comparable with 42.92% from 17–25 years and 37.20% from 26 to 35 years in a study from South India.[17] This study revealed that people over 45 years contributed only 3% of total donations, while the WHO report showed that 25.1% were above 45 years in Nepal.[4] This discrepancy in our findings and WHO reports suggest the necessity for more scientific cross-sectional studies from different parts of Nepal.

Students accounted for 31.2% of total donations, which is slightly higher in comparison with 28% in a study by Unnikrishnan et al.[17] The high percentage of young donors and students may be due to the recruitment of university students,[14] and in addition, students donated blood to fulfill their social responsibility.[17]

In this study, female donors accounted for 24.2% of total registered donors in comparison to only 1.8% of total donations contributed by the female in Saudi Arabia.[14] However, 45% of donors were female in some European countries and the United States.[22] Data from 118 countries by the WHO showed overall 30% of donors were female.[15] Low number of female donors in our study may be due to the cultural practices of Nepal, high prevalence of anemia among females and discomfort during menstruation.

The current study found that only 58.8% of donations were voluntary nonremunerated donations which are below the national average of 85.2%[4] and 83.1% in India.[23] Global database of blood safety 2008 reported that 36% of blood donations were contributed by family/replacement or paid donation in low middle-income countries,[24] while we found a slightly higher rate (41.2%).

The WHO has implemented strategies to move toward 100% voluntary blood donation.[25] However, in our study, nearly half of blood donation is family/replacement donation. To fulfill blood requirements in low middle-income countries, at least 10 in 1000 people must donate blood; however, the donation rate in Nepal is <5/1000 people in 2015.[4] Hence, to fulfill the hospital requirement, family/replacement donation is still high in our study. Out of total donations, 41.7% of donors were first-time donors in this study, which is slightly higher than that reported in India.[17]

Replacement donors had a higher deferral rate with 12.1% as compared to VNRD with 7.6%. A similar finding has been reported where replacement donors were deferred more than VNRD.[26] This proves that VNRD is safer than replacement donor and should emphasize 100% voluntary blood donation to reduce the loss of blood donors.

Limitations of the study

The major limitation of this study is that the results are based on study done at a single blood centre and may not be applicable to the entire country. This study could not record the information of self-deferral donors (underage, underweight, and menstruation) who were not registered in the database of blood bank. Predonation hemoglobin estimation was done only in female donors hence could not cover male donor deferral due to anemia. Hence, in order to get the whole picture of deferral due to anemia, hemoglobin estimation should be carried out.


  Conclusion Top


This study showed the profile of blood donors in the referral center of Nepal. Young people and students cover the majority of blood donors who can be motivated for regular voluntary nonremunerated blood donation. All donors should be informed about the causes and period of deferral, and proper counseling is mandatory for the retention of the temporarily deferred donor. The current findings suggest that it is important to increase awareness on voluntary nonremunerated blood donation and educate people about the common criteria needed to be a healthy donor to minimize the loss of blood donors.

Acknowledgment

The authors would like to acknowledge all staff from the blood bank for their cooperation and support in conducting this study.

Financial support and sponsorship

Nil.

Conflicts of interest

Nil.



 
  References Top

1.
WHO. Blood Donor Counselling Implementation Guidelines [Internet]. 2014 [cited 2022 Jan 15]. Available from: https://apps.who.int/iris/bitstream/handle/10665/163001/9789241548557_eng.pdf?sequence=1&isAllowed=y.  Back to cited text no. 1
    
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Bahadur S, Jain S, Goel RK, Pahuja S, Jain M. Analysis of blood donor deferral characteristics in Delhi, India. Southeast Asian J Trop Med Public Health 2009;40:1087-91.  Back to cited text no. 13
    
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