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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 7  |  Issue : 2  |  Page : 159-163

Donor notification and response rate in a stand-alone blood center in Western India


Life Blood Centre, Rajkot, Gujarat, India

Date of Submission17-Jan-2022
Date of Decision29-Aug-2022
Date of Acceptance30-Aug-2022
Date of Web Publication5-Nov-2022

Correspondence Address:
Spruha Dholakiya
Life Blood Centre, Rajkot, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/gjtm.gjtm_5_22

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  Abstract 


Background and Objectives: Counseling and notification of reactive blood donors play an important part in maintaining the chain of safe blood. The process of notification involves informing donors about the status of their reactivity against five major and mandatory transfusion-transmitted infections (TTIs). Such notification and timely follow-up till the donor reaches the referred place help in reducing the burden of TTI in society, thereby improving blood safety. The aim of this study is to highlight the importance of prompt donor notification, referral, and follow-up. Materials and Methods: This was a retrospective cross-sectional study carried out at a stand-alone blood center from January 2019 to October 2021. A total of 36,162 donations were screened for the five mandatory TTIs-HIV (I and II), hepatitis C virus (HCV), hepatitis B virus (HBV), syphilis, and malaria. All reactive results were retested with a duplicate tube sample and a bag sample to confirm the reactivity. Donors were notified regarding the serostatus by phone and called for reporting at our blood center, and referred to Integrated Testing & Counseling Centre (ICTC) or any other referral center. Results: A total of 212 (0.58%) out of 36162 donors were tested reactive during the study period. Out of them, 40.56% (n = 86) were hepatitis B virus reactive, 21.7% (n = 46) were HIV (I and II) reactive, 20.7% (n = 44) were HCV reactive, and remaining 17.1% (n = 36) were syphilis reactive. All the donors were informed. Out of them, 71.69% (n = 152) responded to the communication and 52.83% (n = 112) personally visited the blood center or respective ICTC for further evaluation. Conclusion: Even after laying strict criteria for predonation screening and counseling, few donors do conceal their high-risk behavior or even their serostatus and continue to donate blood, leading to the wastage of resources. Thorough follow-up of seroreactive donors helps in improving blood safety and also improves their quality of life by the commencement of timely treatment.

Keywords: Counseling, notification, screening


How to cite this article:
Dholakiya S, Nandani S, Vachhani N. Donor notification and response rate in a stand-alone blood center in Western India. Glob J Transfus Med 2022;7:159-63

How to cite this URL:
Dholakiya S, Nandani S, Vachhani N. Donor notification and response rate in a stand-alone blood center in Western India. Glob J Transfus Med [serial online] 2022 [cited 2022 Dec 8];7:159-63. Available from: https://www.gjtmonline.com/text.asp?2022/7/2/159/360487




  Introduction Top


Transfusion of blood and its products is lifesaving with the inherent risk involved. As per the recommendation of the WHO and Drugs and Cosmetics Act, India, five mandatory infectious markers such as HIV, hepatitis C virus (HCV), hepatitis B virus (HBV), syphilis, and malaria are tested before issuing blood.[1],[2] Screening of blood donors and testing them for transfusion-transmitted infections (TTIs) have to be extremely sensitive and specific.

Counseling blood donors and notifying them about the reactive results form an integral part of postdonation counseling and it helps in the overall safety of blood. As per the National Blood Policy and Indian action plan for blood safety adopted by our blood center, every donor is counseled at the time of predonation regarding the testing of his blood for TTI. If the donor gives consent for being informed, they are further notified about their reactive status, and repeat testing either at the blood center or ICTC is arranged for them.[3]

Every blood centers keep a policy to discard even borderline reactive blood bags from the inventory to attain the safest transfusion status. However, such sensitive tests might not be carried out outside the clinical laboratory and those negative reports result in a sense of surprise and resentment from the donors. On the other hand, many such donors with strong reactive results do not respond at all to the blood center and thereby they are a risk to their family members and also the society. If such donors continue to donate, it leads to the wastage of resources for any blood center.[4]

Counseling the donors before donation and assessing the risk is a crucial part of donor screening. Such predonation counseling may help in the deferral of certain donors, thereby saving resources. If the donors are correctly counseled about the disease, their quality of life may improve with the early start of the treatment.[5]

Aims and objectives

The present study was carried out to find out and observe the responsiveness of donors, after the notification and to assess the role of prompt follow-up by counselor/social worker in improving the same.


  Materials and Methods Top


This is a retrospective cross-sectional 34-month study (from January 2019 to October 2021) done at a stand-alone blood center in Western India. All the blood donors turning up at the blood center or in a blood donation camp were given a common questionnaire which is as per the recommendation of national guidelines.[6] They were told to fill out the consent form for allowing the blood center to inform them about the sero results and only those donors who gave consent regarding the same were informed about their reactive status. The sample was processed for five mandatory tests – anti-HIV, anti-HCV, HBV, syphilis, and malaria. HIV, HCV, and HBsAg were done in an automated chemiluminescence analyzer (Cobas e411 by Roche, Switzerland), syphilis by Rapid Plasma Reagin (RPR) method (Beacon diagnostics, India), and MP by Rapid Card (MAL CARD, J. Mitra, India) method.

When a sample is found reactive once, it is retested in duplicate using the bag and pilot sample (Ethylene Diamine Tetra Acetate (EDTA) tube). If any two of the abovementioned three samples are found reactive, the donor is informed regarding the same [Flowchart 1]. Even otherwise the blood bags collected from donors having reactivity even once in electrochemiluminescence assay were discarded.



Statistical analysis of data

All collected data were analyzed in a Microsoft Excel spreadsheet for Windows version 16, 2010. [Flowchart 1] is the protocol followed at our blood center:

Ethical clearance/waver from IRB

This study has been done maintaining patient confidentiality as per the Declaration of Helsinki in line with institutional ethical guidelines. The Institute Research Advisory Committee has given approval for the present study (LBC/RAC/01/2022) and informed consent of all the donors is taken before donation.

After the final results, the counselor was informed to notify the donors. All such reactive donor forms are maintained separately in a file by the counselor. The notification process for donors is started by the counselor maintaining confidentiality at each and every step. We have a protocol of notifying the donor twice a day by phone call, for at least a week and if they do not respond, a letter is sent from the blood center and the same is updated in the file. The donors who pick up the call or replied to a letter were considered notified.

Once the donor reaches the blood center, he/she was designated as a responder, and the ones who, even after notification do not turn up for follow-up were considered nonresponders. After the arrival, demographic details of donors were cross-verified with the donor form available to the counselor. Then, after taking utmost care and confidentiality, the donor was informed about the reactive status.

If at all, the donor tested reactive for HIV, he was referred to a nearby ICTC accompanied by our counselor, and further follow-up was undertaken. For syphilis, the donor was taken to STI clinic, whereas for HCV and HBV donors were referred to a general physician or a gastroenterologist.


  Results Top


A total of 36162 donations took place during the study period, 35605 (98.4%) were male donors and 557 (1.6%) were female donors. Being a stand-alone blood center, we have 100% voluntary blood donation only.

A total of 212 (0.58%) donors were found reactive during the study with one or more infections. There was one female donor and the remaining 211 male donors. Gender-wise prevalence of TTI is shown in [Figure 1].
Figure 1: Gender-wise reactivity ratio

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Most of the reactive donors were of the younger age group between 18 and 30 years. The mean age was found to be 26 years. The remaining reactive donors were between 31 and 60 years. Only one was older than 60 years at 64 years.

As far as notification of the donors is concerned, all of them were notified by phone call or mail. One hundred and fifty-two responded to the calls giving an overall notification rate of 71.69%. They were informed of the results and were impressed to visit the blood center for further follow-up. However, out of 152, only 112 reported personally to the blood center. Out of those 112 donors, 46 donors were HIV reactive. They all reported and were followed up personally at the ICTC center by the counselor. Hence, the response rate of HIV was 100%, whereas 44 donors were notified for HCV reactive; out of them, 50% responded (n = 22/44), 86 were notified for HBV infection, 34.88% responded to the call (n = 30/86), and for syphilis – 36 donors were notified regarding STI, 38.8% (n = 14/34) responded to the notification making an overall response rate of 73.68% as far as follow-up at a blood center is concerned.

[Table 1] depicts the response rate of donors in all infective categories of TTI.
Table 1: Infection-wise response rate of donors (n=112)

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Out of a total of 152 notified donors, 112 responded to the call/SMS.

Rest 40 donors, who did not respond after being notified were considered nonresponders. [Flowchart 2] depicts the process being followed at our blood center for notification of seroreactive blood donors.



In the present study, 28.3% of reactive (n = 60) donors did not respond to the call, either due to unavailability (n = 19), the wrong mobile no entered (n = 8), or due to various miscellaneous reasons like only landline number given, wrong address given, out of network area, etc.(n = 33).

Out of 112 donors who were responsive, the infectious marker-wise distribution is shown in [Figure 2].
Figure 2: Notified and responders' data from the blood center

Click here to view



  Discussion Top


Improvisation of techniques and more sensitive methods of screening are now part of modern blood banking. However, notification of reactive donors still remains an important and fruitful aspect in improving the safety of the blood supply chain and also improves the quality of life of donors and their families.

The overall reactivity rate for all five mandatory infectious markers was 0.58%. Such low infectivity rate can be attributed to 100% voluntary blood donation. Other studies showing comparable seroreactivity results are Bhasker and Aluri 1.07%,[4] Patel et al. 1.41%,[7] and Tiwari et al.[8] having a rate of 0.91%, whereas few studies with high seroreactive results are Kumari et al.[9] with 2.7% and Kotwal et al.[10] with 3.02%.

The response rate and reactive rates of donors found in several recent studies are compared in [Table 2].
Table 2: Response rates of donors among various studies[4],[5],[9],[11],[12]

Click here to view


The response rate of donors depends on the overall mentality and educational background of the population donating blood.[13] The response rate was found to be excellent in the study carried out by Anita et al.[5] who concluded that the higher rate was due to the improved mobile communication and excellent reception from the donor side regarding the sensitivity of the results.

In the present study, the response rate, especially for HIV was excellent due to a personal visit by our counselor to the respective ICTC along with the donor. Further follow-up by the counselor for around 1 month regarding the continuation of ART medications was also done. Such an approach was however not possible in Mishra et al.[11] due to a lack of education and awareness in the donor population. When a moderate response to notification of seroreactivity is noticed, it is advisable to be more vigilant about predonation counseling. The response rate in another study carried out by Kaur et al.[14] was found to be only 38.90% again due to a lack of education and awareness. However, it was 98.2% in a study done by Kotwal et al.[10] due to a very vigilant method of notification.

In the present study, HBV reactive donors were more in nonresponders' category similar to the study by Mukherjee et al.[15] which can be attributed to the reluctant approach from the side of the donor to turn up at the blood bank for further processing and testing.

In the present study, total donors who were not reachable were 28.3% (n = 60) either due to wrong mobile no or wrong demographic details, whereas in a study conducted by Kaur et al.[14] 10.5% of donors were not contacted due to similar reasons or switched off their mobile phones. In another study by Kotwal et al.,[10] the donors who could not be contacted by the blood center was around 49.4% as compared to the present study with 28.3%.


  Conclusion Top


Predonation counseling, donor notification, and postdonation counseling are an essential part of the blood center's functions. There is a requirement to create more awareness among the donors to achieve the goal of “safe blood starts with me.”

Predonation counseling is a very important aspect of donor education and clarifies myths and misconceptions. The donor registration process should be clear and understandable along with identification proof for ease in contacting donors. A total collaborative approach by regulatory bodies, blood center teams, camp organizers, and blood donors is the need of the hour to accomplish “safe blood transfusion.”

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Blood Transfusion Safety. Available from: http://www.who.int/bloodsafety/voluntary_donation/en/;2012. [Last accessed on 2022 Jun 04].  Back to cited text no. 1
    
2.
Government of India. Drugs and Cosmetics rules. (Amended till Feb, 2019) 1945. Available from: http://www.cdsco.nic.in/html/drugsandcosmeticAct.pdf. [Last accessed on 2022 Mar 27].  Back to cited text no. 2
    
3.
National AIDS Control Organization an Action Plan for Blood Safety. National AIDS Control Organization. Ministry of Health and Family Welfare. Government of India. New Delhi, India; 2007. p. 31-2.  Back to cited text no. 3
    
4.
Bhasker PM, Aluri A. Donor notification and counseling: Experiences and challenges from a private multi-specialty hospital in South India. Asian J Transfus Sci 2021;15:166-71.  Back to cited text no. 4
  [Full text]  
5.
Sardeshpande AM, Parate SN. Donor notification & counseling – Our experience from a tertiary care hospital in central India. J Med Sci Clin Res 2009;7:679-84.  Back to cited text no. 5
    
6.
Nbtc.naco.gov.in. New Delhi. National Blood Transfusion Council. Available from: http://nbtc.naco.gov.in/assets/resources/policy/Letter-reg-guidelines-for-blood-donor-selection&referral-2017. [Last accessed on 2022 Mar 15].  Back to cited text no. 6
    
7.
Patel SG, Patel JN, Patel AC, Raja KA, Dobariya GH, Pandya AN. Blood donor notification and counselling of reactive test result in blood bank of South Gujarat: A better approach to prevent reactive donors from donating blood again. Glob J Transfus Med 2016;1:57.  Back to cited text no. 7
  [Full text]  
8.
Tiwari AK, Bhardwaj G, Dara RC, Arora D, Aggarwal G, Bhargava R, et al. Notification and counselling of hepatitis positive blood donors, their immediate emotional response, contact-testing and their follow-up: Study from a tertiary care hospital! Transfus Apher Sci 2018;57:391-7.  Back to cited text no. 8
    
9.
Kumari S. Reactive donor notification and counselling: Reveals concealed risk factors. Indian J Soc Psychiatry 2017;33:38-43.  Back to cited text no. 9
  [Full text]  
10.
Kotwal U, Doda V, Arora S, Bhardwaj S. Blood donor notification and counseling: Our experience from a tertiary care hospital in India. Asian J Transfus Sci 2015;9:18-22.  Back to cited text no. 10
[PUBMED]  [Full text]  
11.
Mishra S, Girijanandini K, Priyanka N, Mlinind A. Blood donor notification and counselling: Experience from a teaching institute in Eastern India. Int J Cur Res Rev 2020;12:163-6.  Back to cited text no. 11
    
12.
Divya NS, Vanishree HR, Sharat Kumar BJ. Sero-positivity of transfusion transmitted infections and reactive donors response to counselling among healthy blood donors. Indian J Path Oncol 2021;8:120-7.  Back to cited text no. 12
    
13.
Chandrashekar S, Kantharaj A. Blood donor notification: Boon for the community, bane for blood donors, and blood centres? Glob J Transfus Med 2018;3:6-12.  Back to cited text no. 13
  [Full text]  
14.
Kaur G, Kaur P, Basu S, Kaur R, Sharma S. Donor notification and counseling – Experience and challenges. Transfus Apher Sci 2013;49:291-4.  Back to cited text no. 14
    
15.
Mukherjee S, Bhattacharya P, Bose A, Talukder B, Datta SS, Mukherjee K. Response to post-donation counseling is still a challenge in outdoor voluntary blood donation camps: A survey from a tertiary care regional blood center in Eastern India. Asian J Transfus Sci 2014;8:80-3.  Back to cited text no. 15
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