Global Journal of Transfusion Medicine

: 2021  |  Volume : 6  |  Issue : 2  |  Page : 141--145

Stop frightening and start donating: An experience from a resource constraint country

Waseem Shahani1, Nida Anwar1, Naveena Fatima2, Haya ul Mujtaba2, Tahir Shamsi1,  
1 Department of Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation, PECHS, Karachi, Pakistan
2 Department of Research and Development, PECHS, Karachi, Pakistan

Correspondence Address:
Dr. Nida Anwar
Department of Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation, PECHS, Karachi


Background and Objectives: One of the observed fears that keep people hesitant to donate blood is anemia. We conducted this study to investigate the hemoglobin (Hb) level post donation in first-time donors and compared it with healthy nondonor group. Methods: An analytical cross-sectional study was conducted from February 2018 to December 2018 after approval from the institutional ethics committee. There were two study groups: Group 1 which included donors who donated blood as per the National Blood Donor Policy. Group 2 comprised gender matched healthy participants. Laboratory investigations included complete blood counts. Informed consent was taken from participants of both the groups. Anemia was defined as Hb of <14 g/dl in males and <12 g/dl in females. SPSS version 23.0 was used for inferential statistics. Results: A total of 928 donations were included, with 9 (1%) females and 919 (99%) males. Out of 919 male donors, 601 (65%) were donating blood for the first time. Out of 601 first-time donors, 175 (29%) participants were recruited for analysis. An equal number of gender-matched healthy nondonor participants were included in the analysis. The age range was 18–55 years in both the groups. Independent t-test was applied, and the mean difference in Hb level in both the groups was found statistically nonsignificant (P = 0.713). Conclusion: Our study revealed a similar mean Hb level in both the groups. Some other factors we encountered were scarcity of voluntary and female participation in blood donation.

How to cite this article:
Shahani W, Anwar N, Fatima N, ul Mujtaba H, Shamsi T. Stop frightening and start donating: An experience from a resource constraint country.Glob J Transfus Med 2021;6:141-145

How to cite this URL:
Shahani W, Anwar N, Fatima N, ul Mujtaba H, Shamsi T. Stop frightening and start donating: An experience from a resource constraint country. Glob J Transfus Med [serial online] 2021 [cited 2022 Jan 18 ];6:141-145
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Blood transfusion is the basic intervention for patients of thalassemia, anemia, cancer, and accident/trauma. Pakistan's annual blood transfusion requirement is approximately 1.5 million bags, with 40% of the demand being met by the public sector. In addition, Pakistan has a high disease and demand burden of thalassemia, and according to an estimate, 5000 children are born annually with thalassemia who require blood transfusion. Youth is the main source of voluntary blood donation, and there are three main sources: paid or professional donors, volunteer donors, and relatives or replacement donors.[1] A recently published study from Iran revealed an increasing trend of blood donation, and found the largest contribution from voluntary donors.[2] A Malaysian study conducted revealed that fear is the most common factor that hinders from donation despite knowing its importance for saving human lives.

In the UK, a randomized trial was conducted which studied the frequency of whole blood donation over the period of 2 years among blood donors monitoring the health-related quality of life and impact of blood donation and concluded no significant difference in quality of life, cognitive function, and physical activity among the randomized groups.[3]

One of the studies conducted in Pakistan on perception and willingness among people toward blood donation found that in majority of people, willingness was found and their intention was helping others. However, the main reason for nonwillingness was found to be fear of weakness and anemia, with greater number of males donating blood than females (69.3% vs. 16.9%), respectively.[4] An organized system for proper history and screening of donors, with counseling of temporary deferred donors, is must to encourage them for repeated donations, as emphasized in previously published study by Khurram et al.[5]

Deferral due to anemia and fear of donation are the most important reported factors for scarce blood donations worldwide as well as in Pakistan.

Aim of the study

This study was conducted with the objective to investigate the hemoglobin (Hb) level post donation in first-time donors and compared it with healthy nondonor group.

 Patients and Methods

An analytical cross-sectional study was conducted from February 2018 to December 2018 at our institute.

Ethical approval

Ethical approval was taken from the institutional review board prior to the study. Data for all the blood donations were collected from the department of blood bank and transfusion. In the study, we analyzed the difference in Hb level between the two groups. Group 1 comprised the donors who donated blood as per the standard operating procedures based on the National Blood Donor Policy developed by safe blood transfusion program as reported by Khurram et al.[5] Donors who were donating blood for the first time and fulfilled healthy donor questionnaire criteria were included in the study. Donors who did not fulfill healthy donor questionnaire criteria and platelet apheresis donors were excluded from the study. Post blood donation, their blood samples were taken to observe the Hb level. Group 2 comprised gender matched healthy participants. Comparison group was taken from healthy people who attended general health camp at our hospital. Controls who had any illness, any known co morbids, and had a history of blood donations were excluded from the study. Informed consent was taken from participants of both the groups. Variables included for the study were gender, age, donation status, and Hb level. Laboratory investigation included complete blood counts. Anemia was defined as Hb of <14 g/dl in males and <12 g/dl in females. Statistics frequency and percentages were calculated for qualitative variables and mean and standard deviation was computed for quantitative variables. IBM statistical package for social sciences (SPSS) Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp was used for inferential statistics. Independent t-test was applied to observe the mean difference between the two groups, and P ≤ 0.05 was considered statistically significant.


A total of 928 donations were received during February 2018 to December 2018 at our center including 9 (1%) females and 919 (99%) males and all were contributed by replacement donors. Females were not included in the analysis because of small sample size. Out of 919 male donors, 318 (35%) were regular donors and 601 (65%) were donating blood for the first time.

Out of 601 first-time donors, 175 (29%) were recruited for analysis. An equal number of gender-matched healthy nondonor participants (n = 175) were included in the analysis and considered a comparison group. The age range was 18–55 years in both the groups. The mean Hb level of the donor (post blood donation) and nondonor groups was 14.6 ± 1.06 mg/dl and 14.4 ± 2.2 mg/dl, respectively. Independent t-test was applied as the data were normally distributed and the difference in Hb level in both the groups was found statistically nonsignificant (P = 0.713).


In our study, the mean Hb level of donors (post donation) and nondonors was almost identical. This finding rejects the perception of being anemic after blood donations, which is reported in the literature. A study[6] reported that 45.9% of the participants had the fear of being anemic post blood donations and another study[7] reported that 12.6% of the participants were scared of blood donations with the similar reason.

Anemia is one of the reasons and it is an exclusion criterion for blood donations. A previous study done in Pakistan by Waheed et al. showed a prevalence of anemia but only 2.14% in first-time donors.[8] These results are almost comparable to another national study published by Khurram et al. showing temporarily deferred donors due to low Hb being 30.76%. These results are in contrast to a study published in India by Didzun et al. showing overall prevalence of anemia about 46.3% despite using cutoff level for anemia being Hb <13 g/dl as compared to our study.[9]

In our study, the majority of donations were done by male donors (99%) with only 1% being female donors that is quiet low but comparable to a previous national study published by Khurram et al. showing 0.9% female donors.

Across the globe, various studies have been conducted depicting low participation from females toward blood donation. A study done in China demonstrated 18.5% as female donors.[10] Females statistically representing nearly half of the country's population are gravely underrepresented in terms of blood donation either replacement or voluntary. This needs to be addressed and explored, in order to seek the reason(s) for this discrepancy in order to encourage voluntary female donation. This can be promoted and encouraged by public awareness and donor awareness campaign via social media as strongly favored by a nationwide survey done in Pakistan by Waheed et al. showing huge proportion, i.e., 84% having access to the Internet, with 96% of respondents having mobile phones and 44% using social media in their leisure time.[11]

The low percentage of female donors in our study is also comparable with 5-year survey (2013–2017) from Iran showing only 4% as female donors. In our study, 35% of donations comprised repeated donations in contrast to 87% in an Iranian study. However, a study by Soodejani et al. revealed 77% blood donation as repeated donations.

Despite the awareness about the importance of blood donation, females are reluctant to donate due to fear of anemia, lack of permission from family, and difficulty to access to donation centers. This could be on account of some of the barriers as depicted in a regional study done in Iran enlightening reasons of low participation of women toward blood donation as anemia, lack of permission from husbands, insufficient time, difficulty in access to centers, and fear.[12]

All the donors in our study were replacement donors similar to results of a previous study of Pakistan showing 93.8% replacement and 6.2% voluntary donations. The results are also comparable to a study published in India by Makroo et al. During 9 years of their follow-up, 96.93% were found to be replacement donors being only 3.06% voluntary.[13] Majority of participants had positive views believing that blood donation is a noble gesture for helping those in dire need of it, so despite knowing its importance, the fear of donation is the main factor for refusal. A recently published Malaysian study revealed positive gesture for donation,yet majority had fear of needle while some had fear of being infected while blood donation.[14] Similar results were obtained by a study on donors from college students at India reporting social responsibility being the most important reason behind their donation (43.4%). In the study, the most common fear during and after procedure of donation was temporary weakness and fainting encountered by (56.4%) students followed by fear of being infected in 26.6%.[15]

People having adequate knowledge donated less often than ones with inadequate knowledge and these findings are similar to a study conducted in five college students in India, Raghuwanshi et al. 2016 which showed students donated three times more often who have inadequate knowledge than those with adequate knowledge.[15] However, a previously published study from Pakistan by Hassan et al. revealed that medical profession-related peoples are more willing to donate blood 72.25% than nonmedical persons 51.8%.

Most of the people who come for donation are unaware of their blood group and majority also wish to donate blood, but due to lack of proper channel of communication between donor and blood seekers, they are unable to donate. Similar results were found in Bangladesh. Thus, there is an immense need to develop a central database of people by using social media channels for importance and awareness so that we can get emergency donations from the nearest one available.

In our study, the repeated donors were only 35%, contrary to the finding reported by Getta et al., in which repeated donors were 50%.[16] The inter-donation period in our study was long as compared with standard period because they perceived that frequent donation causes weakness and lethargy, in contrast to the INTERVAL study published in September 2017 in the UK showing no significant difference observed in mental health, quality of life, and physical activity by reducing inter-donation period to 8–10 weeks and 12-14 weeks compared to standard 12 weeks for men and 16 weeks for women, respectively. Thus, by reducing the inter-donation period, we can get extra units of blood, for which we have to encourage the donors through seminars and social media regarding fear of impact on quality of life and physical activity pertinent to blood donation.

Pakistan as a country and we as an institution encounter an immense scarcity of regular and voluntary blood donors and may fulfill this by some of the methods as suggested by Sun, Lu, and Jin, data collected from large Chinese blood banks on 447,357 donors. According to them, this can be overcomed to some extent by sending motivating messages to existing (repeated) donors via mobile messages, and also motivating patients's friends and family to donate as part of family replacement in time of dire shortage/scarcity of blood products.[17]

In Pakistan, there are private and public organizations that maintain data base of employee's blood group record. This can be another source of voluntary blood donations which can be motivated to donate and help people needing blood. This can be done by building connection via our blood bank team and arranging motivational talks and flyers. Nevertheless most refuse to share such information, as findings reveal in a study of Bangladesh by Md Sahariar Hasan Jiisu 2019. They interviewed manager and staffs of various organizations and also mentioned that sharing such information could be helpful to build a good connection between donor and blood seekers, but most of the organizations refused to do so.[1] Methods and attitudes are needed to be adopted to overcome this gap.

In future, more studies on larger scale including male and female donors with evaluation of causes of low Hb should be carried out along with counseling for follow-up and supplemental treatment (iron, Vitamin b12, and folic acid) be provided with counseling to donate after normalization of Hb level. Qualitative studies regarding awareness among nondonors focusing their worries on donations must be done on a mass scale to encourage them for regular voluntary donations. Moreover, there is a need for representation of female doctor/staff in a donor area for history and proper counseling of female donors, especially with anemia in our part of the world where females are reluctant to socialize with male staff. They need motivation and encouragement to donate as gender specification is one of the limitations found in our study. Policymakers must be educated to come forward and take part in reducing the burden of anemia. Although there was ample number of first-time donors in our study yet the recruited sample size was small, this can be considered a limitation and longitudinal studies with large sample size are needed to be conducted in future.


Our study concluded that many people know the importance of blood donation but are reluctant to donate due to fear of anemia, weakness, or being infected. However, our study revealed similar Hb levels in the donor and nondonor groups. Fear can be defeated by organizing awareness program through seminars and via social media because majority use it in leisure time. Majority of our population still think blood donation is only required when some friends or their families need it. Hence, awareness programs are must needed emphasizing repeated voluntary donation and also encouraging females to come forward and donate to save human lives. They must be assured that there is no impact of donation on their daily physical and mental activities. In our country, it is also necessary to develop a central database of donors to keep in contact with these donors regularly and call them in case of emergency need.


We acknowledge our study subjects for their participation and technical staff for their contribution.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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