Impact of Implementing a Standard Operating Procedure to Reduce Blood Wastage in Blood Centers of Iran.

BACKGROUND: Blood wastage leads to additional costs and reduced blood availability to patients. Above all is the moral issue of wasting donor gifts. This study aimed to determine the rate of blood wastage before and after implementing a new standard operating procedure (SOP) in Iran. METHODS: In this interventional study, a SOP for wastage management was prepared and implemented in all blood centers throughout the country. Data were extracted from the integrated software of the Iranian Blood Transfusion Organization (IBTO). The wastage rate of blood components in the post-intervention years (2016-2017) was then compared with that in the pre-intervention years (2013-2015) using the Z test. RESULTS: The overall wastage rate decreased by 36.86% (P<0.001, 95% CI [36.84-36.88]) after the intervention. Red blood cell (RBC) wastage decreased from 2.6% to 2.5%, platelet wastage from 19.5% to 10.6% and plasma wastage from 15.5% to 7.3% (P<0.001). The highest percentage of waste reduction pertained to plasma components, which decreased by 52.90% (P<0.001, 95% CI [52.86-52.94]). Expiration was the most common cause of RBC and platelet wastage. The most common causes of plasma wastage were RBC contamination and rupture or leakage of the bags. The intervention resulted in a drop of over 250000 discarded components each year, equal to approximately thirty-six million dollars in savings. CONCLUSION: This intervention effectively reduced waste and increased efficiency. Ongoing blood wastage reviews, auditing, and receiving feedback from the central headquarters were powerful tools in following the compliance of blood centers. Further studies are recommended, especially concerning blood wastage in hospital blood banks and various wards.

The activity of labile coagulation factors and fibrinogen in thawed plasma during a 5 day storage period in the hospital blood bank refrigerator.

BACKGROUND: Fresh frozen plasma (FFP) is used to treat coagulation disorders. Even though the activity of labile coagulation factors gradually decreases once thawed, it can be used up to 24 h after thawing, if stored properly. In this study, the level of coagulation factor activity was evaluated in thawed plasma during a 5 day storage period. MATERIALS AND METHODS: This cross-sectional study was performed on 40 FFP units prepared in Yazd Blood Center. Samples were thawed in a waterbath for 20-30 min at 30-37°C and then stored in the hospital blood bank refrigerator. The level of fibrinogen concentration, as a stable factor and, coagulation factors V and VIII, as labile factors, were measured in the plasma immediately following the thawing process as well as 24 and 120 h after the process. Data analysis was performed using SPSS software 20. RESULTS: The fibrinogen level remained stable for up to 24 h after thawing; after 120 h there was a 1.66% decrease with the mean level of 334.0 ± 53.3 mg/dl. The mean activity of factors V and VIII levels decreased by 12.3%, and 26% respectively over 120 h after thawing when compared to that after 24 h. A 120 h after thawing Factor V activity was above 70% in 87.5% of thawed plasmas and its mean activity was 81.6 ± 11.8. Factor VIII activity was above 70% in only 35% of thawed plasmas with the mean activity of 64.4 ± 17.2. CONCLUSION: Thawed plasma can be used for up to 5 days in all therapeutic applications of FFP since it still has the essential hemostatic effects. However, in situations where higher levels of FVIII are needed, Thawed Plasma is not a suitable alternative. In such cases FFP, FVIII concentrate or cryoprecipitated antihemophilic factor should be used.

Effective ways to retain first-time blood donors: a field-trial study.

BACKGROUND: Regular blood donors are the cornerstone of blood safety. Understanding the donors' behavior to donate blood improves blood donor retention programs. The purpose of this study is to evaluate the return rate of first-time blood donors following different interventions to identify effective ways to retain first-time donors. STUDY DESIGN AND METHODS: The study was conducted on 1356 first-time blood donors at four main blood centers in Iran. The donors were randomly assigned based on different interventions (phone calls, educational letter, emotional letter, incentive, motivational meeting, and no intervention) to six groups. The return rate of donors was defined as a second attempt to donate within 6 months after the first donation. Return rate and 95% confidence intervals (CIs) were calculated and compared among different groups. RESULTS: A total of 394 (29%) donors returned within 6 months for a second donation (95% CI, 0.26-0.31). The return rate in the emotional letter group, educational letter, phone reminder, incentives, motivational meeting, and control groups was 36% (95% CI, 0.31-0.42), 33.2% (95% CI, 0.27-0.38), 31.5% (95% CI, 0.25-0.37), 30% (95% CI, 0.22-0.38), 22% (95% CI, 0.17-0.27) and 22.1% (95% CI, 0.17-0.27), respectively. CONCLUSIONS: This study provides evidence supporting the fact that more first-time blood donors can be motivated to donate again by implementing targeted interventions. It demonstrates that emotional letters, educational letters, and phone reminders were effective in improving the return rate of first-time donors.

A change in standard of minimum hemoglobin for male blood donors in Iran.

BACKGROUND: The minimum Hb for blood donation varies from nation to nation. This study assessed the impact of blood donation on donors' iron stores based on different Hb levels. An estimation of drop in the blood collection was made with the new suggested Hb cut-off value. MATERIALS AND METHODS: 2017 male donors were studied. A questionnaire was filled out to gather demographic data, history of donation and risk factors of iron loss. Their blood samples were analyzed for RBC parameters, serum iron, TIBC, and ferritin level. The iron status of all first-time and regular donors was determined for each Hb level. The impact of changing the Hb cut-off value on annual blood collection was assessed. RESULTS: All of the regular donors with Hb levels <13.1g/dL and 75% of those donors with Hb levels of 13.1-13.5 g/dL had abnormal iron stores. Iron deficiency dropped to 35% in donors with Hb levels of 13.5-14 g/dL. It was estimated that increasing the Hb cut-off from 12.5 g/dL to 13 g/dL or to 13.5 g/dL would cause a drop of 0.82% and 2.77% in the annual blood collection, respectively. DISCUSSION: A modification in the minimum Hb level for blood donation is necessary when Hb is used as the single criterion for screening donors. Increasing the minimum Hb level will lead to an increase in donor deferral; therefore a comprehensive donor retention program will be needed.

The impact of donor selection on blood safety in Iran.

INTRODUCTION: Donor selection is a critical process to identify high risk volunteers and defer them from donating blood. Despite viral screening test on all donated blood, one cannot rely on screening tests alone to ensure a safe blood supply. Monitoring and assessment of the deferral procedure is of utmost importance to balance blood availability and safety. This study compares the prevalence of HIV, HCV, and HBV markers between deferred donors and accepted blood donors in order to evaluate the effectiveness of the current donor selection process in Iran. MATERIALS AND METHODS: This study was carried out on deferred blood donors throughout the country. A blood sample was collected from participants and tested for three viral markers: HbsAg, anti-HCV, and anti-HIV. Repeatedly reactive samples were retested with a confirmatory screening assay. The prevalence of viral markers among deferred donors was compared with national statistical data on blood donors. RESULTS: The prevalence of HIV, Hepatitis B, and Hepatitis C was 120 (CI 95%; 90-150), 1280 (CI 95%; 1170-1390), and 580 (CI 95%; 510-650) in 100,000 deferred donors respectively. A significant increase exists in the prevalence of HBV (1.7 times), HIV (24 times) and HCV (15 times) in deferred donors as compared to accepted blood donors. DISCUSSION: The effectiveness of donor selection in identifying high risk individuals is obvious upon comparing the prevalence of selected viral infections in deferred donors with those accepted for blood donation. This study showed the role and necessity of donor selection criteria.

Blood transfusion and alloimmunization in patients with thalassemia: multicenter study.

One of transfusion's side effects is alloimmunization against red blood cell (RBC) antigens. Early diagnosis by antibody screening is an important step in the detection of these alloantibodies. The authors studied the frequency of alloimmunization in thalassemic patients of 4 centers (2 adult and 2 pediatric centers) and compared the rates in children (up to 15 years) and adults. Antibody screening tests were performed by gel method according to its standard pattern and respective program. In positive cases, antibody identification test by gel method was performed. Eight hundred thirty-five patients were studied; 548 (65.6%) were adults (mean age = 24.5), and 287 (34.4%) cases were pediatrics (mean age = 10.05). Of these patients, 74.1% had no history of transfusion reaction, whereas 21 (2.5%) had hemolytic complications. Seventy-eight (9.3%) exhibited allergic symptoms, and 117 (14%) cases experienced febrile reactions during transfusion. Antibody screening showed positive results in 22 pediatric cases (7.7%) and 79 adults (14.4%); 72 (71.3%), 19 (18.8%), 3 (3%), and 1 (1%) cases exhibited single, double, triple, and autoantibodies, respectively. Anti-Kell antibody was seen in 34 (33.7%) cases, anti-D was seen in 11 (10.9%) cases, and anti-E in was seen in 10 (9.9%) cases. The authors observed 8 anti-D+C (7.9%) cases, 1 anti-D+E (1%), 3 anti-Kell+E, 3 anti-Kell+Kpa (3%), and 1 anti-Kell+D double antibodies. These antibodies were also a combination of Rh subgroups or Rh and Kell subgroups. The authors observed meaningful relations between history of transfusion reactions and age with antibody screening results (P = .005). Based on alloantibodies types, more than two thirds of them were Rh subgroups and Kell groups. Phenotype determination of RBCs before beginning chronic blood transfusion and careful cross-matching with Kell and Rh subgroups in addition to ABO may help reduce alloimmunization in chronic transfusion patients.

Blood donation and donor recruitment in Iran from 1998 through 2007: ten years' experience.

BACKGROUND: Recruiting and retaining blood donors is of utmost importance, especially since there is no alternative for human blood. This article describes different aspects of blood donation to evaluate recruitment activities. STUDY DESIGN AND METHODS: Data were obtained from annual reports made by the Statistical Committee of the Iranian Blood Transfusion Organization and the national database. RESULTS: The trend in yearly blood donations has significantly increased from 1,183,630 blood units in 1998 to 1,735,008 by the end of 2007. During this period the overall growth rate was 59.8% (p < 0.005). Yearly blood donation in the northwest region of the country was 13 per 1000 in contrast to 39 per 1000 in the central region. There was a significant decrease in the number of donations during the months of April, September, and January whereas in May, August, and the religious month of Muharram a significant increase was noted. Voluntary donations increased from 77% in 1998 to 100% by the end of 2007. CONCLUSION: Continuous donor recruitment efforts in Iran have resulted in a significant increase in blood donation rates during the past decade as well as achieving 100% voluntary, nonremunerated blood donors. Nevertheless some provinces will have to put more effort into donor recruitment and retention so as to ensure self sufficiency in their blood supply. Educating blood donors and the public about the continuous need for a sufficient blood supply in every community is equally important and times where supply exceeds demand should be avoided at the most.

Short-term ferrous sulfate supplementation in female blood donors.

BACKGROUND: Iron deficiency is a public problem in women, which contributes to the high percentage of deferred blood donations in this group. This study evaluated the effect of iron supplementation in improving iron stores to promote safe blood donation in women. STUDY DESIGN AND METHODS: A total of 412 female blood donors were randomly recruited for the study. The volunteers were scheduled for an initial visit and three subsequent visits at 4-month intervals for possible repeat donation. Each volunteer was given 21 tablets of 150 mg of ferrous sulfate or placebo to be taken three times daily for 1 week after each blood donation. Their hemoglobin (Hb) concentration, hematocrit (Hct), serum ferritin, total iron-binding capacity (TIBC), and percent saturation of the TIBC were tested throughout the course of the study. RESULTS: The group taking ferrous sulfate showed no significant difference between the mean initial and final result for any of the values other than Hb values, whereas there was a significant decline in mean Hb, Hct, serum iron, serum ferritin, and percent saturation in the group taking placebo. Hb concentrations declined significantly in both groups; however, it was more severe in the placebo group when compared to the ferrous sulfate group. The relative risk of iron deficiency in placebo group was 3.6 (95% confidence interval = 1.73-7.74). CONCLUSION: The results indicate that supplementation therapy can be considered as one of the strategies to promote safe blood donation in women. A quantity of 150 mg of elemental iron per day as ferrous sulfate, however, is not the correct dose for Iranian female donors.