Red Blood Cell Alloimmunization in Transfused Patients With Sickle Cell Disease in Sub-Saharan Africa; a Systematic Review and Meta-Analysis.

Sickle cell disease (SCD) is the most common monogenic disorder in sub-Saharan Africa (SSA). Blood transfusion to increase the oxygen carrying capacity of blood is vital in the management of many patients with SCD. However, red blood cell (RBC) alloimmunization is a major challenge to transfusions in these patients. Commonly in SSA, pretransfusion tests only involve ABO D grouping and compatibility without RBC antibody testing. Data on the frequency of RBC alloimmunization in patients with SCD in SSA are limited. We performed a systematic review and meta-analysis on available data on alloimmunization in transfused patients with SCD to determine the published prevalence of RBC alloimmunization in SCD patients in SSA. Six databases were systematically searched to identify relevant studies, without year or language restrictions. In all, 249 articles were identified and 15 met our selection criteria. The overall proportion of alloimmunization was 7.4 (95% confidence interval: 5.1-10.0) per 100 transfused patients. Antibodies against E, D, C, and K antigens accounted for almost half of antibody specificities, and antibodies to low- and high-frequency antigens were also common and represented almost 30% (20% to low-frequency antigens and 9% to high-frequency antigens) of specificities. Heterogeneity between studies was moderate, and meta-analysis found region of Africa as the major contributor to the heterogeneity. We also observed inconsistencies across studies in reporting of factors that may influence alloimmunization. This review provides an overview of the extent of the alloimmunization problem in SSA and provides a baseline against which to compare the effect of any interventions to reduce the alloimmunization risk.

Blood Donor Deferral among Students in Northern Japan: Challenges Ahead.

BACKGROUND: As Japan's aging society needs more blood, young students comprise a progressively smaller portion of the donor pool. To ensure a safe and sustainable blood supply, it is crucial to select suitable donors. This study aims to evaluate donor deferral rates, causes of deferral, and characteristics of deferred Japanese students. METHODS: Computerized records of blood centers in northern Japan (Miyagi and Fukushima Prefectures) from March 2010 through March 2011 were retrospectively analyzed. RESULTS: Among 231,361 individuals visiting during the 12-month period, 24,778 were students. Of these, 19,193 (77%) attempted donation, and 5,585 (23%) were deferred. Low hemoglobin, questionnaire-based interview decisions, and medication were the main reasons for temporary deferral. Age, sex, and blood center location were associated with low hemoglobin; donation history and blood center location were associated with medication-based deferral. The odds ratio among female students deferred for low hemoglobin was 35.48 with a 95% CI of 27.74-45.38. CONCLUSIONS: These results suggest that continued efforts are needed to motivate deferred potential donors to return, to prevent low hemoglobin especially among females, and to review medical interview decisions, while paying close attention to regional differences.

Prevalence of Social Isolation in Community-Dwelling Elderly by Differences in Household Composition and Related Factors: From a Social Network Perspective in Urban Japan.

OBJECTIVE: The aim of this study was to measure the prevalence of social isolation in community-dwelling elderly and related factors based on household composition differences. METHOD: We used the six-item Lubben Social Network Scale to measure social isolation in 2,000 individuals. Multiple logistic regression analysis was performed to examine factors related to social isolation with household composition after adjusting for gender and age. RESULTS: The prevalence of social isolation was 31.0% for elderly living alone and 24.1% for those living with family. For both, poor mental health and lack of social support from nonfamily members were associated with social isolation risk. For elderly living with family, low intellectual activities and poor health practice were associated with social isolation risk. DISCUSSION: This study showed high prevalence of social isolation. For prevention, promoting mental health and encouraging them to make friends may be important. For elderly living with family, promoting intellectual activities and good health practice is recommended.

Analysis of blood donor deferral in Japan: characteristics and reasons.

BACKGROUND AND OBJECTIVES: To ensure an adequate and safe blood supply, it is crucial to select suitable donors according to stringent eligibility criteria. This study aims to evaluate donor deferral rates, causes of deferral, and characteristics of deferred Japanese donors. MATERIALS AND METHODS: Computerized records of blood centers in Miyagi and Fukushima Prefectures from March 2010 through March 2011 were retrospectively analyzed. RESULTS: Among 231,361 individuals presenting during this period, 186,513 had complete data. Of these 160,763 (86%) attempted donation and 25,750 (14%) were deferred. The overall proportion of deferrals was higher among those less than 20 years old (24% vs 13%, P<0.0001), female (26% vs 7%, P<0.0001), and first-time donors (28% vs 12%, P<0.0001). Factors that were significantly associated with deferral status were female sex [Odds ratio (OR)=4.40], first-time donation attempt (OR=2.42), and donation at Fukushima blood centers (OR=0.57). Main reasons for temporary deferral were low hemoglobin and questionnaire-based interview decisions. CONCLUSIONS: First-time and female were more frequently deferred whereas those presented at Fukushima blood centers were less frequently deferred. Low hemoglobin was the major contributor for female donors. Strategies to minimize deferral are needed to ensure an adequate and safe blood supply.