|Year : 2016 | Volume
| Issue : 2 | Page : 103-107
Retrospective evaluation of prospective blood donor deferral in a tertiary hospital-based blood bank in South-East Nigeria
C John Aneke, U Theodora Ezeh, A Gloria Nwosu, E Chika Anumba
Department of Haematology and Blood Transfusion, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
|Date of Web Publication||13-Oct-2016|
C John Aneke
Department of Haematology and Blood Transfusion, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State
Source of Support: None, Conflict of Interest: None
Background: Blood transfusion safety is vital to improving the quality of health-care delivery, particularly in developing countries. An efficient donor deferral system is critical to blood transfusion service because it ensures the safety of both prospective donors and recipients.
Objective: We sought to determine the pattern of prospective blood donor deferral with a view to understanding the dynamics of blood donor sourcing in a tertiary hospital-based blood bank in South-Eastern Nigeria in this study.
Subjects and Methods: The blood donor records from the blood transfusion unit of our hospital from April 2014 to September 2015 were analyzed in retrospect. Screening results for transfusion transmissible infections, hemoglobin concentration, and information on the donor selection of the blood bank were retrieved from the blood bank records. Data were analyzed using the Statistical Package for Social Sciences version 20.0 (SPSS Inc., Chicago, IL, USA) computer software. Descriptive statistics were employed to represent the distribution of donor characteristics as means ( standard deviation) and percentages.
Results: A total of 5249 individuals presented for donation within the study period with an overall donor deferral rate of 32.50%; out of which 29.24% were temporarily deferred while 3.26% were deferred permanently. The most common reason for temporal deferral was low hemoglobin concentration (25.30%), while positivity for hepatitis B virus (1.71%) was the most common reason for permanent deferral.
Conclusion: Low hemoglobin concentration is responsible for the majority of prospective donor deferral in our population which may reflect the burden of anemia in the general population.
Keywords: Anemia, blood donor, blood transfusion safety, donor deferral
|How to cite this article:|
Aneke C J, Ezeh U T, Nwosu A G, Anumba E C. Retrospective evaluation of prospective blood donor deferral in a tertiary hospital-based blood bank in South-East Nigeria. J Med Trop 2016;18:103-7
|How to cite this URL:|
Aneke C J, Ezeh U T, Nwosu A G, Anumba E C. Retrospective evaluation of prospective blood donor deferral in a tertiary hospital-based blood bank in South-East Nigeria. J Med Trop [serial online] 2016 [cited 2021 Feb 26];18:103-7. Available from: https://www.jmedtropics.org/text.asp?2016/18/2/103/192241
| Introduction|| |
An efficient blood transfusion service is critical to good health-care delivery; over the years the emphasis on blood transfusion safety has greatly reduced potential adverse reactions to blood donors and recipients.  Among measures geared toward blood transfusion safety is the adoption of stringent donor selection criteria, which is aimed at evaluating the suitability or otherwise of a potential blood donor.  The donor selection criteria are made up of a set of questions and screening tests which are administered to every potential donor before such person is adjudged fit to donate blood for subsequent transfusion. Any potential donor who "fails" these eligibility criteria is said to have been deferred, this may be on a temporal or permanent basis.  Temporal deferral implies that such individuals are deferred based on a removable, time-bound factor such as low hematocrit. On the other hand, donors on permanent deferral have nonremovable, long lasting factors, such as positivity for any of the transfusion-transmissible infections (TTIs). Nigeria (and most countries in sub-Saharan Africa) grapples with huge blood supply deficit, and this has been shown to negatively impact on health-care indices. , In 2006, the national blood transfusion service emphasized the huge blood supply deficit in Nigeria by showing that only 1.5 million units of blood were available to the Nigerian population (of over 100 million people) annually.  This situation is further worsened by the fact that the culture of altruism and voluntary blood donation is not generally as acceptable and as common in parts of Africa as it is in Europe and America. ,, In fact, some studies in Africa have shown that family replacement and in some instances commercial are the predominant types, while voluntary donors constitute the minority. ,, Family replacement donors describe family members (or other individuals) who donate blood to a patient in need of a transfusion based on acquaintance; they are essentially nonremunerated.  Over the years, this class of donors has become increasingly important in parts of Africa because it appears to be well adapted to the extended family system of most African communities. They are therefore believed to hold the potential to significantly bridge the huge blood demand/supply gap in Africa, if well harnessed. 
Schutz et al. evaluated the pattern of deferral among prospective blood donors who were at risk of human immunodeficiency virus (HIV) infection in Abidjan, Cote d'Ivoire and observed that a good deferral system would correctly exclude up to 27% of HIV-positive potential donors.  The study further emphasized the importance of a robust donor deferral strategy in positively impacting on transfusion safety in sub-Saharan Africa. Even though blood donor selection and deferral are critical to the availability of safe blood for transfusion, this should be handled with utmost care so that the feeling of rejection and dejection following deferral does not discourage potential donors, particularly those coming for the first time.  This is all the more important for donors in our clime because their procurement is difficult, even in well-informed target populations such as health-care workers.  It is believed that understanding the reasons for deferral of potential blood donors could assist in future donor recruitment planning and also gives insight into the general health of the population, such as the prevalence rates of TTIs and anemia. , More so, the strategy of deferring donors at very high risk of harboring TTIs has been variously shown to be very cost-effective and appropriate for resource-poor settings of sub-Saharan Africa (in terms of reduction in the cost of screening kits and eventual blood pint wastages). , Some studies had identified anemia and presence of TTIs as the predominant contributors to donor deferral among donors in Asia and some parts of Nigeria. ,,
There is no any study sighted on blood donor deferral in South-Eastern Region of the country.
This study evaluated the factors for potential blood donor deferral at tertiary hospital-based blood bank in South-Eastern Nigeria.
| Subjects and Methods|| |
This was a retrospective study; carried out at the blood bank unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-Eastern Nigeria between April 2014 and September 2015. The blood donor register which contained all the details of donors within the study period was retrieved for analysis. Relevant information retrieved included age, gender, hematocrit and TTIs screening results for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV), and syphilis. The donor deferral criteria used by the unit was adapted from the World Health Organization blood donor selection criteria which included hemoglobin concentration of less than 12.5 g/dl (Hematocrit of <38.0%), body weight <45 kg, age <18 or >60 years, recent blood donation (within the last 3 months), presence of skin tattoos, rashes, yellowness of the eyes and a history of intravenous drug abuse and chronic illnesses, such as hypertension.  Data were analyzed using the Statistical Package for Social Sciences version 20.0 (SPSS Inc., Chicago, IL, USA) computer software. Descriptive statistics were employed to represent the distribution of donor characteristics as means (± standard deviation) and percentages.
| Results|| |
A total of 5249 individuals presented for donation within the study period, 4595 (87.54%) males and 654 (12.50%) females; the mean age of all donors was 28.64 ± 8.23 years.
The overall donor deferral rate in this study was 1706/5249 (32.50%), consisting of 1535/5249 (29.24%) temporary and 171/5249 (3.26%) permanent deferrals [Table 1] and [Table 2].
|Table 1: Reasons for temporary deferral among male and female donors in a tertiary hospital blood bank within the study period|
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|Table 2: Reasons for permanent deferral among male and female donors in a tertiary hospital blood bank within the study period|
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Among all the donors seen within the study period, the following were deferred on a temporary basis, 1328 (25.30%), 80 (1.52%), 2 (0.04%), 20 (0.38%), 100 (1.91%), and 5 (0.10%), on account of low hemoglobin concentration, recent blood donation, low body weight, presence of skin tattoos, hypertension, and rashes, respectively [Table 1]. No donor was deferred on account of being under age, yellowness of the eyes, history of recent surgery, and intravenous drug abuse. The predominant reasons for temporary deferral among all donors were low hemoglobin concentration and hypertension accounting for 25.30% and 1.91%, respectively [Table 1].
Conversely, permanent deferrals occurred in 23 (0.44%), 90 (1.71%), 41 (0.78%), and 17 (0.32%) of all donors, on account of seropositivity for TTIs; HIV, HBV, HCV, and syphilis, respectively [Table 2]. The predominant reason for deferral on permanent basis among all donors was seropositivity for HBV [prevalence rate 1.71% [Table 2]].
A larger proportion of females were deferred for both temporal and permanent reasons compared to their males counterparts in this study; 70.34% versus 23.39%; 6.57% versus 2.79%, respectively, [Table 1] and 2]. Overall, the most common reason for donor deferral in this study was low hemoglobin concentration, which was the factor present in 69.35% of male and 30.65% of female donors [Table 1].
| Discussion|| |
The donors in this study consisted of young adults (mean age of 28.64 ± 8.23 years) with a preponderance of males. This finding is in keeping with previous reports in Nigeria which have consistently shown a blood donor pool dominated by males and young adults. , Interestingly, probably due to a combination of increased sexual exposure and experimentations as well as involvement in other high-risk behaviors, studies have equally shown that the prevalence of TTIs was very high in donors within this age stratum, particularly those of the male gender. , This therefore places a profound premium on the need to further strengthen transfusion safety through the universal application of intense donor selection, screening, and counseling protocol.
The donor deferral rate observed in this study (32.50%) is higher than previously reported. Teneja, Rathod, Aswasthi and Kouao independently reported deferral rates of 17.1%, 3.55%, 10.4%, and 10.8% among blood donors from different parts of the Indian subcontinent and sub-Saharan Africa. ,,,, Similarly Ekwere et al., in a study that involved 5636 prospective blood donors in Uyo, South-South Nigeria reported a deferral rate which is lower than that observed in this study (16% vs. 32.50%, respectively).  These differences in deferral rates compared to our finding probably reflect variations in the epidemiology of anemia and TTIs (the major contributors of donor deferral) in the general populations of the different study locations. The prevalence of anemia in South-Eastern Nigeria is high and often worsened by concurrent conditions such as pregnancy, where rates as high as 64.1% has been earlier reported.  Similarly, TTIs often occur concurrently in the general population in this region of the country; Ebie and Pela earlier reported a prevalence of HBV and HCV coinfection of 14.1%. 
This study recorded a temporary deferral rate of 29.24%; this is lower than reported by Taneja et al. in India but higher than that of Kagu et al. in Nigeria. , The predominant predictors of temporary deferral in this study were the presence of low hemoglobin concentration (25.3%) followed distantly by hypertension (1.91%), [Table 1]. Overall, anemia was the single most important predictor of deferral among our donor set; present in 69.35% and 30.65% males and females, respectively. This is in agreement with earlier reports from India, South-South and North-East Nigeria which variously emphasized the contributions of anemia to temporary blood donor deferral. ,, These findings underscore the huge burden of anemia (particularly iron deficiency anemia) in these populations and may be attributable to poor nutrition, the presence of concurrent tropical (and subtropical) diseases, coupled with menstrual blood loss in females.  It is, therefore, important to observe that adequate donor deferral system could actually protect the prospective donor from further iron depletion. A single unit of blood donation has been shown to result in depletion of up to 236 mg of iron from body stores.  Therefore, without temporary deferral of prospective donors with low hemoglobin concentration, the burden of anemia (particularly iron deficiency anemia) in the population could significantly worsen. It may also be imperative that anemia in these populations should be reevaluated in subsequent studies with a view to better understanding its epidemiology and possibly proffer interventional modalities aimed at appropriately addressing it.
Permanent deferral occurred at the rate of 3.26% in this study; this is lower than reported among Indian prospective donors.  The predominant reason for deferral was HBV positivity [1.71%, Table 2]. This was earlier observed to be a significant contributor of permanent deferral of donors among Nigeria and Indian subjects in earlier studies. ,
| Conclusion|| |
The donor deferral rate in our blood donor population is higher than previously documented in Nigeria and even parts of the Indian sub-continent. Anemia and seropositivity for HBV constituted the predominant reasons for donor deferral among our donors. Stringent donor selection protocols have great potentials for protecting the prospective donor from anemia related to blood donation and recipient from TTIs and should be encouraged and strengthened in all blood banks across the country.
The authors would like to acknowledge Onyiye Emodi and Stella Ezema, both of the blood group serology units for assisting in data retrieval from the departmental archives.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
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[Table 1], [Table 2]