ANALYSIS OF PRE-DONATION DEFERRAL REASONS AMONGST BLOOD DONORS IN VADODARA , GUJARAT

Background: Blood transfusion saves lives and improves health, but many patients requiring transfusion do not have timely access to safe blood. Providing safe and adequate blood should be an integral part of every country’s national health care policy and infrastructure. Aim: The main aim of the study was to analyze the reasons for pre-donation deferral amongst blood donors attending our blood bank and outdoor camp organized by our blood bank and to evaluate and categorize the reasons into temporary and permanent deferral. Materials and methods: It is a Record based Retrospective Study conducted in Department of Immunohematology and blood transfusion over a period of two years from July 2015 to July 2017. The reasons of deferral were analyzed after classification into following categories, namely, temporarypermanent deferral, in-house –camp blood donors, genderbased (male -female), and various age group categories. Results: A total of 30,022 prospective blood donors registered for blood donation out of which 2241 blood donors were deferred (7.46%) with low hemoglobin level, medication and hypertension as top three causes. The majority of deferral was seen in 18-25 years of age group which mainly comprises the youth population. The female donors were rejected eight times the male donors. Conclusion: The knowledge of the deferral incidences and their causes in a particular region helps in deciding the magnitude and the direction of the blood donor recruitment efforts. This knowledge also helps in calculating the eligible and the potential blood donor pool.


Introduction
A well organized Blood Transfusion Service (BTS) is a vital component of any health care delivery system. An integrated strategy for Blood Safety is required for elimination of transfusion transmitted infections and for provision of safe and adequate blood transfusion services to the people. The main component of an integrated strategy include collection of blood only from voluntary, nonremunerated blood donors, screening for all transfusion transmitted infections and reduction of unnecessary transfusion. Blood donor suitability criteria are based on science, informed medical opinion, and regulatory rules. [1] Blood donors are deferred for various reasons. Individuals disqualified from donating blood are known as "deferred" donors. Blood safety is ensured through selection of appropriate donor population, screening of donors, testing of donated blood units, and efficient blood transfusion practices as per drug and cosmetic act 1940. [2] AIMS: The main aim of the study was to analyze the reasons for pre-donation deferral amongst blood donors attending our blood bank and outdoor camp organized by our blood bank and to evaluate and categorize the reasons into temporary and permanent deferral and compare the reasons amongst various age groups, sex, and in-house and camp donations.

MATERIALS AND METHODS:
The record based retrospective study was conducted at Department of Immunohematology and Blood Transfusion in Government Medical College and S.S.G Hospital, Baroda, Gujarat for a period of two years from July 2015 to July 2017. The data was collected from donor deferral records. The reasons of deferral were analyzed after classification into following categories, namely, temporary-permanent deferral, in-house -camp blood donors, gender-based (male -female), and various age group categories. For simplicity of analysis the donors were categorized into three categories based on reasons for deferral. The deferral criteria used for classifying the causes of deferral in categories 1, 2 and 3 were as follows: Category -1: Donors whose own health might be affected by donating.
Category -2: Donors with risk of transfusion transmissible infections.
Category -3: Donors with the condition were transmissibility by blood is unknown or donor with diseases or a condition not suitable for blood donation.

RESULT:
A total of 30,022 blood donors registered for blood donation in which 1,309 (4.36%) were females and 28,713 (95.64%) were males. The deferral rate of 7.46% (2,241/30,022) represents whole blood donors deferred under the three categories and the evaluation is summarized in [       Table-6]. The maximum number of donor deferral was in category-1 followed by category-3 and least being in category-2. The most common cause of temporary deferral in category-1 is low hemoglobin (65.66%) followed by hypertension (8.02%)and hypotension (6.94%) and least being female with ongoing breast feeding (0.94%) and anxiety (0.94%) among deferred donors. The most common cause of temporary deferral in category-2 is tattoo (51.40%) followed by jaundice (24.02%) and malaria (23.46%) least being high risk behavior (1.12%). The most common cause of temporary deferral in category-3 is donor on medication (50.77%) followed by alcohol intake (16.05%), dengue (7.56%) and acute infection (9.10%) and least being open wound (0.15%)( Table-6).

DISCUSSION:
Blood transfusion is an essential part of the medical care system due to its importance in the management of many diseases and conditions. [3] Blood is transfused to patients as red cells, whole blood, platelets or plasma products. [4,5] The basic goal of any blood facility is to improve the safety of blood donor and blood recipient. Blood donor selection criteria policies are modeled to protect both the donor and the recipient. This is attained by continual and consistent efforts to upgrade the standards of blood transfusion services. Although, blood services aim to supply safe blood products, it is not possible to have a transfusion that is totally free from risk of transfusion transmissible diseases. [6] Blood donor deferral criteria are designed to protect both the blood donor and recipient. Some deferrals protect the donors from the risk of blood donation, some like those related to infectious diseases protect the recipient and some deferrals protect both. [7] Deferral rates ranged from 5. In our study the most common cause of permanent deferral was endocrinal disorder 38/118 (32.20%) followed by diabetes on insulin 21/118 (17.80%). Nagarekha Kulkarni (2012) in a study found hypertension in 48.96% donors as the most common cause of permanent deferral. [21] CONCLUSION: The deferral data is not widely recorded and reported till date. If collected and studied in a systematic way it will definitely improve the collection of blood from prospective blood donors. It is important to determine the rates and the causes of the donor deferrals to guide the recruitment and the retention efforts at the local, regional, and the national levels.
In present study, the incidence of donor deferral was 7.46% with low hemoglobin level, medication and hypertension as top three causes. The knowledge of the deferral incidences and their causes in a particular region helps in deciding the magnitude and the direction of the blood donor recruitment effort.