Deferred and deterred: a review of literature on the impact of deferrals on blood donors

Background: Potential blood donors can be deferred due to concerns about the impact of the donation on their health or the safety of the blood supply. To date, we lack a comprehensive review of the impact of deferrals on donors and how to mitigate adverse effects. Aims: The aim of this review was to describe the available literature on deferrals, with a focus on the impact of deferrals on donors’ subsequent behaviour, potential reasons for impact and the effectiveness of strategies to improve deferral processes and facilitate donor return. Method: A narrative review of the literature on blood donation deferrals was undertaken. Results: Deferral rates vary widely across different contexts, with female, younger, first time and minority donors more likely to be ineligible to donate. There is clear evidence that deferrals impact on future donation behaviour, particularly for those deferred at their first donation attempt. Deferral has a negative emotional impact if the deferral is permanent or related to positive test results, while emotions experienced at the time of a temporary deferral are related to donors’ willingness to return. Conclusion: An understanding of the impact of deferrals from the donor perspective provides key information to improve the blood centre practices. There is preliminary evidence of the effectiveness of strategies to retain donors, including enabling the ineligible donor to make an alternative contribution, providing clear information about the deferral, notifying the donor when they can return to donate and addressing practical barriers to return

Patient-reported outcomes of serum eye drops manufactured from Australian blood donations and packaged using Meise vials

IntroductionSerum eye drops (SED) are an effective treatment for dry eye syndrome. However, autologous serum collection can have challenges. Patient-tailored (allogeneic) SED (PT-SED) can be made from healthy blood donors. Australian Red Cross Lifeblood has manufactured both autologous SED (Auto-SED) and PT-SED and, in May 2021, introduced Meise vial packaging. This study aimed to explore SED patient-reported outcomes and vial packaging satisfaction.MethodsA prospective cohort study was conducted with recruitment between 1 November 2021 and 30 June 2022. Participants completed the dry eye questionnaire (DEQ5), health-related quality-of-life (SF-8™), functional assessment of chronic illness therapy-treatment satisfaction-general (FACIT-TS-G), and general wellbeing surveys. Existing patients completed these once, and new patients were surveyed at baseline, 3 months post-treatment, and 6 months post-treatment.ResultsParticipants who completed all study requirements were 24 existing and 40 new Auto-SED and 10 existing and 8 new PT-SED patients. Auto-SED patients were younger [56.2 (±14.7) years] than PT-SED patients [71.4 (±10.0) years]. Participants used a mean of 1.8 (±1.1) SED, 5.3 (±2.9) times per day. In new patients, DEQ5 scores improved within 6 months from 14.0 (±2.9) to 10.6 (±3.4) for Auto-SED and from 12.9 (±3.7) to 11.4 (±2.8) for PT-SED. General wellbeing measures improved in the new Auto-SED from 7.0 (±1.9) to 7.8 (±1.7) but were reduced for new PT-SED from 6.7 (±2.9) to 6.1 (±2.9).DiscussionSED improved dry eye symptoms in most patients, regardless of the serum source. Patients using PT-SED showed decreases in some quality-of-life measures; however, recruitment was reduced due to operational constraints, and concurrent comorbidities were not assessed. General feedback for SED and vial packaging was positive, with some improvements identified

Frequent whole blood donors: understanding this population and predictors of lapse

BACKGROUND: Frequent blood donors are an important resource as they contribute many donations over their lifetime. The aim of this research was to develop a demographic profile of Australian frequent whole blood donors and to determine predictors of lapse within this group. STUDY DESIGN AND METHODS: Routinely collected data were used to profile individuals who had donated whole blood frequently (three or more times) between December 2010 and November 2011. Two segments were identified: 1) existing donors who had donated before December 2010 and 2) new donors who had not donated before December 2010. Donation records were followed to the end of December 2013 to examine retention. RESULTS: A total of 90,867 donated frequently between December 2010 and November 2011. The group was composed of slightly more men (51.4%), was typically of middle socioeconomic status, and many were employed in skilled trades such as a builder or a plumber (21.3%). Existing donors (n = 81,762) were significantly older, more likely to be male, and more likely to have a D– blood type compared to the smaller group of new donors (n = 9105). For both segments, being older and male and having a D– blood type increased the likelihood of return in the follow-up period. Deferrals and adverse events had negative impacts on retention for both groups. CONCLUSIONS: This study highlights specific factors that blood collection agencies may focus on to support continued donation among frequent donors

Trends in return behavior after an adverse event in Australian whole blood and plasma donors

Background: This study examined the impact of donor adverse events (DAEs) on plasma donor return and compared these against trends in whole blood (WB) donors. Study Design and Methods: Using a retrospective cohort design, donors who attempted to give plasma or WB in 2014-2015 were categorized by DAE and followed for 2 years. Analyses of return rate, time to return, subsequent donation frequency, and recurrent risk were performed. Donor characteristics associated with return were also assessed. Results: For both plasma and WB donors, vasovagal reactions (VVRs) were the strongest deterrent to return, with a lower proportion returning, taking longer to return, and making fewer subsequent donations than those with uncomplicated donations. Despite a higher likelihood of a recurrent event among those who experienced a DAE, the majority had an uncomplicated subsequent donation. Donor characteristics associated with return varied by phlebotomy and DAE type. For donors experiencing a VVR, differences were observed by donor experience, age, sex, and site type between plasma and WB. For phlebotomy-injured donors, differences were observed by sex, blood type, donor experience, and donation outcome between the two groups. No factors associated with return after a citrate reaction were found. Conclusion: This study highlights the detrimental effects of DAEs on plasma return, in particular VVRs, and the differences in factors associated with return compared to WB donors. Further research is required to understand the mechanisms underlying the decision to return following a DAE

Bringing new plasma donors back: testing the efficacy of telephone and e‐mail communications with first‐time donors

As demand for plasma-derived products grows, retention of voluntary nonremunerated plasmapheresis donors is crucial for many blood collection agencies. Currently, there is limited evidence of how to encourage first-time plasmapheresis donors to return and establish a high-frequency donation routine. This study tested the effectiveness of an intervention designed to increase retention of first-time plasmapheresis donors, increase donation frequency, and reduce time to return.A total of 6788 first-time plasmapheresis donors were randomly assigned to one of four conditions. Donors received an alternative e-mail or the business-as-usual control e-mail paired or not with a phone call. Outcomes were compared to the control e-mail in intention-to-treat analyses.Compared with control, donors in all intervention conditions were more likely to donate plasma as their first return donation in 6 months; however, there were no significant differences between intervention conditions. Rates of plasma donation in the alternative e-mail, control e-mail plus call, and alternative e-mail plus call conditions were 17.0, 15.0, and 18.0% higher than control. While the extra donations obtained in the alternative e-mail condition were cost neutral, the cost of one additional donation in the call conditions ranged from 20.14-20.89 AUD (13.08-13.56 USD).Communications specifically designed to encourage first-time plasmapheresis donors to view regular plasmapheresis donations as "easy"; to forward-book more than one appointment; and to provide education about plasma are effective in encouraging donors to return to plasma, to donate more frequently, and to return faster

Does using applied muscle tension at strategic time points during donation reduce phlebotomist- and donor-reported vasovagal reaction rates? A three-armed randomized controlled trial

Vasovagal reactions (VVRs) have a negative impact on donor safety and return. Applied muscle tension (AMT) increases blood pressure temporarily and has been suggested as a way to reduce donors' risk of VVRs. This study evaluated whether using AMT at three different time points during the donation procedure reduces the VVR symptoms reported by donors and the VVR reactions recorded by phlebotomists.A three-arm, multicenter, open-label randomized controlled trial was used to compare VVR symptoms and reaction rates between those practicing AMT during the entire donation (n = 244) to practicing AMT at VVR high-risk time points (n = 250) to a standard blood donation control group (n = 240). All participants were asked to drink 500 mL of water in the waiting area, and an even distribution of new and repeat donors was sought across conditions.Across all conditions, donors reported few VVR symptoms and the rate of reporting did not differ significantly across conditions. However, donors who practiced AMT at strategic time points had a significantly lower number of phlebotomist-registered VVRs in comparison to the other two study groups, with these rates not varying by sex or donor status. Greater compliance by donors with AMT instructions was observed in those asked to practice AMT at strategic time points compared to those asked to practice AMT during the entire donation.Practicing AMT at VVR high-risk time points reduces the number of phlebotomist-registered VVRs

Facilitating donor compliance with strategies to prevent vasovagal reactions: comparison of web-based and in-center approaches

BACKGROUND: Research has documented beneficial effects of water loading (WL) and applied muscle tension (AMT) on reducing self-reported vasovagal reactions (VVRs) in whole blood (WB) donors. However, the optimal approach to reducing VVRs using these strategies in routine blood collection practice is not known. This study evaluated the effectiveness of embedding newly developed web-based and on-site donor education materials to increase the use of these two prevention techniques during blood collection. STUDY DESIGN AND METHODS: Two studies were conducted with WB donors. In Study 1, donors (n = 375) were randomly allocated to evaluate one of three forms of educational materials (video, webpage, card) in an online questionnaire. In Study 2, donors (n = 598) were randomly assigned to view either off-site web-based or in-center educational materials and were surveyed after donation to assess compliance to the VVR prevention procedure and to self-report VVR. RESULTS: In Study 1, donors rated the video as having the highest message appeal and indicated greater likelihood to use AMT compared to the webpage and card. No differences were found in likelihood to use WL. In contrast, in Study 2, greater adherence to VVR prevention strategies was observed in donors who received the in-center instruction card in comparison to those who received the web-based materials. Examination of viewing data indicated that only a small number of donors had seen the web-based materials. No significant effects of the techniques were found on self-reported VVRs. CONCLUSION: Providing on-site instructions is the most effective method to increase donor compliance to VVR prevention techniques

Sustained benefits of autologous serum eye drops on self-reported ocular symptoms and vision-related quality of life in Australian patients with dry eye and corneal epithelial defects

Background: This research examined the effect of autologous serum eye drops (ASED) on ocular symptoms, visual-related functioning and quality of life for patients failing other therapies. Methods: Patients (N=77) were asked to complete a survey prior to ASED use, and 2 and 12 months post-treatment. Results: Significant improvements in symptom frequency and severity were documented for dryness, ocular pain and grittiness at 2 and 12 months. Patients felt more in control and required less help from others at 12 months. Conclusions: ASED produce sustained benefits to dry eye symptoms, improve feelings of control and reduce requirements for assistance from others

Willingness of blood donors in Australia to provide additional data and blood sample for health research

Background:Many blood collection agencies are generating important data on donor health outcomes using large-scale blood donor cohort studies. Such studies can be very effective when donors provide access to linkage of their data to external health databases, and storage and genomic testing of their blood sample. In this study, we aimed to assess the willingness of Australian blood donors to provide additional data and blood sample for donation-related and other health research. Study design and methods: We invited 2017 donors to complete a survey using four methods (postal letter, postal letter and email, email only, and-center recruitment). The survey asked for information on demographics,lifestyle behaviors, health, experience and attitude to blood donation, and willingness to give blood sample and additional data for research.Results:Response rates ranged from 23.8% for email only to 77.2% for in-center recruitment. Of those who responded (n=827), 95.5% indicated they would be willing to provide a blood sample for donation and transfusion-related research.Of these, >90.0% were willing for their sample to be used in research involving genetic testing and other health-related topics. Also, >90.0% were willing to consent for linkage of their information to external health databases. Conclusions:Donors surveyed reported a high willingness to participate inhealth research by completing surveys, allowing linkage to external datasets, and providing a blood sample. These findings provide strong support for future longitudinal research studies with Australian blood donors