Improving the US blood supply and blood donation safety for both women and men

Abstract

I n 2004, approximately 9 million whole-blood donors or approximately 3 percent of the US population donated 14.8 million allogeneic units of whole blood. 1 The total number of allogeneic donations is adequate for the US blood supply, but there are seasonal, holiday, blood group, and geographic shortages that require a better inventory. The national goal should be to have red blood cell (RBC) units available in a sufficient quantity in all blood groups at all times and in all locations. Therefore, we need to build a sufficient inventory before the summer and before the December winter vacation, have good methods to shift units between different areas of the country and within a collection territory, and have a larger donor pool so that we can achieve a sufficient blood supply upon demand.The focus of this commentary is twofold. The first is to focus on a large group of interested blood donors, premenopausal women, who present to donate blood but are rejected on an ongoing basis because the hemoglobin (Hb) concentration acceptance standard of 12.5 g per dL (hematocrit [Hct] 38%), which is defined by the AABB Standards for Blood Banks and Transfusion Services 2 and the Code of Federal Regulations, 3 is in the normal range for women. The second focus is on blood donation safety.The low end of normal for Hb concentration is 11.3 g per dL for African American women, 12.0 g per dL for Caucasian women, 12.5 g per dL for African American men, and 13.5 g per dL for Caucasian men. 4,5 In addition to the Hb acceptance barrier for women, capillary blood samples are not uniform. In a recent study of 50 subjects, individual operators obtained a finger stick-derived blood sample from each hand and compared them. There was a mean Hb difference of 0.76 g per dL (2.25 Hct points) between the two hands, which is a 6 percent difference for a donor with a Hb concentration of 12.5 g per dL. 6 This intradonor variation increases the donor deferral rate for women because the Hb measurement may be below the true value, but the intradonor variation is almost irrelevant for Caucasian men because the low end of normal in Caucasian men (13.5 g/dL) is 1.0 g per dL higher than the Hb acceptance cutoff (12.5 g/dL). In contrast, the same study found no intradonor difference when venous samples were collected from each arm. 6 Two studies have also shown that donors deferred for low Hb have lower blood donor return rates. 7,8 Custer and colleagues 7 found that Hb deferrals decreased subsequent blood donations by 29 percent in repeat donors and by 68 percent in firsttime donors over a 5-year period, and Halperin and colleagues 8 found that Hb deferrals decreased subsequent blood donations by 30 percent over 4.25 years. These two studies suggest that the loss of donations in donors deferred for low Hb over a 4-to 5-year period is approximately 30 percent. In sum, the current Hb acceptance standard for women causes an immediate loss of blood units and also decreases the blood donor pool.What is the immediate loss in terms of allogeneic whole-blood do...

The impact of analytical variation of hemoglobin measurement on blood donors' hemoglobin and deferral rates

“…Donor age and the time of donation are factors known to be associated with cHb values in donor populations . In this study, we chose to use a very simple parameterization of donor age at donation and time of day.…”

“…Strict threshold values ignore many physiologic phenomena and technical aspects that affect Hb values and deferral rates. These factors include the age, ethnicity, smoking status, and body weight of the donor; the effect of the season and the time of day; methodologic variables; and sample type (venous or capillary blood) …”

Capillary versus venous haemoglobin determination in the assessment of healthy blood donors

“…New gender‐based deferral criteria for donor haemoglobin values are being widely discussed in the United States . Attention to stringent training and periodic competency assessments of staff performing fingerstick haemoglobin assessments will be a critical part of this reevaluation of haemoglobin eligibility standards, with the intent of improving both the blood supply and the safety of blood donation.…”

Switching iron‐deficient whole blood donors to plateletpheresis

“…12,13,20 Efforts to avoid donor pool attrition and in particular the loss of women in childbearing age, a group at risk of ID, should be made. 21 Only 1 of 39 women in this study had to be excluded when Hb and ferritin values failed to improve after switching to PLT donation and a course of IRT. Plateletpheresis proved to be a valid alternative to WB donation, even for younger women.…”