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Journal of the Academy of Hospital Administration

Study of Blood Donor Profile at a Tertiary Care Teaching Hospital

Author(s): N. Madan, J. Qadiri, F. Akhtar

Vol. 17, No. 2 (2005-01 - 2005-12)

Key Words: Donor Screening, Safe Blood Supply, Donor Motivation, Good Manufacturing Practices (GMP)

Key Messages:

  • Blood donation in our society is seen as a compulsion, not as a social responsibility
  • Donor motivation as well as donor screening mechanisms need to be strengthened to target the young population

Abstract:

Blood banking is one of the pillars of modern medicine. However, it has come under a lot of flak recently due to its potential to transmit lethal diseases. National and international efforts for ensuring a safe blood supply target donor collection through screening and education. The profile of the typical donor who serves as raw material for a blood bank and is subject to controls by the National AIDS Control Organisation (NACO) is described herein.

INTRODUCTION

The blood donor programme is the life force of any transfusion service. It is essentially a human operation that interacts with the community and relies totally on the support and goodwill of individual donors. The purpose of donor screening and deferral programmes is to minimize the possibility of transmitting infectious agents from a unit of donated blood to the recipient of that unit and to ensure the welfare of the donor. In January, 1983, the Blood Banking Organisation of USA recommended the use of donor screening questions to detect early symptoms of AIDS or exposure to AIDS patients among donors and the Centre for Disease Control, Atlanta suggested the use of surrogate tests for certain blood borne diseases (1).

In India, National Aids Control Organisation (NACO) paid special attention to the condition of the blood banks and in tandem with the Drug Controller of India (DCI), introduced stringent by-laws and testing procedures for infectious agents in blood banks. Screening of blood for HIV was made mandatory in India in 1988. In 1992, testing blood for Hepatitis B, Syphilis, and Malaria was required of all blood banks. Similar legislation came into effect for HCV from June 1, 2001. NACO has put into place a system for testing blood units rather than donors. On the other hand, the emphasis on nonremunerated, voluntary donations to minimize the risk of transfusion transmitted disease has told heavily upon the available donor pool.

This study was conducted with the aim of identifying the profile of the donors reporting at a tertiary care blood bank, and studying the efficacy of its donor screening program.

METHODOLOGY

Between October 2002 and March 2003, 350 donors (10% of the donor sample), selected by systematic random sampling were interviewed using a predesigned interview schedule at the blood bank of a teritary super special hospital at srinagar. The variables identified as significant to be included in the interview were based on the donor deferral criteria developed by NACO and American Association of Blood Banks (AABB) (2,3). A general physical examination of the sample under study was conducted. Donor blood samples were tested for hemoglobin by the cyanmethemoglobin method; for HIV, HCV and Australia antigen by ELISA and for syphilis by the VDRL technique. Positive cases of HIV were confirmed by the Department of Immunology using Rapidex spot test followed by the ELISA method, repeated twice using kits from different companies; and positive cases of Australia antigen and HCV were confirmed by a repetition of the ELISA technique in the Department of Microbiology.

OBSERVATIONS

Information on demographic profile, risk factors and laboratory results was collected after the donors had been recruited by the blood bank functionaries. These observations thus served the dual purpose of determining donor profile as well as the efficacy of the process of donor selection by the blood bank staff. ( Fig.1-5)

Fig. 1: Socio-Demographic Profile of Donors

Fig. 1: Socio-Demographic Profile of Donors

DISCUSSION

The typical donor is a young, educated, married rural male in the third decade of life, belonging to the lower socioeconomic status and donating blood for a close relative. He also tends to be a first time donor, donating mostly out of social compulsion for an exchange donation of the allogeneic kind. This is in concordance with results of similar studies in other third world countries (4). Education and awareness play a positive role in encouraging hospital attendance and blood donation by creating a demand for blood and dissipating ignorance.

Only 2.6% of the donations are purely voluntary. This is far below the national average of 39.3% for voluntary donations (5) vis a vis 50% replacement donations from a study conducted in 1996.

Viewed in its proper perspective, such a demographic profile and donation history seems to hint at the concept of Individual responsibility as the chief motivator behind the donations. Studies in the past have identified altruism and humanitarian values (6) as the main motives for donations, which have been overtaken by concern for self and family((7). Donors reporting at the blood bank seem to be guided primarily by this concern. Westphal has identified a voluntary donor’s desire to donate with the need to feel good about himself (8). In a society where the gradient of lower level needs can barely be fulfilled, it is unrealistic to expect the population to progress to the higher level needs of self actualization and esteem by voluntarily making donations; where the introduction of Good Manufacturing Practices and Quality Assurance programmes in the West told heavily upon the community spirit of blood donation, the ignorance, fear and confusion of our indigenous donor have never given him the courage to donate blood freely on a voluntary basis. In contrast to this, UK obtained 52.3% of its blood supply from voluntary donations in the late nineties (8). Blood donation in Kashmir is yet to achieve the status of community responsibility. A fall out of individual responsibility is that it sometimes puts pressure to donate blood on those barely able to give it.

Significantly, no professional donors could be identified in the sample, which is in keeping with the guidelines developed by the National Aids Control Organization (9).

First time donors form nearly 76% of the total donor population under study at the tertiary level hospital. Units from first time donors form only 15% to 25% of the total blood collected in blood centre in the US. Elsewhere in the world also, there is a higher population of repeat rather than first time donors (4). This paradox in the study reflects the inability of the blood bank to hold donors. Greater man hours are spent on the education and orientation of first time donors. They are also twice as likely to have disqualifying medical conditions as are regular donors (10). Unit losses for first time donors are greater after testing for infectious diseases, as positive rates are higher in them. This increases the economic strain on the blood bank. Nearly 20% of the sample studied reported with positive relevant history and should have been excluded from donation. Low haemoglobin levels were found in 14% of the donors. This is a telling comment upon the state of the donor deferral services; especially notable is the case with bleeding disorder on coagulation therapy, as are donors with blood pressure beyond acceptable limits and recent history of jaundice. The risk of transfusion related HCV remains 1 in 100,000 despite all precautions of screening and testing under optimum conditions. Infectious disease markers were found to be present in 2.2% of the sample tested. Compared to other third world countries this is much less, but high when compared to Europe and US . Though this sample size is too small to derive generalizations from, such cases were found to be associated more with illiterate males donating blood for the first time, in their third decade of life. There was also greater likelihood of their being associated with risk factors/ reasons for deferral.

CONCLUSION

It may be summarized that the blood bank at teritary Level Hospital does not have a stable, voluntary donor pool to fall back upon during times of need, so that uncertainty of supply remains a very real possibility, which could be mitigated to some extent by encouraging alternative modalities like freeze drying of blood, autologous donations, establishing rapport with NGOs and the media and targeting the younger population for motivation and awareness regarding blood donation. The healthy young donor continues to be the ideal raw material for the blood banking industry.

Fig 2: Type of Donation

Fig 2: Type of Donation

Fig 3: Donation History

Fig 3: Donation History

Fig 4: Presence of Risk Factor

Fig 4: Presence of Risk Factor

Fig 5: General Physical Examination

Fig 5: General Physical Examination

REFERENCES

  1. CDC: Recommendations for the prevention of HIV transmission in health care settings; Morbidity and Mortality Review, 21 August,1987;(36 : 25) : 25- 185.
  2. Drugs and Cosmetics Rules, 1945, 401, Sch-F, Pt-XII-B.
  3. Quality Assurance, AABB tech Manual 2005(15).
  4. Sawanpany et al: Donor deferral criteria for HIV virus positivity among blood donors in N. Thailand: Transfusion 12996 (36:3); 242 – 9.
  5. Kapoor et al: Blood transfusion practices in India: results of national survey; Ind. Jr. of Gastroent: April-June, 2000 (19:2); 64-71.
  6. Oswalt RM: Review of blood donor motivation and recruitment; Transfusion 1997(17); 123-24.
  7. Baden P: Donor motivation; donor room policies and procedures. AABB, Arlington, VA 1985; 1-9.
  8. Westphal RG. Donors and the US Blood Supply. Transfusion 1997 (37): 237-41.
  9. Section 5.11: An Action Plan for Blood Safety, MOHFW, GOI; 2003: 17-18.
  10. Bontz N, A Bondruand, P Fondu: Blood donor management in a high risk environment- The NBTS of the Ivory Coast; Transfusion Jan ‘97 (37): 106-7.

N. Madan1, J. Qadiri2, F. Akhtar3

1 Senior Resident, Department of Hospital Administration, AIIMS, New Delhi

2 Professor and Head, Deptt. of Hospital Administration, Sher-e-Kashmir Institute of Medical Science, Srinagar

3 Associate Professor, Coordinator, Blood Bank Services, Sher-e-Kashmir Institute of Medical Sciences, Srinagar

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