|Year : 2018 | Volume
| Issue : 4 | Page : 217-221
Monitoring response rate of blood donors concerning positive screening tests for HIV and syphilis: an institutional approach toward donor hemovigilance
Maria Ali1, Farheen Karim2
1 Department of Pathology, Jinnah Medical and Dental College, Karachi, Pakistan
2 Section of Hematology and Transfusion Medicine, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan
|Date of Submission||10-Apr-2018|
|Date of Acceptance||27-Jun-2018|
|Date of Web Publication||10-Apr-2019|
Department of Pathology, Jinnah Medical and Dental College, Shaheed-e-Millat Road, Karachi, 74800
Source of Support: None, Conflict of Interest: None
Objective To investigate the response rate among our blood donors when notified about their positive screening results of HIV and syphilis.
Study setting An observational study conducted at a Division of Hematology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital from January 2013 to December 2014.
Materials and methods Computerized donor inventory data were retrieved. The frequency of screening-positive donors for HIV and syphilis was calculated and the donors were informed through telephone to provide fresh samples for confirmatory tests. The frequency of those donors who responded by providing fresh blood sample was computed.
Results Of the total 1684 screening-positive doors, 255 were reactive for syphilis and 11 were reactive for HIV. Only 232 (91%) of the venereal disease research laboratory positive were successfully contacted, out of these only 65 (28%) gave fresh samples and treponema pallidum particle agglutination (TPHA) test results confirmed 56 (86%) donors as positive and nine (14%) as negative for syphilis. On the other hand, of the11 anti-HIV-reactive donors 10 (91%) were successfully approached, five (50%) donors showed a positive response by giving fresh samples for Western blot confirmatory test, which affirmed three (60%) donors to be positive and two (40%) donors to be negative for HIV.
Conclusion The results reverberate the lack of awareness among our blood donors. Better predonation counseling can improve the overall outcome.
Keywords: blood donors, human immunodeficiency virus, response, venereal disease research laboratory
|How to cite this article:|
Ali M, Karim F. Monitoring response rate of blood donors concerning positive screening tests for HIV and syphilis: an institutional approach toward donor hemovigilance. Egypt J Haematol 2018;43:217-21
|How to cite this URL:|
Ali M, Karim F. Monitoring response rate of blood donors concerning positive screening tests for HIV and syphilis: an institutional approach toward donor hemovigilance. Egypt J Haematol [serial online] 2018 [cited 2019 May 21];43:217-21. Available from: http://www.ehj.eg.net/text.asp?2018/43/4/217/255867
| Introduction|| |
Donor hemovigilance is becoming a new focus of contemplation worldwide ,; it is practiced with an objective to improve donor safety and contentment . Donor adverse events are mainly the center of attention whereas the percipience of positive screening results and their consequences are of similar significance.
As an important therapeutic agent blood saves millions of lives, concurrently it also puts an immense number of lives at risk due to unsafe transfusion practices . Safe blood transfusion is an elusive fantasy far from accomplishment as long as it is associated with transfusion-transmitted infections . The Government of Pakistan has taken multiple steps to standardize the blood-safety system nationwide, and to integrate it the national blood transfusion project was established in March 2009, the main goal of which is to affirm satisfactory transfusion in terms of safety, quality, and quantity ,.
On the whole blood, transfusion services intend to provide safe and healthy blood and to ensure safety they adopt the strategies to recruit healthy blood donors filtered by both verbal and serological screening. According to the WHO criteria, all blood products must be screened for hepatitis B virus, hepatitis C virus, HIV, and syphilis . In Pakistan, in addition to the general WHO recommendations, blood is also screened for malaria which is endemic in the country as per the WHO epidemiologic data .
In the beginning, it was believed that sexual contact was the only mode of HIV transmission. It was later in the middle of 1982 that the disease prevalence was observed in other populations like hemophilic and drug addicts ,. HIV-contaminated blood clotting factor concentrates led an AIDS epidemic among hemophiliacs in late 1970s and early 1980s . AIDs epidemic brought a significant consideration about malpracticing transfusion services in developing countries .
Consequently, the donor who may apparently appear healthy and asymptomatic but harbors an infection  can receive timely treatment if informed about screening test results. Accordingly, it is of considerable importance that the donor is informed about positive serological results and be counseled adequately so that he can seek medical attention and refrain from further donations .
In accordance with our blood bank protocol, all the blood donors who are found to have positive serological results must be informed. Considering the possibility of false-positive screening results, it is of crucial value to substantiate the screening results with a confirmatory test. Donors having reactive tests for syphilis and HIV are requested to provide fresh samples for confirmatory tests. However, it has been observed that many of these notified donors either do not acknowledge the telephonic calls or do not make appearance for counseling and for giving fresh samples for confirmatory tests. This portends the oblivion among our blood donors regarding the significance of positive infectious disease results.
With this background and observation we conducted this study to determine the response rate of blood donors when updated about positive serology results of HIV and syphilis. The outcome might support us for endorsement of strategies to revamp the overall donation process in the greater interest of donor well-being.
| Materials and methods|| |
Study setting and the hospital transfusion system
Aga Khan University Hospital is a tertiary care and has one of the largest blood banks in the region which provides transfusion services to a 700-bed hospital and three other maternity homes linked to it. It accepts voluntary and exchange donors fulfilling the stringent donor selection criteria. Occasionally, the blood donors of specific groups are called from donor inventory if desired. An average of 2000 donors donate their blood every month. After having collected the donation from the donor area, the bags are moved to the processing bench where the blood components are prepared. All the donated units are then screened for transfusion-transmitted infections, until then all bags are held in quarantine. Anti-HIV is a screening test for HIV and is performed by the serological method, using VITROS ECi/ECiQ Immunodiagnostic System (Vitros Eci, Johnson and Johnson, Ortho Clinical and Diagnostics, Raritan, NY, USA). The venereal disease research laboratory (VDRL) is used as the screening test for syphilis and it is performed on VDRL Carbon antigen CA/010 Plasmatec (VDRL Carbon antigen, RPR kit, Plasmatec Laboratory Products, Bridport, UK). VDRL and anti-HIV-positive reports are only issued after performing confirmatory tests by IMMUTREP Treponema pallidum rticle agglutination (TPHA) and HIV-1 Western blotting (New Lav Blot I, Bio-Rad, Marnes-la-Coquette, France), respectively.
Procedure of donor recruitment
The blood donor is selected with bearing in mind the responsibility of providing safe and healthy blood. After walking into the blood bank, the donor is attended by trained and skilled donor attendants. He goes through a verbal interview of screening. In case if he meets the initial screening requirements he goes under general physical examination. To get registered every donor has to provide a national identity card number and a valid telephonic number for future contact, if needed. As part of donor recruitment, he also has to sign a valid consent form which has every detail documented.
Determination of response rate
Due to the sensitive social aspect of having positive HIV and syphilis results, all positive screening results of anti-HIV and VDRL are validated with confirmatory tests of Western blot and TPHA, respectively, on fresh samples. For this process, to eventuate the donors with reactive screening results are approached via telephonic calls and are requested to provide new samples. The response rate is determined by calculating the number of donors who after being approached successfully came forth for offering fresh samples.
Study design and statistical analysis
It is a retrospective cross-sectional study in which all the blood donors were included who came for blood donation during the period from January 2013 till December 2014. Computerized data sheets from the donor inventory were retrieved. Donors with screening-positive results for HIV and syphilis were included while the donors with positive screening tests for all other infectious diseases were excluded. The frequency of donors who tested positive for infectious diseases of HIV and syphilis was calculated. The percentage of the donors who responded to the call and provided fresh blood samples was computed. Data were analyzed using SPSS (version 19.0; SPSS Inc., Chicago, Illinois, USA).
| Results|| |
A sum of 49 687 donors participated for blood donation during the study period of January 2013 till December 2014. The male to female ratio was 159 : 1. The median age of donors was 37±5 years. Of these total number of donors, 1684 (3.3%) were reported to have positive screening results for various transfusion-transmitted infections, out of those 255 (0.5%) were reactive for syphilis and 11 (0.02%) were reactive for HIV.
Out of the 255 VDRL screening-positive donors, 232 (91%) were successfully reached through telephonic contact; on the other hand, the remaining 23 (9%) donors did not receive multiple calls or the contact number provided was not accurate. In regard to 232 VDRL positive notified donors only 65 (28%) turned up to give new samples for further testing, whereas supplemented with confirmatory TPHA test, the results confirmed 56 (86%) donors as positive and nine (14%) as negative for syphilis ([Figure 1] and [Figure 2]).
|Figure 1 Bar chart showing the degree of response among donors with reactive screening results.|
Click here to view
Of all 11 anti-HIV-reactive donors, 10 (91%) were successfully approached and conveyed the message through a telephonic call. However, only five (50%) donors showed a positive response by giving fresh samples for Western blot confirmatory test, which authenticated three (60%) donors to be positive and two (40%) donors to be negative ([Figure 1] and [Figure 2]).
The donors who could not be communicated and those who did not cooperate, their likelihood of being positive is measured in terms of probability which is 219.7% for syphilis and 6.6% for HIV ([Figure 2]).
| Discussion|| |
Blood is an important therapeutic remedy with its requirement increasing every passing year. The provision of safe blood is a challenging task involving a toilsome activity from donor recruitment to blood product screening and releasing. However, the understanding of the blood donation process is by and large inadequate in general public . The results of our study highlight the small scale of knowledge with regard to health care and transfusion-transmitted infections amidst our blood donors. Informing process of reactive results encompasses two important objectives first that the donor concedes the test results and second that he has full understanding of disqualification from the donation process . Some of the donors find the results disturbing and upsetting and experience confusion regarding the deferral status .
Our analysis displays that hardly one-third (28%) of the VDRL positive and only half (50%) of anti-HIV-reactive population came forth for confirmatory tests when made aware of screening test results. In a similar study done in Malaysia to assess the response rate of Malaysian blood donors it has been unfolded that the response rate was 67.1% in the VDRL-positive group measured by attending the clinics, whereas 32.9% showed no response to calls. At the same time, 54.0% anti-HIV-positive donors responded to call and out of these 63.8% went ahead to complete investigations and the remaining 46% in HIV-positive donors did not response to multiple calls .
Agarwal  impart that in his study done on blood donors in the Uttarakhand region of India shows relatively better response rates when compared with other centers in the region. He concludes that it is by virtue of the predonation counseling provided by their committed unit.
The analytical conclusion of the study done on blood donors in Kerala projects the ethical challenges that are unveiled following informing donors regarding positive serological status via mail or telephone, so the blood bank has adopted the practice of discarding infectious blood components without updating donors. The author suggests the provision of rapid tests so that the donor could be counseled without delay; moreover, it affirms confidentiality .
However, a feedback from the donor reflects his understanding of screening results. In the United States a multicenter study was conducted after delivering information by letters to donors about their reactive results to perceive their understanding, and to observe if recommendations are being followed. It was concluded that out of total 94% informed donors, 53% found it easy to understand while 45% found it bit hard to understand, but 60% of the study subjects consulted a health-care provider to discuss their results . In addition, it is learned that the donors have contrasting cognizance on the subject of screening tests. Sharma et al.  noted that in spite of having high-risk behavior donors went on donating blood and roughly 23% believed it is permissible to donate blood to be screened for HIV. Similar results were observed in some other studies where the donors with risk factors donated their blood with an objective to be tested for HIV despite the availability of anonymous counseling centers ,.Aside from the prime objective of this study which provides the insight into the donor behavior concerning their own well-being, the results have brought up several other findings for consideration. For instance, there is a grave need to upgrade predonation counseling which could provide donors better understanding of screening tests and deferral status on grounds of screening results. Furthermore, it indicates that the donor attendant should be better trained to peruse blood donors to chase their screening results and follow the recommendations if needed. In a similar manner, the donor attendant also needs to focus on obtaining the appropriate contact number so that the donors could be reached more efficiently.
Taking into account the results of confirmatory tests, none of the donors professed the high-risk behavior, which makes it of foremost importance that skills of donor attendants should be refined enough to give donors adequate confidence to disclose their involvement in high-risk activities . Based on these observations, the concerns which needs to be reasoned are the credibility of the questionnaire pertaining to high-risk evaluation and effectiveness of dialog between the donor attendant and the blood donor.
However, the fate of the donors is vague with whom the contact could not be established. Moreover, the donors with whom the communication was established and did not extend their cooperation for confirmatory tests, their probability of positive screening can be assumed to be equal to those who extended their cooperation for providing new samples for the confirmatory test and found to be positive.
| Conclusion|| |
Our analysis concludes that the response rate of notified donors for VDRL was 28% and for HIV it was 50%, which is significantly low and reflects the amplitude of negligence and this fact makes it imperative to develop more awareness amidst blood donors pertaining to transfusion-transmitted infections. It is concluded that a more appropriate predonation counseling can overhaul the outcome and should be implemented as an obligatory part of the overall procedure. It is proposed that this conduct will not only enhance the response of notified donors, but may also emend the gap of communication within donors who could not be reached.
The authors acknowledge Ahmed Rahim, statistical analyst, Department of Pathology and Laboratory Medicine, The Aga khan University Hospital, for providing his technical assistance through this project.
Dr Maria Ali has collected the data and analyzed it along with writing the major parts of the manuscript. Dr Farheen Karim has provided technical help in writing the overall manuscript along with writing discussion and suggested the layout of tables, added in the original article.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
AuBuchon JP, Whitaker BI. America finds hemovigilance! Transfusion
Sorensen BS, Johnsen SP, Jorgensen J. Complications related to blood donation: a population-based study. Vox Sang
Tomasulo P, Kamel H, Bravo M, James RC, Custer B. Interventions to reduce the vasovagal reaction rate in young whole blood donors. Transfusion
Diro E, Alemu S, GY A. Blood safety & prevalence of transfussion transmissible viral infections among donors at the Red Cross Blood Bank in Gondar University Hospital. Ethiop Med J
Agarwal N. Response rate of blood donors in the Uttarakhand region of India after notification of reactive test results on their blood samples. Blood Transfus
Moiz B, Ali B, Chatha MH, Raheem A, Zaheer HA. HIV prevalence in blood donors and recipients in Pakistan: a meta-analysis and analysis of blood-bank data. WHO South East Asia J Public Health
Zaheer HA, Waheed U. Blood safety system reforms in Pakistan. Blood Transfus
WHO Guidelines Approved by the Guidelines Review Committee. Screening donated blood for transfusion-transmissible infections: recommendations
. Geneva: World Health Organization 2009.
Odolini S, Gautret P, Kain KC, Smith K, Leder K, Jensenius M et al.
Imported Plasmodium vivax malaria ex Pakistan. J Travel Med
Center for Disease Control. Opportunistic infections and Kaposi’s sarcoma among Haitians in the United States. MMWR Morb Mortal Wkly Rep
Ehrenkranz N, Rubini J, Gunn R, Horsburgh C, Collins T, Hasiba U et al.
Pneumocystis carinii pneumonia among persons with hemophilia A. MMWR Morb Mortal Wkly Rep
Lorenzo JI, Moscardo F, Lopez-Aldeguer J, Aznar JA. Progression to acquired immunodeficiency syndrome in 94 human immunodeficiency virus-positive hemophiliacs with long-term follow-up. Haematologica
van Dam CJ, Sondag-Thull D, Fransen L. The provision of safe blood-policy issues in the prevention of human immunodeficiency virus transmission. Trop Doct
Attaran MS, Sharifi Z, Hosseini SM, Samei S, Ataee Z. Prevalence of hepatitis B and hepatitis D coinfection in asymptomatic blood donors in Iran. APMIS
Kotwal U, Doda V, Arora S, Bhardwaj S. Blood donor notification and counseling: our experience from a tertiary care hospital in India. Asian J Transfus Sci
Shi L, Wang J, Liu Z, Stevens L, Sadler A, Ness P et al.
Blood donor management in China. Transfus Med Hemother
Kleinman S, Wang B, Wu Y, Glynn SA, Williams A, Nass C et al.
The donor notification process from the donor’s perspective. Transfusion
Roshan TM, Rosline H, Ahmed SA, Rapiaah M, Khattak MN. Response rate of Malaysian blood donors with reactive screening test to transfusion medicine unit calls. Southeast Asian J Trop Med Public Health
Choudhury LP, Tetali S. Ethical challenges in voluntary blood donation in Kerala, India. J Med Ethics
Sharma UK, Schreiber GB, Glynn SA, Nass CC, Higgins MJ, Tu Y et al.
Knowledge of HIV/AIDS transmission and screening in United States blood donors. Transfusion
Nebie KY, Olinger CM, Kafando E, Dahourou H, Diallo S, Kientega Y et al.
Lack of knowledge among blood donors in Burkina Faso (West Africa); potential obstacle to transfusion security. Transfus Clin Biol
Goncalez TT, Sabino EC, Murphy EL, Chen S, Chamone DA, McFarland W. Human immunodeficiency virus test-seeking motivation in blood donors, Sao Paulo, Brazil. Vox Sang
Goncalez TT. Risk behavior disclosure among blood donors in Sao Paulo, Brazil. Rev Bras Hematol Hemoter
[Figure 1], [Figure 2]