Turkish Journal of Hematology Volume: 37 Issue: 1 / 2020

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RESEARCH ARTICLEDOI: 10.4274/tjh.galenos.2019.2019.0166Turk J Hematol 2020;37:30-35First-time Blood Donors Are Double-edged Swords for BloodTransfusion Centers: A Retrospective Study in Southwest Iranİlk Kez Kan Vericisi Olanlar Kan Transfüzyon Merkezleri için İki Ucu Keskin Bıçaktır:Güneybatı İran’dan Retrospektif Bir ÇalışmaHamid Reza Niazkar 1 , Akbar Dorgalaleh 2 , Fariba Rad 3,41Gonabad University of Medical Sciences, Student Research Committee, Gonabad, Iran2School of Allied Medical Science, Department of Hematology and Blood Transfusion, Tehran, Iran3Yasuj University of Medical Sciences, Cellular and Molecular Research Center, Yasuj, Iran4Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, IranAbstractObjective: First-time blood donors are the most common groupof blood donors. They usually have different motivations for blooddonation, some of which provoke the donors to hide risk factors oftransfusion-transmissible infections (TTIs). Therefore, detection of TTIsamong first-time donors is crucial and can decrease the rate of TTIsamong blood recipients. This study aimed to evaluate the prevalence ofTTIs among first-time donors in the transfusion center of Kohgiluyehand Boyer-Ahmad Province (KBTC), Iran.Materials and Methods: This retrospective study was conductedwith volunteer blood donors in 2004-2014 in the KBTC. Various data,including sex, confidential unit exclusion (CUE), previous donationhistory, and the laboratory findings of confirmatory tests, wereextracted from blood donor software. Data were analyzed by SPSSusing the chi-square test.Results: Among 198,501 blood donors, 52,527 (26.46%) were firsttimedonors, while 145,974 donors (73.54%) were repeat and regulardonors. Most of the donors (94.5%) were male, while a minority (5.5%)were female. The CUE option was chosen by 2,237 (1.13%) donors.The incidence of hepatitis B surface antigen (HBsAg) and hepatitis Cvirus (HCV) was 247 (0.13%) and 134 (0.07%) among the entire studypopulation, respectively. Three donors (0.002%) had confirmed humanimmunodeficiency virus (HIV), while none of the blood donors werepositive for syphilis. Most of the donors with positive HBsAg (95.8%),HCV (86.6%), and HIV (100%) infection were first-time donors.Conclusion: Since TTIs are more common among first-time blooddonors than regular and repeat donors, special considerations shouldbe taken into account for this common group of blood donors.Keywords: Transfusion-transmissible infections, Blood donor, BlooddonationÖzAmaç: Kan donörlerinin büyük çoğunluğunu ilk kez kan verendonörler oluşturmaktadır. Bu kişilerin genellikle kan vermek içinfarklı motivasyonları vardır ve bu da vericilerin transfüzyon ilişkilienfeksiyonları (TTI) saklaması açısından risk oluşturur. Bu nedenle ilkkez verici olanlarda TTI’ları tespit etmek çok önemlidir ve böylece kanalıcılarında TTI’lar azaltılabilir. Bu çalışmada amaç İran’da Kohgiluyehve Boyer-Ahmad Bölgesi (KBTC) transfüzyon merkezindeki ilk kezverici olan kan donörlerinde TTI prevelansının araştırılmasıdır.Gereç ve Yöntemler: Bu çalışma, KBTC’de 2004-2014 yılları arasındagönüllü kan vericilerinin dahil edildiği retrospektif bir çalışmadır.Cinsiyet, gizli ünite dışlaması (CUE), daha önceki kan bağışları, vedoğrulama testlerinin laboratuvar bulguları gibi veriler, kan vericileriyazılımından elde edilmiştir. Elde edilen veriler ki-kare testi kullanılarakSPSS ile değerlendirilmiştir.Bulgular: 198,501 kan vericisinden 52,527’i (%26,46) ilk kez kanveren donörler, 145,974’i ise düzenli olarak kan verenler veya dahaönce kan vermis olanlardı (%73,54). Vericilerin çoğu erkekti (%94,5),kadın verciler azınlıktaydı (5,5%). CUE seçeneği 2,237 (%1,13) vericitarafından kullanılmıştı. Bütün çalışma grubunda hepatit B yüzeyantijeni (HBsAg) ve hepatit C virüsü (HCV) sıklığı sırasıyla 247 (%0,13)ve 134 (%0,07) idi. Üç vericide doğrulanmış insan bağışıklık yetmezliğivirüsü (HIV) bulundu (%0,002), hiç bir hastada sifilis tespit edilmedi.HBsAg (%95,8), HCV (86,6%), ve HIV (100%) enfeksiyonu olanvericilerin çoğunluğu ilk kez kan vericisi olan gruptaydı.Sonuç: TTI’lar tekrarlayan kez verici olanlar veya düzenli vericiolanlarla karşılaştırıldığında ilk kez verici olanlarda daha sıkgörülmektedir ve bu vericilerin kullanılması durumunda özelönlemlerin alınması gereklidir.Anahtar Sözcükler: Transfüzyon ilişkili enfeksiyonlar, Kan vericisi,Kan bağışı©Copyright 2020 by Turkish Society of HematologyTurkish Journal of Hematology, Published by Galenos Publishing HouseAddress for Correspondence/Yazışma Adresi: Fariba Rad, M.D., Yasuj University of Medical Sciences, Cellularand Molecular Research Center, Yasuj, Iran and Blood Transfusion Research Center, High Institute for Researchand Education in Transfusion Medicine, Tehran, IranPhone : +98 9196028093E-mail : fariba.rad89@gmail.com ORCID: orcid.org/0000-0002-6143-9979Received/Geliş tarihi: April 26, 2019Accepted/Kabul tarihi: September 2, 201930
Turk J Hematol 2020;37:30-35Niazkar HR, et al: First-time Blood Donors in Southwest IranIntroductionBlood transfusion has a fundamental role in medical services.Although blood donation can improve the quality of patients’lives, it is one of the main causes of the transmission of viralinfections, including hepatitis B virus (HBV), hepatitis C virus(HCV), and human immunodeficiency virus (HIV). Several studieshave shown that the chance of transmission of these infectionsis about 1% in each blood unit transfusion, while a 6.2% chanceto transmit hepatitis was also reported [1,2,3,4].Since blood can only be provided by human resources,transfusion-transmissible infections (TTIs) via these products areimportant issues. Therefore, blood safety is the most importantconcern of blood transfusion worldwide [5]. In the processof ensuring blood safety, donors have a crucial role [6]. As aresult, standard and relatively strict blood donation conditionsare used by blood transfusion centers to improve blood safety.This includes a voluntary blood donation system, a confidentialunit exclusion (CUE) system, the exclusion of high-risk donors,and standard and sensitive blood-borne disease detectionsystems. High-risk donors are those with risky behaviors, suchas multiple sexual partners or intravenous drug injection, whichcan increase the risk of TTIs [7,8,9].According to the standards of blood transfusion organization,volunteer donors are classified into two groups: first-timedonors and repeated and regular donors [10]. Several studieshave shown that first-time blood donors are the most commongroup of blood donors [10]. These donors usually have differentmotivations for blood donation. Some of these motivationsprovoke donors not only to hide risk factors during interviewsbut also to increase the risks of the blood donation system. Atthe same time, studies in different communities have shownthat the prevalence of TTIs in first-time donors is higher thanthat of other donors [10]. Therefore, evaluation and detectionof TTIs in first-time donors are crucial and can decrease the rateof TTIs among blood recipients.Despite various strategies and significant advances in thedetection and diagnosis of these diseases and the reductionof the window period by new-generation diagnostic kits, TTIsremain the most important challenge in blood transfusion. Thisstudy aimed to evaluate the prevalence of TTIs among first-timedonors at the transfusion center of Kohgiluyeh and Boyer-Ahmad Province, Iran (KBTC).Materials and MethodsThis retrospective study was performed with 198,501 volunteerblood donors from 2004 to 2014 at the KBTC. Demographicdata including sex and CUE, as well as donation history andlaboratory findings of confirmatory tests, were extracted fromblood donation software. Blood donors were classified into twogroups as first-time donors or repeated and regular donors. Afirst-time donor is a donor who is donating blood for the firsttime. A repeated and regular donor is a donor who has donatedblood at least once in the past [10].The results of HIV, HBV, HCV, and syphilis tests werealso extracted. The screening tests were performed withcommercially available enzyme-linked immunosorbent assaykits.Hepatitis B surface antigen (HBsAg) was checked with Behring(Marburg, Germany), Siemens (Marburg, Germany), and Bio-Rad(Hercules, CA, USA) kits; anti-HCV was checked with BioMerieux(Marcy l’Etoile, France) and Avicenna (Avicenna Medical Center,Moscow, Russia) kits; and HIV-Ab was tested with BioMerieux(Marcy l’Etoile, France), Bio-Rad (Hercules, CA, USA), andAdaltis (Montreal, Canada) kits. All repeatedly reactive resultswere confirmed by a neutralization test (Behring, Marburg,Germany) for HBV, a recombinant immunoblot assay for HCV(Inonogenetic, Ghent, Belgium), or a western blot assay for HIV(Inonogenetic, Ghent, Belgium).According to Iranian Blood Transfusion Organization (IBTO)policies, each blood unit with positive results confirmed forblood-borne diseases was excluded and the correspondingdonor was recalled for counseling and appropriate treatment.The rate of confirmed positive HBV, HCV, and HIV tests wascompared between the studied groups. The frequencies ofHBsAg, HIV, and HCV and 95% confidence intervals (CIs)were calculated using SPSS software. The prevalence rate ofinfections was calculated for each group and compared usingthe chi-square test, and differences were considered significantat p<0.05. This study was approved by the ethic committee ofYasuj University of Medical Sciences (IR.Yuma.rec.1396.22).ResultsA total of 198,501 blood donations were performed from 2004to 2014 at the KBTC. These included 52,527 (26.46%) first-timedonors and 145,974 (73.5%) repeated and regular donors. Outof the total of 198,501, 187,691 donors (94.5%) were male and10,810 donors (5.5%) were female (17.1:1). The CUE option waschosen by 2,237 (1.13%) donors, while 196,264 (98.87%) of thevolunteer donors did not choose the CUE option and were thusconsidered as the CUE-negative group. According to the historyof donation, the distribution of blood donors in CUE groups ispresented in Table 1.Among the 198,501 blood donors, 247 (0.13%) and 134 (0.07%)donors were positive for HBsAg and HCV, respectively. HBsAghad higher prevalence compared to HCV infection in theentire study population [0.13% and 0.07%, respectively; oddsratio (OR)=1.84; 95% CI=1.49-2.27; p<0.0001]. Three donors31
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