Analyzing the Causes of Blood Donor Deferrals and Characteristics of Deffered Individuals in Kurdistan Province , Iran

Introduction: Donor recruitment is an essential step in blood banking. Accordingly, this study aimed to evaluate donor deferral rate, causes of deferrals, and characteristics of deferred individuals in Kurdistan province located in west of Iran. Methods: This was a cross-sectional study carried out in Kurdistan Blood Transfusion Center from 2010 to 2015. A total of 175845 donors were selected to be screened. They were physically examined and detailed interviews were conducted with all the donors. In addition, standard operating procedures (SOPs) were used for donor selection and deferral. Results: According to the obtained results, the deferral rate was 14.55% (25 586 out of 175 845). The top 7 deferral reasons included the use of certain medications (n = 3996, 15.6%), abnormal blood pressure (n = 2311, 9.03%), polycythemia (n = 2177, 8.5%), risky behaviors (n = 1848, 7.2%), previous donation in the last 3 months (n = 1512, 5.9%), history of repeatedly reactive tests for infectious agents (n = 1334, 5.21%), and anemia (n = 1243, 4.85%). Meanwhile, the overall rate of deferral was higher in donors <35 years old (P < 0.001), females (P < 0.001), firsttime donors (P < 0.001), unmarried (P < 0.001), and less than 12 years of schooling (P < 0.001). Conclusion: The findings of this study indicated that the main reason for deferral was related to medications. Therefore, public education regarding health requirements of blood donors can be effective in reducing the number of deferrals.


Introduction
Donor screening process is a crucial step to increase donaed blood saftey. 1 The purpose of blood donor screening is to minimize the risk of infections transmitted by blood products. 2Both temporary and permanent bood donor deferrals result in a shrinkage in donor pools and low blood components available for transfusion. 3Consequently, there should be an awareness regarding the causes of blood donation deferrals.Moreover, identification of the reasons for deferrals can lead to modifications in blood safety programs and recruitment strategies. 4][5][6][7][8][9][10][11] This difference in prevalence pertentage of deferral may be attributed to various donor selection criteria due to differences in donor population and geographic distribution of transfusiontransmitted infections (TTIs). 12The donor deferral rate in several cities of Iran has been reported as 25.6% (Isfahan), 8 26.5% (Ilam), 13  22.5% (Tehran), 14 and 30.9% (Shiraz). 15According to what has been mentioned, the aim of this study was to determine the prevalence and reasons for blood donor deferrals in Kurdistan Province.To the best of the researchers' knowledge, this study is the first report analyzing the rate and reason of donor deferral in Kurdistan.

Donor Screening Strategy
This cross-sectional epidemiologic study was performed in Kurdistan Blood Transfusion Organization during 2010-2015.All the donors underwent a screening process to determine their eligibility for donation.The standard operating procedures (SOPs) developed by the safe blood transfusion programme (SBTP) were applied for donor screening. 16The screening process included identification, medical interview as well as blood pressure and hemoglobin measurements.
Post-donation serologic analysis contained tests to detect hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis.Regular donors were considered based on their previous history of blood donation while first-time donors were defined as those without any records of blood donation.Besides, individuals who did not meet the donor selection criteria were deferred temporarily or permanently.Deferral rates, frequencies of different medical reasons for deferral, and demographic details were collected.Subjcts who failed to donate, due to inability in venous access or vasovagal reaction, were not considered as defferals since these donors were otherwise eligible.

Statistical Analysis
The SPSS software, version 16 was run to analyse the data.In addition, the chi-square test was used to assess a significant relationship between the categorical variables.

Discussion
In the present study, the deferral rate of Kurd blood donors for a 6-year long period was estimated as 14.55%.These donors were deferred for various reasons in predonation screening.This deferral rate was lower than those of the most previous reports in Iran 8,[13][14][15] and other countries. 3,9,25However, lower deferral rates have been reported in Islamabad (4.3%) 22 and Karachi (12.2%) in Pakistan 27 , Malaysia (5.6%), 24 India (11.16%), 17 Saudi Arabia (8.7%), 19 and Namibia (8.6%). 20The most common cause of deferral at blood center of the present study was the use of medications (15.6%).This finding is consistent with the result of a recent report by Maleki et al 13 in Ilam (west of Iran).
Certain drugs can reduce the function and applicability of blood cells and products or cause adverse effects in recipients. 28Blood donors on eligible medications should be deferred for a period consistent with the pharmacokinetics of the drugs.For example, in cases of anti-platelet drugs consumption, donors are deffered for piroxicam and clopidogrel from 2 to 14 days, respectively.Defferals for aspirin and paracetamol usage have been reported in nearly 5% of blood donations. 29ypersensitivity reactions due to asprin is regarded as a common concern in donors.Moreover, penicillin induced allergy may be encountered in blood recipients due to anti-penicillin antibodies in donated blood units. 29he second most common cause of deferral among Kurd donors was abnormal blood pressure.As regards gender, the highest leading cause of blood donation deferral in males was taking medications (17.03%) while polycythemia (24.6%) was found to be the leading deferral reason in females.1][22][23][24] In the present study, anemia was the second common cause of deferral in females and the seventh cause overall.
In addition, the overall deferral rate was higher in firsttime compared to regular donors (21.08% vs. 11.54%,respectively).Similarly, the results from a study performed in southwest of Iran (Shiraz) 15 showed a higher deferral rate among first-time donors (48.1%) as compared to repeated donors (13.1%).In another study in Isfahan (center of Iran), 8 first-time donors constituted 76.5% of the total deferrals compared to 17.5% in repeated donors.
The findings of the present study also showed that 37.35% of the deferrals belonged to female donors while only 12.35% of the referrals was found to be related to male donors.Namely, deferral rates were higher in female donors as compared to their male counterparts (P < 0.001).This finding is in line with the results obtained by other studies. 3,8,17,23,30In the current study, temporary deferrals were responsible for 91.05% of defferals whereas permanent deferrals accounted for the remaining8.95%(), which is similar to the findings of Khurram et al. 27

Conclusion
Generally, findings of this study indicated that the main reason for blood donation deferral was related to medications affecting donated blood quality or exposing the blood recippients at risk.Therefore, public education regarding the importance of blood donation and donors' conditions can be effective in reducing the number of deferrals.

Ethical Approval
The present project was approved by the Research Ethics Committees of the Iranian Blood Transfusion Organization (IBTO).

Table 1 .
Blood Deferral Rate During 2010-2015 in Kurdistan Blood Transfusion Organization

Table 2 .
Demographic Features of Deffered Donors in Kurdistan Blood Transfusion Organization

Table 3 .
Causes of Blood Donor Deferrals in Kurdistan Blood Transfusion Organization