Introduction
Blood donation is a noble act which saves life of many patients.1 Voluntary blood donors are the mainstay of any blood donation setup, whether in a hospital or a blood bank. It is a vital cog in the wheel of safe blood transfusion services. However, some individuals get disqualified from blood donation if they fail to meet the selection criteria put in place to safeguard the health of both the donor and the recipient. Such individuals are called as “deferred donors”. The various reasons for deferral can be temporary or permanent.2
The spread of COVID-19 disease which is a highly contagious disease caused by SARS-CoV-2 virus had been declared a pandemic. The pandemic had a crippling impact on blood donations, blood supply and blood safety and had posed a huge challenge to the entire healthcare system.3 Hence, this study was undertaken to gain insight into conduction of a blood donation camp during the pandemic and to analyse various reasons for donor deferral in such a camp.4
Material and Methods
This is an observational study done in a voluntary blood donation camp conducted for general public during the second wave of COVID-19 pandemic in a school at Kottur, Karnataka. As the camp was organised during the pandemic, appropriate COVID-19 protocols were followed and proper precautions were taken. The local government authorities had arranged for Rapid Antigen Testing (RAT) for COVID-19 screening of donors and those who were negative for COVID-19 were sent for further evaluation before blood donation.
A total of 6 doctors were involved in screening of donors. Screening was done with the help of donor questionnaires and general physical examination. The individuals who came forward for donation were given the donor questionnaire form and were requested to write relevant information and history collected according to the questionnaire and then taken up for general physical examination. Parameters like weight, Hb, blood pressure, temperature, pulse, pallor along with systemic examination were done and noted down. Haemoglobin level was determined with the help of copper sulphate (gravimetric) method. Copper sulphate solution having a specific gravity of 1.053 was used (corresponding to haemoglobin level of 12.5 g/dL).
All the guidelines for a regular blood donation screening was followed along with few COVID-19 specific guidelines which included 14 days deferral for COVID-19 vaccinated individuals and 28 days deferral for COVID-19 infected patients following recovery. Those who fulfilled all the criteria were taken up for donation under all aseptic precautions. Post donation, they were asked to rest for 15 minutes, given refreshments and sent with post-donation counselling. The samples collected were sent to blood bank immediately under proper preservation. In blood bank they were screened for transfusion transmitted infection (T.T.I.) and component separation done.
Results
The camp was conducted with proper COVID-19 safety protocols in place. A total of 105 individuals came forward for blood donation of which 74 (70%) units of blood was collected from eligible donors. Of the total donors, 100 were males and 5 were females. The deferral rate was 35.24%, (37 individuals - 33 males and 4 females being deferred). There were various reasons for deferral which included both COVID-related and non-COVID-related causes.
On screening 6 units were HbsAg positive (16.2%). So total 68 units were suitable for issue of transfusion.
The gender distribution of donors and number of donors deferred are given in Table 1. The various reasons for deferral are enlisted in Table 2. The donor questionnaire is given in Figure 1.
Table 1
Gender distribution of donors
|
Gender |
No. of voluntary donors |
No. of donors deferred |
|
Male |
100 |
33 (33%) |
|
Female |
5 |
4 (80%) |
Table 2
Reasons for donor deferral
Discussion
The advent of COVID-19 pandemic has rendered a staggering blow to the healthcare services including blood banking and transfusion services. Raturi et al in their study says that blood donation, which is the only way to maintain the blood supply chain, has suffered drastically due to the outbreak.5 Divya et al also reported that there is a decline in the number of blood donations due to the fear of exposure to the infection.6 Sachdev et al in their study reported similar fear emanating from the scepticism about safety measures put in place at hospitals to prevent transmission of infection.7 In the present study, the organizers of the blood donation camp made sure that proper COVID-19 protocols were incorporated to allay the fear of infection like mandatory use of masks, observing a social distance of six feet among the donors, availability of sanitisers at each and every stage as well as RAT (Rapid Antigen Testing) to screen infected individuals.
Donor screening and evaluation is a prerequisite for blood safety.2 Accordingly, deferred donors are informed and counselled. The various reasons for deferral in the voluntary blood donation camp held during second wave of COVID-19 pandemic were analysed. However, due to lack of similar studies during the pandemic, comparisons were drawn with studies done prior to the pandemic.8
The most common reason of deferral in the present study was hypertension (43.3%) which is a permanent cause. Similar observation was made in the studies by RS Patil et al, where hypertension was the most common cause of permanent deferral.9 The most common cause of temporary deferral was COVID-19 vaccination within 14 days which is an exclusive observation in the present study, the period of deferral post vaccination being reduced to 14 days after changes in NBTC guidelines as concluded by Bhasker and Gupta et al in their respective studies.10, 11
Shah et al in their study observed that male volunteers were the predominant donors as compared to female volunteers which is similar to the present study.1 Similar observation was reported by Sundar et al in their study.12
Antwi-Baffour et al in their study observed that anaemia was a leading cause of donor deferral which is similar to the present study.13
Agnihotri in his study observed that hypertension and anaemia were the major causes of deferral and low body weight of donor a less common cause of deferral which is similar to the present study.14 Joy S et al reported that low haemoglobin and low body weight as major cause of donor deferral which was done among the student donors.2 Shrivastava et al in their study mentioned that transfusion transmitted diseases was another major cause of donor deferral which is in accordance to the present study. One donor was underage (<18 years) which was deferred similar to other studies. Endocrine diseases were also reported to be another cause of deferral by Shrivastava et al which was also noted in the present study where 2 (5.4%) donors had hypothyroidism.15
The present study reported 1 (2.7%) case of COVID-19 positivity by RAT testing which was deferred and unique in this study.
Out of 37 total deferrals, 24 were permanent deferrals and 13 were temporary deferrals.
Conclusion
The pandemic had a great impact to the blood bank stock which heavily depends on voluntary blood donation to ensure its supply chain. Hence, this study was undertaken to assess the various aspects of a blood donation camp held during the pandemic which can help in controlling and preventing spread of COVID-19 while ensuring availability of sufficient and safe blood for the patients in need. The authors also hope that this study can help in throwing a light to the path of conducting such a camp in the face of a similar outbreak in future in order to maintain the supply of a blood bank.
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