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Blood donor screening: Procedures and processes to enhance safety for the blood recipient and the blood donor

INTRODUCTION

A major goal of transfusion medicine practice has been to reduce the risk of transfusion-transmitted infection to as low a level as possible [1,2]. In order to approach the desired level of zero risk from transfused allogeneic blood, multiple layers of safety are needed. Methods used in attempting to maximize safety from donated allogeneic units include donor selection criteria, donor medical history interview, the confidential unit exclusion (CUE) option, donor deferral registries, laboratory testing of donated units, donor initiated telephone call backs, and modification of the blood unit after collection, either by leukocyte removal or pathogen inactivation [3,4].

In addition to these recipient protections, the evaluation of each prospective blood donor includes procedures to assure that the donor will not suffer any adverse reactions from the donation itself or from hematopoietic growth factors employed to facilitate donation [5,6].

This discussion will provide an overview of the procedures involved in blood donor screening. Specific aspects of blood donor screening including medical history and laboratory testing are presented separately. (See "Blood donor screening: Medical history" and "Blood donor screening: Laboratory testing".)

ESTABLISHMENT OF PROCEDURES

When it is first suspected that an infectious agent may be transmitted by transfusion, the initial response is to develop donor deferral policies using epidemiologic data derived from high risk populations [3,5]. After this initial step, subsequent review and debate often leads to the nationwide implementation of a particular donor screening procedure following recommendations of the US Food and Drug Administration (FDA) and/or the AABB (formerly the American Association of Blood Banks) [7,8]. Once implemented, screening procedures tend to become permanent due to the current regulatory, political, and legal climate, even if their efficacy cannot be established.

For many diseases, such as Creutzfeldt-Jacob disease (CJD), which has not been proven to be transfusion transmitted, variant CJD, babesiosis, and malaria, non-laboratory donor screening procedures are the only method available for increasing transfusion safety [9-12]. In contrast, for those infectious diseases for which routine blood donor testing is performed (HIV, HTLV, hepatitis C virus, hepatitis B virus, and syphilis), the importance of non-laboratory donor screening procedures relates to their ability to identify some potentially infectious donors during the infectious, seronegative window period (table 1) [2,13].

                            

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Literature review current through: Jul 2014. | This topic last updated: May 2, 2014.
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References
Top
  1. AuBuchon JP, Birkmeyer JD, Busch MP. Safety of the blood supply in the United States: opportunities and controversies. Ann Intern Med 1997; 127:904.
  2. McCullough J. The nation's changing blood supply system. JAMA 1993; 269:2239.
  3. Kleinman S. Donor selection and screening procedures. In: Safety Current Challenges, Nance SJ (Ed), American Association of Blood Banks, Bethesda, MD 1992. p.169.
  4. Goodnough LT, Shander A, Brecher ME. Transfusion medicine: looking to the future. Lancet 2003; 361:161.
  5. Kleinman S. Donor Screening Procedures. In: Practice of Transfusion Medicine, 3rd ed, Petz L, Swisher S, Kleinman S, et al (Eds), Churchill-Livingstone, New York 1996. p.245.
  6. McCullough J, Kahn J, Adamson J, et al. Hematopoietic growth factors--use in normal blood and stem cell donors: clinical and ethical issues. Transfusion 2008; 48:2008.
  7. Standards for blood banks and transfusion services, 18th ed, Price TH (Ed), American Association of Blood Banks, Bethesda, MD 2008.
  8. US Department of Health and Human Services, Food and Drug Administration. The code of federal regulations, Washington, DC: US Government Printing Office, 2008 (revised annually).
  9. Ricketts MN, Cashman NR, Stratton EE, ElSaadany S. Is Creutzfeldt-Jakob disease transmitted in blood? Emerg Infect Dis 1997; 3:155.
  10. Appleman MD, Shulman IA, Saxena S, Kirchhoff LV. Use of a questionnaire to identify potential blood donors at risk for infection with Trypanosoma cruzi. Transfusion 1993; 33:61.
  11. Gerber MA, Shapiro ED, Krause PJ, et al. The risk of acquiring Lyme disease or babesiosis from a blood transfusion. J Infect Dis 1994; 170:231.
  12. Nahlen BL, Lobel HO, Cannon SE, Campbell CC. Reassessment of blood donor selection criteria for United States travelers to malarious areas. Transfusion 1991; 31:798.
  13. Schreiber GB, Busch MP, Kleinman SH, Korelitz JJ. The risk of transfusion-transmitted viral infections. The Retrovirus Epidemiology Donor Study. N Engl J Med 1996; 334:1685.
  14. Whittaker S, Carter N, Arnold E, et al. Understanding the meaning of permanent deferral for blood donors. Transfusion 2008; 48:64.
  15. Kaplan HS, Kleinman SH. AIDS: blood donor studies and screening methods. In: Infection, Immunity and Blood Transfusion, Barker LF, Dodd RY (Eds), Alan R Liss, New York 1985. p.297.
  16. Cherubin CE, Prince AM. Serum hepatitis specific antigen (SH) in commercial and volunteer sources of blood. Transfusion 1971; 11:25.
  17. Szmuness W, Prince AM, Brotman B, Hirsch RL. Hepatitis B antigen and antibody in blood donors: an epidemiologic study. J Infect Dis 1973; 127:17.
  18. Alter HJ, Holland PV, Purcell RH, et al. Posttransfusion hepatitis after exclusion of commercial and hepatitis-B antigen-positive donors. Ann Intern Med 1972; 77:691.
  19. Barker LF. International forum: Which criteria must be fulfilled for a donation or a donor to be considered voluntary. Vox Sang 1978; 34:363.
  20. Glynn SA, Williams AE, Nass CC, et al. Attitudes toward blood donation incentives in the United States: implications for donor recruitment. Transfusion 2003; 43:7.
  21. Mayo DJ. Evaluating donor recruitment strategies. Transfusion 1992; 32:797.
  22. Sanchez AM, Ameti DI, Schreiber GB, et al. The potential impact of incentives on future blood donation behavior. Transfusion 2001; 41:172.
  23. Strauss RG. Blood donations, safety, and incentives. Transfusion 2001; 41:165.
  24. Glynn SA, Smith JW, Schreiber GB, et al. Repeat whole-blood and plateletpheresis donors:unreported deferrable risks, reactive screening tests, andresponse to incentive programs. Transfusion 2001; 41:736.
  25. Williams AE, Glynn SA, Bethel J, Ameti DI. Blood donation incentives: attitudes and risk relationships among first time and repeat whole blood donors (abstract). Transfusion 2000; 40:1S.
  26. Doll LS, Petersen LR, White CR, Ward JW. Human immunodeficiency virus type 1-infected blood donors: behavioral characteristics and reasons for donation. The HIV Blood Donor Study Group. Transfusion 1991; 31:704.
  27. Leitman SF, Klein HG, Melpolder JJ, et al. Clinical implications of positive tests for antibodies to human immunodeficiency virus type 1 in asymptomatic blood donors. N Engl J Med 1989; 321:917.
  28. Williams AE, Thomson RA, Schreiber GB, et al. Estimates of infectious disease risk factors in US blood donors. Retrovirus Epidemiology Donor Study. JAMA 1997; 277:967.
  29. Schreiber GB, Sharma UK, Glynn SA, et al. Evaluation of donors who give primarily for HIV testing (abstract). Transfusion 2001; 41(Supplement):35S.
  30. SCHAFER IA, MOSLEY JW. A study of viral hepatitis in a penal institution. Ann Intern Med 1958; 49:1162.
  31. Krugman S, Friedman H, Lattimer C. Hepatitis A and B: serologic survey of various population groups. Am J Med Sci 1978; 275:249.
  32. American Association of Blood Banks, American Red Cross, Council of Community Blood Centers: Joint statement on acquired immune deficiency syndrome related to transfusion. January 13, 1983.
  33. Tan L, Khan MK, Hawk JC 3rd. Use of blood therapeutically drawn from hemochromatosis patients. Council on Scientific Affairs, American Medical Association. Transfusion 1999; 39:1018.
  34. 21 CFR 640.120 (April, 2000).
  35. Sanchez AM, Schreiber GB, Bethel J, et al. Prevalence, donation practices, and risk assessment of blood donors with hemochromatosis. JAMA 2001; 286:1475.
  36. Barton JC, Grindon AJ, Barton NH, Bertoli LF. Hemochromatosis probands as blood donors. Transfusion 1999; 39:578.
  37. Barton JC, Preston BL, McDonnell SM, Rothenberg BE. Severity of iron overload in hemochromatosis: effect of volunteer blood donation before diagnosis. Transfusion 2001; 41:123.
  38. Leitman SF, Browning JN, Yau YY, et al. Hemochromatosis subjects as allogeneic blood donors: a prospective study. Transfusion 2003; 43:1538.
  39. Grossman BJ, Springer KM. Blood donor deferral registries: highlights of a conference. Transfusion 1992; 32:868.
  40. Mayo DJ, Rose AM, Matchett SE, et al. Screening potential blood donors at risk for human immunodeficiency virus. Transfusion 1991; 31:466.
  41. http://www.americasblood.org/go.cfm?do=page.view&pid=13#age_limits (Accessed on January 14, 2013).
  42. Dunbar N, Katz J, Nambiar A. The potential impact of new donor height and weight criteria on young donor eligibility and faint or prefaint reaction rates. Transfusion 2011; 51:737.
  43. Tomasulo PA, Anderson AJ, Paluso MB, et al. A study of criteria for blood donor deferral. Transfusion 1980; 20:511.
  44. Yuan S, Gornbein J, Smeltzer B, et al. Risk factors for acute, moderate to severe donor reactions associated with multicomponent apheresis collections. Transfusion 2008; 48:1213.
  45. Eder AF, Dy BA, Kennedy JM, et al. Improved safety for young whole blood donors with new selection criteria for total estimated blood volume. Transfusion 2011; 51:1522.
  46. Pi DW, Krikler SH, Sparling TG, et al. Reappraisal of optimal hemoglobin standards for female blood donors in Canada. Transfusion 1994; 34:7.
  47. Holland PV. Measuring the volume of packed RBCs in donors. Transfusion 2001; 41:309.
  48. Standards for blood banks and transfusion services, 25th ed, Price TH (Ed), American Association of Blood Banks, Bethesda, MD 2008.
  49. Wood EM, Kim DM, Miller JP. Accuracy of predonation Hct sampling affects donor safety, eligibility, and deferral rates. Transfusion 2001; 41:353.
  50. Mendrone A Jr, Sabino EC, Sampaio L, et al. Anemia screening in potential female blood donors: comparison of two different quantitative methods. Transfusion 2009; 49:662.
  51. Pottgiesser T, Specker W, Umhau M, et al. Recovery of hemoglobin mass after blood donation. Transfusion 2008; 48:1390.
  52. Gordeuk VR, Brittenham GM, Bravo J, et al. Prevention of iron deficiency with carbonyl iron in female blood donors. Transfusion 1990; 30:239.
  53. Bianco C, Brittenham G, Gilcher RO, et al. Maintaining iron balance in women blood donors of childbearing age: summary of a workshop. Transfusion 2002; 42:798.
  54. Bier-Ulrich AM, Haubelt H, Anders C, et al. The impact of intensive serial plasmapheresis and iron supplementation on iron metabolism and Hb concentration in menstruating women: a prospective randomized placebo-controlled double-blind study. Transfusion 2003; 43:405.
  55. Mast AE, Foster TM, Pinder HL, et al. Behavioral, biochemical, and genetic analysis of iron metabolism in high-intensity blood donors. Transfusion 2008; 48:2197.
  56. Cable RG, Glynn SA, Kiss JE, et al. Iron deficiency in blood donors: analysis of enrollment data from the REDS-II Donor Iron Status Evaluation (RISE) study. Transfusion 2011; 51:511.
  57. Radtke H, Tegtmeier J, Röcker L, et al. Daily doses of 20 mg of elemental iron compensate for iron loss in regular blood donors: a randomized, double-blind, placebo-controlled study. Transfusion 2004; 44:1427.
  58. Magnussen K, Bork N, Asmussen L. The effect of a standardized protocol for iron supplementation to blood donors low in hemoglobin concentration. Transfusion 2008; 48:749.
  59. Maghsudlu M, Nasizadeh S, Toogeh GR, et al. Short-term ferrous sulfate supplementation in female blood donors. Transfusion 2008; 48:1192.
  60. Newman B. Iron depletion by whole-blood donation harms menstruating females: the current whole-blood-collection paradigm needs to be changed. Transfusion 2006; 46:1667.
  61. Brittenham GM. Iron deficiency in whole blood donors. Transfusion 2011; 51:458.
  62. Benjamin RJ, Dy BA, Kennedy JM, et al. The relative safety of automated two-unit red blood cell procedures and manual whole-blood collection in young donors. Transfusion 2009; 49:1874.
  63. Högler W, Mayer W, Messmer C, et al. Prolonged iron depletion after allogeneic 2-unit RBC apheresis. Transfusion 2001; 41:602.
  64. Radtke H, Mayer B, Röcker L, et al. Iron supplementation and 2-unit red blood cell apheresis: a randomized, double-blind, placebo-controlled study. Transfusion 2004; 44:1463.
  65. O'Meara A, Infanti L, Stebler C, et al. The value of routine ferritin measurement in blood donors. Transfusion 2011; 51:2183.
  66. Pasricha SR, McQuilten ZK, Keller AJ, Wood EM. Hemoglobin and iron indices in nonanemic premenopausal blood donors predict future deferral from whole blood donation. Transfusion 2011; 51:2709.
  67. Mast AE, Lee TH, Schlumpf KS, et al. The impact of HFE mutations on haemoglobin and iron status in individuals experiencing repeated iron loss through blood donation*. Br J Haematol 2012; 156:388.
  68. Stohlawetz P, Stiegler G, Jilma B, et al. Measurement of the levels of reticulated platelets after plateletpheresis to monitor activity of thrombopoiesis. Transfusion 1998; 38:454.
  69. Strauss RG. Risks of clinically significant thrombocytopenia and/or lymphocytopenia in donors after multiple plateletpheresis collections. Transfusion 2008; 48:1274.
  70. Lazarus EF, Browning J, Norman J, et al. Sustained decreases in platelet count associated with multiple, regular plateletpheresis donations. Transfusion 2001; 41:756.
  71. Katz L, Palmer K, McDonnell E, Kabat A. Frequent plateletpheresis does not clinically significantly decrease platelet counts in donors. Transfusion 2007; 47:1601.
  72. Richa E, Krueger P, Burgstaler EA, et al. The effect of double- and triple-apheresis platelet product donation on apheresis donor platelet and white blood cell counts. Transfusion 2008; 48:1325.
  73. Bolan CD, Greer SE, Cecco SA, et al. Comprehensive analysis of citrate effects during plateletpheresis in normal donors. Transfusion 2001; 41:1165.
  74. Bolan CD, Cecco SA, Yau YY, et al. Randomized placebo-controlled study of oral calcium carbonate supplementation in plateletpheresis: II. Metabolic effects. Transfusion 2003; 43:1414.
  75. Laspina SJ, Browne MA, McSweeney EN, et al. QTc prolongation in apheresis platelet donors. Transfusion 2002; 42:899.
  76. Despotis GJ, Goodnough LT, Dynis M, et al. Adverse events in platelet apheresis donors: A multivariate analysis in a hospital-based program. Vox Sang 1999; 77:24.
  77. Bolan CD, Wesley RA, Yau YY, et al. Randomized placebo-controlled study of oral calcium carbonate administration in plateletpheresis: I. Associations with donor symptoms. Transfusion 2003; 43:1403.
  78. Bolan CD, Cecco SA, Wesley RA, et al. Controlled study of citrate effects and response to i.v. calcium administration during allogeneic peripheral blood progenitor cell donation. Transfusion 2002; 42:935.
  79. Kishimoto M, Ohto H, Shikama Y, et al. Treatment for the decline of ionized calcium levels during peripheral blood progenitor cell harvesting. Transfusion 2002; 42:1340.
  80. Buchta C, Macher M, Bieglmayer C, et al. Reduction of adverse citrate reactions during autologous large-volume PBPC apheresis by continuous infusion of calcium-gluconate. Transfusion 2003; 43:1615.
  81. Newman BH, Pichette S, Pichette D, Dzaka E. Adverse effects in blood donors after whole-blood donation: a study of 1000 blood donors interviewed 3 weeks after whole-blood donation. Transfusion 2003; 43:598.
  82. Eder AF, Dy BA, Kennedy JM, et al. The American Red Cross donor hemovigilance program: complications of blood donation reported in 2006. Transfusion 2008; 48:1809.
  83. Casale G, Bignamini M, de Nicola P. Does blood donation prolong life expectancy? Vox Sang 1983; 45:398.
  84. Salonen JT, Tuomainen TP, Salonen R, et al. Donation of blood is associated with reduced risk of myocardial infarction. The Kuopio Ischaemic Heart Disease Risk Factor Study. Am J Epidemiol 1998; 148:445.
  85. Meyers DG, Jensen KC, Menitove JE. A historical cohort study of the effect of lowering body iron through blood donation on incident cardiac events. Transfusion 2002; 42:1135.
  86. Glynn SA, Kleinman SH, Schreiber GB, et al. Trends in incidence and prevalence of major transfusion-transmissible viral infections in US blood donors, 1991 to 1996. Retrovirus Epidemiology Donor Study (REDS). JAMA 2000; 284:229.
  87. Edgren G, Tran TN, Hjalgrim H, et al. Improving health profile of blood donors as a consequence of transfusion safety efforts. Transfusion 2007; 47:2017.
  88. Newman BH. Donor reactions and injuries from whole blood donation. Transfus Med Rev 1997; 11:64.
  89. Tomita T, Takayanagi M, Kiwada K, et al. Vasovagal reactions in apheresis donors. Transfusion 2002; 42:1561.
  90. Wieling W, France CR, van Dijk N, et al. Physiologic strategies to prevent fainting responses during or after whole blood donation. Transfusion 2011; 51:2727.
  91. Trouern-Trend JJ, Cable RG, Badon SJ, et al. A case-controlled multicenter study of vasovagal reactions in blood donors: influence of sex, age, donation status, weight, blood pressure, and pulse. Transfusion 1999; 39:316.
  92. Newman BH, Graves S. A study of 178 consecutive vasovagal syncopal reactions from the perspective of safety. Transfusion 2001; 41:1475.
  93. Newman BH. Vasovagal reactions in high school students: findings relative to race, risk factor synergism, female sex, and non-high school participants. Transfusion 2002; 42:1557.
  94. Newman BH, Siegfried BA, Buchanan LA. Donor reactions among African-American and Caucasian first-time whole-blood donors. Transfusion 2005; 45:1398.
  95. Eder AF, Hillyer CD, Dy BA, et al. Adverse reactions to allogeneic whole blood donation by 16- and 17-year-olds. JAMA 2008; 299:2279.
  96. Hanson SA, France CR. Predonation water ingestion attenuates negative reactions to blood donation. Transfusion 2004; 44:924.
  97. Ando S, Kawamura N, Matsumoto M, et al. Simple standing test predicts and water ingestion prevents vasovagal reaction in the high-risk blood donors. Transfusion 2009; 49:1630.
  98. Newman B, Tommolino E, Andreozzi C, et al. The effect of a 473-mL (16-oz) water drink on vasovagal donor reaction rates in high-school students. Transfusion 2007; 47:1524.
  99. Tomasulo P, Kamel H, Bravo M, et al. Interventions to reduce the vasovagal reaction rate in young whole blood donors. Transfusion 2011; 51:1511.
  100. Hanson SA, France CR. Social support attenuates presyncopal reactions to blood donation. Transfusion 2009; 49:843.