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      Blood donor notification and counseling: Our experience from a tertiary care hospital in India

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          Abstract

          Aims:

          To evaluate the response rate of transfusion-transmissible infection (TTI)-reactive donors after notification of their abnormal test results for the year 2012.

          Materials and Methods:

          This study is an observational descriptive study performed in our department over a period of 1 year. We evaluated the response rate of TTI-reactive donors after notification of their abnormal test results over 1 year as per the existing strategy (three telephonic and two postal communications).

          Results:

          During the study period, among the annual donation of 15,322 units, 464 blood donors were found to be seroreactive. Of these 464 seroreactive cases, 47 were HIV positive, 284 were reactive for Hepatitis B surface antigen (HBsAg), 49 were Hepatitis C (HCV) positive and 84 were VDRL reactive. The TTI-reactive donors (464) for various markers were contacted: 229 (49.4%) telephonically and the remaining 235 (50.6%) not contacted on phone were informed by post. Of the 229 contacted donors, the response rate was 98.2% as only 225 donors reported (221 on the first, three on second and one on the third call) for one to one counseling. The remaining four non-responders were - one HIV and three HBsAg reactive. The remaining 235 (50.6%) reactive donors did not respond to any communication.

          Conclusion:

          Donor notification and post-donation counseling are an essential aspect of the blood bank that entails provision of information on serological status, assess the impact of test results on the donor and finally referral for medical care. As in our data only 49.4% of the blood donors could be contacted successfully, incomplete demographic details was the major limiting factor in communicating with rest. Of the 229 contacted donors, the response rate was 98.2%. A large majority (94.75%) of the notified donors in our study contacted their health care provider when given clear instructions to do so. These results are encouraging because they indicate that a major element of the notification message is acted upon when it is worded clearly. The very high response rate of the contacted donors ensured their concern for knowing their test result status.

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          Most cited references17

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          Blood safety & prevalence of transfussion transmissible viral infections among donors at the Red Cross Blood Bank in Gondar University Hospital.

          Although millions of lives are saved by blood transfusion, unsafe transfusion is also putting millions of people at risk of Transfusion Transmissible Infections (TTI). In Ethiopia the safety and magnitude of blood transfusion and TTIs is not well investigated to investigate the magnitude of TTIs and assess TTI related risk factors among blood donors. Cross-sectional study among blood donors at the Red Cross Society Blood Bank in Gondar University Hospital, North West Ethiopia. The study was conducted among 600 adult blood donors between April and July 2004. Their mean age was 28 +/- 10.4 years (range: 16-64) and 66% of them were urban dwellers. The donors included farmers (30.7%), daily laborers (22.7%) and students (20%). All the donors were first time donors and 75% of the donations were replacement donations by remunerated donors or family members. The prevalence of HIV, Hepatitis B surface antigen (HBSAg) and Hepatitis C virus (HCV) infections were 4.5% (95%CI: 3.0-6.6), 8.2% (95%CI: 6.2-10.7) and 5.8% (95%CI: 4.2-8.1), respectively. The overall discard rate of donated blood because of these viral markers was 16.3%. In univariate analysis, HCV infection was significantly associated with presence of HIV (OR: 5.36, 95%CI: 2-14.3). Experiences of traditional surgical incisions or phlebotomy were present in 93.8% of donors. While 6.5% of donors admitted a history of multiple sexual partners, none of them admitted a history of any sexually transmitted infections (STI). The prevalence of TTIs among blood donors is very high. The majorities of blood donors are replacement or paid donors with one or more of the risk factors for TTIs implying that blood transfusion is unsafe. These findings call for the urgent implementation of the national strategy for safe blood transfusion in Ethiopia. As the utilization of advanced technology and skilled-personnel-based screening of blood are not in the immediate horizon, establishing stringent selection criteria of donors and setting clinical indications for transfusion would be indispensable and cost-effective interventions to minimize the risk of TTIs to blood recipients in Ethiopia.
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            The donor notification process from the donor's perspective.

            Despite large numbers of blood donors being notified of abnormal infectious disease screening results, there has been little scientific study of the effects of this process.
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              Ethical challenges in voluntary blood donation in Kerala, India.

              The National Blood Policy in India relies heavily on voluntary blood donors, as they are usually assumed to be associated with low levels of transfusion-transmitted infections (TTIs). In India, it is mandatory to test every unit of blood collected for hepatitis B, hepatitis C, HIV/AIDS, syphilis and malaria. Donors come to the blood bank with altruistic intentions. If donors test positive to any of the five infections, their blood is discarded. Although the blood policy advocates disclosure of TTI status, donors are not, in practice, informed about their results. The onus is on the donor to contact the blood bank. Out of approximately 16 000 donations in the past 2 years, 438 tested positive for TTI, including 107 for HIV. Only 20% of the donors contacted the blood bank; none of them were HIV positive. Disclosure by blood banks of TTI status by telephone or mail has resulted in serious consequences for some donors. Health providers face an ethical dilemma, in the absence of proper mechanisms in place for disclosure of test results, regarding notification to donors who may test positive but remain ignorant of their TTI status. Given the high cost of neglecting to notify infected donors, the authors strongly recommend the use of rapid tests before collecting blood, instead of the current practice, which takes 3 h to obtain results, and disclosure of results directly to the donor by a counsellor, to avoid dropouts and to ensure confidentiality.
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                Author and article information

                Journal
                Asian J Transfus Sci
                Asian J Transfus Sci
                AJTS
                Asian Journal of Transfusion Science
                Medknow Publications & Media Pvt Ltd (India )
                0973-6247
                1998-3565
                Jan-Jun 2015
                : 9
                : 1
                : 18-22
                Affiliations
                [1] Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, New Delhi, India
                Author notes
                Correspondence to: Dr. Veena Doda, Department of Transfusion Medicine, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi - 110 001, India. E-mail: Veenadoda@ 123456gmail.com
                Article
                AJTS-9-18
                10.4103/0973-6247.150941
                4339925
                b7590673-e97a-41cd-a48a-2f98c27bebb4
                Copyright: © Asian Journal of Transfusion Science

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original Article

                Hematology
                counseling,donor notification,transfusion-transmitted infections
                Hematology
                counseling, donor notification, transfusion-transmitted infections

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