Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar;63(3):541-551.
doi: 10.1111/trf.17277. Epub 2023 Feb 16.

Impact of a post-donation hemoglobin testing strategy on efficiency and safety of whole blood donation in England: A modeling study

Lois G Kim  1   2 , Thomas Bolton  2   3 , Michael J Sweeting  4 , Steven Bell  5 , Sarah Fahle  1   2 , Amy McMahon  1   2 , Matthew Walker  1   2 , Eamonn Ferguson  1   6 , Gail Miflin  7 , David J Roberts  1   8   9 , Emanuele Di Angelantonio  1   2   10   11   12 , Angela M Wood  1   2   10   11   13
Affiliations

Impact of a post-donation hemoglobin testing strategy on efficiency and safety of whole blood donation in England: A modeling study

Lois G Kim et al. Transfusion. 2023 Mar.

Abstract

Background: Deferrals due to low hemoglobin are time-consuming and costly for blood donors and donation services. Furthermore, accepting donations from those with low hemoglobin could represent a significant safety issue. One approach to reduce them is to use hemoglobin concentration alongside donor characteristics to inform personalized inter-donation intervals.

Study design and methods: We used data from 17,308 donors to inform a discrete event simulation model comparing personalized inter-donation intervals using "post-donation" testing (i.e., estimating current hemoglobin from that measured by a hematology analyzer at last donation) versus the current approach in England (i.e., pre-donation testing with fixed intervals of 12-weeks for men and 16-weeks for women). We reported the impact on total donations, low hemoglobin deferrals, inappropriate bleeds, and blood service costs. Personalized inter-donation intervals were defined using mixed-effects modeling to estimate hemoglobin trajectories and probability of crossing hemoglobin donation thresholds.

Results: The model had generally good internal validation, with predicted events similar to those observed. Over 1 year, a personalized strategy requiring ≥90% probability of being over the hemoglobin threshold, minimized adverse events (low hemoglobin deferrals and inappropriate bleeds) in both sexes and costs in women. Donations per adverse event improved from 3.4 (95% uncertainty interval 2.8, 3.7) under the current strategy to 14.8 (11.6, 19.2) in women, and from 7.1 (6.1, 8.5) to 26.9 (20.8, 42.6) in men. In comparison, a strategy incorporating early returns for those with high certainty of being over the threshold maximized total donations in both men and women, but was less favorable in terms of adverse events, with 8.4 donations per adverse event in women (7.0, 10,1) and 14.8 (12.1, 21.0) in men.

Discussion: Personalized inter-donation intervals using post-donation testing combined with modeling of hemoglobin trajectories can help reduce deferrals, inappropriate bleeds, and costs.

Keywords: blood donation; low hemoglobin deferral; post-donation testing; simulation modeling.

PubMed Disclaimer

Conflict of interest statement

Lois G. Kim, Thomas Bolton, Steven Bell, Sarah Fahle, Amy McMahon, Matthew Walker, Eamonn Ferguson, Gail Miflin, David J. Roberts, Emanuele Di Angelantonio and Angela M. Wood declare no conflict of interest. Michael J. Sweeting is a full‐time employee of AstraZeneca.

Figures

FIGURE 1
FIGURE 1
(A) Current strategy, (B) post‐donation testing strategies, (C) post‐donation testing with limited on‐site testing. [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

Comment in

References

    1. de Groot RPFJ, Broekman‐Piets R, de Kort WLAM, Pasker‐de Jong PCM. On‐site deferral of whole blood and plasma donors in The Netherlands between 2006 and 2013. ISBT Sci Ser. 2015;10:73–81.
    1. Zalpuri S, Romeijn B, Allara E, Goldman M, Kamel H, Gorlin J, et al. Variations in hemoglobin measurement and eligibility criteria across blood donation services are associated with differing low‐hemoglobin deferral rates: a BEST collaborative study. Transfusion. 2020;60(3):544–52. - PubMed
    1. Zou S, Musavi F, Notari EP, Rios JA, Trouern‐Trend J, Fang CT. Donor deferral and resulting donor loss at the American Red Cross Blood Services, 2001 through 2006. Transfusion. 2008;48(12):2531–9. - PubMed
    1. Spekman MLC, van Tilburg TG, Merz EM. Do deferred donors continue their donations? A large‐scale register study on whole blood donor return in The Netherlands. Transfusion. 2019;59(12):3657–65. - PMC - PubMed
    1. Hillgrove T, Moore V, Doherty K, Ryan P. The impact of temporary deferral due to low hemoglobin: future return, time to return, and frequency of subsequent donation. Transfusion. 2011;51(3):539–47. - PubMed

Publication types