| ObjectiveBlood donors were divided into 3 categories internationally:voluntary non-remunerated blood donor (VNRD), family replacement donor and paid blood or occupational donors. Family replacement donors referred to their family members or social members. Sometimes, it seemed to be difficult to distinguish VNRD and mutual blood donors, because they were the part of social members who voluntarily donated his blood to help the other social members (recipients). However, there is difference between voluntary blood donation and mutual blood donation in strictly speaking, because replacement donors donate blood for "specific" blood recipients. Voluntary blood donors donated blood was not for concrete, specific recipients, but for any receptors who demand for the blood. For many years, WHO and many western transfusion experts have recommend exclusively that, in order to minimize the risks, voluntary, non-remunerated blood donation is the cornerstone of a safe and adequate national blood supply which meets the transfusion requirements of all patients, and eliminated replacement donors who promoted to provide blood to their relatives or friends.However, some transfusion experts have pointed out that these assumptions of WHO have not been supported by evidence, and recent published evidences clearly indicate that the lower level of safety of family or replacement donor compared to first-time volunteers in several countries of SSA are not substantiated. After comparing the relative of first-time volunteers and replacement donors in West Africa, Professor JP Allain thought that the donor selection policy focusing on strategies to retain both volunteers and replacement donors as repeat donors would improve the safety of the donor pool and improve the blood supply significantly. In our country, mutual blood donation was a kind of donation model to solve the blood supply by patients with family or friends and relatives, which was an important part of unpaid blood donation, especially in recent years, in the face of increasingly normalized clinical blood supply tight, mutual blood donation, as a special pattern of blood demand to a guarantee of emergency and clinical medicine under the new form, which became the effectively way to get the blood in time.In the past, replacement donors were often mixed with paid donors who were widely recognized to be "unsafe". But today in China, hospitals and blood transfusion services had made grade efforts to eliminate paid donors leaving genuine replacement donors, so the evidences and policies around the safety characteristic of replacement donors need to be reexamined.The present study aimed to evaluate viral safety of replacement donation. We analyzed the data of mutual donors and voluntary donors from 2006 to 2012 in Zhaoqing city, and analyzed the risk factors related to blood safety by Binary logistic. We also analyzed the characteristics of mutual donation population, which would provide guideline for recruitment strategy improvement in next step.Methods(1)Rapid tests for hepatitis B surface antigen (HBsAg, Colloidal gold labeling method) and amino acids transferees (ALT, dry chemical method) were performed before donation for every donor. Nonreactive donors were suitable for donation. When the whole blood units were collected, homologue blood sample were collected simultaneously and serum were tested HBsAg, anti-HCV, anti-HIV(1+2) and syphilis by Enzyme linked immunosorbent assay (ELISA), and were tested ALT by kinetic analysis method. All the viral markers were detected twice by two different reagents, and reactive samples were confirmed by repeat test. Reactive anti-HIV samples were confirmed at local public-health-station HIV reference laboratories certified by the Ministry of Health. ALT were also detected by two different reagents, either result exceeding 40 U/L (after 2012, male>45 U/L, female> 40U/L) was considered abnormal.(2) Differences in seroprevalence (including viral markers and ALT) between groups were tested for significance by chi-square test (p value< 0.05 was significance). Relative risks of blood safety were tested by Binary logistic.(3) Basic information about replacement donor and voluntary donor such as:age, gender, occupation, donation time and screen results were collected by Maike blood bank information system network, and analyzed by SPSS software (18.0 versions).Results(1) From 2006 to 2013, the total prevalence for the all donors was 5.88%, and the prevalence for each mark were descend that:ALT (4.87%)> HBsAg (0.5%)> syphilis (0.36%)> Anti-HCV (0.15%)> Anti-HIV (0.01%). The total seroprevalence was higher in replacement group than in voluntary group (7.33%vs 5.88%, p<0.05), but differences of individual markers were not identical. The prevalence of HBsAg, anti-HCV and syphilis in replacement group were higher than in voluntary group (1.48% vs 0.49%, p<0.001 and 0.58% vs 0.14%, p<0.001 and 0.76% vs 0.36%, p<0.001), and the prevalence of ALT and anti-HIV were not significantly difference (4.44% vs 4.88%, p=0.36 and 0.76% vs 0.36%, p=0.06).(2) Sex, age and donation time were the risk factors related to blood safety. Total positive prevalence was higher in female replacement donors than in male (7.7% vs 3.2%, p<0.001), and was higher in replacement donor over 30 years than below 30 years, the prevalence in 18-20 years group was 0, and 21-30 years group was 4.9%, 31-40 years group was 9.3%, and 41-50 years group was 8.0%, and 51-60 years group was 6.1%. But the positive prevalence in repeated replacement donors was lower than in first-time replacement donors, and the prevalence in≥3 times group,2 times group and once time group were 1.6%,5.1% and 7.8%, respectively.(3) There were 2771 replacement donors, which account for 1.07% in 254 973 donors from 2006 to 2013. Male donors accounted for the majority proportion of the donors, and the proportion of male replacement donors was as high as 81%. The proportion of young donors in volunteers was higher than in replacement donors (42% vs 37%). The main relationship between mutual donor and recipient was relative:first degree relatives accounting for 55.9%, unrelated relatives accounting for 26.3% and other relatives (classmate, colleague or friend, et al) accounting for 22.8%. 11.2% replacement donors became repeat donors (donation more than 2 times).Conclusions(1) With special donor selection procedure and appropriate pre-donor Screening, replacement donors, which were the necessary complement for blood supply, can provide the same viral safety as voluntary donors.(2) Sex, age and donation time are the association risk factors of viral safety Female, young (below 30) and repeat donors could provide more viral safety than male, more than 30 years and first time donors.(3) Replacement donors only accounted for 1.07% of total donors, but it was rising year by year. At present, male donors accounting for the majority proportion of the donors, most of them were first time donors. In order to further improve the blood supply and safety, in future, our donor selection policy should focus on retaining both replacement and voluntary young donors as repeat donors and promoting donation proportion of female. |
PDF Full Text Request