Are university students a favorable target group for blood donation campaigns? / Universite ogrencileri kan bagis kampanyalari icin uygun bir hedef kitle midir?
Subject: Blood banks
Students
Authors: Eser, Bulent
Kurnaz, Fatih
Kaynar, Leylagul
Yay, Mehmet
Sivgin, Serdar
Unal, Ali
Cetin, Mustafa
Pub Date: 12/01/2010
Publication: Name: Turkish Journal of Hematology Publisher: Aves Yayincilik Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 Aves Yayincilik ISSN: 1300-7777
Issue: Date: Dec, 2010 Source Volume: 27 Source Issue: 4
Product: Product Code: 8093000 Blood Banks & Collection Centers NAICS Code: 621991 Blood and Organ Banks SIC Code: 8099 Health and allied services, not elsewhere classified
Accession Number: 305562396
Full Text: Abstract

Objective: The aim of this study was to investigate the willingness of university students regarding blood donation and to compare results among residents living in the Kayseri city center. Materials and Methods: Admission for blood donation after donor acquisition campaigns and the rates of repeated donation over a one-year period were compared between the two groups.

Results: Between November 2006 and August 2008, a total of 29614 people were included in the study. After educational campaigns, the rate of admission for blood donation was 66% among university students, while it was only 29% among the city residents. Although the deferral rate and adverse events during donation were found to be higher in the student group, they had a higher repeated donation rate and higher return rate after a short message system.

Conclusion: University students appear to be good candidates for long-term regular blood donation. Use of a short message system to issue reminders about blood donation may be a reasonable method to replenish the blood supply. (Turk J Hematol 2010; 27: 275-81)

Key words: Blood donation, university, student

Received: June 24, 2010

Accepted: August 10, 2010

Ozet

Amac: Bu calismanin amaci universite ogrencilerinin kan bagisi konusundaki istekliliklerini arastirmak ve bu grubu Kayseri sehir merkezinde yasayan insanlarla karsilastirmakti.

Yontem ve Gerecler: Iki grup donor kazanim kampanyalari sonrasi kan bagisi icin basvurma ve bir yil icinde tekrar kan bagisi yapma oranlari yonunden karsilastirildi.

Bulgular: Kasim 2006 ile Agustos 2008 arasinda toplam 29614 kisi calismaya dahil edildi. Egitimsel kampanyalar sonrasinda kan bagisi icin basvurma orani universite ogrencilerinde %66 iken bu oran universite disi grupta sadece %29 idi. Reddedilme ve kan verme islemi sirasinda istenmeyen etki gozlenme orani ogrenci grubunda daha fazla gozlenmesine ragmen bu grupta toplam tekrar donor olma ve kisa mesaj sistemiyle hatirlatma sonrasi yeniden donor olma orani daha yuksekti.

Sonuc: Universite ogrencileri uzun sureli duzenli kan bagiscisi olmak icin iyi bir aday grubudur. Kan bagisinin hatirlatilmasi icin kisa mesaj sisteminin kullamlmasi kan stoklarmm yerine konmasi icin akilci bir yontem olabilir. (Turk J Hematol 2010; 27: 275-81)

Anahtar kelimeler: Kan bagisi, universite, ogrenci

Gelis tarihi: 24 Haziran 2010

Kabul tarihi: 10 Agustos 2010

Introduction

The recruitment and retention of sufficient numbers of regular, volunteer blood donors are important issues for maintaining an adequate and safe blood supply. The World Health Organization (WHO) and the Council of Europe recommend that blood and blood components should be collected only from voluntary donors in order to ensure the safety of blood products (1), (2). According to this recommendation, a person donates of his/her own free will and receives no payment; thus, the donation should be voluntary and non-remunerated. It is of the utmost importance to prevent the transfusion-transmissible infectious diseases. Paid donations are prohibited by law in Turkey. Blood product requirements are generally provided from voluntary blood donors and partially from patients' relatives in the country. Acquisition of regular volunteer blood donors remains an important issue for maintaining the blood supply.

Volunteer blood donation recruitment and retaining strategies include all the activities that increase the number of volunteer donors. Television, posters, bulletins, newspapers, and the internet are some of the methods that promote blood donation and acquaint individuals with the process (3). It seems the best means of providing face to face information to blood donor candidates about blood donation and to inform them regarding the importance of the safety of blood and blood products for patients in order to increase donor retention (4). To remind regular donors and request their donations are also important steps toward replacing depleted blood supplies. There are some methods that have been used for this purpose; however, the short message system (SMS) request via mobile phones has not been widely used in our country.

It is not enough to just inform candidates about the benefits and necessity of blood donation; they must also be convinced to put aside any misconceptions they may have on the subject (5), (6). Educational and social status and prior misconceptions are important factors in blood donation. Young people may be good candidates for becoming regular blood donors. Furthermore, red blood cells obtained from those younger in age have a longer survival potential than the cells obtained from older individuals because of less deformability of the red blood cells (7). As university students are well educated and young, we investigated their willingness regarding blood donation and compared results with the willingness among other residents in the city center.

Materials and Methods

Approximately 25,000 units of whole blood are collected annually in Erciyes University Blood Bank. The data between November 2006 and August 2008 were evaluated. Up to November 2006, it was not a routine practice for regular volunteer donors to donate blood because limited regular blood donors were available in the city. In general, blood products were obtained from occasional replacement donors (from the close friends and family of the patients). In order to increase the number of voluntary blood donations, an acquisition program was started in November 2006. Two experienced blood bank employees were trained for two weeks concerning donor motivation. Then, they were charged with donor motivation members to reach the volunteers effectively and to create a high awareness about the importance of blood donation. Six persons, including three nurses and one doctor, were also assigned as a mobile blood collection team. People were informed with announcements and publications via television, the internet, brochures, and posters. The information contained a brief education about the necessity of blood donation for the patients and the safety of the blood donation process. Each group consisted of 40-50 persons and information was given in approximately 20 minutes. Any suspicions or questions from the audience were addressed and a face to face interview was conducted if required. After being given information about blood donation, candidates were kindly asked whether or not they wanted to be a blood donor. A questionnaire was then distributed for all candidates older than 18 years who were admitted for donation. All candidates underwent a medical examination and laboratory tests including pulse rate, arterial blood pressure, fever and hemoglobin (Hb) level. If the physical examination results and Hb level were within normal ranges, a physician interviewed the candidates to investigate the risk of syphilis and blood transmissible viral infections (hepatitis B, C and human immunodeficiency virus [HIV]). The deferral criteria of donor candidates were evaluated according to the directives of Turkey's Ministry of Health. Candidates were compared regarding reasons for deferral after pre-donation screening interviews. The appropriate candidates were asked to donate blood.

Adverse events during blood donation were also recorded. Samples for syphilis and viral markers (HBsAg, Anti-HCV, and Anti-HIV) were obtained from the blood bags. The syphilis test was conducted with VDRL and others with the ELISA method. Tests were studied with the micro ELISA method in Etimax 3000 device; a second generation bio-assay (Diasorin) was used for HBsAg, a third generation bio-assay (Diasorin) for anti-HCV, and a fourth generation bio-assay (Diasorin) for HIV. Viral parameters (HBsAg, anti-HCV, anti-HIV), reasons for donor deferral and adverse events were compared between the two groups. The donors' personal data were recorded on the computer, and they were followed up for further donations. Mobile phone numbers were also requested in order to recall them via the SMS. They were invited for blood donation by SMS when stores of rare blood groups were depleted or in the case of emergent blood product requirements. In the content of the SMS, the candidate was asked to donate for emergency patients by admitting to our blood bank or to call us regarding a donation. Donations could be taken in the donor's own locale, if they so desired. SMS requests were sent only once for each donor, and all volunteer donors were thus asked once a year for blood donation sequentially. At the time of donation, the candidates were queried regarding whether the admission was voluntary or in reply to a SMS request.

The data were evaluated and analyzed by Pearson's chi-square statistical method. A p value less than 0.005 was considered statistically significant. Analyses were performed with SPSS, release 16.0 (SPSS, Inc., Chicago, IL).

Standard written informed content forms were obtained from all donors for blood donation, according to the directives of Turkish Ministry of Health.

Results

From November 2006 to August 2008, 29614 people were informed about the safety of the donation procedure and the importance of voluntary contribution of blood products for patients. A total of 8730 students were registered on the university campus, and 5832 (66%) of them applied for blood donation. Blood was drawn from 4424 (75%) of those who were eligible for donation. Median age of the students was 20 years (range: 18-22 years). Of the donors, 1198 (27%) were female and 3226 (73%) were male. Outside the university, 20884 people residing in the city center were informed, 6111 (29%) of those applied as volunteer donor, and 5341 (87%) of them were eligible for blood donation. The group consisted of 267 (5%) females and 5074 (95%) males, and the median age of the group was 31 years (range: 18-60 years). Most of the donors (19840 of 20884) from outside the university had high school or lower educational levels (95%). The rate of application for donation after the brief education was significantly higher among the student group than the other donors (p < 0.001).

A total of 2178 persons were deferred; from the whole group, the top deferral reason was low Hb level in 892 (40%). Types of deferrals and their distribution are outlined in Table 1. There were significant differences between the two groups with respect to the deferral reasons of low body mass index (BMI), fear and age (p < 0.001).

Infectious screening test results were as follows: HBsAg was detected in 46 of the students (1.03%) while anti-HCV was detected in only 1 (0.02%). HBsAg was detected in 92 (1.7%) of the donors from outside the university and anti-HCV was detected in 1 (0.018%). The rate of HBsAg positivity was significantly higher (p =0.005) in the group from outside the university. There was no statistically significant difference in the rate of anti-HCV positivity between the university group and those from outside the university. HIV and syphilis test results were negative in both groups.

During the study period, volunteers were followed concerning repeated donation for a one-year after their donation. A total of 1403 volunteer donors (32%) from the university group applied more than once for blood donation (1088 once more, 315 more than twice). In this group of volunteers, 533 were responders to SMS and 870 applied of their own accord (without any call or SMS). On the other hand, 582 donors (11%) in the group outside the university applied more than once (419 once more, 163 more than twice). While 434 of them applied to the blood bank after SMS messages, 148 applied of their own accord. The rate of candidates who donated blood more than once was significantly higher in the university donor population when compared with the other group (p < 0.001). The donation rate after SMS requests was also significantly higher in the university group (12% vs. 8%; p < 0.001).

There were 106 recorded adverse events. The most commonly observed adverse reaction related to the donation procedure was vasovagal symptoms (n=97), including sweating, pallor, nausea and dizziness. Others were hematomas near the venipuncture site (n=5) and signs of hypocalcemia (n=4). There was no serious adverse reaction. Adverse events were significantly more frequently observed (p < 0.001) in the university group (n=77) than in the group from outside the university (n=29) (1.7% and 0.5%, respectively) (Figure 1a, 1b).

[FIGURE 1a OMITTED]

[FIGURE 1b OMITTED]

Discussion

In recent years, there has been an increase in blood consumption. Improvements in the areas of surgery, stem cell transplantation and cancer chemotherapy are some of the factors responsible for this increment in blood demand (8-10). Stringent eligibility criteria for donors increase safety standards in blood transfusion, but this approach may decrease the number of voluntary donors due to donor deferrals (8), (9), (11). Young adults, in general, have good health and may have a long donor career. An increase in the number of younger blood donors gives us an opportunity to improve donor recruitment and its maintenance (4), (12). In Turkey, the number of young people under 28.5 years represents approximately 50% of the population, so it is very important to make efforts in recruiting and retaining this source of young donors in the country (13).

Lack of request was the most frequently reported reason for not donating blood among young donors (12), (14). Effective communication is one way of raising awareness among eligible donors while also increasing the frequency of donations. Personal communication, advertisement using classical communication instruments (i.e. newspaper, TV), the internet, brochures, and posters have all been used in the recruitment of new donors. In the present study, it was observed that after receiving brief information about the importance of volunteer blood donation, willingness rates among individuals were significantly higher in the university population than among those from outside the university (66% and 29%, respectively). Some studies have suggested that a higher educational level is associated with a higher return rate (5), and our study supports these findings.

Phone calls, SMS, letters, and e-mails can be used both to remind donors to give blood and to retain regular donors (4), (14). In one study, a survey of 3,167 blood donors revealed that only 15.7% of those who received automated telephone recalls returned for blood donation, whereas 35% of those who received a telephone call from a donor recruiter returned to donate blood [2007, unpublished]. This shows that direct communication is a more effective way to retain donors (4). In the present study, volunteer donors were reminded by SMS to replenish the increased blood need, especially when stores of rarely found blood groups were depleted. In this way, a total of 9625 volunteer donors were requested and 967 (10%) of them returned for blood donation. The return rate was higher in the university student population. The university students might be more sensitive about the importance of blood donation. Difficulty in getting permission from employers, transportation difficulties, and physical and economic loss may be some of the reasons for low blood donation, particularly in developing countries. To establish a wider donation web, the formation of a donor access team to take blood from donors in their own area should lead to an increase in donation rates.

There are some eligibility criteria in order to maintain blood safety and to protect blood donors and recipients. In the present study, 24.1 % of the student donors and 12.6% of the other donors were deferred. The most common deferral reason was a low Hb level, and the others were chronic diseases or drug use, a low BMI, being outside the age limits, and fear (e.g. of hospitals, nurses, needles, and hematophobia), respectively. Low Hb levels and a low BMI were significantly more frequent among donors from the university population than from outside the university. These results may be due to the higher rate of female donors in the university population (27%) than in the population from outside the university (5%). In the literature, it was shown that approximately 10-15% of potential donors were deferred (15-17). Our relatively higher deferral rate may be explained by our strict deferral criteria in order to ensure safe donation and to provide safer blood products.

Safe blood donors are the cornerstone of a safe and adequate supply of blood and blood products. There was no positive result for HIV or syphilis in our volunteer donor group. HBsAg was detected in 46 of the students (1.03%) and anti-HCV was detected in only 1 (0.02%), while the rates were 1.7% and 0.018%, respectively, for HBsAg and anti-HCV in the volunteer blood donor population outside the university. HBsAg incidence was significantly lower in the university population. Experiences show that the safest blood donors are voluntary, non-remunerated blood donors. Paid donors are statistically more likely to carry some infection. Their blood is more likely to be of a lower standard, as they tend to donate more frequently. Fortunately, paid donations have been prohibited by law in Turkey. Voluntary blood donation from a low-risk population requires identifying such a population and motivating them to donate blood regularly. A younger population is considered more impressionable and has low risks (18). This may be due to low exposure risk to blood transmissible infections because of youth. In the present study, university student donors were found to be safer than other donors in terms of HBsAg positivity. Donor programs and researches should be focused primarily on retaining regular blood donors since they have a lower incidence of transfusion-transmissible infectious diseases (4), (19).

Although complications and adverse reactions during the blood donation process are rare, it is thought that they play a role in subsequent willingness to donate blood (20), (21). In the present study, the most common adverse events were fatigue and vasovagal symptoms. Total adverse events were significantly higher in the university population than in the population outside the university, and this may have been due to the higher number of female donors and the young age. It was shown previously that adverse events were seen frequently in the young donor population (22). In one study, it was detected that the most common systemic adverse events were fatigue (7.8%), vasovagal symptoms (5.3%), nausea and vomiting (1.1%), and those adverse events were frequent in donors younger than 30 years old (23).

In conclusion, efforts to increase the number of volunteer donors to ensure an adequate and safe blood supply are of great importance. Since it is easy to convince university students and they potentially have a long donor career, they are good candidates for becoming regular volunteer blood donors. A continuous educational program about blood donation and the correction of misconceptions about blood donation will increase donation rates. All technological utilities should be used effectively to reach more donors and to increase the success of the donor acquisition programs. Well-documented records facilitate easy access to donors in case of increased blood demand. Finally, easy access to donation centers will motivate donors. Mobile blood donation teams for easier access to donors and to facilitate their making blood donations in their own locale may increase donation rates.

Conflict of interest

The authors declare that no conflicting or competing interests of any nature exist between the authors of this work and their academic activity.

Address for Correspondence: M.D. Biilent Eser, Department of Hematology, Erciyes University Medical School, Internal Medicine, 38280, Kayseri, Turkey Phone: +90 535 202 99 74 E-mail: beser@erciyes.edu.tr

References

(1.) Council of Europe. Guide to the preparation, use and quality assurance of blood components: Recommendation No. R(95)15, 9th edition, January 2003.

(2.) Dhingra N. Blood safety in developing world and WHO initiatives. Vox Sanguinis 2002;83:173-7.

(3.) Moog R, Fourne K. Recruitment of prospective donors: what do they expect from a homepage of a blood transfusion service? Transfus Med 2007;17:279-84.

(4.) Maghsudlu M, Nasizadeh S, Abolghasemi H, Ahmadyar S. Blood donation and donor recruitment in Iran from 1998 through 2007: ten years' experience. Transfusion 2009;49:2346-51.

(5.) Ownby HE, Kong F, Watanabe K, Tu Y, Nass CC. Analysis of donor return behavior. Transfusion 1999;39:1128-35.

(6.) Chliaoutakis J, Trakas DJ, Socrataki F, Lemonidou C, Papaioannou D. Blood donor behaviour in Greece: implications for health policy. Soc Sci Med 1994;38:1461-7.

(7.) Tugral E, Yalcin 0, Baskurt OK. Effect of donor age on the deformability and aggregability of density-separated red blood cells. Turk J Haematol 2002;19:303-8.

(8.) Wallace EL, Churchill WH, Surgenor DM, Cho GS, McGurk S. Collection and transfusion of blood and blood components in the United States, 1994. Transfusion 1998;38:625-36.

(9.) Sullivan MT, Cotten R, Read EJ, Wallace EL. Blood collection and transfusion in the United States in 2001. Transfusion 2007;47:385-94.

(10.) Lemmens KP, Abraham C, Hoekstra T, Ruiter RA, De Kort WL, Brug J, Schaalma HP. Why don't young people volunteer to give blood? An investigation of the correlates of donation intentions among young nondonors. Transfusion 2005;45:945-55.

(11.) Council of Europe: Guide to the preparation, use and quality assurance of blood components. 13th ed. Strassbourg: Council of Europe Publishing, 2007.

(12.) Misje AH, Bosnes V, Heier HE. Recruiting and retaining young people as voluntary blood donors. Vox Sanguinis 2008;94:119-24.

(13.) < www.tuik.gov.tr >; 2008.

(14.) Moog R. Retention of prospective donors: a survey about services at a blood donation centre. Transfus Apher Sci 2009;40:149-52.

(15.) Custer B, Johnson ES, Sullivan SD, Hazlet TK, Ramsey SD, Hirschler NV, Murphy EL, Busch MP. Quantifying losses to the donated blood supply due to donor deferral and miscollection. Transfusion 2004;44:1417-26.

(16.) Newman B. Blood donor suitability and allogeneic whole blood donation. Transfus Med Rev 2001;15:234-44.

(17.) Arslan 0. Whole blood donor deferral rate and characteristics of the Turkish population. Transfus Med 2007;17:379-83.

(18.) Mansour AK Blood donor recruitment. ISBT Science Series 2009;4:11-3.

(19.) Schreiber GB, Sanchez AM, Glynn SA, Wright DJ; Retrovirus Epidemiology Donor Study. Increasing blood availability by changing donation patterns. Transfusion 2003;43:591-7.

(20.) Newman BH, Newman DT, Ahmad R, Roth Al. The effect of whole-blood donor adverse events on blood donor return rates. Transfusion 2006;46:1374-9.

(21.) Stewart KR, France CR, Rader AW, Stewart JC. Phlebotomist interpersonal skill predicts a reduction in reactions among volunteer blood donors. Transfusion. 2006;46:1394-401.

(22.) Zervou EK, Ziciadis K, Karabini F, Xanthi E, Chrisostomou E, Tzolou A. Vasovagal reactions in blood donors during or immediately after blood donation Transfus Med 2005;15:389-94.

(23.) 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;43:598-603.

Bulent Eser (1), Fatih Kurnaz (1), Leylagul Kaynar (1), Mehmet Yay (2), Serdar Sivgin (1), Ali Unal (1), Mustafa Cetin (1)

(1) Department of Hematology, Erciyes University Medical School, Internal Medicine, Kayseri, Turkey

(2) Blood Bank, Erciyes University Medical School, Kayseri, Turkey

doi:10.5152/tjh.2010.42
Table 1. Causes of donor deferral

    Causes of donor        U group  OU group  Statistics
    deferral                n (%)     n (%)

1   Hb levels outside          654       238      p<0.001
    normal limits           (15.8)     (4.5)

2   Hypertension or             33        48       P>0.05
    hypotension              (0.8)     (0.9)

3   Outside age limits         119        48      p<0.001
    (>65, <18                (2.7)     (0.9)
    years old)

4   BMI                        208        72      p<0.001
    <18kg/[m.sup.2]          (4.7)     (1.3)

5   High risk for               35        59       P>0.05
    hepatitis or HIV         (0.8)     (1.1)
    infection

6   Fear (hospital,             88        40      p<0.001
    nurse, needle,           (2.0)     (0.7)
    hematophobia)

7   Acute infections            28        31       P>0.05
                             (0.6)     (0.6)

8   Chronic diseases or        170       172       P>0.05
    drug use                 (3.8)     (3.2)

9   Blood donation within       26        35       P>0.05
    last 2 months            (0.6)     (0.6)

10  Other                       47        27       p<0.05
                             (1.1)     (0.5)

    Total                     1408       770      p<0.001
                            (24.1)    (12.6)

U: University; OU: Outside university; BMI: Body mass index
Gale Copyright: Copyright 2010 Gale, Cengage Learning. All rights reserved.