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Evaluation of donor self exclusion program
P Chiewsilp1, S Kitkornpan, S Stabunswadigan
1Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Donor self-exclusion programs aim to prevent HIV transmission through blood donations. A study found that while self-exclusion identified some unsafe donations, it wasn't perfectly specific and requires donor education.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Blood Transfusion Safety
Background:
- Donor self-exclusion is a strategy to mitigate transfusion-associated Acquired Immunodeficiency Syndrome (AIDS) by excluding high-risk individuals.
- This low-technology procedure has been adopted in Western countries to enhance blood safety.
Purpose of the Study:
- To evaluate the effectiveness of a donor self-exclusion program in identifying unsafe blood donations at Ramathibodi Hospital.
- To assess the prevalence of HIV, Hepatitis C, Hepatitis B, and Syphilis markers in self-excluded and non-excluded blood donations.
Main Methods:
- A study was conducted from March to December 1991, analyzing 4,286 units of blood.
- Donors self-excluded blood based on sexual behavior and intravenous drug use history.
- Blood donations were tested for HIV-Ag, anti-HIV, anti-HCV, HBsAg, and VDRL.
Main Results:
- Between 2.60% and 6.55% of donors self-excluded their blood as potentially unsafe.
- HIV-Ag was detected in one self-excluded unit, while anti-HIV was found in both self-excluded (3.46%) and safe (0.46%) donations.
- Hepatitis C and B markers were significantly higher in self-excluded donations compared to safe donations.
Conclusions:
- Confidential self-exclusion or HIV-Ag testing could have prevented the transfusion of HIV-Ag reactive units during the "window period".
- Syphilis screening (VDRL) was not a valuable surrogate marker in this self-exclusion context.
- Self-exclusion programs may lack specificity and require enhanced donor education for optimal effectiveness.
Abstract:
Donor self exclusion is a low technology procedure to avoid blood donations from the high-risk groups for HIV infection. This strategy has been widely used in western countries to reduce the risk of transfusion associated AIDS. At Ramathibodi Hospital, we conducted a study on donor self exclusion program during March-December 1991. It was found 2.60%-6.55% (mean = 4.59%) of a total of 4,286 units of blood that were from the donors who indicated that their blood may not be safe for transfusion while the rest of them declared that their blood was safe based on sexual behavior during the past 3 months and the history of intravenous drug use. Among 202 units of unsafe blood, there were 1 (0.49%) positive for HIV-Ag, 7 (3.46%) for anti-HIV, 5 (2.48%) for anti-HCV, 10 (4.95%) for HBsAg and 6 (2.97%) for VDRL while there was no HIV-Ag detected in 4,084 units of safe blood but 19 (0.46%) were positive for anti-HIV (p < 0.05), 65 (1.59%) for anti-HCV, 219 (5.36%) for HBsAg and 56 (1.37%) for VDRL. It was clearly demonstrated in this study that confidential self-exclusion or HIV-Ag testing would have eliminated this HIV-Ag reactive unit in the "window period" from transfusion, while the syphilis screening would not have had any value as a surrogate marker. However, self-exclusion programs are likely to prove too non-specific and need more time to educate the donors.(ABSTRACT TRUNCATED AT 250 WORDS)