research studies on blood donation

4. Discussion

4.1. decline in the number of blood donors, 4.2. intention to donate blood among the participants of the study, 4.3. behavioral beliefs and their effects on the willingness of blood donors, 4.4. normative beliefs and their effects on the willingness of blood donors, 4.5. control beliefs and their effects on the willingness of blood donor, 5. conclusions, acknowledgements.

New evidence shows blood or plasma donations can reduce the PFAS ‘forever chemicals’ in our bodies

Chief Environmental Scientist, EPA Victoria; Honorary Professor, Macquarie University

Director, Strategic Research Initiatives, Macquarie University

Professor, Simon Fraser University

Senior Research Fellow and NHMRC Emerging Leadership Fellow, Macquarie University

Senior Lecturer and Haematologist, Macquarie University

Clinical Research Manager, Macquarie University

Disclosure statement

Mark Patrick Taylor and co-authors from Macquarie University received funding for their study published in JAMA Network Open (2022): "Efficacy of plasma and blood donation on serum per- and poly-fluoroalkyl substances (PFAS) concentrations in firefighters: a randomised clinical trial.” MPT received funding for two other separate projects for the Metropolitan Fire Brigade that merged in July 2020 to form Fire Rescue Victoria: (1) Chemical and health risks associated with the Tottenham Fire, Melbourne, 30 August 2018; (2) An assessment of PFAS and other toxicants at Metropolitan Fire Brigade’s 51 fire stations; provided expert advice and environmental guidance to South Australia United Firefighter’s Union and South Australian Metropolitan Fire Service in 2019 in relation to a PFAS contaminated fire station. MPT is also a member of the Victorian Presumptive Rights Advisory Committee. MPT is an Honorary Professor at Macquarie University and a full time employee of EPA Victoria, appointed to the statutory role of Chief Environmental Scientist. In his current role as Chief Environmental Scientist for EPA Victoria, part of his work involves working with emergency services, including Fire Rescue Victoria.

Bruce Lanphear receives funding from the National Institutes of Health, Canada Institute for Health Research, the US Environmental Protection Agency and the US Department of Housing and Urban Development.

Miri Forbes receives funding from the National Health and Medical Research Council (NHMRC), in addition to the funding received from Fire Rescue Victoria to conduct this study.

This study was funded by a grant from Fire Rescue Victoria.

Dr Yordanka Krastev and co-authors from Macquarie University received funding from Fire Rescue Victoria for their study published in JAMA Network Open (2022): "Efficacy of plasma and blood donation on serum per- and poly-fluoroalkyl substances (PFAS) concentrations in firefighters: a randomized clinical trial.”

Brenton Hamdorf does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Simon Fraser University provides funding as a member of The Conversation CA.

Simon Fraser University provides funding as a member of The Conversation CA-FR.

Macquarie University provides funding as a member of The Conversation AU.

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You might have heard of PFAS, a synthetic chemical found in certain legacy firefighting foams, non-stick pans, carpets, clothes and stain- or water-resistant materials and paints.

PFAS stands for “per- and poly-fluorinated alkyl substances”. These molecules, made up of chains of carbon and fluorine atoms, are nicknamed “forever chemicals” because they don’t degrade in our bodies.

There is global concern about PFAS because they have been used widely, are persistent in the environment and accumulate in our bodies over time.

There was no way to reduce the amount of PFAS found in the body – until now.

Our new randomised clinical trial, published in the journal JAMA Network Open , has found regularly donating blood or plasma can reduce blood PFAS levels.

Read more: PFAS 'forever chemicals' are widespread and threaten human health – here's a strategy for protecting the public

What’s the concern about PFAS chemicals?

The science is unresolved around what levels of PFAS exposure, if any, are safe.

The historical use of some firefighting foams at fire stations , fire training bases , airports , military and industrial facilities has led to widespread environmental contamination across Australia , Europe and the US .

Major environmental and health agencies, including the US Agency for Toxic Substances and Disease Registry , US Environmental Protection Agency , and the Australian Department of Health have noted PFAS exposure has been associated with adverse health effects.

But now, new research from Macquarie University and Fire Rescue Victoria has found that the concentration of PFAS in a person’s blood can be reduced if that person regularly donates blood or plasma.

Read more: Wearing shoes in the house is just plain gross. The verdict from scientists who study indoor contaminants

How can PFAS in our bodies be reduced?

The trial aimed to find out whether plasma or blood removal are effective strategies for reducing serum PFAS concentrations. It was funded and supported by Fire Rescue Victoria to find a way to remove the PFAS from firefighters’ bodies.

The trial involved 285 Fire Rescue Victoria staff and contractors with elevated levels of PFOS, a common detected type of PFAS used in some firefighting foams.

They were randomly allocated to donate plasma every six weeks, to donate whole blood every 12 weeks, or to make no donations (the control group) for 12 months.

Their PFAS levels were measured at four intervals: at recruitment, the start of the trial, after 12 months of following their treatment plan, and again three months later to test if the results were sustained.

Both blood and plasma donation resulted in significantly lower PFAS chemicals than the control group, and these differences were maintained three months later.

Plasma donation was most effective, resulting in a roughly 30% decrease in average blood serum PFAS concentrations over the 12-month trial period.

Why would donating blood or plasma help?

Reductions in PFAS levels from blood or plasma donations may be because PFAS are bound to proteins primarily found in the serum; many other organic pollutants are bound to fats.

The finding that plasma was more effective than blood donation might be because firefighters in the plasma donation group donated blood every six weeks, whereas those in the blood donation group donated every 12 weeks.

In addition, each plasma donation can amount to as much as 800mL compared with 470mL for whole blood.

Plasma PFAS concentrations are also about two times higher than blood PFAS concentrations, which could make plasma donation more efficient at reducing the body burden of PFAS chemicals.

Still, plasma donation is more complex and can be more uncomfortable than blood donation. Indeed, the adherence to the study protocol was lower for the plasma group than the other groups.

Overall, the randomised clinical trial — which is the gold standard for evaluating the effectiveness of intervention — had an exceptional 94% participant retention rate, with the 285 firefighters completing more than 1,000 blood tests and hundreds of blood and plasma donations.

This engagement from the Fire Rescue Victoria staff was a remarkable achievement because it spanned the Black Summer Bushfires as well as the extensive COVID-19 lockdowns in Melbourne.

It is a testament to their tenacity to support the discovery of an effective intervention to benefit others with substantial PFAS exposure.

Fire Rescue Victoria has replaced firefighting foams that contain PFAS and decontaminated fire trucks to eliminate or reduce ongoing occupational exposure to PFAS.

Still, because these chemicals accumulate in the body, many firefighters have elevated levels of PFAS because of historical exposures.

More research is needed to understand the ideal frequency and volumes of donations that will be effective for lowering PFAS, balancing the treatment efficacy with the obstacles to frequent donations.

It is also not clear whether reducing PFAS leads to improved health outcomes in the longer term. More research is needed to evaluate the clinical implications of the findings.

How can these findings be used in practice?

This study provides the first avenue for affected individuals to remove PFAS from their bodies and redress the effects of their PFAS exposure.

In future, more people with significant PFAS exposures may be encouraged to donate blood or plasma. According to the Australian Red Cross Lifeblood program, people who have been exposed to PFAS can still donate . For recipients of donated blood components, no PFAS threshold has been identified as posing an increased risk. Our study didn’t investigate this risk, but blood authorities should continue to monitor the possible health effects of PFAS and consider any implications of elevated PFAS levels in blood donors.

In late March, a Senate joint standing committee looking into PFAS recommended the government examine this research. For people with high PFAS levels who can’t donate blood or plasma – because, for example, of potential exposure to blood-borne illnesses – the committee recommended the government consider finding a way for them to make therapeutic donations.

The inquiry also recommended :

that the Australian government provide funding for further longitudinal studies on potential adverse health effects for firefighters and members of PFAS-affected communities.

• Firefighters
• Blood donation
• environmental pollutants
• Environmental pollution
• Blood plasma
• volunteer firefighters
• Forever chemicals

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Donor/Recipient Health & Epidemiology

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The Epidemiology Group is responsible for performing research at the American Red Cross, focusing on blood safety and availability topics such as the epidemiology of transfusion-transmissible infections, and blood donor health and safety. The group maintains and updates ARCNET, the largest US longitudinal database of blood donor donation and deferral information, as a resource for this research, and frequently provides data and expertise for national and international collaborations. In addition to supporting the statistical, epidemiologic and analytical needs of internal projects, the scientists work on several federal-agency-funded contracts and vendor sponsored studies.

Ed Notari , MPH

Director, Epidemiology Analytics

Bryan Spencer , PhD

Scientist IV

Laura Tonnetti , PhD

Lauren Crowder , PhD, MPH, CPH

Epidemiologist III

Current Projects

U.S. Centers for Disease Control and Prevention funded research contract investigating the possibility of non-variant CJD transmission by blood. This project utilizes donor lookback to trace recipient outcomes.

Crowder LA, Schonberger LB, Dodd RY, Steele WR. Creutzfeldt-Jakob disease lookback study: 21 years of surveillance for transfusion transmission risk. Transfusion 2017;57: 1875-8.  

The American Red Cross is a participant in the FDA, NHLBI and HHS-OASH funded Transfusion-Transmissible Infections Monitoring System (TTIMS) project. TTIMS consists of two coordinating centers: The Donation Database Coordinating Center (DDCC) and the Laboratory and Risk Factor Database Coordinating Center (LRCC). The American Red Cross acts as the DDCC and Vitalant Research Institute acts as the LRCC for the study. TTIMS brings together donation and test data acquired during routine blood donation collections at four major US blood systems (American Red Cross, New York Blood Center, OneBlood and Vitalant) with data collected from specialty research studies. Together this data provides critical blood safety and monitoring information on more than 50% of the US blood supply.

The DDCC is responsible for acquiring and validating donor demographic data from the four participating blood systems plus testing results from Creative Testing Solutions, ensuring that the data available from each system are harmonized, and that appropriate consensus positive definitions are consistently applied across sites. The DDCC then analyzes and reports on the prevalence and incidence of HIV, HBV and HCV in US blood donors and donations, with special attention paid to temporal and demographic changes and trends. The DDCC also reports positive and false positive donors to the LRCC. The LRCC coordinates the Risk Factor Questionnaire study. The LRCC provides each blood center lists from which donors are interviewed by each center’s donor counselors. LRCC compiles and analyses this data. The LRCC also acts as the repository for positive samples and conducts follow-up molecular sequencing, recency and other testing of interest. The American Red Cross participates in both the DDCC and the LRCC activities.

Steele WR, Dodd RY, Notari EP, et al. Prevalence of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in United States blood donations, 2015 to 2019: The Transfusion-Transmissible Infections Monitoring System (TTIMS) [published online ahead of print, 2020 Aug 31]. Transfusion. 2020;10.1111/trf.16005. doi:10.1111/trf.16005

Custer B, Stramer SL, Glynn S, Williams AE, Anderson SA. Transfusion-transmissible infection monitoring system: a tool to monitor changes in blood safety. Transfusion 2016;56: 1499-502.

Dodd RY, Notari EP, Nelson D, Foster GA, Krysztof DE, Kaidarova Z, Milan-Benson L, Kessler DA, Shaz BH, Vahidnia F, Custer B, Stramer SL, NHLBI REDSI. Development of a multisystem surveillance database for transfusion-transmitted infections among blood donors in the United States. Transfusion 2016;56: 2781-9.

Vahidnia F, Stramer SL, Kessler D, Shaz B, Leparc G, Krysztof DE, Glynn SA, Custer B. Recent viral infection in US blood donors and health-related quality of life (HRQOL). Qual Life Res 2017;26: 349-57.

Vahidnia F, Stramer SL, Kessler D, Goncalez TT, Shaz BH, Leparc G, Krysztof DE, Dodd RY, Glynn SA, Custer B, Nhlbi Retrovirus Epidemiology Donor Study I. Motivations for donating and attitudes toward screening policies in US blood donors with viral infection. Transfusion 2016.

Custer B, Kessler D, Vahidnia F, Leparc G, Krysztof DE, Shaz B, Kamel H, Glynn S, Dodd RY, Stramer SL, Nhlbi Retrovirus Epidemiology Donor Study I. Risk factors for retrovirus and hepatitis virus infections in accepted blood donors. Transfusion 2015;55: 1098-107.

ARCNET is a database containing information on every donation and deferral to the American Red Cross since 1995 including demographics, procedure information, infectious disease testing data and deferral information, as applicable. Blood donors can be followed longitudinally giving the ability to track an individual Red Cross donor’s donation-deferral history or to examine temporal trends in donor demographics or transfusion-transmissible diseases for the entire population. ARCNET is frequently used to provide estimates for the FDA, WHO, CDC and other interested parties.

Zou S, Eder AF, Musavi F, Notari EP, Fang CT, Dodd RY, Group AS. Implementation of the Uniform Donor History Questionnaire across the American Red Cross Blood Services: increased deferral among repeat presenters but no measurable impact on blood safety. Transfusion 2007;47: 1990-8.

Zou S, Notari EP, Stramer SL, Wahab F, Musavi F, Dodd RY, ARCNET Research Group. Patterns of age- and sex-specific prevalence of major blood-borne infections in United States blood donors, 1995 to 2002: American Red Cross blood donor study. Transfusion 2004;44: 1640-7.

Orton SL, Liu H, Dodd RY, Williams AE, ARCNET Epidemiology Group. Prevalence of circulating Treponema pallidum DNA and RNA in blood donors with confirmed-positive syphilis tests. Transfusion 2002;42: 94-9.

The ARC is at the leading edge of investigations into iron depletion in blood donors. Recently, this has included studies of prevalence of and risk factors for iron depletion, and current efforts are oriented more to adverse consequences resulting from iron depletion and potential mitigation options. Current studies are collecting information on the practice of and motivations for iron supplementation and simulations of different iron depletion mitigation strategies to assess likely efficacy and impact on blood availability.

Spencer BR, Guo Y, Cable RG, Kiss JE, Busch MP, Page GP, Endres-Dighe SM, Kleinman S, Glynn SA, Mast AE, National Heart L, Blood Institute Recipient E, Donor Evaluation S, III. Iron status and risk factors for iron depletion in a racially/ethnically diverse blood donor population. Transfusion 2019;59: 3146-56.

Spencer BR, Bialkowski W, Creel DV, Cable RG, Kiss JE, Stone M, McClure C, Kleinman S, Glynn SA, Mast AE, National Heart L, Blood Institute Recipient E, Donor Evaluation Study IIIP. Elevated risk for iron depletion in high-school age blood donors. Transfusion 2019;59: 1706-16.

The Red Cross work on infectious risks of transfusion has focused primarily on vector-borne diseases, especially parasitic diseases including malaria and babesiosis. Of particular interest is the relationship between human mobility (such as travel and migration) and risk for transfusion-transmissible infections, and how these relationships and the attendant risk-mitigation alternatives might differ markedly by infectious agent.

• Transfusion-transmitted parasitic infections in the United States are almost exclusively due to Babesia microti, the tick-borne intraerythrocytic protozoan agent of babesiosis, naturally transmitted to humans through the bite of infected deer tick. Hospital-reported transfusion-transmitted babesiosis (TTB) are investigated by the American Red Cross’s Hemovigilance program.
• The ARC has been screening blood collected in endemic areas for B. microti under investigational protocols since 2010, performing clinical trials that lead to the Food and Drugs Administration (FDA) licensure of multiple screening tests. In May 2020, Babesia screening has  been implemented in 14 endemic states plus Washington DC, as recommended by the FDA guidance released in May 2019. The screening is performed with the Procleix Babesia assay, an FDA licensed nucleic acid amplification test for the detection of RNA from Babesia species from Grifols. 
• In the absence of an FDA licensed babesia confirmatory test, a research indirect immunefluorescenceassay (IFA) for the detection of antibody against B. microti is performed in our laboratory.
• During a collaboration between the ARC and Canadian blood centers, the Procleix Babesia assay and B. microti IFA were used to assess the risk of Babesia infection in blood donors resident in geographic areas of Canada bordering the Northeastern and Upper Midwest United States, where B. microti is endemic.  

Transfusion-transmitted malaria has declined in the U.S. by approximately 95% since the 1970s, from roughly 1 case per million RBCs transfused to 1 per 20 million RBCs.

With increasing travel amongst the U.S. public, the Red Cross saw a sustained increase in deferrals for malaria risk travel that reached 1.2% of presenting donors by 2013, resulting in more than 70,000 excluded from donation. Following changes to donor eligibility criteria that were implemented in December 2013, 60% fewer donors are deferred. The Red Cross conducted several studies that provided data supporting the eligibility changes made by FDA.

Tonnetti L, Dodd RY, Foster G, Stramer SL. Babesia blood testing: the first-year experience. Transfusion. 2022 Jan;62(1):135-142.

Tonnetti L, O'Brien SF, Gregoire Y, Proctor MC, Drews SJ, Delage G, Fearon MA, Bres V, Linnen JM, Stramer SL. Prevalence of Babesia in Canadian blood donors: June-October 2018. Transfusion 2019;59: 3171-6.

Tonnetti L, Townsend RL, Deisting BM, Haynes JM, Dodd RY, Stramer SL. The impact of Babesia microti blood donation screening. Transfusion 2019;59: 593-600.

Tonnetti L, Townsend RL, Dodd RY, Stramer SL. Characteristics of transfusion-transmitted Babesia microti, American Red Cross 2010-2017. Transfusion 2019;59: 2908-12.

Spencer B, Kleinman S, Custer B, Cable R, Wilkinson SL, Steele W, High PM, Wright D, Nhlbi Retrovirus Epidemiology Donor Study I. Deconstructing the risk for malaria in United States donors deferred for travel to Mexico. Transfusion 2011;51: 2398-410.

Spencer B, Steele W, Custer B, Kleinman S, Cable R, Wilkinson S, Wright D. Risk for malaria in United States donors deferred for travel to malaria-endemic areas. Transfusion 2009;49: 2335-45.

Katz LM, Spencer BR. Travel and Related Health History: Malaria, Prions, and Other Transfusion-Transmissible Diseases. In: Eder A, Goldman M, eds. Screening Blood Donors with the Donor History Questionnaire. Bethesda: AABB Press, 2019: 159-193.

Spencer BR. Transfusion transmission of parasites. In: Simon TL, McCullough J, Snyder EL, Solheim BG, Strauss RG, eds. Rossi’s Principles of Transfusion Medicine, 5th Ed. John Wiley & Sons, 2016: 599-607. 

On June 15, 2020 the American Red Cross initiated screening allogeneic blood donations for antibodies to the SARS coronavirus-2 (SARS-CoV-2), which is the virus that causes COVID-19. Reactive donations were tested by a second COVID-19 antibody test using a different molecular target to confirm reactivity. To see how long the antibodies are present, the Scientific Support Office (SSO) contacted donors who tested reactive by the two assays and asked them to give follow-up samples. The follow-up samples were tested for antibodies to COVID-19 using the same assays as the initial donation. The initial follow-up sample was collected about a month after the reactive index donation and then approximately every other month. The results of this additional testing were provided to the donors by letter. With the rollout of COVID-19 vaccines in the US, the American Red Cross also invited donors who have been vaccinated, independently of prior SARS-CoV-2 infection, to participate in this follow-up study. Following vaccinated donors over time helps determine the duration of the antibody response to vaccines and potential reinfections and vaccine breakthrough infections; that is, people who get reinfected with SARS-CoV-2 following prior natural infection or infected following vaccination, respectively. Additionally, these donors received a link to a survey asking questions about any COVID-19 symptoms they may have experienced before their reactive index donation. The survey also inquired about testing, vaccination status, and potential exposures to the coronavirus. This research survey, along with the testing, will help provide the American Red Cross with additional information regarding the value of coronavirus antibody testing, the duration of the antibody response following exposure to SARS-CoV-2, and the donor experience during the pandemic.

Currently, there are no Food and Drug Administration (FDA) approved tests for screening donated blood for Plasmodium, the agent that causes malaria. Therefore, donor screening in the U.S. occurs by questionnaire. The estimated incidence of Transfusion-Transmitted Malaria in the U.S. is less than one per million units of collected blood, but about 72,000 donors are deferred yearly due to malaria risks. 

The American Red Cross Scientific Support Office (SSO) is conducting two research studies on testing for Plasmodium nucleic acid (DNA and RNA) in blood donors, one in collaboration with Grifols and Grifols Diagnostics, Inc. and the other in collaboration with Roche Diagnostics Solutions. Both studies aim to evaluate new research assays and learn more about the prevalence of Plasmodium infection in donors deferred for malaria risk. What we learn will help us know how many deferred donors are indeed infected with the malaria parasite. Implementation of universal donation screening for malaria would aid in reducing the number of deferred donors for malaria risks.

Enrollment is Complete - THANK YOU! 

A heartfelt thank you to our LGBTQ+ community partners, study participants, and all those who supported the groundbreaking ADVANCE Study as we all seek to make blood donation a more inclusive process while maintaining the safety of the blood supply. Together, the LGBTQ+ community, blood centers and the FDA are collaborating to determine if a blood donor history questionnaire based on individual risk would be an acceptable alternative to a time-based deferral in reducing the risk of HIV among gay and bisexual men who present to donate blood.

This could potentially lead to changes to the FDA’s current three-month deferral policy for men who have sex with men or MSM.  ADVANCE Study enrollment concluded on September 30, 2022. Researchers from the participating blood centers – Vitalant, OneBlood and the American Red Cross – will complete their final work by the end of 2022, which includes completing follow-up visits with participants into the fall, and then forward the information to the FDA. The FDA will determine the next steps after the analysis is complete and the results will be made public. We look forward to learning what comes next from the FDA in the months to come. For more information, please email [email protected] 

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Memorial Blood Centers is seeking participants for research studies that support our mission of saving lives through blood donation. We are proud to provide biomedical expertise and consultation to a variety of organizations in order to help advance the scientific study of infectious diseases and the development of life-saving medicines and blood products.

Research Donation FAQ

Research donors help save lives. Volunteers who participate in research studies ultimately contribute to the health and well-being of countless others. Without research study participants, future advancements in medicine wouldn’t be possible.

Participants will be asked to donate blood samples or components (such as whole blood, plasma, or platelets), and will be compensated for their time. Donation will take place at our  St. Paul donor center , conveniently located near the U of M Twin Cities campus, close to the  Green Line’s Raymond Avenue station.

Requirements vary for each study. If you are deferred from donating blood for non-medical reasons such as travel, you may still be eligible to participate in a research study. To confirm eligibility, you must make a voluntary donation with Memorial Blood Centers at any  donor center or blood drive  (if you haven’t already) before participating in a research study.

If you, your family, or friends would like to donate blood for research, please call us at 651-332-7135 or send us an  email .

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Memorial Blood Centers is currently working with researchers at local universities and medical device companies to improve patient care. Please contact us if you are interested in participating in this study.

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Open Access

Peer-reviewed

Research Article

Self-reported high-risk behavior among first-time and repeat replacement blood donors; a four-year retrospective study of patterns

Roles Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Resources, Supervision, Validation, Visualization

* E-mail: [email protected] , [email protected]

Affiliations Department of Medical Laboratory Science, Faculty of Applied Science and Technology, Sunyani Technical University, Sunyani, Ghana, Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria

Roles Data curation, Methodology, Validation, Writing – original draft, Writing – review & editing

Affiliations Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria, Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana

Roles Data curation, Methodology, Writing – original draft, Writing – review & editing

Affiliation Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana

Roles Data curation, Methodology

Affiliations Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria, Department of Medical Laboratory Technology, School of Applied Science and Arts, Bolgatanga Technical University, Bolgatanga, Ghana

Roles Writing – original draft, Writing – review & editing

Affiliation Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria

Affiliation Department of Biotechnology, Faculty of Science, Ebonyi State University, Abakaliki, Nigeria

Roles Validation, Writing – original draft, Writing – review & editing

• Felix Osei-Boakye, 
• Charles Nkansah, 
• Samuel Kwasi Appiah, 
• Gabriel Abbam, 
• Charles Angnataa Derigubah, 
• Boniface Nwofoke Ukwah, 
• Victor Udoh Usanga, 
• Emmanuel Ike Ugwuja, 
• Ejike Felix Chukwurah

• Published: August 8, 2024
• https://doi.org/10.1371/journal.pone.0308453
• Peer Review
• Reader Comments

There is no replacement for blood, and patients requiring transfusion depend on human donors, most of whom are family donors. Family donors may deny engagement in high-risk activities, which threaten the safety of donated blood. This study determined frequency of self-reported high-risk behaviors among replacement donors.

This retrospective study recruited 1317 donor records from 2017–2020, at Mankranso Hospital, Ghana. Data from archived donor questionnaires were extracted and analyzed with SPSS and GraphPad. Frequencies, associations, and quartiles were presented.

The donors were predominantly males (84.4%), 17–26 years old (43.7%), informal workers (71.8%), rural inhabitants (56.5%), first-time (65.0%), and screened in the rainy season (56.3%). Donation frequency was significantly associated with age, sex, occupation, and residence. Repeat donors were significantly older ( p ≤0.001). More males than females were deferred ( p = 0.008), drug addicts ( p = 0.001), had body modifications ( p = 0.025), multiple sexual partners ( p = 0.045), and STIs ( p ≤0.001), whereas, more females were recently treated ( p = 0.044). Weight loss ( p = 0.005) and pregnancy ( p = 0.026) were frequent among 17–26-year group, whereas, tuberculosis was frequent among 37–60-year group ( p = 0.009). More first-time donors were unwell ( p = 0.005), deferred ( p ≤0.001), pregnant ( p = 0.002), drug addicts, had impending rigorous activity ( p = 0.037), body modifications ( p = 0.001), multiple sexual partners ( p = 0.030), and STIs ( p = 0.008). STIs were frequent in the dry season ( p = 0.010). First-time donors had reduced hemoglobin ( p = 0.0032), weight ( p = 0.0003), and diastolic pressure ( p = 0.0241).

Donation frequency was associated with age, sex, occupation, and residence, with first-time donors younger than repeat donors. Deferral from donation, drug addiction, body modification, multiple sexual partners, and STIs were frequent among males, whereas, more females received treatment. Tuberculosis was frequently reported among older adults, whereas, weight loss and pregnancy were frequent among younger individuals. More first-time donors reported being unwell, deferred, drug addiction, body modifications, multiple sexual partners, STIs, and pregnant. Hemoglobin, weight, and diastolic BP were reduced among first-time donors.

Citation: Osei-Boakye F, Nkansah C, Appiah SK, Abbam G, Derigubah CA, Ukwah BN, et al. (2024) Self-reported high-risk behavior among first-time and repeat replacement blood donors; a four-year retrospective study of patterns. PLoS ONE 19(8): e0308453. https://doi.org/10.1371/journal.pone.0308453

Editor: Theresa Ukamaka Nwagha, University of Nigeria Faculty of Medical Sciences and Dentistry: University of Nigeria Faculty of Medical Sciences, NIGERIA

Received: April 19, 2024; Accepted: July 24, 2024; Published: August 8, 2024

Copyright: © 2024 Osei-Boakye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Blood transfusion is a therapeutic and lifesaving procedure useful in conditions that require whole blood, or blood-derived products transfusion, particularly for people with extremely reduced blood volumes and consequent hypoxia. Overall, the aim of blood transfusion services is to provide safe blood and to restore the lives of patients. Currently, there is no true replacement for blood, and patients requiring blood transfusion therapy depend on altruistic human donors for survival [ 1 ]. However, this process is not without challenges, as the propensity to spread infections through transfusing human blood persist [ 1 , 2 ]. In all safety of the patient as well as donor protection are of immense clinical importance in transfusion medicine [ 3 ].

Worldwide, about 118.5 million units of blood are donated annually [ 4 ], whereas, only 2 million blood donations are made in sub-Saharan Africa [ 4 , 5 ]. This resulting deficit in blood supply, and the increased demand for hemotransfusions in sub-Saharan Africa is due to increased morbidity in expectant mothers, malaria [ 1 ], nutritional insufficiencies [ 6 ], deranged hemostasis, hemoglobinopathies, and patients with trauma. In order to meet the increased demands and mitigate the shortages in blood supply, many blood centers in Ghana rely mainly on family replacement blood donors. However, replacement donors are a potential source for the spread of blood-borne infections [ 7 ]. Consequently, the National Blood Service Ghana (NBSG), has instituted a more stringent donor recruitment criteria to improve on the existing hemovigilance practices.

The algorithm for screening blood donors recommended by the NBSG, includes a preliminary physical assessment of the donors, followed by the administration of a self-deferral health questionnaire, intended to either temporarily defer or permanently disqualify high-risk and unsuitable donors. Subsequently, serological screening for infectious biomarkers, including, hepatitis B surface antigen (HBsAg), and antibodies to hepatitis C virus, Treponema pallidum , and human immunodeficiency virus (HIV) is performed. The aim of these multifaceted selection criteria is to protect individuals who are unfit to donate blood, exclude infected blood, and minimize infections that may be missed by the serological assays during the window period. Despite the safety measures recommended by the NBSG, the screening of blood donors in many blood centers in Ghana is skewed towards the identification of serological biomarkers, while clinical history, anthropometric variables, and lifestyle indicators which may provide early warning signs for blood donor recruiters remain underutilized. Also, the screening for infections may be improperly performed due to scarce resources [ 1 , 6 ]. Furthermore, family donors may conceal useful information, including denying their engagement in high-risk activities [ 8 ], which are contraindications for blood donation. These practices, in turn, threaten the safety of the donors, donated blood units, and the recipients of blood transfusions. Furthermore, there is paucity of literature on the frequency and patterns of high-risk donor behaviors in Ghana. Therefore, it is imperative to establish evidence to justify the need to educate the public on blood donation and blood donor practices to safeguard the blood supply chain.

Therefore, this study determined the frequency and patterns of self-reported high-risk behaviors among first-time and repeat replacement blood donors. Documenting this data will provide blood centers in Ghana with a baseline information, to: help identify high-risk donor groups, determine the effect of sociodemographic factors on high-risk donor practices, and to unravel the relationship between donation frequency, blood hemoglobin level and some anthropometric variables. Also, this study would help to understand the health educational needs of prospective blood donors in the study setting.

Participants and methods

Study design and setting.

The present study was a four-year (2017–2020) retrospective cross-sectional study conducted at the Mankranso Government Hospital. In this study, we retrospectively reviewed and collected archived data spanning 2017 and 2020. And, this was done as a onetime sampling conducted between 14 th March and 4 th April 2024. The hospital offers healthcare to both outpatients and inpatients who seek its services, and has an inpatient capacity of about 88 beds [ 9 ]. The hospital has separate admission wards for males, females, children, and another for obstetric- and neonatal patients. Furthermore, the hospital offers services like clinical laboratory, x-ray, ultrasound, antenatal care, and therapy for patients requiring antiretroviral, hypertension, and antidiabetic medications. Also, it operates a surgical theatre where caesarean section and other minor surgeries are performed. The hospital is located at Mankranso in the Ahafo-Ano Southwest district of Ashanti Region, Ghana. It is the major public hospital in the district, and is regulated by the Ghana Health Service. Mankranso is a rural community and is the administrative capital of the Ahafo-Ano Southwest constituency.

Study population

In this study, all prospective family replacement donors who visited the clinical laboratory unit of Mankranso Government Hospital to undergo screening for the purpose of blood donation were considered. Overall, information was extracted from 1317 clinical records of replacement blood donors who visited the laboratory during a four-year period (1 st January 2017 to 31 st December 2020). The participants were between the ages of 17 and 60 years.

Sample size determination.

The computation of sample size in this study, was done with the Epi Info v7.2 epidemiological software (Centers for Disease Control and Prevention [CDC], United States). A previous study from Ghana by Seidu et al ., [ 10 ] observed 6.0% prevalence of self-reported sexually transmitted infections (STIs), which was used as the percentage for unexposed group in this study. With a two-sided confidence interval of 95%, statistical power of 80%, 1:2 ratio of unexposed-to-exposed, and assumed percentage of 12% was used for the exposed group. This produced the largest sample size of 905 participants (unexposed: 302, and exposed: 603) using the Fleiss w/CC value, and this was increased to 1317 to include all eligible replacement donor records to enhance the representation of the study population.

Data collection

The National Blood Service Ghana (NBSG) blood donor clinical records (form: NBTS/DN 20 v2) were retrieved from the laboratory’s archive, from 14 th to 17 th March 2024. Pre-donation screening data on the blood donors were then extracted on to a spreadsheet. Blood donors’ data extracted from the questionnaire included hemoglobin level; anthropometric data (including weight, systolic blood pressure [SBP], diastolic blood pressure [DBP]); and sociodemographic data (like sex, age, occupation, residence, and season). However, personal identifiers like names were not retrieved from the registers in order to ensure anonymity of the donors. Furthermore, information on blood donation history, and high-risk behaviors were collected. Some of the risky behaviors captured included history of unprotected sex with multiple sexual partners, history of sex with a homosexual, history of needle-stick injury, history of receiving injections outside a hospital, body modifications like tattoos and tribal cutting, history of self-injected drug use, and history of jaundice. Additionally, information on history of chronic and non-chronic diseases like sickle cell disease (SCD), epilepsy, tuberculosis, hepatitis, gonorrhea, human immunodeficiency virus (HIV), and or syphilis were collected.

Ethical consideration and informed consent

The protocol for the study was approved by the Committee on Human Research, Publication and Ethics (CHRPE) of the School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology (Reference: CHRPE/AP/177/24). Also, permission was obtained from the authorities of the Mankranso Government Hospital before conducting the study. However, due to the retrospective design of the study, consent from the subjects was not required.

Statistical data analysis

The data were entered directly into IBM SPSS Statistics for Windows, version 27.0.1.0. (Armonk, NY: IBM Corp.). Continuous data were assessed for skewness using the Kolmogorov-Smirnov test, and subsequently presented as median and interquartile ranges. Age was further transformed into three groups, and presented as frequencies and proportions, along with other categorical data like sex, occupation, frequency of donation, residence, and season. The association of high-risk behavior with sex, donation frequency, and season were determined using the Fisher’s Exact test, whereas, the association between high-risk behavior and age was performed with the Chi-Square test. Hemoglobin level, body weight, SBP, and DBP were stratified by donation frequency and further presented as boxplots and whiskers showing the median, lower-, and upper quartiles. The boxplots were visualized using GraphPad Prism 8.4.3 (GraphPad Software, San Diego, California USA). All analysis were considered significant at p ≤0.05.

Sociodemographic characteristics of the prospective blood donors

Table 1 shows the sociodemographic characteristics of the prospective family-replacement blood donors stratified by frequency of donation. The median age of the donors was 28.0 (23.0–35.0) years, with the repeat donors significantly older than first-time donors (30.0 [25.0–36.0] vs 27.0 [22.0–34.0], p ≤0.001). Of the 1317 blood donor data reviewed, the majority 1111 (84.4%) were males, 575 (43.7%) were within 1–26-year age range, 945 (71.8%) worked in the informal sector, 744 (56.5%) were rural inhabitants, 741 (56.3%) were screened in the rainy season, and 856 (65.0%) were first-time donors.

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https://doi.org/10.1371/journal.pone.0308453.t001

Of the 856 first-time donors, the majority (702 [82.0%]) were males, 415 (48.5%) were 17–26 years of age, 645 (75.4%) worked in the informal sector, and 524 (61.2%) were rural inhabitants. Of the 461 prospective repeat blood donors, 409 (88.7%) were males, 188 (40.8%) were 27–36 years of age, 300 (65.1%) worked in the informal sector, and 241 (52.3%) were urban inhabitants. The frequency of donation was significantly associated with age ( p ≤0.001), gender ( p = 0.001), occupation ( p ≤0.001), and residence ( p ≤0.001), but not season ( p = 0.684) ( Table 1 ).

Frequency of high-risk donor behavior, stratified by sex and age of blood donors

Table 2 shows the frequency of high-risk donor behavior stratified by sex and age of the blood donors. With respect to sex, increased proportions of males than females had previously been deferred from donating blood (81/1111 [7.3%] vs 5/206 [2.4%], p = 0.008), were drug addicts (59/1111 [5.3%] vs 1/206 [0.5%], p = 0.001), had body modifications (47/1111 [4.2%] vs 2/206 [1.0%], p = 0.025), have had unprotected sex with multiple sexual partners (180/1111 [16.7%] vs 14/206 [6.8%], p = 0.045), sexually transmitted infections (185/1111 [16.7%] vs 14/206 [6.8%], p ≤0.001), whereas more females than males had recently received treatment or vaccination (8/206 [3.9%] vs 17/1111 [1.5%], p = 0.044).

https://doi.org/10.1371/journal.pone.0308453.t002

Increased proportion (16/266 [6.0%]) of the prospective blood donors within the 37–60-year range had history of tuberculosis, followed by 17–26 years (15/575 [2.6%]), and 27–36 years (10/476 [2.1%]). History of tuberculosis infection was significantly associated with age group ( p = 0.009). Significantly increased proportion of donors in the 17–26-year group than the 27–36-year group had history of >5kg body weight loss due to illness (21/575 [3.7%] vs 10/476 [2.1%], p = 0.005). Similarly, increased proportion of donors in the 17–26-year group than the 27–36-year group were pregnant (4/575 [1.4%] vs 6/476 [1.3%], p = 0.026) ( Table 2 ).

Frequency of high-risk donor behavior among the prospective blood donors stratified by frequency of donation and season

Table 3 shows the frequency of high-risk blood donor behavior stratified by frequency of donation and season. A significantly increased proportion of first-time than repeat donors were unwell (70/856 [8.2%] vs 19/461 [4.1%], p = 0.005), had previously been deferred from donating blood (72/856 [8.4%] vs 14/461 [3.0%], p≤0.001), were drug addicts (47/856 [5.5%] vs 13/461 [2.8%], p = 0.027), had body modifications (42/856 [4.9%] vs 7/461 [1.5%], p = 0.001), have had unprotected sex with multiple sexual partners (145/856 [16.9%] vs 57/461 [12.4%], p = 0.030), had history of sexually transmitted infections (146/856 [17.1%] vs 53/461 [11.5%], p = 0.008), were going to perform rigorous activities after donation (31/856 [3.6%] vs 7/461 [1.5%], p = 0.037), and were pregnant (12/856 [1.4%] vs 2/461 [0.2%], p = 0.002). Furthermore, a significantly increased proportion of the prospective donors screened in the dry season than rainy season had previously tested positive for gonorrhea and other sexually transmitted infections (104/576 [18.1%] vs 95/741 [12.8%], p = 0.010), whereas no association existed between season and the other risk behaviors ( Table 3 ).

https://doi.org/10.1371/journal.pone.0308453.t003

Levels of hemoglobin and anthropometric characteristics of the blood donors, stratified by frequency of donation

Fig 1 shows the median hemoglobin, weight, systolic- and diastolic BP of the prospective donors. The level of hemoglobin (13.5 vs 13.8, p = 0.0032), weight (64.0 vs 65.8, p = 0.0003), and diastolic BP (79.0 vs 80.0, p = 0.0241) were significantly reduced in the first-time donors than in the repeat donors. However, the median systolic BP did not differ between first-time and repeat donors (120.0 vs 120.0, p = 0.9209) ( Fig 1 ).

The data are presented as boxplots and whiskers showing 25 th , 50 th , and 75 th quartiles; The Mann-Whitney U test was used to compare differences in medians of hemoglobin and anthropometric characteristics between first-time and repeat blood donors; BP: Blood pressure; p was significant at ≤0.05.

https://doi.org/10.1371/journal.pone.0308453.g001

Association between hemoglobin level and sexually transmitted infections

Fig 2 shows the association between the level of hemoglobin and history of STIs. Out of 199 donors that responded ‘yes’ to history of gonorrhea and other STIs, 17.6% (36) had low hemoglobin, while 82.4% (164) had normal hemoglobin level. Conversely, out of the 1118 donors that responded ‘no’, 21.0% (235) had low hemoglobin, while 79.0% (883) had normal hemoglobin. Furthermore, out of 8 donors who responded ‘yes’ to the question ‘have you or your partner tested positive for HIV or hepatitis?’, 12.5% (1) had low hemoglobin, while 87.5% (7) had normal hemoglobin. However, out of the 1309 donors that responded ‘no’, 20.6% (269) had low hemoglobin, while 79.4% (1040) had normal hemoglobin level. Hemoglobin level had no significant association with both history of gonorrhea/other STIs, and either the donors or their partners having a history of positive HIV or hepatitis ( p = 0.295 vs p = 1.000, respectively) ( Fig 2 ).

HgB: Hemoglobin; STI: Sexually transmitted infection; p ≤0.05 was considered significant for all analyses.

https://doi.org/10.1371/journal.pone.0308453.g002

High-risk behavior and practices perpetrated by blood donors could compromise blood safety owing to the existence of the immunological incubation period. The current study, therefore, determined the frequency and patterns of self-reported high-risk behavior among replacement blood donors that could negatively impact the safety of blood in Ghana. In the current study, most (43.7%) of the prospective donors were significantly young and in their prime (17–26 years). The frequency of the donors then decreased consistently with increasing age. These were similar to the findings of studies from Ghana [ 11 ] and Nepal [ 12 ]. A similar pattern was observed in the first-time donors when stratified by donation frequency, which is consistent with the findings of Asamoah-Akuoko et al ., [ 11 ]. In Ghana, many young individuals with ages 17–26 years are likely in high school, college/university or undergoing national service after tertiary education, and are therefore, still dependent on their parents/guardians. Also, in many Ghanaian societies, young individuals are forbidden from questioning the authority of elders. Therefore, it is plausible that such individuals unwillingly participated in replacement blood donations out of fear of losing financial support from parents/guardians and to prevent being stigmatized by other relatives. Conversely, the majority (40.8%) of the repeat donors were significantly older, with the majority between 27 and 36 years. These donors are relatively matured compared to the 17–26-year group, and therefore have a better understanding of the value of blood, and what their social obligations are in regard to ensuring sustainability of the blood supply chain. Conversely, the low participation of much older individuals (37–60 years), is probably because, they are prone to risk factors like obesity that predisposes them to other chronic non-communicable diseases like diabetes, hypertension, and deranged cardiac function, all of which are contraindications for blood donation.

The donors were predominantly (84%) males, and culminated in a 5:1 male-to-female ratio, with similar patterns observed in both first-time and repeat donors. The observation of more male than female ( p = 0.001) donors in this study was consistent with findings of several studies conducted in Ghana [ 1 , 6 , 9 , 11 , 12 ], and other parts of Africa [ 13 – 16 ]. In many societies, men are socially obliged and responsible for the safety and wellbeing of their family members [ 2 ], which could have resulted in the increased participation of males in blood donation. Conversely, the low number of female donors is attributed to pregnancy and childbearing-related characteristics such as menstruation, and breastfeeding, which render females less suitable donor candidates compared to males [ 1 ]. Furthermore, some studies [ 10 , 15 ] suggest that the frequent loss of blood through menstruation could culminate in anemia, and this rather increases males’ prospects for blood donation than females.

The observation of more informal sector workers ( p ≤0.001) among the blood donors in this study corroborates the findings of a study from Gabon [ 17 ]. It is worthy to note that, the current study area was a rural setting where majority of the inhabitants were engaged in non-formal occupations like farming, trading, artisanal jobs, and illegal mining (known locally as galamsey). This may have accounted for the significantly increased frequency of both informal sector workers ( p ≤0.001), and rural inhabitants ( p ≤0.001) in the donor population. More donors were recorded in the rainy- than the dry season, probably due to the increased demand for blood transfusion in the rainy season [ 5 ], and although not different between first-time and repeat donors, the relationship between seasonal variation and certain transfusion-associated diseases have been established [ 18 ].

The observation of more male than female drug addicts in this study was consistent with existing literature, which suggests that although substance abuse is considered a deviant behavior and therefore associated with public disapproval, more females than males are stigmatized for their involvement [ 19 ]. Furthermore, men are believed to have more social exposure to such social vices than females [ 19 ]. In recent years, aesthetic body enhancements like tattoos, and piercings have gained popularity in Ghana. In this study, more males than females had undergone permanent body modifications, which is consistent with the findings of Heywood et al ., [ 20 ]. Males are more likely to belong to gang groups, in which a display of group tattoos proves membership [ 21 ] and loyalty. Also, according to Weiler et al ., [ 22 ], tattoos in particular are used by many to express one’s unique identity. Furthermore, certain body modifications like tribal marks, and cuttings by traditional healers are particularly confined to some ethnic groups in Ghana and Africa. Therefore, the descent of the population could have contributed to the frequency of body modifications among the respondents.

The observation of more males with multiple sexual partners corroborates the findings of Dendup et al ., [ 23 ] from Bhutan, although, their study involved a slightly younger population. Maintaining female purity (“virginity until marriage”) [ 23 ] and monogamy are among some social norms expected of females in many Ghanaian settings, and could have contributed to the reduced involvement of females with multiple sexual partners. Dendup et al ., [ 23 ] report that males having sex with multiple sexual partners is a way of expressing male masculinity and dominance. Furthermore, the increased illegal mining activities in the study district may have contributed to this, as it has attracted many people from different parts of the country, most of whom are males and individuals with low- or no level of formal education.

In the present study, self-reported history of sexually transmitted infections (STIs) was significantly associated with the sex of respondents, with more males than females reporting STIs. This finding is consistent with studies from Ghana [ 1 , 11 ] and Ethiopia [ 16 ] that determined the burden of STIs among blood donors in which more males were infected with blood-borne STIs. Scientific evidence suggests a positive correlation between immunity and the female sex, with females less infected by viral pathogens [ 1 ]. The high concentration of estrogen in females enable them to produce sufficient resistance to viral pathogens by synthesizing more CD4+ cells that trigger a marked T cell response against viruses [ 1 , 24 ]. Furthermore, this observation could be attributed to the increased involvement of males in other predisposing high risk behaviors like sex with multiple partners, use of self-injected drugs, and body modifications [ 20 ], all of which were common among males in this study.

A self-reported history of tuberculosis (TB) was significantly associated with age, with older respondents (37–60 years) reporting previous TB infection. This finding corroborates a study from Ghana [ 25 ]. The possible reason is that immunity in humans diminishes with ageing, which may result from a reduced capacity to produce cytokines and restore old T lymphocytes [ 25 ]. In Ghana, the ages, 17–26 years are typical of individuals in high school or other tertiary institutions. Therefore, the frequent weight loss in this population could be ascribed to unhealthy lifestyles, and lack of monitoring due to the absence of parents in schools. Also, the weight loss may have been motivated by looks and peer pressure [ 26 ]. Furthermore, it could be due to malnutrition, since the predominant male population is usually dependent on females for their nutritional needs. Pregnancy was frequent among teenagers and younger adults, since this population is considered a vulnerable group.

It is plausible that first-time replacement blood donors have limited to no knowledge regarding the requirements for blood donation compared to repeat donors, who may have completed the donor selection questionnaire in the past, and therefore, are familiar with the recruitment process. This may have accounted for the significantly increased frequency of some self-reported risk behaviors among the first-time donors. For instance, increased proportion of them were unwell ( p = 0.005), had been deferred from donating in the past ( p ≤0.001), were drug addicts ( p = 0.027), had body modifications ( p = 0.001), have had unprotected sex with multiple sexual partners ( p = 0.030), had tested positive for STIs ( p = 0.008), had impending rigorous activities following blood donation ( p = 0.037), and were pregnant ( p = 0.002). This could explain the increased hemoglobin and body weight among the repeat donors compared to first-time donors. Therefore, it is imperative that repeat donations are encouraged even during first-time donations, since such donors are familiar with the donor selection criteria, and are likely to self-defer if they fail to meet the requirements. However, the observation of a significantly increased self-reported STIs among replacement donors in the dry season ( p = 0.010) is not well understood.

The study was not without limitations: for instance, the practice of tribal marks is common particularly among some ethnic groups in northern Ghana, therefore, information about ethnicity would have explained the increased reports of body modifications. Also, the study did not present the nexus between high-risk behavior and donor adverse events. Furthermore, the retrospective nature of the study did not permit decoupling of the various STIs. We, therefore, recommend that future studies should decouple the STIs and consider collecting data on blood donor adverse events to fill this knowledge gap.

The frequency of blood donation was significantly associated with age, sex, occupation, and residence of the donors, with first-time donors younger than repeat donors. Deferral from blood donation, drug addiction, body modification, multiple sexual partners, and positive STIs were frequent among male- than female donors, whereas, vaccination was frequent among females than males. A history of tuberculosis was frequently self-reported by older adults, whereas, weight loss and pregnancy were frequent among teenagers and younger individuals. An increased proportion of first-time replacement- than repeat donors reported being unwell, deferred from donating, drug addicts, had body modifications, had multiple sexual partners, were positive for STIs, and were pregnant during the screening. Hemoglobin, weight, and diastolic BP were significantly reduced among first-time donors.

Supporting information

S1 data. dataset used for the study..

https://doi.org/10.1371/journal.pone.0308453.s001

Acknowledgments

The authors wish to thank the Medical Superintendent, and all Laboratory staff of Mankranso Government Hospital for their support.

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• 4. World Health Organization. Blood transfusion. 2022. https://www.who.int/news-room/facts-in-pictures/detail/blood-transfusion

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The benefits of public cord blood banking.

When Kristin Kleinhofer’s leukemia returned, her mom did some research.

“And she kept telling me, because you don’t have a match , I really want you to have cord blood. It was the whole thing about a lower rate of cancer relapse. Also, the lower chance of graft versus host disease, which is usually something that just really derails people’s quality of life post-transplant.”

Car-T therapy using Kristin’s own stem cells cured her cancer; a cord blood transplant from a public cord blood bank ensured that it didn’t come back.

While the landscape of medical treatments evolves and more options become available, cord blood transplants remain a crucial — and sometimes the only — option for many patients.

Bloodworks’ public Cord Blood Donation Program facilitates lifesaving transplants and provides hope and healing to patients like Kristin.

What is a matched donor?

More than 1 in 200 people will need a stem cell transplant in their lifetime to cure blood cancer, sickle cell disease, or many other conditions. Stem cells are unspecialized cells in our bloodstream that can mature to become any type of tissue or organ cell. A stem cell transplant can restore the body after intensive treatments like chemotherapy or radiation or, with blood cancers like leukemia, may actually fight the cancer itself.

You have likely heard of the need to “ find a matching donor ” for a patient in need of a stem cell transplant – someone whose human leukocyte antigens (HLA) closely match their own. HLA is part of the immune system : protein markers on your cells that determine what belongs in your body and what doesn’t. Without a close HLA match, a patient’s body will reject the donor’s cells.

A patient in need of a stem cell transplant may have a few options:

• Siblings. HLA is genetic. Because of the way HLA types are inherited, a sibling who shares the same parents has a 25% chance of being a match . However, 70% of patients don’t have a matching donor within their family.
• Unrelated adult donor. The likelihood of finding a suitable matched unrelated donor (MUD) ranges from 29% to 79% depending on the patient’s ethnic background. These donors provide stem cells through bone marrow or peripheral blood stem cell (PBSC) donation.
• A haploidentical (half) match , typically a parent or a child. Despite advances in medical technology making haploidentical matches a viable option when a patient needs a transplant sooner than a match can be located, fully matched donors still provide better long-term survival and quality of life .
• Their own cells . An autologous stem cell transplant filters healthy cells from a patient’s own body and returns them to engraft after rigorous treatment to kill the unhealthy cells.
• Cord blood . The blood left in the umbilical cord and placenta after a baby is born and the cord is clamped. Cord blood is rich in stem cells and can be used in place of bone marrow from adult donors. Because infant stem cells are so new and malleable, cord blood doesn’t need to match a patient’s own HLA type as closely as that from an adult donor.

The type of stem cell transplant received by the patient will depend on their specific illness, available donors, their body’s response to chemotherapy and other treatments, their overall health, and many other factors.

The more options of all types of stem cell transplant available to patients, including cord blood, the better the outcome.

What is cord blood?

Cord blood transplants are used to treat over 80 diseases and disorders, such as blood cancers like leukemia and lymphoma and sickle cell disease.

Despite being an invaluable resource, most umbilical cord blood is routinely discarded as medical waste. Saving and preserving cord blood in a frozen state, called cord blood banking , provides options for patients who would otherwise not have access to a potentially life-saving transplant resource.

Umbilical cord blood donated to public cord blood banks is used for about 10% of stem cell transplants facilitated through NMDP (formerly known as National Marrow Donor Program and Be the Match), the national stem cell registry.

Patients from diverse racial and ethnic backgrounds have a challenging time finding a perfect match. But cord blood with a less-perfect match can be used with similar clinical outcomes, which means that racial and ethnic minorities have more opportunity for treatment.

And researchers, such as Filippo Milano, MD, PhD of Fred Hutchinson Cancer Center , are continually finding new uses for this lifesaving resource.

Why is public cord blood banking important?

Public cord blood donation is an important part of Bloodworks’ lifesaving mission: we’re home to the first and only public cord blood bank in the Pacific Northwest.

The American College of Obstetricians and Gynecologists (ACOG) states , “Public umbilical cord blood banking is the recommended method of obtaining umbilical cord blood for use in transplantation, immune therapies, or other medically validated indications.”

In the case of many diseases, such as blood cancers, public banks matter because one’s own cord blood cannot be used as treatment , since it likely contains the predisposition for the condition being treated and will not be curative.

In more than 20 years, our Cord Blood Donation Program has banked over 15,500 cords for transplant and sent out 1200 units to patients in need. In 2023, we banked 273 donated cord blood units and distributed 18 for transplant.

Public cord blood donation is free and can be arranged in advance or until active labor. It does not impact the birth process or family bonding afterwards.

With public cord blood donation, like Bloodworks’ Cord Blood Donation Program, cord blood is collected and sent to a local cord blood bank, where it is evaluated and, if it meets the US FDA’s rigorous regulatory standards for banking and transplantation, stored in a controlled environment until it matches with a patient in need of a transplant.

“We work hard with our clinical partners to make sure they’re optimizing the collection to make sure it’s the best possible treatment it can be,” said Evan Delay, RN, Director of Bloodworks Bio Donation Programs.

Public cord blood banks operate under strict regulations to provide donated cord blood for any patient in need. Unlike private banks, which store cord blood for personal use, our focus remains on community health and broader accessibility.

Learn more at BloodworksNW.org/cordblood

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Critical appraisal of knowledge, attitude and practice studies for blood donation in India

Affiliation.

• 1 Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India.
• PMID: 36941796
• DOI: 10.1111/tme.12968

Background and objectives: A critical appraisal of the literature helps to assess the strength and weakness of the research and suggests ways to improve future research. Our aim was to critically appraise the knowledge, attitude, and practice (KAP) studies conducted in India for blood donation.

Materials and methods: Of 70 articles identified in our search on PubMed, Scopus and Google Scholar, 32 were assessed for quality using an appraisal tool for cross-sectional studies (AXIS) and questionnaire items.

Results: Quality assessment revealed that only 6 of 32 studies had acceptable reporting (≥80% score on the AXIS tool). The most frequently identified shortcomings were failure to address the non-responders, lack of justification for sample size, assessment of outcome variables and demographic results for the survey. Our evaluation of questionnaires revealed that knowledge for need for blood donation, its benefits and site/place for blood donation were assessed by very few studies. With this, issues such as parental/family consent, religious beliefs, and indifference to blood donation process were amongst the common reasons for non-donation. Many studies also failed to ask questions related to procedural information/instructions, which are necessary for promoting voluntary blood donations.

Conclusion: Most published KAP studies for blood donation in India were not appropriately described, especially the methodology and result section. These deficiencies could have led to suboptimal interpretation of the prevalent issues. Use of an open-ended and validated KAP questionnaire with a problem-based approach and inclusion of participants from various socio-cultural backgrounds is required for good quality of evidence.

Keywords: KAP study; blood donation; critical appraisal.

© 2023 British Blood Transfusion Society.

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• ISSN: 1560-7917

Syphilis testing in blood donors, France, 2007 to 2022

• View Affiliations Hide Affiliations Affiliations: 1 Direction médicale, EFS Siège, Saint Denis, France 2 Direction des maladies infectieuses, Santé publique France, Saint Maurice, France 3 Direction nationale, EFS Siège Saint Denis, France 4 Centre National de Référence des Infections Sexuellement transmissibles, Cochin Hospital, APHP, Paris, France 5 Université Paris Cité, Institut Cochin-Inserm U1016, Paris, France 6 Université de Franche-Comté, EFS, INSERM, UMR RIGHT, Besançon, France Correspondence:  Syria Laperche syria.laperche efs.sante.fr

Citation style for this article: Laperche Syria , Sauvage Claire , Le Cam Sophie , Lot Florence , Malard Lucile , Gallian Pierre , Pouchol Elodie , Richard Pascale , Morel Pascal , Grange Philippe , Tiberghien Pierre , Benhaddou Nadjet , Dupin Nicolas . Syphilis testing in blood donors, France, 2007 to 2022. Euro Surveill. 2024;29(32):pii=2400036. https://doi.org/10.2807/1560-7917.ES.2024.29.32.2400036 Received : 12 Jan 2024;   Accepted : 29 Apr 2024

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Syphilis in blood donors (BD) has increased in many countries.

We aimed to describe trends in syphilis seroposivity in BD in France, to identify risk factors and assess if a non-treponemic test (NTT) could define BD having recovered from syphilis for more than 1 year.

The analysis covered the period 2007 to 2022 and 45,875,939 donations. Of the 474 BD syphilis-positive in 2022, 429 underwent additional investigations with an NTT. History of syphilis was obtained at the post-donation interview or based on serology results for repeat donors.

Until 2021, positivity rates remained stable (mean: 1.18/10,000 donations, range: 1.01–1.38). An increased rate was observed in 2022 (1.74/10,000; p = 0.02). Over the whole study period, prevalence was 2.2 times higher in male than in female BD (4.1 times higher in 2022). The proportion of males with an identified risk factor who have sex with men increased from 16.7% in 2007 to 64.9% in 2022. Based on NTT, 79 (18%) of the donors who were seropositive in 2022 were classified as having been infected in the previous year. History of syphilis was available for 30 of them. All had an infection within the previous 3 years. Among seven donors with a syphilis < 12 months before testing, one had an NTT titre ≥ 8, three a titre between 1 and 4, three were negative.

Syphilis seropositivity increased considerably in BDs in 2022, mostly in males, notably MSM. Available data did not allow appropriate evaluation of the NTT to distinguish recent from past infection.

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• Received : 12 Jan 2024
• Accepted : 29 Apr 2024
• Published online : 08 Aug 2024

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Red Cross, America’s Blood Centers, AABB Say U.S. Faces Critical Blood and Platelet Shortages

AHA Special Bulletin August 7, 2024

Individuals are urged to donate blood and platelets 

The American Red Cross ,  America’s Blood Centers and the Association for the Advancement of Blood and Biotherapies (AABB) in separate messages this week expressed concerns about the nation’s low blood supply levels and urged individuals to donate to boost supplies.

The American Red Cross said it faces an emergency blood shortage after its national blood inventory plummeted more than 25% in July. The blood groups said the summer’s record heat, as well as recent disruptions in blood collections in the Southeast United States, including a cyberattack on OneBlood and Tropical Storm Debby, have created additional challenges for blood collection. The most needed blood products are platelets, O-positive blood and O-negative blood.

AABB’s Interorganizational Disaster Taskforce, of which the AHA is a member, has been meeting regularly on the situation and is working closely with the federal government and blood centers.

CALL TO ACTION

Hospitals and health systems are encouraged to urge eligible individuals in their communities to make an appointment to donate blood or platelets at their nearest blood collection location. Regular blood donations are a critical resource for hospitals and health systems to provide lifesaving care for their communities. The public understands the lifesaving importance of blood and blood products and often steps forward to donate when made aware of a supply shortage.

• AAAB, www.WhereToDonateBlood.org
• America’s Blood Centers, www.americasblood.org
• American Red Cross, www.RedCrossBlood.org

FURTHER QUESTIONS

If you have questions, please contact Nancy Foster, AHA vice president of quality and patient safety policy, at [email protected] , or Roslyne Schulman, AHA’s director of policy, at [email protected] . 

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Knowledge, Attitude, and Practices Regarding Organ Donation among Blood Donors – A Comparative Study with Nonblood Donors at a Rural Tertiary Care Hospital in Central India

Mehta, Aryan Sunil; Deshmukh, Abhay Vilas * ; Sonkusale, Pratiksha Moreshwar 1 ; Joshi, Mudita Nitin 2 ; Gupta, Anupama

Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India

1 Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India

2 Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India

Corresponding Author: Dr. Abhay Vilas Deshmukh, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India. E-mail: [email protected]

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 4.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

• Infographic

Introduction:

Organ transplantation is the most preferred treatment for many end-stage organ diseases. However, its rate is relatively low in India. There is a gross discrepancy between the number of people requiring organ transplantation due to failure and the organ donor pool. It is expected that the donors can easily accept the idea of organ donation as they are already involved in acts of humanitarianism.

This study aimed to compare knowledge, attitudes, and practices regarding organ donation among blood donors and nonblood donors.

Materials and Methods:

It was a cross-sectional analytical study among two groups: blood donors and nonblood donors, conducted over 2 months. A standardized questionnaire proforma was prepared, which consisted of questions to assess the person’s knowledge, attitude, and awareness about organ donation.

A total of 754 people participated in the study. Of which, 722 were enrolled after strict inclusion and exclusion criteria. Three hundred and sixty-one were blood donors, and 361 were nonblood donors. There was a comparatively large difference in knowledge, attitude, and practices among blood donors regarding organ donation compared to nondonors. It was statistically significant ( P < 0.05).

Conclusion:

The blood donors had significantly more knowledge, attitude, and practices regarding organ donation than nondonors. Even though blood donors had a positive attitude toward organ donation, only 42 participants have committed to organ donation to date. If we can bridge the gap and provide the basic knowledge regarding organ donation, it can help to build a positive attitude regarding the same in society. An awareness campaign regarding organ donation can be conducted in the community regularly to promote the process of organ donation.

I NTRODUCTION

Organ donation is a process where an organ is surgically removed from one person (organ donor) and placed in another required person (recipient). Organ transplantation is the most preferred treatment for many end-stage organ diseases. It not only increases the life expectancy of the recipient but also improves the quality of life in circumstances such as skin, cornea, or bone transplantation. [ 1 ]

As per Global Observatory data on donation and transplantation, 144,302 solid organ transplantations were reported in 2021, of which 12,259 were done in India. It was reported that although there is an 11.3% increase in the trend of organ donation in 2021 as compared to 2020, [ 2 ] this is also not sufficient for the existing needs of diseased recipients. The organ donation rate is relatively low in India. There is a gross discrepancy between the number of people requiring organ transplantation due to failure and the organ donor pool. [ 3 ]

People who are willing to donate blood or have donated blood in the past (“donors”) are more likely to engage in similar pro-social behaviors, like engaging in activities like organ donation, as compared to people who have never donated blood in their lifetime (“nondonors”). [ 4 ] It is expected that the donors can easily accept the idea of organ donation as they are already involved in acts of humanitarianism. [ 5 ] The primary obstacle to the organ transplantation program in India appears to be the shortage of donor organs. It leads to a wide gap between the number of patients who actually need transplantation and the availability of organs. Thus, there is a necessity to identify the reasons for this wide gap.

The lack of awareness and negative attitude toward organ donation can be possible reasons for the gap between the need and availability of organs. Mani reported that lack of awareness about the concept of brain death, superstitions related to rebirth, religious attitudes, fear of misuse of organs, health risks due to organ donation, and lack of consensus among family members are the potential barriers to successful implementation of organ donation program in India. [ 6 ]

There is a dearth in literature regarding the comparison of knowledge and attitude of donors and nondonors regarding organ donation, especially in central India. Hence, this study was designed in order to know the differences between the knowledge, attitudes, and practices about organ donation among blood donors compared to nonblood donors at a rural tertiary care hospital in central India.

M ATERIALS AND M ETHODS

Study design and study setting.

It was a cross-sectional analytical study among two groups: blood donors and nonblood donors, which was conducted in the blood bank, different outpatient departments, and wards of rural tertiary care hospitals from December 2022 to January 2023 (a total duration of 2 months). The blood bank caters to a 1260 bedded rural tertiary care hospital in central India.

Methodology

We used the standardized questionnaire used by Saleem et al. , [ 7 ] in their study, after validating its content to our setting and checking for reliability. It consisted of questions to assess the person’s knowledge, attitude, and awareness about the organ donation. To understand their perception about organ donation further, questions about previous organ donation or their committed to do so were included. The questionnaire had an option to write remarks by the subject, if any.

The questionnaire included the following segments:

• Sociodemographic details
• Blood donation characteristics
• Questions about knowledge, attitude, and practices about organ donation.

We tried to highlight the knowledge of both the donors and nondonors, referring to the facts or information known to them, theoretical or practical understanding regarding organ donation. Furthermore, their attitude refers to the views or opinions regarding the act of organ donation. Practices refer to the act of donating or pledging organs by the participants.

We prepared a questionnaire in English and translated it into local regional languages (Hindi and Marathi), allowing the participants to read, write, and comprehend in the language they are more comfortable with. The written consent for participation in the study was obtained from the participants. The answers to the questionnaire were either in a written format on their own or with assistance from the interviewer, whenever required. The participant’s sociodemographic details were collected, including occupation, education status, religion, monthly income, type of family, and means of transport used by the individual.

Definitions

We defined “donors” as people who were of age above 18 years and made at least one whole blood/apheresis donation at a blood center or during any blood donation camp.

Nondonors were the ones who were of age above 18 years and had not donated the whole blood/apheresis blood products in the past. Nondonors were the persons accompanying volunteers at our blood center or blood camps or patients visiting our hospital outpatient departments.

Inclusion and exclusion criteria

Inclusion criteria.

All the participants who were fit in the above definition of “donor” and who voluntarily participated in the study.

Exclusion criteria

The persons who refused to participate in the study and the persons with chronic diseases.

Statistical analysis

All the responses were entered in the Microsoft Excel sheets and statistical analysis will be carried out using Statistical Package for the Social Sciences version 20, IBM Corp, Chicago, IL, USA. Descriptive statistics about the sociodemographic status and responses were summarized as frequency and proportions. The difference among groups was tested using the Chi-square test for independent variables, and P < 0.05 was considered significant.

Declaration of patient consent

The consent has been taken for participation in the study and for publication of clinical details and images. The participants understand that the names and initials would not be published, and all standard protocols will be followed to conceal their identity.

Ethics statement

The study protocol was approved by the Institute Ethics Committee of Mahatma Gandhi Institute of Medical Sciences, Sevagram (MGIMS/IEC/PATH/91/2022), letter number 113, dated June 11, 2022. The participant’s identity was kept confidential during all research procedures. The study was performed according to the guidelines in Declaration of Helsinki.

Around 4355 people were approached during the study of which 754 provided consent for the same. A total of 32 forms were discarded as it were incompletely filled. Hence, out of 722 participants, 361 were blood donors and 361 were nonblood donors.

The mean age of participants was 33.06 ± 10.15 years, ranging from 18 to 63 years. 72% of males and 28% of females were involved in the study. The maximum number of participants (55%) were studied till the 12 th standard and were self-employed (36.5%). 64.40% of participants were married and 76.5% belonged to the Hindu religion. Regarding family income, half of the participants (50%) belonged to the category of monthly income of Rs. 5000–20,000/-. Majority of the participants (44%) were from the nuclear family and were using personal motorbikes (47%) as a primary means of transport [ Table 1 ].

Regarding knowledge about organ donation, we found that there was a significant statistical difference among blood donors as compared to nonblood donors. It was related to knowledge about organ donation ( P = 0.001), different organs to be donated ( P = 0.002), whether religion allows this procedure ( P < 0.00001), regarding the decision for mentally disabled person ( P < 0.00001), risks involved in organ donation ( P = 0.00007), any legislation regarding organ donation ( P = 0.003), consent about living donors ( P = 0.023), regarding the term “organ donation” ( P = 0.08) and the media from where participants have heard about organ donation ( P = 0.03). The answers to few questions from participants showed statistically insignificant differences among the two groups. It included questions regarding consent for organ donation after death, the decision of organ donation in case of unclaimed dead bodies, and the exact meaning of organ donation (0.25, 0.50, and 0.13, respectively) [ Table 2 ].

We also found a significant statistical difference between knowledge of different organs which can be donated among two groups ( P = 0.002) [ Table 2 ]. The maximum number of participants among both groups responded as eyes ( n = 110 and 130, respectively). The other organs included kidneys, heart, liver, skin, and bone marrow in descending order. Strikingly, we found that none of the nondonor knew about lung donation [ Figure 1 ].

We also found that there was a statistically significant difference among blood donors as compared to nonblood donors regarding attitude. The answers to various questions include effective laws to govern the process of organ donation ( P = 0.05), attitude of participants toward organ donation ( P = 0.01), factors which are of greatest importance to the participants while donating an organ ( P = 0.002), anyone know who has donated organ previously ( P = 0.03), and important risks involved in organ donation ( P = 0.08). We found a statistically insignificant difference in answers to questions regarding whether organ donation should be promoted ( P = 0.94), why it should not be promoted ( P = 0.20), and the dangers of misuse of donated organs ( P = 0.20) [ Table 3 ].

We also found statistically significant differences among donors as compared to nondonors regarding practices about organ donation in answers for questions such as whether they donated an organ ( P = 0.003), whether committed or signed to donate ( P = 0.012), and preference to donate the organ ( P = 0.00001) [ Table 4] .

D ISCUSSION

We found that there is a statistically significant difference regarding knowledge, practices, and attitude among both groups, blood donors and nondonors. A majority (>70%) of participants belonged to the Hindu religion, while the rest belonged to Buddhist, Muslim, and Christian religion in our study [ Table 1 ]. We found that strong religious beliefs play an important role among nonblood donors in our study ( P < 0.0001) [ Table 2 ]. Our findings are consistent with Merz et al . [ 5 ] and Wakefield et al . [ 8 ] Merz et al . [ 5 ] in their study found that participants think that it is a social duty to save a life by organ donation. Certain religions such as Islam and Christianity do not believe in organ donation after death as it is supposed to be a mutilation of the body. Our findings are not consistent with the findings of Randhawa [ 9 ] and Basavarajegowda et al . [ 10 ] ( P = 0.27). Both of the studies did not find any significant difference regarding the role of religion for organ donation in Asian and Australian as well as the Indian population. Even though we found a significant difference for the same, many of the nonblood donors ( n = 140) did not know whether their religion allowed for organ donation or not. The reason could be attributed to a lack of knowledge regarding the procedure in India. In our study, we found that the majority of blood donors believed that parents or guardians can make a substitute for mentally disabled persons in regard to organ donation as compared to nondonors ( P < 0.00001) [ Table 2 ]. Ideally, no clarity has been mentioned regarding this matter in India in Mental Health Act, 1987 or Organ Donation Act, 1994. [ 2 , 11 ] The responses from donors might be due to the act of altruism without knowing the actual requirement of consent from the person itself in reality and this issue needs to be addressed in the future.

In our study, only 38% ( n = 274) of the participants were familiar with their own blood group [ Table 2 ]. There was a striking difference among blood donors and nondonors in our study. As blood group is routinely checked after donation and a card indicating the same is issued to the donor after donation, so it is expected that blood donors are knowing it already. Knowledge about blood group is one of the essential aspects of organ donation. Few studies have been conducted on the first year undergraduate students in Nigeria and in India showed that only 44% and 74% of students were aware regarding blood donation, respectively. [ 12 , 13 ] Even though the participants in our study were well educated (more than half of them were diploma, graduation or postgraduation level), both donors as well as nonblood donors were unaware regarding the person who can provide the consent for organ donation and decision regarding organ donation in case of unclaimed dead bodies ( P = 0.25 and 0.50, respectively). Our findings are consistent with Basavarajegowda et al . [ 10 ] ( P = 0.94 and 0.11, respectively). In this regard, the knowledge should be provided to the people starting from the school level to increase awareness regarding the same. It is also important to remove all negative aspects regarding organ donation (e.g. donation done for the sake of money which is usually imprinted on minds via television sets, usually casted in older movies). Our findings are inconsistent with Saleem et al . [ 7 ] who found that knowledge about organ donation was significantly associated with education ( P = 0.000) and socioeconomic status ( P = 0.038) in their study. The reason could be attributed to different geographical conditions and education levels in study groups. Wakefield et al . [ 8 ] also found that higher socioeconomic status and education were predictive of willingness for organ donation in their study. Most of the participants know about eye donation but not the rest organs [ Figure 1 ]. We also found that even the main motto of the organ donation was not known to participants in both groups. The training, if planned in a proper way, can provide at least basic knowledge regarding the same among people and thus society.

We found that blood donors were well aware of the need for laws governing organ donation process and important factors while donating an organ as compared to nondonors ( P = 0.05 and 0.002, respectively). Our findings are consistent with Basavarajegowda et al . [ 10 ] ( P = 0.08 and 0.002, respectively). In general, there seems to be more awareness and willingness to donate an organ among blood donors as compared to nondonors [ Table 3 ]. Our findings are consistent with Li et al . [ 14 ] who found statistically significant values for the same ( P = 0.002 and < 0.0005, respectively) in their study. The blood donors knew well about someone who had already donated an organ among their family or friends and the important risks involved in organ donation as compared to nondonors ( P = 0.03 and 0.008, respectively) [ Table 3 ]. Our findings are consistent with Basavarajegowda et al . [ 10 ] ( P = 0.008 and < 0.0001, respectively). Even though less participants among nondonors responded to the infection as an important risk involved after organ donation, many of them responded for irrelevant answers such as weakness, pain, and depression. It shows that nondonors might have different ideas regarding this process and complications after organ donation. The donors were well aware of the important possible risks involved and thus, responded it as negligible. Although blood donors had a positive attitude for organ donation as compared to nondonors ( P = 0.01); most of the participants in the study ( n = 312, 43.2%) answered that they will think about the organ donation instead of definitely want to donate ( n = 145, 20%). Here, definitely want to donate refers to the quality of donors being happy after organ donation. This clearly shows that there is a strong need to change this attitude in order to promote organ donation in India.

There was a positive response from blood donors as compared to nondonors regarding practices [ Table 4 ]. We found only a smaller number of blood donors ( n = 19) have donated organs and committed to donate ( n = 42) till date as compared to nondonors ( P = 0.003 and 0.012) in our study. Similarly, in a study conducted by Basavarajegowda et al. , in 2021, [ 10 ] found positive attitude toward organ donation ( P = 0.002). However, out of 416 participants, only one participant from donor have donated an organ and four have committed to donate, while none of the nondonors did the same ( n = 0 out of 413) in it. [ 10 ] In our study, considering overall participants, 90% have not even signed to donate an organ till date. This shows lack of positive attitude regarding this important issue among participants. Blood donors expressed preference for organ donation among family and friends, the physically disabled, younger people, and mentally sound people. The reason could be attributed to the knowledge regarding the appropriate willingness among blood donors as compared to nondonors since they are actively involved in the practice of blood donation. The act of humanitarianism also plays an important role in this process.

The strength of the present study was that it was conducted on a reasonably large sample size. We used a comprehensive and detailed questionnaire to identify the knowledge, attitude, and practices in both groups. While limitations of the study were that this study was conducted in a health-care facility. If we can conduct the study at a community and household level, we can identify the true depth of the problem and accordingly, measures can be taken to motivate for the process of organ donation. There are various ways to increase the awareness and importance of organ donation among the community. The various campaigns, media, and print can help in this important aspect. A lecture on this in medical education should be included. The hospital staff also needs to be sensitized regarding it. Pamphlets/reading material should be made available for patients and attendants in all hospitals, etc., The rotary clubs, nongovernment organizations and advertisements by celebrities, etc., can also help to a large extent. The guest lectures on this topic should be conducted at school and college levels compulsorily, etc.

There is a dearth in literature regarding studies who tried to compare knowledge, attitude, and practices of blood donors regarding organ donation in India. We did not find any study regarding the same till date in central India as per our knowledge. This is probably the first study with a large sample size in central India on this aspect. We recommend more studies with such a large sample size to identify the problems among community at a deeper level so that government can take an appropriate steps to promote the process of organ donation.

C ONCLUSION

The blood donors had significantly more knowledge, attitudes, and practices regarding organ donation than nondonors. These donors can motivate others in their community regarding this important issue to increase organ donations in India. However, even though blood donors had a positive attitude toward organ donation, only forty-two participants have committed to organ donation to date in our study. If we can bridge the gap and provide the basic knowledge regarding organ donation, it can help to build a positive attitude regarding the same in society. An awareness campaign regarding organ donation should be conducted in the community regularly to promote the process of organ donation.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

R EFERENCES

Awareness; blood donor; nondonor; organ donation

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Original research

Knowledge of blood donation and associated factors in ethiopia: a systematic review and meta-analysis, addisu getie.

1 Nursing, Woldia University, Woldia, Ethiopia

Adam Wondmieneh

Melaku bimerew, getnet gedefaw.

2 Midwifery, Woldia University, Woldia, Ethiopia

Asmamaw Demis

Associated data.

bmjopen-2020-044343supp001.pdf

All data relevant to the study are included in the article or uploaded as supplementary information.

To assess the level of knowledge about blood donation and associated factors in Ethiopia.

Systematic review and meta-analysis.

Both published and unpublished cross-sectional studies on the level of knowledge about blood donation in Ethiopia were included. Articles from different databases such as PubMed/MEDLINE, HINARI, EMBASE, Scopus, Google Scholar and African Journals Online were searched. Cochrane I 2 statistics were used to check for heterogeneity. Subgroup and sensitivity analyses of evidence of heterogeneity were carried out. Egger’s test with funnel plot was conducted to investigate publication bias.

Twenty cross-sectional studies with a total of 8338 study participants (4712 men and 3626 women) were included. The overall nationwide level of knowledge about blood donation was 56.57% (95% CI 50.30 to 62.84). Being in secondary school and above (adjusted OR=3.12; 95% CI 2.34 to 4.16) and being male (adjusted OR=1.81; 95% CI 1.44 to 2.28) were the factors associated with level of knowledge about blood donation.

More than half of the study participants were knowledgeable about blood donation. Sex and educational status were the factors significantly associated with level of knowledge about blood donation in Ethiopia. Therefore, there is a need for education and dissemination of information about blood donation among the general population to build adequate knowledge and maintain regular blood supply.

Strengths and limitations of this study

• This study highlights the nationwide level of knowledge about blood donation in Ethiopia.
• This study covers a wide area and investigates different articles, making the review more accurate.
• Subgroup and sensitivity analyses were carried out to investigate the heterogeneity of the included studies.
• All included studies were cross-sectional in design, which may limit investigation of the cause–effect relationship.

Introduction

Blood donation is life-saving for people in different emergency conditions, such as road traffic accidents, surgical procedures, pregnancy and delivery complications, chemotherapy, and diseases such as malaria, anaemia and intestinal parasites. 1 Blood donation is a noble practice of saving the life of millions of people. Donating safe and adequet blood can safe up to three lives of a patient who need blood. 2

Although the demand for adequate and safe blood is significantly increasing, there is a serious and critical shortage of blood stocks in low-income and middle-income countries. In low-income and middle-income countries, family replacement and paid blood donors are the most common sources of blood transfusion. 3 The availability of blood for transfusion in low-income countries is very limited due to the low level of knowledge, unwillingness to donate blood and poor blood donation practices. Meanwhile, patients suffer from lack of blood transfusion due to increased need from different medical and surgical conditions 4

While every blood donor is considered a hero, the amount of blood collected from donors and the average rate of blood collection in low-income countries including Ethiopia are low compared with the demand for blood. 5 The act of family replacement therapy is a common blood donation practice than collecting from volunteer blood donors, which is a common predisposing factor for misconception towards blood donation practice. 6

As different studies have shown, the prevalence of level of knowledge regarding blood donation ranged from 32.4% to 40.45%. 7 4 8 Education, sensitisation of blood donation, increasing public awareness, and campaign through the internet and media are recommended strategies to increase awareness, attitude and motivational practice of blood donation. 9–11 Fear of the different health risks after blood donation and lack of information on where, when and how to donate blood are the most common factors that hinder blood donation. 12 Even though beliefs, attitudes and behaviours regarding blood donation differ, adequate knowledge is needed among non-donors. There is a gap between willingness to donate blood and the number of donors in most populations around the world, which affects the practice of blood donation. 13 There is a need to spread awareness on blood donation among the general population to maintain an adequate and safe blood supply, which can be done through well-designed communication strategies to overcome the problem. 7

While there is a very high need for blood supply in Ethiopia, there is a serious shortage of blood stocks in the country. Thus, identifying the different factors that hinder knowledge about the practice of blood donation is essential. This systematic review and meta-analysis aims to review the different studies conducted so far on the level of knowledge about blood donation and associated factors in Ethiopia.

Methods and materials

Study protocol.

In this meta-analysis, the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines for reporting of findings were used 14 ( online supplemental table S1 ).

Supplementary data

Databases and search strategy.

Different databases such as PubMed/MEDLINE, Hinari, EMBASE, Google Scholar and African Journals Online were used to search for available articles. Both published and unpublished articles from the repository of Ethiopian universities were also searched. The search date was from 1 January 2000 up to 1 May 2021. Articles reporting on knowledge about blood donation and associated factors in Ethiopia were included in the final analysis. The search items were “knowledge” OR “awareness” AND “blood donation” OR “volunteer blood donation” AND “associated factors” OR “determinant factors” AND “Ethiopia”. These search strings were developed using “AND” and “OR” Boolean operators ( table 1 ).

Search of different databases for studies about level of knowledge and associated factors regarding blood donation in Ethiopia

Search and eligibility of studies

All retrieved articles were exported to EndNote reference software V.8 citation manager (Thomson, Stamford, Connecticut, USA) to sort and delete duplicates. Two investigators (AG and AD) independently evaluated each article by title and abstract, assessed the eligibility of the articles, and critically reviewed the selected articles. Extraction was done by author name, publication year, region where the study was conducted, study subjects, sampling method, method of survey, study period, sample size, study design, level of education, level of knowledge regarding blood donation and factors associated with level of knowledge about blood donation.

Eligibility criteria

Both published and unpublished cross-sectional studies conducted on the level of knowledge about blood donation among populations in Ethiopia were included, whereas qualitative studies, different trials, case reports, review articles, updates and news were excluded from the analysis. Furthermore, articles not reporting on the outcome of the study and those without full texts were excluded.

Outcome measurement of the study

There are two main outcomes, namely level of knowledge about blood donation and the factors associated with it. Level of knowledge was measured using the mean score on the knowledge assessment questions. Study participants who scored with a mean score and above on the knowledge assessment items were considered knowledgeable about blood donation, whereas those who scored below the mean score were considered not knowledgeable.

Quality assessment

Two authors (AG and AD) independently assessed the quality of the studies using the Newcastle-Ottawa Scale for cross-sectional studies. 15 Methodological quality, comparability, outcome and statistical analysis of the studies were the main assessment tools used to determine quality. Studies that scored ≥7 out of 10 were considered to be of high quality. During quality appraisal of the articles, any discrepancies between the two authors were resolved. All authors independently assessed the eligibility of the articles to be considered in the final analysis.

Data processing and analysis

In this systematic review and meta-analysis, a weighted inverse variance random-effects model at 95% CI was used to calculate the pooled prevalence of level of knowledge about blood donation and the associated factors. 16 After extraction and cleaning using Microsoft Excel spreadsheets, the data were exported to STATA V.11 statistical software for analysis. The heterogeneity of the studies was assessed using the Cochrane Q-test and I 2 with the corresponding p value. I 2 values of 25%, 50% and 75% represent low, moderate and high heterogeneity, respectively. 17 The source of heterogeneity was examined through subgroup analysis based on region, study subjects, study setting and sample size. Sensitivity analysis was also carried out to confirm the presence or absence of influential studies. The presence of publication bias was evaluated using Egger’s test and presented with funnel plots. 18 For associated factors, log OR was used to decide on the association between the associated factors and the level of knowledge about blood donation. A statistical test with a p value of less than 0.05 was considered statistically significant. 19

Patient and public involvement

It was not appropriate or possible to involve the patients or the public in the design, conduct, reporting or dissemination plans of our research.

Six hundred and ninety-four articles were retrieved. Of these retrieved articles, 284 were excluded due to duplication. Three hundred and sixty-eight articles were further excluded after reviewing the titles and abstracts. Furthermore, 22 articles which did not fulfil the inclusion criteria were excluded. Finally, 20 articles were used in the analysis ( figure 1 ).

Flow chart of selection of studies for the systematic review and meta-analysis of the level of knowledge about blood donation and associated factors in Ethiopia.

Characteristics of the studies and study participants

Twenty cross-sectional studies with a total of 8338 study participants (4712 men and 3626 women) were involved. Of the included articles, eight were from the Amhara region, 1 12 20–25 five from the Oromia region, 4 26–29 two from the Addis Ababa city administration, 5 30 two from Southern Nations, Nationalities and Peoples Region, 31 32 two from Tigri region, 33 34 and the remaining was from the Afar region. 35 The sample size of the included studies ranged from 218 to 845 ( table 2 ).

Characteristics of studies included in the review and meta-analysis of knowledge about blood donation and associated factors in Ethiopia

SNNPR, South Nations, Nationalities and Peoples Region.

Knowledge about blood donation

The overall pooled prevalence of level of knowledge about blood donation in Ethiopia was 56.57% (95% CI 50.30 to 62.84) ( figure 2 ).

Forest plot of the pooled prevalence of knowledge about blood donation and associated factors in Ethiopia. ES, Effect Size.

Heterogeneity and publication bias

In this systematic review and meta-analysis, heterogeneity was identified within the studies (I 2 =97.3%, p<0.001). The funnel plot showed an asymmetrical distribution of studies included in the review and a statistically significant Egger’s test (p=0.02), suggesting the presence of publication bias ( figure 3 ).

Funnel plot with 95% confidence limits of the pooled prevalence of knowledge about blood donation and associated factors in Ethiopia. sep; standared error of prevalence.

Subgroup analysis

Subgroup analysis was done by region, study subjects, study setting and sample size. The highest pooled prevalence of level of knowledge about blood donation was reported by healthcare workers (65.28%, 95% CI 55.16 to 75.40). Similarly, the level of knowledge about blood donation was higher among studies done in institutions (institution-based) (60.45%, 95% CI 51.05 to 69.83) than studies conducted in the community ( table 3 ).

Subgroup analysis of the level of knowledge about blood donation and associated factors in Ethiopia (n=20)

Other: Addis Ababa, Eastern Ethiopia.

Sensitivity analysis

As shown in table 4 , all of the point’s estimates are within the overall 95% CI, which confirms that omission of any of the studies included in this systematic review and meta-analysis does not affect the overall prevalence of the level of knowledge about blood donation.

Sensitivity analysis of knowledge about blood donation and associated factors in Ethiopia

Factors associated with knowledge about blood donation

In this study, participants’ sex and level of education were significant factors associated with level of knowledge about blood donation. The odds of level of knowledge were 1.81 times more likely among men than women (adjusted OR (AOR)=1.81; 95% CI 1.44 to 2.28) ( figure 4 ). Similarly, the odds of level of knowledge were 3.12 times more likely among participants whose educational status was above secondary school than those who did not attend any formal education (AOR=3.12; 95% CI 2.34 to 4.16) ( figure 5 ).

Overall pooled OR of the association between sex and level of knowledge about blood donation in Ethiopia. AOR, adjusted OR.

Overall pooled OR of the association between educational status and level of knowledge about blood donation in Ethiopia. AOR, adjusted OR.

In this systematic review and meta-analysis, the pooled prevalence of good knowledge about blood donation is 56.57% (95% CI 50.30 to 62.84), which indicates that there is a lack of adequate knowledge about blood donation in the country. This might be due to the absence of regular blood donation programmes, less media coverage, limited campaign and limited educational access with regard to blood donation in the country.

The level of knowledge in this study is lower than the studies conducted in Malaysia (98%), 2 Barabanki, India (90%), 36 and Benin City, Nigeria (92.65 %). 37 This variation might be due to differences in study participants. In Malaysia, the study participants were nursing students; in Benin City, Nigeria the study participants were healthcare workers; and in Barabanki, India the study participants were undergraduate medical students. In contrast, this study targeted all populations in the country. This variation might also be due to the status and level of media coverage and the educational status of people in Ethiopia; Ethiopia is one of the low-income countries with very limited education coverage and media accessibility. There is an almost similar finding with regard to knowledge about blood donation with a study done among students of a tertiary institution in Nigeria. 9 However, the finding of this study is higher than the studies conducted in Kerala, India (35%) 7 and in Nepal (32%), 8 which may be due to time variations, where the previous studies were conducted before 7 and 5 years, respectively.

In the subgroup analysis, there was no significant variation with regard to the prevalence of knowledge about blood donation within the region where the studies were done. However, there were variations with regard to knowledge prevalence within study participants, study setting and sample size categories. Accordingly, the highest prevalence of knowledge was reported among healthcare workers. This is because healthcare workers have formal education on blood donation and know more about human physiology than others. Healthcare workers may also have experience with blood donation. This agreed with a study conducted in developing countries where regular donors had good knowledge compared with non-donors. 13 Studies conducted in institutions (institution-based) showed a higher prevalence of knowledge than studies conducted in the community (community-based). This is due to the populations in institutions having more access to information. 7

In this systematic review and meta-analysis, the odds of knowledge about blood donation were 1.81 times more likely among men than women. This might be due to women being more prone to different physiological conditions such as menstruation and bleeding during pregnancy and delivery, which deter them from donating blood. As a result they have poor blood donation practices when compared with men. This poor practice may indirectly affect women’s knowledge about blood donation. 3 Educational status also had a significant association with knowledge about blood donation. The odds of knowledge about blood donation were 3.12 times more likely among participants who had a level of education above secondary school compared with illiterates. 11 This is because formal education is the cornerstone of acquiring knowledge. Therefore, participants who reached secondary school and above have more access to information than participants who did not have any formal education.

Limitations of the study

All studies included in this systematic review and meta-analysis were cross-sectional studies, which may limit the generation of a cause–effect link between independent and dependent variables.

More than half of the study participants were knowledgeable about blood donation. Sex and educational status were significantly associated with level of knowledge about blood donation in Ethiopia. Therefore, there is a need for education and dissemination of information about blood donation among the general population to build adequate knowledge and maintain regular blood supply.

Supplementary Material

Contributors: AG and MB designed the study, as well as designed and run the literature search. AG, AW, MB, GG and AD acquired the data, screened the records, extracted the data and assessed the risk of bias. AG and AD did the statistical analyses and wrote the report. All authors provided critical conceptual input, analysed and interpreted the data, and critically revised the report. All authors read and approved the final manuscript.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Data availability statement

Ethics statements, patient consent for publication.

Not required.

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Zero calorie sweetener linked to blood clots and risk of heart disease, study finds

Sandee LaMotte, CNN

(CNN) — Consuming a drink with erythritol — an artificial sweetener used to add bulk to stevia and monk fruit and to sweeten low-carb keto products — more than doubled the risk of blood clotting in 10 healthy people, according to a new pilot study.

Clots can break off blood vessels and travel to the heart, triggering a heart attack, or to the brain, triggering a stroke. Previous research has linked erythritol to a higher risk of  stroke , heart attack and death.

“What is remarkable is that in every single subject, every measure of platelet responsiveness (clotting) went up following the erythritol ingestion,” said lead study author Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic   Lerner Research Institute.

Consuming a drink with an equal amount of glucose, or sugar, did not affect blood platelet activity in another group of 10 people, said Hazen, who is also the Jan Bleeksma chair in vascular cell biology and atherosclerosis at the Cleveland Clinic.

“This is the first direct head-to-head comparison of the effects of ingesting glucose versus ingesting erythritol on multiple different measures of platelet function,” Hazen said. “Glucose doesn’t impact clotting, but erythritol does.”

While small, the study was “very intriguing and interesting,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.

“I’m not saying we need to cease using these sugar alcohols immediately, but this line of research certainly begs the question: Are they safe or not?” said Freeman, who was not involved in the research.

In response to the study, the Calorie Control Council, an industry association, told CNN that 30 years of science has shown erythritol to be a “proven safe and effective choice” for sugar and calorie reduction.

“Consumers should interpret the results of this pilot with extreme caution. The limited number of participants, a total of 10, were given an excessive amount of erythritol, nearly quadruple the maximum amount approved in any single beverage in the United States,” the council’s president, Carla Saunders, said in an email.

However, the amount of erythritol used in each drink in the study — 30 grams — was the equivalent of what is included in typical sugar-free sodas, ice creams or muffins, of which people often eat more than one, Hazen said.

“This research raises some concerns that a standard serving of an erythritol-sweetened food or beverage may acutely stimulate a direct clot-forming effect,” said study coauthor Dr. Wai Hong Wilson Tang, research director for heart failure and cardiac transplantation at the Cleveland Clinic, in a statement.

What are sugar alcohols?

Like sorbitol and xylitol, erythritol is a sugar alcohol, a carb found naturally in many fruits and vegetables. The human body also makes erythritol as a byproduct of glucose metabolism but only in small quantities.

Artificially manufactured in massive quantities, erythritol has no lingering aftertaste, doesn’t spike blood sugar and has less of a  laxative effect  than some other sugar alcohols. It has about 70% of the sweetness of sugar and is considered zero calorie,  according to experts .

Erythritol is the largest ingredient by weight in many “natural” stevia and monk fruit products, Hazen said. It looks and tastes like sugar and can be used for baking. It is also a key ingredient in many keto-friendly products including ice cream, Hazen said.

“If you look at nutrition labels on many keto ice creams, you’ll see ‘reducing sugar’ or ‘sugar alcohol,’ which are terms for erythritol,” he told CNN in an earlier interview .

“You’ll find a typical pint has somewhere between 26 and 45 grams in it.”

Artificially created erythritol, along with its cousins, are considered “generally recognized as safe,” or GRAS, by the US Food and Drug Administration.

Series of studies show similar results

The new study, published Thursday in the journal Arteriosclerosis, Thrombosis, and Vascular Biology , asked 20 participants to fast overnight in preparation for a morning blood draw. Next, they were given a drink with either 30 grams of erythritol or 30 grams of sugar. After 30 minutes, blood was drawn again.

Levels of erythritol in the blood rose by a thousandfold after the one drink with that substance, while blood sugars rose a small amount after the drink containing glucose. However, it was the change in platelet activity that was startling, Hazen said.

“We saw enhanced clotting, using measures of how quickly clots will occlude a vessel or stop blood flow, which is like a model of a heart attack or a stroke,” he said.

Similar results appeared in a 2023 study by Hazen and his colleagues in which eight healthy volunteers also consumed the same amount of erythritol and saw a thousandfold spike of the substance in their blood.

“(Erythritol) remained elevated above the threshold necessary to trigger and heighten clotting risk for the following two to three days,” Hazen said at the time.

That study also analyzed the blood of more than 4,000 people in the United States and Europe and found that those with the highest levels of erythritol were twice as likely to experience  a heart attack  or stroke.

“What we’re seeing with erythritol is the platelets become super responsive: A mere 10% stimulant produces 90% to 100% of a clot formation,” Hazen said.

The studies were done in healthy people without chronic disease; however, the study’s findings still apply for the future, Hazen said.

“However, if you look at middle-aged America, the average person has two to three risk factors for heart disease, and 70% of us are going to develop heart disease in our lifetime, so maybe we should all be considering action,” he said.

When it comes to the risk of cardiovascular disease, occasional sugar-sweetened treats in small amounts may be preferable to consuming drinks and foods sweetened with the sugar alcohols, he said. That’s especially true for anyone at highest risk for clotting, heart attack and stroke — such as those with existing cardiac disease or diabetes.

“Cardiovascular disease builds over time, and heart disease is the leading cause of death globally,” he said. “We need to make sure the foods we eat aren’t hidden contributors.”

The-CNN-Wire ™ & © 2024 Cable News Network, Inc., a Warner Bros. Discovery Company. All rights reserved.

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Blood Biomarkers to Detect Alzheimer Disease in Primary Care and Secondary Care

• 1 Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden
• 2 Memory Clinic, Skåne University Hospital, Malmö, Sweden
• 3 Neurology Clinic, Skåne University Hospital, Lund, Sweden
• 4 Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
• 5 Department of Neurology, Washington University School of Medicine, St Louis, Missouri
• 6 Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
• 7 Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
• 8 Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
• 9 University Clinic Primary Care, Skåne, Sweden
• 10 C2N Diagnostics LLC, St Louis, Missouri
• 11 Paris Brain Institute, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
• 12 Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
• 13 Clinical Neurochemistry Lab, Sahlgrenska University Hospital, Mölndal, Sweden
• Editorial Blood Tests for Alzheimer Disease Stephen Salloway, MD, MS; Christopher Rowe, MD; Jeffrey M. Burns, MD, MS JAMA
• Editorial Blood-Based Biomarkers for Alzheimer Disease—Ready for Primary Care? Lawren VandeVrede, MD, PhD; Gil D. Rabinovici, MD JAMA Neurology
• Original Investigation Alzheimer Disease Blood Biomarkers and Incident Dementia Yifei Lu, PhD; James Russell Pike, MBA; Jinyu Chen, MS; Keenan A. Walker, PhD; Kevin J. Sullivan, PhD; Bharat Thyagarajan, MD, PhD; Michelle M. Mielke, PhD; Pamela L. Lutsey, PhD, MPH; David Knopman, MD; Rebecca F. Gottesman, MD, PhD; A. Richey Sharrett, MD, DrPH; Josef Coresh, MD, PhD; Thomas H. Mosley, PhD; Priya Palta, PhD, MHS JAMA

Question   Can a blood test based on the ratio of plasma phosphorylated tau 217 (p-tau217) relative to non–p-tau217 (expressed as percentage of p-tau217) combined with the amyloid-β 42 and amyloid-β 40 plasma ratio (the amyloid probability score 2 [APS2]) accurately identify Alzheimer disease in primary care and secondary care when prospectively applying predefined biomarker cutoff values?

Findings   There were 1213 patients undergoing cognitive evaluation in primary or secondary care. The APS2 had high diagnostic accuracy (range, 88%-92%) for detecting Alzheimer disease pathology in both primary and secondary care. Dementia specialists identified clinical Alzheimer disease with a diagnostic accuracy of 73% vs 91% using the APS2 and primary care physicians had a diagnostic accuracy of 61% vs 91% using the APS2.

Meaning   This blood test (the APS2) had high diagnostic accuracy for identifying Alzheimer disease among individuals with cognitive symptoms in primary and secondary care, providing superior performance compared with the diagnostic accuracy after standard clinical evaluation (not using Alzheimer disease biomarkers).

Importance   An accurate blood test for Alzheimer disease (AD) could streamline the diagnostic workup and treatment of AD.

Objective   To prospectively evaluate a clinically available AD blood test in primary care and secondary care using predefined biomarker cutoff values.

Design, Setting, and Participants   There were 1213 patients undergoing clinical evaluation due to cognitive symptoms who were examined between February 2020 and January 2024 in Sweden. The biomarker cutoff values had been established in an independent cohort and were applied to a primary care cohort (n = 307) and a secondary care cohort (n = 300); 1 plasma sample per patient was analyzed as part of a single batch for each cohort. The blood test was then evaluated prospectively in the primary care cohort (n = 208) and in the secondary care cohort (n = 398); 1 plasma sample per patient was sent for analysis within 2 weeks of collection.

Exposure   Blood tests based on plasma analyses by mass spectrometry to determine the ratio of plasma phosphorylated tau 217 (p-tau217) to non–p-tau217 (expressed as percentage of p-tau217) alone and when combined with the amyloid-β 42 and amyloid-β 40 (Aβ42:Aβ40) plasma ratio (the amyloid probability score 2 [APS2]).

Main Outcomes and Measures   The primary outcome was AD pathology (determined by abnormal cerebrospinal fluid Aβ42:Aβ40 ratio and p-tau217). The secondary outcome was clinical AD. The positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and area under the curve (AUC) values were calculated.

Results   The mean age was 74.2 years (SD, 8.3 years), 48% were women, 23% had subjective cognitive decline, 44% had mild cognitive impairment, and 33% had dementia. In both the primary care and secondary care assessments, 50% of patients had AD pathology. When the plasma samples were analyzed in a single batch in the primary care cohort, the AUC was 0.97 (95% CI, 0.95-0.99) when the APS2 was used, the PPV was 91% (95% CI, 87%-96%), and the NPV was 92% (95% CI, 87%-96%); in the secondary care cohort, the AUC was 0.96 (95% CI, 0.94-0.98) when the APS2 was used, the PPV was 88% (95% CI, 83%-93%), and the NPV was 87% (95% CI, 82%-93%). When the plasma samples were analyzed prospectively (biweekly) in the primary care cohort, the AUC was 0.96 (95% CI, 0.94-0.98) when the APS2 was used, the PPV was 88% (95% CI, 81%-94%), and the NPV was 90% (95% CI, 84%-96%); in the secondary care cohort, the AUC was 0.97 (95% CI, 0.95-0.98) when the APS2 was used, the PPV was 91% (95% CI, 87%-95%), and the NPV was 91% (95% CI, 87%-95%). The diagnostic accuracy was high in the 4 cohorts (range, 88%-92%). Primary care physicians had a diagnostic accuracy of 61% (95% CI, 53%-69%) for identifying clinical AD after clinical examination, cognitive testing, and a computed tomographic scan vs 91% (95% CI, 86%-96%) using the APS2. Dementia specialists had a diagnostic accuracy of 73% (95% CI, 68%-79%) vs 91% (95% CI, 88%-95%) using the APS2. In the overall population, the diagnostic accuracy using the APS2 (90% [95% CI, 88%-92%]) was not different from the diagnostic accuracy using the percentage of p-tau217 alone (90% [95% CI, 88%-91%]).

Conclusions and Relevance   The APS2 and percentage of p-tau217 alone had high diagnostic accuracy for identifying AD among individuals with cognitive symptoms in primary and secondary care using predefined cutoff values. Future studies should evaluate how the use of blood tests for these biomarkers influences clinical care.

• Editorial Blood Tests for Alzheimer Disease JAMA
• Editorial Blood-Based Biomarkers for Alzheimer Disease—Ready for Primary Care? JAMA Neurology

Read More About

Palmqvist S , Tideman P , Mattsson-Carlgren N, et al. Blood Biomarkers to Detect Alzheimer Disease in Primary Care and Secondary Care. JAMA. Published online July 28, 2024. doi:10.1001/jama.2024.13855

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