Lois G. Kim
Impact of a post-donation hemoglobin testing strategy on efficiency and safety of whole blood donation in England: A modeling study
Kim, Lois G.; Bolton, Thomas; Sweeting, Michael J.; Bell, Steven; Fahle, Sarah; McMahon, Amy; Walker, Matthew; Ferguson, Eamonn; Miflin, Gail; Robert, David J.; di Angelantonio, Emanuele; Wood, Angela M.
Authors
Thomas Bolton
Michael J. Sweeting
Steven Bell
Sarah Fahle
Amy McMahon
Matthew Walker
EAMONN FERGUSON eamonn.ferguson@nottingham.ac.uk
Professor of Health Psychology
Gail Miflin
David J. Robert
Emanuele di Angelantonio
Angela M. Wood
Abstract
Background: Deferrals due to low hemoglobin are time-consuming and costly for blood donors and donation services. Furthermore, accepting donations from those with low hemoglobin could represent a significant safety issue. One approach to reduce them is to use hemoglobin concentration alongside donor characteristics to inform personalized inter-donation intervals. Study Design and Methods: We used data from 17,308 donors to inform a discrete event simulation model comparing personalized inter-donation intervals using “post-donation” testing (i.e., estimating current hemoglobin from that measured by a hematology analyzer at last donation) versus the current approach in England (i.e., pre-donation testing with fixed intervals of 12-weeks for men and 16-weeks for women). We reported the impact on total donations, low hemoglobin deferrals, inappropriate bleeds, and blood service costs. Personalized inter-donation intervals were defined using mixed-effects modeling to estimate hemoglobin trajectories and probability of crossing hemoglobin donation thresholds. Results: The model had generally good internal validation, with predicted events similar to those observed. Over 1 year, a personalized strategy requiring ≥90% probability of being over the hemoglobin threshold, minimized adverse events (low hemoglobin deferrals and inappropriate bleeds) in both sexes and costs in women. Donations per adverse event improved from 3.4 (95% uncertainty interval 2.8, 3.7) under the current strategy to 14.8 (11.6, 19.2) in women, and from 7.1 (6.1, 8.5) to 26.9 (20.8, 42.6) in men. In comparison, a strategy incorporating early returns for those with high certainty of being over the threshold maximized total donations in both men and women, but was less favorable in terms of adverse events, with 8.4 donations per adverse event in women (7.0, 10,1) and 14.8 (12.1, 21.0) in men. Discussion: Personalized inter-donation intervals using post-donation testing combined with modeling of hemoglobin trajectories can help reduce deferrals, inappropriate bleeds, and costs.
Citation
Kim, L. G., Bolton, T., Sweeting, M. J., Bell, S., Fahle, S., McMahon, A., …Wood, A. M. (2023). Impact of a post-donation hemoglobin testing strategy on efficiency and safety of whole blood donation in England: A modeling study. Transfusion, 63(3), 541-551. https://doi.org/10.1111/trf.17277
Journal Article Type | Article |
---|---|
Acceptance Date | Dec 15, 2022 |
Online Publication Date | Feb 16, 2023 |
Publication Date | 2023-03 |
Deposit Date | Mar 17, 2023 |
Publicly Available Date | Apr 27, 2023 |
Journal | Transfusion |
Print ISSN | 0041-1132 |
Electronic ISSN | 1537-2995 |
Publisher | Wiley |
Peer Reviewed | Peer Reviewed |
Volume | 63 |
Issue | 3 |
Pages | 541-551 |
DOI | https://doi.org/10.1111/trf.17277 |
Keywords | Blood donation; low hemoglobin deferral; post-donation testing; simulation modeling |
Public URL | https://nottingham-repository.worktribe.com/output/17386228 |
Publisher URL | https://onlinelibrary.wiley.com/doi/10.1111/trf.17277 |
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Publisher Licence URL
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