DEVELOPING DONOR

RETENTION STRATEGIES
Blood needs estimation
Donor motivation
Managing adverse donor reactions

Compiled by: Fortune Lapira – Torrecampo, RMT, MPH

 LEARNING
OUTCOMES
• Outline three methods of estimating blood
requirements
• Explain the factors that need to be taken into account in
setting donor recruitment and blood collection targets
• Apply strategies that would motivate donors to donate
blood
• Discuss the measures needed to minimize the risk of
adverse donor reactions
• Explain the basic requirements for the management of
adverse donor reactions
 BLOOD NEEDS
ESTIMATION
Methods of estimating blood needs
Setting targets for donor recruitment, recall and blood collection
Factors to be considered in setting targets for donor recruitment and blood
collection
 ROLE OF BLOOD
TRANSFUSION SERVICE
• To provide an EQUITABLE supply of safe blood/blood
products that are:
• ADEQUATE to meet needs of the health care system
• ACCESSIBLE to all patients requiring transfusion
• AVAILABLE in timely manner when required for routine
and emergency transfusions
 ROLE OF BLOOD
TRANSFUSION SERVICE
• Plan donor recruitment and
blood collection systematically to
meet blood requirements
 ROLE OF BLOOD
TRANSFUSION SERVICE
• Adjust blood supply
to actual needs
 BLOOD SUPPLY
• Balance between demand and supply is needed to:
• Meet clinical demands for blood
• Avoid blood shortages
• Minimize blood wastage
• Optimize the use of resources
• Maintain the safety of the blood supply
 BLOOD SUPPLY
• Shortages
• various reasons (lack of donors or lack of well
organized donor programs, lack of safety
measures…)
• periodic or continuous
• crucial for patients when no alternative is available
 DEFINITIONS OF BLOOD
REQUIREMENT
• Current use of blood
• Current demand for blood
• Population demand for blood
 CURRENT USE OF BLOOD
NUMBER OF UNITS of whole blood or RBC
CONSUMED BY A DEFINED NUMBER OF
FACILITIES OVER A DEFINED PERIOD OF
TIME (usually one year).
 CURRENT USE OF BLOOD
INCLUDES:
oBlood transfused for emergencies and
elective procedures
CURRENT USE OF BLOOD
INCLUDES:
oWastage due to UNUSED BLOOD
and/or OUTDATING
 CURRENT USE OF BLOOD
• Reflects:
• disease burden
• health services offered (facility factors)
• access to health care
• prescribing practice (including inappropriate transfusions)
• May also be constrained by inadequate supply
 CURRENT USE OF BLOOD
• COMPONENTS THAT MAY AFFECT CURRENT USE OF
BLOOD
• If the number of facilities is greater than one:
• current use of blood will have a spatial component driven by
the disease burden of the catchment population and facility
factors such as facility type and services available
 CURRENT USE OF BLOOD
• Disease burden (e.g. malaria) and/or facility factors (e.g. a
visiting surgeon)

• SINGLE PROVIDER

• NATIONAL SERVICE OR MIXED SYSTEM

 CURRENT DEMAND FOR
BLOOD
NUMBER OF WHOLE BLOOD UNITS
REQUIRED to meet ALL CONFIRMED
REQUESTS for blood transfusion for emergencies
and elective procedures at a defined number of
facilities over a defined period of time (usually one
year)
 CURRENT DEMAND FOR
BLOOD
• Reflects:
• disease burden
• health services offered (facility factors)
• access to health care
• prescribing practice
• Is not directly affected by inadequate supply
 CURRENT DEMAND FOR
BLOOD
COMPONENTS THAT MAY AFFECT
CURRENT DEMAND:
oNumber of facilities is greater than one
oSeasonal disease burden
 CURRENT DEMAND FOR
BLOOD
• Developed countries: Current demand will closely match
current use and supply

• Developing countries: There may be unmet demand,

which will have a cost
 CURRENT DEMAND FOR
BLOOD
• Death (unmet demand for emergency transfusions)
• Disability (unmet demand for transfusions for elective
procedures).
• If the magnitude of the unmet demand and the demographic
profile of those affected are known, its cost may be quantified in
Years of Life Lost (YLL) or Disability Adjusted Life Years
(DALY)
 CURRENT DEMAND FOR
BLOOD
Years of Life Lost (YLL)
• Potential years of life lost (YLL) provide a summary measure of premature mortality.
Potential years of life lost may be defined as the years of potential life lost due to premature
deaths.
• Years of life lost (YLL) take into account the age at which deaths occur, giving greater weight
to deaths at a younger age and lower weight to deaths at older age. The indicator measures
the YLL due to a cause as a proportion of the total YLL lost in the population due to
premature mortality.
• YLL is used in public health planning to compare the relative importance of different causes
of premature deaths within a given population, to set priorities for prevention, and to
compare the premature mortality experience between populations.
 CURRENT DEMAND FOR
BLOOD
• Disability Adjusted Life Years (DALY)
• One DALY can be thought of as one lost year of "healthy" life.
The sum of these DALYs across the population, or the burden
of disease, can be thought of as a measurement of the gap
between current health status and an ideal health situation
where the entire population lives to an advanced age, free of
disease and disability.
 POPULATION DEMAND FOR
BLOOD
• The NUMBER OF WHOLE BLOOD UNITS
that would be required to transfuse ALL
INDIVIDUALS WHO REQUIRE A BLOOD
TRANSFUSION IN A DEFINED
POPULATION (USUALLY A NATION) over
a defined time period (usually one year)
 POPULATION DEMAND FOR
BLOOD
Includes:
o transfusions for emergencies and for those elective
procedures that are provided by the health service that
serves that population
 POPULATION DEMAND FOR
BLOOD
• Reflects:
• disease burden of a population
• health care interventions available to that
population but assumes universal access to the
health service
POPULATION DEMAND FOR
BLOOD
Within populations, need for blood will have a
spatial component as disease burden and/or
population density is likely to be heterogeneous
 POPULATION DEMAND FOR
BLOOD
• Developed countries with good access to health
care and a sufficient blood supply with little
wastage
• population need for blood will closely match what
is supplied by blood providers and used in facilities
 POPULATION DEMAND FOR
BLOOD
• Less developed countries
• unmet population need for blood includes, but is
likely to exceed, the unmet demand
CLINICAL DRIVERS OF
BLOOD TRANSFUSION
One approach to understanding
and estimating blood transfusion
requirements is to identify the
clinical conditions and/or
interventions for which a blood
transfusion may be necessary
 CLINICAL DRIVERS OF
BLOOD TRANSFUSION
IF
frequency of these in a particular population over a
specified period of time, and the volume of blood
required per transfusion episode is also known then
theoretically the TOTAL VOLUME OF BLOOD
REQUIRED CAN BE ESTIMATED.
CLINICAL DRIVERS OF
BLOOD TRANSFUSION
• Influenced by
epidemiological,
ecological,
geographical, socio-
economic and health
system factors
Methods
 CLINICAL DRIVERS OF
BLOOD TRANSFUSION
• Examples of clinical drivers:
• malaria
• complications related to pregnancy
and nutritional anemia
• civil or military conflict and major
natural disasters
• trauma
 PATTERN OF BLOOD USAGE

• Developed countries
• Developing countries
• Emergency trauma care
• Maternal Mortality
 DEVELOPED COUNTRIES
• complex medical and • trauma care
surgical procedures • cancer chemotherapy
ocardiac, vascular, neuro,
transplant
• haematological
• malignancies
 DEVELOPING COUNTRIES
• Limited diagnostic and • severe childhood anemia,
treatment facilities often resulting from
malaria or malnutrition
• complications during
pregnancy and • trauma:
childbirth • conflict, disasters, violence,
road-traffic accidents
 EMERGENCY TRAUMA CARE
• Worldwide, >100 million people sustain injuries each year and
>5 million die from violence and injury

• RTAs are the 2nd leading cause of death and a leading cause
of serious injury for both sexes aged 5–29
 EMERGENCY TRAUMA CARE
• Uncontrolled bleeding accounts for >40% of trauma related
deaths
• Capacity to provide safe blood transfusion - essential
component of
• Emergency Trauma Care Systems to minimize death and
disability in injured patients
EMERGENCY TRAUMA CARE
 MATERNAL MORTALITY
Globally, MORE THAN 530,000 women
die each year during pregnancy, childbirth
or in PP period
 MATERNAL MORTALITY
• 99% of them in the developing world
• 14 countries had MMRs of at least 1000
• 13 are in the severe bleeding during delivery or after childbirth:
commonest cause of MM
• contributing up to 44% of maternal deaths in Africa
• 31% in Asia
• 21% in Latin America and the Caribbean
 MATERNAL MORTALITY
• In most developing countries 50-80% of supplied blood
is used for obstetrics emergencies
• Blood transfusion: one of the eight signal functions of
Comprehensive Emergency Obstetric Care (EmOC)
facilities
 MMR IN THE PHILIPPINES

114 deaths/100,000 live births

 VARIABLES AFFECTING
DEMAND AND SUPPLY
• Geography, population and epidemiology
• Level and rate of development of health care system
• Prevention: e.g. anemia, malaria
• Diagnosis: e.g. hemophilia
• Treatment: e.g. advanced medical and surgical procedures
• Location and accessibility of health care facilities
 VARIABLES AFFECTING
DEMAND AND SUPPLY
• Availability and use of alternatives to transfusion
• Blood conservation strategies
• Replacement fluids
• Medicines to avoid need for transfusion
 VARIABLES AFFECTING
DEMAND AND SUPPLY
• Capacity of blood service to provide safe blood to meet
routine and emergency transfusion needs
• Level of development of blood component program
• Communication and transportation system
 METHODS FOR BLOOD
ESTIMATION
• METHOD 1: BASED ON PREVIOUS USAGE
• METHOD 2: BASED ON POPULATION
• METHOD 3: BASED ON ACUTE HOSPITAL BEDS
 METHOD 1: BASED ON
PREVIOUS USAGE
• Analyze records for a specified period in a defined geographical
area, population or hospital:
• Number of units of blood/components requested
• Number of units of blood/components issued for transfusion
• Number of unfilled requests for blood/components:
e.g. elective surgeries cancelled
 METHOD 2: BASED ON
POPULATION
• Used to estimate the number of units of blood needed to
meet the blood requirements of a defined population
over one year
• Calculation is based on 1-3 % of population requiring
blood per year, based on level of development of health
care system
 METHOD 2: BASED ON
POPULATION
• Can be used to estimate the blood requirements of
individual regions or districts within the country
• Limitations: actual clinical demands for blood will depend
on:
• Epidemiology
• Level of sophistication of health care facilities and procedures
METHOD 3: BASED ON ACUTE
HOSPITAL BEDS
• Used to estimate the number of units of blood needed to
meet blood requirements of a defined hospital
population
• Calculate 6.7 units of blood required per acute hospital
bed per year
METHOD 3: BASED ON ACUTE
HOSPITAL BEDS
Example
• For a hospital with 50 acute beds, calculate: 50 x 6.7 = 335 units of blood
per year or approx. 7 units per week
• Number of donors required will depend on frequency of donation: e.g.
• 1 donation per donor per year = minimum 335 donors
• 2 donations per donor per year = minimum 168 donors
 METHOD 3: BASED ON ACUTE
HOSPITAL BEDS
Limitations:
• Number of hospital beds may be insufficient to meet requirements for
patient care
• Acute hospital beds will be used for patients requiring different levels of
transfusion support
• Growing trend for outpatient treatment, leading to reduced relevance of
hospital beds as health care indicator
 CHOICE OF METHOD
• Method 1 is the most practical, but depends on availability of records
of previous blood usage / unmet clinical demands for blood
• Methods 2 and 3 can be used to check estimates obtained using
Method 1
• Methods 2 and 3 are also useful for a newly established blood center or
where no data are available
 PLANNING BLOOD
COLLECTION
• Blood collection must be planned in a
systematic and cost-effective way to meet blood
requirements
• Blood groups
• Blood components
 PLANNING BLOOD
COLLECTION
• Donor recruitment and recall must similarly be planned
in a systematic way to meet blood collection targets
• Adequate number of donors
• Donor deferral
• Donation : donor ratio (how many donors give 2/3/4 donations
per year)
 SETTING TARGETS
• Number of donors recruited must be higher than number of blood units
required:
• Loss of donors between recruitment and donation: e.g. temporary/permanent
deferrals
• Loss of donated units during collection process: e.g. donor reactions, low volume
units
• Loss of donated units between donation and transfusion: e.g. discards after post
donation information from donors or TTI testing, expiry
 FACTORS TO CONSIDER IN
SETTING TARGETS
Donors
• Current donation rate per 1000 population
• Eligible donor population: proportion of the population likely to meet
donor selection criteria
• Proportion of regular donors
• Frequency of donation by regular donors
 FACTORS TO CONSIDER IN
SETTING TARGETS
Donors
• Difficulty in predicting number of donors who will attend a donor
session
• Deferrals: temporary or permanent
• Seasonal availability of donor populations: e.g. holiday periods,
school/university vacations, rainy season
 FACTORS TO CONSIDER IN
SETTING TARGETS
• Blood service
• Effectiveness of donor recruitment and recall systems
• Convenient locations and operating hours
• Public perception of the blood service
 FACTORS TO CONSIDER IN
SETTING TARGETS
• General
• Epidemiology
• General health and nutritional status of the population
• Social, political and economic conditions
• Conflict and natural disasters
 KEY POINTS
• Estimates of blood requirements are essential for
planning donor recruitment and blood collection
• Number of blood donors required will be greater than
number of units of blood required
 KEY POINTS
• Targets for donor recruitment and recall must be set in
conjunction with teams responsible for blood collection,
testing, processing and issue
• Meeting blood requirements requires a panel of regular
voluntary blood donors
DONOR MOTIVATION
 Donation venues and schedules:
• Least disruption to their normal activities

Strategy No. 1 • Accessibility

• Clean and pleasant
Make it • Safe with appropriate materials &
Convenient for equipment
Donors to Give • Reduce waiting time (efficient)
Blood • Pleasant experience
 • Improves accessibility to
donation opportunities
Strategy No. 2
• Carefully planned- donor
Reach out to oriented
Donors Through
Mobile Donor
• Challenges: logistics,
Sessions hygiene, temperatures
• Confidentiality
 • Donor & Patient safety
• Standard criteria
Strategy No. 3 • Deferral: self, temporary,
Assess Donors’ permanent
Suitability to • The assessment of donor
Donate Blood suitability: undertaken on
each occasion that a donor
attends to donate blood
 • Informing donors – “the right
to know”
Strategy No. 4 • Duty of care to deferred
donors
Provide Blood
Donor • Promote healthy lifestyle
Counselling • Sensitivity, care &
understanding
• Donor confidentiality
 • GUEST
• Friendly and welcoming
Strategy No. 5 atmosphere
• Positive attitude, sensitivity and
Make Blood attention to the donor
Donation a Safe • Smart, clean appearance
and Pleasant
Experience
• Technical and interpersonal
skills of personnel
• Addressing donor reactions
MANAGING ADVERSE
DONOR REACTIONS
 CORE TOPICS
• Types of adverse donor reaction
• Preventing adverse reactions
• Immediate management of adverse reactions
• Requirements for managing adverse reactions
 TYPES OF ADVERSE DONOR
REACTIONS
• Local reactions due to complications of the
venipuncture: e.g.
• Bruising, haematoma, allergy, infection, nerve injury, arterial
puncture
• Accidents:
• e.g. Falls
 TYPES OF DONOR
REACTIONS
• Systemic reactions
• Usually due either to vasovagal effects or
hypovolaemia
• Other severe systemic reactions include seizures,
myocardial infarction, cerebrovascular accidents, tetany
 PREVENTING ADVERSE
DONOR REACTIONS
• Before blood donation
• Donor information
• Careful donor selection process with regard to medical conditions and
previous donation history
 PREVENTING ADVERSE
DONOR REACTIONS
• Use of simple, evidence-based and cost effective methods to
reduce donor reactions: e.g.
• Increased fluid intake before donation, especially for young donors
 PREVENTING ADVERSE
DONOR REACTIONS
• During blood donation, extra care for:
• First-time donors
• Young donors
• Female donors
• Anxious donors
 PREVENTING ADVERSE
DONOR REACTIONS
• After blood donation
• Appropriate resting time
• Refreshments
• Postdonation instructions
• Close monitoring, especially of susceptible donors
MANAGING ADVERSE DONOR
REACTIONS
• Donor safety and well-being is a priority
• Early and prompt treatment is required
• To minimize the severity of the reaction
• To prevent it from worsening
MANAGING ADVERSE DONOR
REACTIONS
• Appropriate management
• Minimizes negative donor perceptions resulting from
the reaction
• Encourages the likelihood of donor return
 MANAGING ADVERSE DONOR
REACTIONS
• Reactions before blood is withdrawn
• Defer the donor and reschedule for another time
 MANAGING ADVERSE DONOR
REACTIONS
• Reactions during or after withdrawal of blood
• Secure the donor
• Discontinue the donation and remove the needle
• Continue to manage the reaction appropriately
• Provide advice on specific self-care
MANAGING ADVERSE DONOR
REACTIONS
• Provide reassurance and counselling
• Record the incident in individual donor record
• Report to the hemovigilance
MANAGING ADVERSE DONOR
REACTIONS
• Try to find the cause by following up on the donor's history:
medical and personal
• Contact the donor after leaving the donor clinic
• If multiple recurrence or severe reactions
• Discourage donor from donating again
• Encourage donor to support donor recruitment
 RESOURCES REQUIRED
• Standard operating procedures
• Staff training in identifying and managing adverse reactions, counselling
and first aid measures
• Equipment for emergency management
• Fixed sites
• Mobile sites
• Donor information and education materials
 RESOURCES REQUIRED
• Postdonation care instructions
• Documentation in individual donor record
• Reporting as part of haemovigilance system
 DONOR INCIDENTS
• Record of incidents at donor sessions
• Errors
• Accidents
• Donor reactions
 DONOR INCIDENTS
• Follow-up of incidents
• Investigation
• Findings
• Corrective and preventive action
 KEY POINTS
• Donor well-being is the blood service’s top priority
• Good donor education and donor selection procedures
minimize the likelihood of adverse reactions
• Adverse reactions must be managed professionally with
the health and safety of the donor being the first concern
 REFERENCES
• Adapted from the Course on Developing VBD Program by WHO
• Donor Recruitment Officer Training conducted by the PBCC
• Estimation of blood needs report by WHO