Volume 22, Issue 1 (Spring 2025)
Sci J Iran Blood Transfus Organ 2025, 22(1): 1-10 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Amini-kafiabad S, Teimourpour A, Rafiee M H, Maghsudlu M, Moghtadaee M. Analysis of Trends in Look-back Units Based on Post-Donation Information in Plasma Shipments for Contract Fractionation, 2018-2021. Sci J Iran Blood Transfus Organ 2025; 22 (1) :1-10
URL: http://bloodjournal.ir/article-1-1570-en.html
URL: http://bloodjournal.ir/article-1-1570-en.html
Sedigheh Amini-kafiabad * 
, Amir Teimourpour , Mohammad Hesam Rafiee , Mahtab Maghsudlu , Mina Moghtadaee
, Amir Teimourpour , Mohammad Hesam Rafiee , Mahtab Maghsudlu , Mina Moghtadaee
Abstract: (377 Views)
A B S T R A C T
Background and Objectives
In 2006, the Iranian Blood Transfusion Organization (IBTO) mandated the look-back process as a critical measure to improve blood safety. A fundamental aspect of this process is post-donation information (PDI), which focuses on identifying high-risk donor behaviors that may not be recognized during the donor selection process. This study examines trends in the number of look-back units associated with high-risk donor behaviors in plasma used for the production of plasma-derived medicines (PDMPs).
Materials and Methods
In this cross-sectional study, we collected retrospective data from Blood Transfusion Centers authorized to supply plasma for the production of PDMPs. The data included information on blood donations, deferred blood donors, plasma units designated for fractionation, and Look-back units related to PDI, as well as associated risk factors. These data were categorized based on various risk factors. The Cochran-Armitage test was employed to assess the linear trend in Look-back risk over time. The risk ratio was reported as the effect size, accompanied by a 95% confidence interval. All statistical calculations were performed using the 'epitools' package in R software.
Results
From 2018 to 2021, voluntary non-remunerated blood donors contributed a total of 8,035,586 units of blood. Of these, 46% were sent to plasma fractionators to produce PDMPs. During this period, the number of Look-backs related to PDI decreased from 24.4 (2,191 units) to 17.7 (1,727 units) per 10,000 plasma units intended for medicine production (RR: 0.73; 95% CI: 0.68-0.78; p< 0.001). The key risk factors associated with Look-back cases based on PDI were injection drug use (p= 0.001) and high-risk sexual behavior (p< 0.001), both of which showed a significant decreasing trend over the study period. In contrast, factors such as tattooing (p= 0.01) and traditional practices including wet cupping (Hijama), and acupuncture (p< 0.001) showed an increasing trend and significant changes.
Conclusions
This study emphasizes the critical role of evaluating high-risk behaviors in blood donor selection to enhance blood safety. High-risk behaviors include practices such as injection drug use, high-risk sexual behaviors, as well as getting tattoos, wet cupping (Hijama), and acupuncture. Strengthening donor selection may minimize the number of Look-back units and improve overall blood safety.
Background and Objectives
In 2006, the Iranian Blood Transfusion Organization (IBTO) mandated the look-back process as a critical measure to improve blood safety. A fundamental aspect of this process is post-donation information (PDI), which focuses on identifying high-risk donor behaviors that may not be recognized during the donor selection process. This study examines trends in the number of look-back units associated with high-risk donor behaviors in plasma used for the production of plasma-derived medicines (PDMPs).
Materials and Methods
In this cross-sectional study, we collected retrospective data from Blood Transfusion Centers authorized to supply plasma for the production of PDMPs. The data included information on blood donations, deferred blood donors, plasma units designated for fractionation, and Look-back units related to PDI, as well as associated risk factors. These data were categorized based on various risk factors. The Cochran-Armitage test was employed to assess the linear trend in Look-back risk over time. The risk ratio was reported as the effect size, accompanied by a 95% confidence interval. All statistical calculations were performed using the 'epitools' package in R software.
Results
From 2018 to 2021, voluntary non-remunerated blood donors contributed a total of 8,035,586 units of blood. Of these, 46% were sent to plasma fractionators to produce PDMPs. During this period, the number of Look-backs related to PDI decreased from 24.4 (2,191 units) to 17.7 (1,727 units) per 10,000 plasma units intended for medicine production (RR: 0.73; 95% CI: 0.68-0.78; p< 0.001). The key risk factors associated with Look-back cases based on PDI were injection drug use (p= 0.001) and high-risk sexual behavior (p< 0.001), both of which showed a significant decreasing trend over the study period. In contrast, factors such as tattooing (p= 0.01) and traditional practices including wet cupping (Hijama), and acupuncture (p< 0.001) showed an increasing trend and significant changes.
Conclusions
This study emphasizes the critical role of evaluating high-risk behaviors in blood donor selection to enhance blood safety. High-risk behaviors include practices such as injection drug use, high-risk sexual behaviors, as well as getting tattoos, wet cupping (Hijama), and acupuncture. Strengthening donor selection may minimize the number of Look-back units and improve overall blood safety.
References
1. Amini Kafi-abad S, Rezvan H, Abolghasemi H, Talebian A. Prevalence and trends of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus among blood donors in Iran, 2004 through 2007. Transfusion 2009; 49(10): 2214-20. [DOI:10.1111/j.1537-2995.2009.02245.x] [PMID]
2. Cohn Claudia S, Delaney M, Johnson ST, Louis MK. Technical Manual. 21st ed. USA: AABB; 2023. p. 169-214.
3. WHO. Blood donor counselling: implementation guidelines. USA: WHO; 2014.
4. WHO. Blood donor selection: guidelines on assessing donor suitability for blood donation. USA: WHO; 2012.
5. WHO. Guidelines for blood donor counselling on human immunodeficiency virus (HIV). USA: WHO; 1994.
6. Byrne L, Brant LJ, Davison K, Hewitt P. Transfusion transmitted human immunodeficiency virus (HIV) from seroconverting donors is rare in England and Wales: results from HIV lookback, October 1995 through December 2008. Transfusion 2011; 51(6): 1339-45. [DOI:10.1111/j.1537-2995.2010.02996.x] [PMID]
7. Gill M, Towns D, Allaire S, Meyers G. Transmission of human immunodeficiency virus through blood transfusion: the use of lookback and traceback approaches to optimize recipient identification in a regional population. Transfusion 1997; 37(5): 513-6. [DOI:10.1046/j.1537-2995.1997.37597293883.x] [PMID]
8. FDA. Nucleic Acid Testing (NAT) for Human Immunodeficiency Virus Type 1 (HIV-1) and Hepatitis C Virus (HCV): Testing, Product Disposition, and Donor Deferral and Reentry. USA: Department of Health and Human Sciences; 2017.
9. FDA. Guidance for Industry: "Lookback" for Hepatitis C Virus HCV): Product Quarantine, Consignee Notification, Further Testing, Product Disposition, and Notification of Transfusion Recipients Based on Donor Test Results Indicating Infection with HCV. USA: Department of Health and Human Sciences; 2013.
10. Pawson R, Rajan S, Hazlehurst G, Dusheiko G, Miller R, Hewitt P, et al. Hepatitis C lookback programme: a single hospital experience. Transfus Med 1999; 9(3): 189-93. [DOI:10.1046/j.1365-3148.1999.00197.x] [PMID]
11. Christensen PB, Groenbæk K, Krarup HB, Gaub J, Møller A, Skinhøj P, et al. Transfusion-acquired hepatitis C: the Danish lookback experience. Transfusion 1999; 39(2): 188-93. [DOI:10.1046/j.1537-2995.1999.39299154734.x] [PMID]
12. Tynell E. Prevention of transfusion transmitted infections. Donor screening and characteristics of recipient populations [Thesis]. Stockholm: Karolinska University; 2005. p. 29-30.
13. Menozzi D, Udulutch T, Llosa AE, Galel SA. HCV lookback in the United States: effectiveness of an extended lookback program. Transfusion 2000; 40(11): 1393-8. [DOI:10.1046/j.1537-2995.2000.40111393.x] [PMID]
14. IBTO. Iranian National Standards for Blood Transfusion. 3rd ed. Tehran: Teimourzadeh Pub; 2016. p. 33. [Persian]
15. JPAC. Chapter 5.7: Whole blood donation. Guidelines for the Blood Transfusion and Tissue Transplantation Services in the UK. https://www. transfusionguidelines. org. Accessed 24 October 2024.
16. Health Canada. Guidance Document: Blood Regulations. Canada: Health Canada; 2016. p. 242.
17. Vuk T, Garraud O, Politis C. Post-donation information management. Transfus Clin Biol 2021; 28(4): 407-13. [DOI:10.1016/j.tracli.2021.08.006] [PMID]
18. Teimourpour A, Moghtadaee M, Amini-Kafiabad S, Maghsoodlu M, Rafiee M. Investigating the trend of look-back units in the plasma for contract fractionation during 2018-2021. Sci J Iran Blood Transfus Organ 2024; 21(3): 185-96. [Article in Farsi]
19. FDA. Revised Recommendations for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products. USA: Department of Health and Human Sciences; 2020.
20. Kiely P, Hoad VC, Wood EM. False positive viral marker results in blood donors and their unintended consequences. Vox Sang 2018; 113(6): 530-9. [DOI:10.1111/vox.12675] [PMID]
21. Ramsey G. Blood component recalls and market withdrawals: frequency, reasons, and management in the United States. Transfus Med Rev 2013; 27(2): 82-90. [DOI:10.1016/j.tmrv.2012.11.001] [PMID] []
22. Williams AE, Thomson RA, Schreiber GB, Watanabe K, Bethel J, Lo A, et al. Estimates of infectious disease risk factors in US blood donors. JAMA 1997; 277(12): 967-72. [DOI:10.1001/jama.1997.03540360035027]
23. Agresti A. Categorical Data Analysis. USA: John Wiley & Sons; 2018. p. 46.
24. Rafiee MH, Kafiabad SA, Maghsudlu M. Analysis of blood donors' characteristics and deferrals related to COVID-19 in Iran. Transfus Apher Sci 2021; 60(2): 103049. [DOI:10.1016/j.transci.2020.103049] [PMID] []
25. Iranian Blood Transfusion Organization's Booklet; 2023. Available from: https://en.ibto.ir/uploads/En-ketabche1-final.pdf.
26. Ranjbar Kermani F, Chegini A, Sharifi Sh, Zadsar M. Changing Blood Donor's Characteristics after COVID-19 Emergence, the Young and Female Blood Donors' Role to Maintain A Safe Supply. Iranian Red Crescent Medical Journal (IRCMJ) 2024; 26(1): 1-7.
27. Divkolaye N, Arabkhazaeli A, Hajibeigi B, Eshghi P. The impact of COVID-19 on blood safety and availability in the Islamic Republic of Iran. East Mediterr Health J 2022; 28(11): 823-8. [DOI:10.26719/emhj.22.080] [PMID]
28. Conti G, Notari IV EP, Dodd RY, Kessler D, Custer B, Bruhn R, et al. Changes in transfusion-transmissible infection prevalence and demographics among US blood donors during the COVID-19 pandemic. Transfusion 2024; 64(6): 1040-9. [DOI:10.1111/trf.17851] [PMID]
29. Burananayok S, Nachatri W, Choothanorm P, Kusolthammarat K, Jaruthamsophon K, Yodsawad C, et al. COVID-19 impact on blood donor characteristics and seroprevalence of transfusion-transmitted infections in southern Thailand between 2018 and 2022. Sci Rep 2024; 14(1): 7920. [DOI:10.1038/s41598-024-57584-z] [PMID] []
30. Loua A, Kasilo OMJ, Nikiema JB, Sougou AS, Kniazkov S, Annan EA. Impact of the COVID-19 pandemic on blood supply and demand in the WHO African region. Vox Sang 2021; 116(7): 774-84. [DOI:10.1111/vox.13071] [PMID] []
31. Yazer MH, Jackson B, Pagano M, Rahimi-Levene N, Peer V, Bueno JL, et al. Vox Sanguinis international forum on transfusion services' response to COVID-19: summary. Vox Sang 2020; 115(6): 536. [DOI:10.1111/vox.12943] [PMID] []
32. Franchini M, Farrugia A, Velati C, Zanetti A, Romanò L, Grazzini G, et al. The impact of the SARS-CoV-2 outbreak on the safety and availability of blood transfusions in Italy. Vox Sang 2020; 115(8): 603. [DOI:10.1111/vox.12928] [PMID] []
33. Seighali F, Divkolaye NSH, Rezaei N, Kangarloo M. Risk factors associated with human immunodeficiency virus infection in blood donors in Iran: A case-control study. Asian J Transfus Sci 2021; 15(2): 183-8. [DOI:10.4103/ajts.AJTS_47_18] [PMID] []
34. Rezaei N, Amini-Kafiabad S, Maghsudlu M, Abolghasemi H. Risk factor analysis of hepatitis C virus seropositivity in Iranian blood donors: a case-control study. Transfusion 2016; 56(7): 1891-8. [DOI:10.1111/trf.13660] [PMID]
35. Ranjbar Kermani F, Hosseini KM, Kafi-abad SA, Maghsudlu M, Sharifi Z, Mansournia MA, et al. Update on transmission modes of hepatitis C virus among volunteer Iranian blood donors: analysis of a matched case-control study by penalized conditional logistic regression. Hepat Mon 2018; 18(10): e69395. [DOI:10.5812/hepatmon.69395]
36. Lieshout-Krikke RW, van 't Ende EA, Slot E, Karomi S, Kivit RM, Zaaijer HL. Infectivity of pre-seroconversion donations: an analysis of lookback exercises in The Netherlands, 2000-2006. Vox Sang 2012; 102(3): 193-7. [DOI:10.1111/j.1423-0410.2011.01537.x] [PMID]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
