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Background and objectives Many Western countries face a shortage of African blood donors, while their specific blood groups are needed to transfuse chronic transfusion patients of similar ethnic background. Blood donation awareness and attitudes greatly impact the decision to become a blood donor, but how they are related and differ across ethnic groups is understudied. This study investigated blood donation awareness and attitudes of individuals of Dutch and African descent in the Netherlands. Materials and methods Survey data of 257 African and 152 Dutch non-donors measuring donation awareness (i.e. being familiar with the Dutch blood bank organization and knowing others who donated blood), cognitive (evaluative judgements) and affective (emotional reactions) attitudes were included. t-Tests, chi-square tests, linear and logistic regressions were conducted to study differences and associations between donation awareness and attitudes. Results African individuals were less often aware of the Dutch blood bank organization (43%; p < 0·05) or others who donated blood (51%; p < 0·05) than Dutch individuals (55% and 68%, respectively). African individuals had lower cognitive donation attitudes compared with Dutch individuals (p < 0·001), but no differences were found for affective attitudes (p = 0·55). High donation awareness was associated with higher cognitive (p < 0·001) and affective (p < 0·05) donation attitudes among African minorities, but not among Dutch individuals. Conclusion The lower donation awareness and cognitive attitudes of African minorities should be taken into consideration in donor recruitment. Raising awareness through effective communication strategies might be essential in the donor decision making process of this target group.

Whole blood donors, especially frequently donating donors, have a risk of iron deficiency and low hemoglobin levels, which may affect their health and eligibility to donate. Lifestyle behaviors, such as dietary iron intake and physical activity, may influence iron stores and thereby hemoglobin levels. We aimed to investigate whether dietary iron intake and questionnaire-based moderate-to-vigorous physical activity were associated with hemoglobin levels, and whether ferritin levels mediated these associations. In Donor InSight-III, a Dutch cohort study of blood and plasma donors, data on heme and non-heme iron intake (mg/day), moderate-to-vigorous physical activity (10 minutes/day), hemoglobin levels (mmol/L) and ferritin levels (μg/L) were available in 2,323 donors (1,074 male). Donors with higher heme iron intakes (regression coefficients (β) in men and women: 0.160 and 0.065 mmol/L higher hemoglobin per 1 mg of heme iron, respectively) and lower non-heme iron intakes (β: -0.014 and -0.017, respectively) had higher hemoglobin levels, adjusted for relevant confounders. Ferritin levels mediated these associations (indirect effect (95% confidence interval) in men and women respectively: 0.074 (0.045; 0.111) and 0.061 (0.030; 0.096) for heme and -0.003 (-0.008;0.001) and -0.008 (-0.013;-0.003) for non-heme). Moderate-to-vigorous physical activity was negatively associated with hemoglobin levels in men only (β: -0.005), but not mediated by ferritin levels. In conclusion, higher heme and lower non-heme iron intake were associated with higher hemoglobin levels in donors, via higher ferritin levels. This indicates that donors with high heme iron intake may be more capable of maintaining iron stores to recover hemoglobin levels after blood donation.

BACKGROUND: Willingness to donate blood depends on personal characteristics, beliefs, and motivations, but also on the cultural context. The aim of this study was to examine whether willingness to donate blood is associated with attitudes toward blood transfusion, personal motivators, and incentives and whether these factors vary across countries in the European Union (EU). STUDY DESIGN AND METHODS: The sample consisted of 27,868 participants, from 28 EU member states, who were interviewed about blood donation and transfusion-related issues for the 2014 round of the Eurobarometer, a country-comparative survey, collected on behalf of the European Commission. Participants were asked whether they would be willing to donate blood and for which reasons (motivators) and which incentives are appropriate to receive in return for a blood donation. RESULTS: Willingness to donate varied significantly across countries and was positively associated with perceived blood transfusion safety. Furthermore, helping family or people in need were the most powerful motivators for blood donation willingness in almost all countries. In contrast, the number of participants who were willing to donate to alleviate shortages or to contribute to research varied widely across countries. The wish to receive certain incentives, however, did not seem to be related to willingness to donate. CONCLUSION: Perceived blood transfusion safety and personal motivations may be stronger determinants of willingness to donate than receiving certain incentives. EU-wide strategies and guidelines for donor recruitment and retention should take both overall and country-specific patterns into account. For example, education on the importance of donation could be considered.

In this paper, we use register data on all blood donors (n = 259,172) and changes in geographical locations of blood donation centers in the Netherlands over the past decade, to examine the strength of altruistic motivations in blood donation by testing how blood donor behavior changes after the cost of donating in the form of time and inconvenience increases. We examined whether closing donation centers influences blood donor lapse, and whether the risk for lapse varies between donors with different blood groups. A lower lapsing risk for donors with universal, O-negative blood as costs increase is considered as evidence of altruism: continued efforts in making a societal impact despite the increased time commitment would indicate altruism in donor behavior. In the total sample, 137,172 (52.9%) donors lapsed at least once. We found a very strong effect of changes in the distance to the nearest collection point on donor lapse. Donors whose nearest donation center closed were 53% more likely to lapse than donors whose donation center remained open, with the risk for donor lapse increasing with each extra kilometer distance to the new nearest donation center. While O-negative donors were 10.5% less likely to lapse after closing a donation center compared to donors with other blood groups, the effect of closing was similar across blood groups. Based on these results, we conclude that blood donors are clearly sensitive to cost changes imposed by blood banks and that they are not particularly motivated by altruistic concerns. Future studies are recommended to further examine the role of contextual factors in motivational change across the blood donor career. Blood banks are advised to strategically place donation centers throughout the country to promote blood donations, and design interventions to reduce donation barriers after changing their donation centers’ locations.

Background and objectivesBlood donors of African descent are essential for the availability of specific antigen-negative blood, yet past recruitment strategies yielded limited successes. The aim was to systematically develop an intervention to recruit African blood donors in the Netherlands, following the Intervention Mapping (IM) protocol.Materials and methodsBased on the previous needs-assessment (Step 1), change objectives (Step 2) and practical strategies (Step 3) were developed, and further determined through eight interviews and two focus groups with blood bank staff and experts. The strategies were then translated into a magazine article pilot-experiment (n = 16) as part of the programme production (Step 4). The magazine appraisal and intention-change were studied of the target group and compared with a previously published magazine article and a control group in an online survey.ResultsImportant factors in the needs-assessment related to donation awareness and knowledge and were also rated by staff and experts as most relevant and feasible determinants. The finalized objectives and strategies consisted of awareness raising and understanding how and where to donate blood. In the magazine pilot, the look and feel of the previously published article was higher valued, but the newly developed article’s content was higher rated. Reading the magazine articles increased donation intention as compared to the pre-test and reference, but the increase did not differ between the articles.ConclusionIM helped to define intervention objectives and strategies and gave valuable insights in how to implement (step 5) and evaluate (step 6) a donor recruitment intervention.

Background and objectives: Blood donors might develop iron deficiency as approximately 250 mg of iron is lost with every donation. Susceptibility to iron deficiency and low haemoglobin levels differs between individuals, which might be due to genetic variation. Therefore, the aim of this study was to investigate associations between single nucleotide polymorphisms (SNPs) and haemoglobin trajectories, haemoglobin levels and ferritin levels in blood donors. Materials and methods: In 2655 donors participating in the observational cohort study Donor InSight-III (2015–2017), haemoglobin and ferritin levels were measured in venous EDTA whole blood and plasma samples, respectively. Haemoglobin trajectories (stable/declining) were determined by fitting growth-mixture models on repeated pre-donation capillary haemoglobin measurements. Genotyping was done using the UK Biobank – version 2 Axiom Array. Single SNP analyses adopting an additive genetic model on imputed genetic variants were performed for haemoglobin trajectories, haemoglobin levels and ferritin levels. Conditional analyses identified independent SNPs. Results: Twelve, twenty and twenty-four independent SNPs were associated with haemoglobin trajectories, haemoglobin levels and ferritin levels respectively (P

Background Blood donors are at risk for reduced iron stores, because of which donor iron monitoring received increased attention in the last decade. Despite the importance for donor health, international consensus on an appropriate policy for iron monitoring is lacking. Therefore, we conduct a trial to evaluate to what extent ferritin-guided donation intervals are effective in increasing haemoglobin and ferritin levels, decreasing low-haemoglobin deferral, increasing donor return and improving the health of whole blood donors in the Netherlands. Methods Sanquin Blood Bank is implementing ferritin-guided donation intervals to prevent donors from increasing iron loss at repeated donations. Using a stepped wedge cluster randomised trial approach, the design involves a random crossover of 29 clusters of blood collection centres from the existing policy without ferritin measurements to a ferritin-guided donation interval policy. This new policy includes ferritin measurements for all new donors and at every 5th whole blood donation, extending donation intervals to 6 months if ferritin is 15–≤ 30 ng/mL and to 12 months if ferritin is Discussion This stepped wedge cluster randomised trial will provide insight into the effectiveness of ferritin-guided donation intervals in lowering iron deficiency, decreasing donor deferrals due to low haemoglobin and improving donor health. We will evaluate a policy that is implemented nationwide in a real-life setting. Our study is therefore not limited to a small experimental setting and the results will guide policymakers seeking an appropriate policy for iron monitoring. Trial registration The Dutch trial registry NTR6738. Registered on 29 September 2017. Retrospectively registered.

BACKGROUND: Blood donors with a relatively low haemoglobin (Hb) level at their previous donation attempt have an increased risk of Hb deferral at the subsequent donation attempt. The aim of this study was to investigate whether the interventions prolongation of donation interval and/or a dietary advice decrease the Hb deferral rate.METHODS: 11 897 whole blood donors with Hb levels from below to 0·2 mmol/l above the cut-off level for donation received either no intervention, a prolongation of the donation interval to six or twelve months, a dietary advice, or both. Deferral rates for low Hb levels at the subsequent donation attempt were compared in the different intervention groups. Additionally, the effects of the interventions on Hb deferral risk and donor return for a subsequent donation attempt were analysed using generalized estimating equations.RESULTS: The Hb deferral rate was substantially lower in the group that received a prolongation of the donation interval to six months than in the Control Group (12·9% vs. 6·3% in men and 20·4% vs. 13·4% in women). However, the additional benefit of twelve over 6-month interval prolongation was small, and no benefit of a dietary advice showed up. On the other hand, receiving a dietary advice increased the likelihood of donor return for a subsequent donation attempt.CONCLUSION: Implementation of a protocol for the prolongation of donation intervals to six months for donors with Hb levels from below to slightly above the cut-off level for donation may reduce the deferral rate for low Hb levels while keeping donor lapse at a minimum.

Objective: To investigate the added value of questionnaire-based predictors to existing prediction models for low haemoglobin (Hb) deferral in whole blood donors. Background: Prediction models for Hb deferral risk can be applied in the invitation process of donors for a blood donation. Existing prediction models are based on routinely collected data. The model performance might be improved by the addition of predictive factors. Methods: The added value of food consumption, smoking, physical activity, ethnicity and menstruation in the prediction of Hb deferral was assessed by comparing the existing models with extended models using the following measures: model X2, concordance (c)-statistic and net reclassification improvement (NRI). Results: Addition of one candidate predictor to the models did not substantially improve the model performance. Addition of multiple new candidate predictors significantly increased the model X2 (from 137 to 159 for men, and from 157 to 199 for women) and resulted in a non-significant increase of the c-statistic (from 0.85 to 0.87 for men, and from 0.78 to 0.81 for women). The NRI for men was 11.4% and for women 1.5% after addition of multiple predictors. Conclusion: Addition of lifestyle behaviours, ethnicity or menstruation to prediction models for low Hb deferral in whole blood donors improved the model performance, but not substantially. For easy use in practice, we do not recommend addition of the investigated predictors to the prediction models.

Background and objectives: The likelihood of donating blood changes over the life course, with life events shown to influence entry to and exit from the donor population. While these previous findings provide valuable insights for donor management, blood collection agencies need to be cautious about generalizing findings to other countries as blood donor behaviour is context-specific. To examine cross-country variations in donor behaviour, the repeatability of a previous Dutch study on life events and blood donor lapse is examined by using a sample of Danish donors.Materials and methods: Register data from Statistics Denmark was linked to the Scandinavian Donations and Transfusions database (n = 152 887). Logistic regressions were conducted to examine the association between life events in 2009–2012 and blood donor lapse in 2013–2014.Results: Of the total sample, 69 079 (45·2%) donors lapsed. Childbirth and losing a job increased the lapsing risk by 11% and 16%, respectively, while health-related events in the family (i.e. blood transfusion, disease and death) decreased the lapsing risk by 5%, 7% and 9%, respectively.Conclusion: Life events are associated with donor lapse of Danish donors. These results are comparable to previous findings from the Netherlands (i.e. childbirth and labour market transitions increased lapsing risk; health-related events decreased lapsing risk), with two thirds of the associations being in the same direction. Differences between study results were mainly related to effect sizes and demographic compositions of the donor pools. We argue contextual factors to be of importance in blood donor studies.

BACKGROUND: The successful introduction of prophylaxis with anti-RhD immunoglobulin has resulted in a significant decline of pregnancy-related RhD immunizations but also has decreased the availability of naturally immunized women as (new) anti-D donors. An influx of new donors is necessary to maintain a sufficient pool of anti-D donors. We investigated motivators, barriers, and predictors for anti-D donorship in RhD-immunized women. STUDY DESIGN AND METHODS: A mixed-methods design was applied, including focus group discussions and questionnaires. Two focus groups (including 11 women) served as input for the questionnaire. RESULTS: In total, 47.6% of 750 anti-D donors and potential donors completed the questionnaire (50.4% donors; 38% nondonors; 11.6% former donors). Almost 70% of the nondonors would have become donors if they had known about the possibility. Travel time investment was reported as a disadvantage; one-half of donors mentioned no disadvantages. Motivators for anti-D donorship were “doing something in return” (31.2%) and “preventing others having a sick child or losing a child” (33.9%). In multivariable analysis, living single (odds ratio, 5.8; p = 0.02) and living partnered without resident children (odds ratio, 7.9; p = 0.03), compared with living partnered with children, were predictors for anti-D donorship. Not being registered as an organ donor (odds ratio, 0.25; p < 0.001) predicted that the individual would not be an anti-D donor. CONCLUSION: The main barrier for anti-D donorship was a lack of knowledge. Positive predictors of anti-D donorship were living without resident children, altruism, and being registered as an organ donor. A blood bank should develop targeted recruitment strategies with a focus on spreading knowledge about anti-D donorship among RhD-immunized women.

Background Deferral for low hemoglobin (Hb) increases the likelihood that donors do not return for future donations. Zinc protoporphyrin (ZPP) has been described as a sensitive marker of iron-deficient erythropoiesis, before Hb decreases. It is a relatively cheap, rapid, and easy-to-perform measurement in a drop of whole blood. To assess the utility of ZPP measurement in donor management we examined whether ZPP and Hb levels among first-time donors differ from repeat donors. We further explored whether ZPP increases over subsequent donations at a donor population level and whether increasing ZPP levels coincide with decreasing Hb levels and donor deferral. Study design and methods We included first-time (n = 4983) and repeat (n = 3533) whole blood donors from the ZPP and Iron in the Netherlands Cohort (ZINC) study. ZPP and Hb were measured at each subsequent donation during a 4-year period after inclusion in the study. Results Median ZPP levels were higher in repeat than in first-time donors. In first-time donors, especially women, ZPP levels were increased with a corresponding decline in Hb levels over subsequent donations. ZPP levels were increased among first-time donors deferred for low Hb. Conclusion Our results suggest that adding ZPP to Hb measurements in the daily blood collection setting, especially for first-time donors and first-time female donors may add to the identification of a donor subpopulation with low functional iron stores.

BACKGROUND: Several countries have changed, or are reevaluating, their blood donor policies for men who have had sex with men (MSM). Changing policies has consequences for donor recruitment and the donor pool. In this study, we investigated whether MSM are eligible and willing to donate blood. STUDY DESIGN AND METHODS: Members of a research panel (n = 4422) in the Netherlands were invited to participate in an online survey. We asked questions about male-to-male sex and risk behavior that are also asked during the predonation screening of a blood donor. Furthermore, we asked questions about willingness to donate. RESULTS: The total response rate was 60% (n = 2654). Of MSM nondonors (n = 230), 32.2% would be eligible to donate under a 12-month deferral policy, according to their reported risk history and last male-to-male sex. In other scenarios, 42.6% (4-month deferral), 38.7% (6-month deferral), and 18.7% (5-year deferral) would be eligible to donate. When not taking their last male-to-male sex into account (n = 203), 47.8% of MSM reported a moderate or high willingness to donate. CONCLUSION: A 12-month deferral after last male-to-male sex is a commonly used criterion by blood services. Approximately one-third of the MSM in our study would be eligible to donate under this deferral policy. Higher proportions of MSM would be eligible to donate in shorter deferral scenarios. Almost half of MSM are willing to donate blood. Targeting MSM by donor recruitment campaigns could therefore prove fruitful.

Introduction: In the Netherlands, there is a constant shortage in donor organs, resulting in long waiting lists. The decision to register as organ donor is associated with several demographic, cultural, and personal factors. Previous research on attitudes and motivations toward blood and organ donations provided similar results. Research Question: The current study investigated demographic, cultural, and personal determinants of organ donation registration among current Dutch blood donors. Design: We used data from Donor InSight (2012; N = 20 063), a cohort study among Dutch blood donors, to test whether age, gender, religious and political preferences, donor attitude, and altruism predicted organ donor registration among current blood donors. Results: Organ donors were more often represented in the blood donor population compared to the general Dutch population. Women showed a higher propensity to be registered as organ donor. Higher education as well as higher prosocial value orientation, prosocial behavior, that is, doing volunteer work, and awareness of need significantly associated with being registered as organ donor. Religious denomination negatively predicted organ donation registration across all faiths. Discussion: Results are discussed in light of cultural context, and possible implications for improving information provision and recruitment are mentioned.

BACKGROUND: In the Netherlands, needle-related events (NREs) including tattoos, piercings, and acupuncture are a reason for temporary blood donor deferral. This study aims to evaluate whether donors with recent NREs had a higher risk of transfusion-transmissible infections (TTIs) compared to donors without recent NREs. STUDY DESIGN AND METHODS: Data from 2006 through 2015 on all blood donation attempts in the Netherlands were collected. Multivariate regression models (for repeated measurements) were used to assess the associations between recent NREs and the acquisition of TTIs. Posttest counseling data were used to determine the most likely risk factor in TTI-positive new and repeat donors. RESULTS: Recent NREs were documented in 97,518 out of 9,266,036 (1.1%) donation attempts; 14,097 (14.5%) NREs resulted in NRE-based donor deferral. Recent NREs reported pre-donation were not associated with an increased risk for TTIs. A total of 29 out of 287 TTI-positive donors (11 repeat donors, 18 new donors) reported a recent NRE pre- and/or post-donation. Recent NREs, all needle-stick injuries, were the likely route of transmission in 12 out of 287 (4.2%) of TTI-positive donors. The donor health questionnaire (DHQ) identified only 1 out of 12 TTI-linked NREs. Non-return after NRE deferral, any deferral, or no deferral was 24, 15, and 5%, respectively. DISCUSSION: Recent tattoos, body piercings, or acupuncture were not associated with an increased risk for TTIs in Dutch donors. Given the lower return rates of donors following a temporary NRE-based deferral, we advocate ending blood donor deferral policies for acupuncture, tattooing, and body piercings, but not needle-stick injuries, in countries where these practices can be considered safe.

African migrants are underrepresented as blood donors in many Western countries, which can lead to shortages of specific blood types for transfusion. More insight in the reasons for this underrepresentation is required to improve blood donor recruitment and retention strategies. The aim of this qualitative study was to explore barriers and motivators for donating blood among migrants of African background. The research population consisted of first and second generation African‐Surinamese (n = 20) and Ghanaian (n = 16) migrants living in the Netherlands. In semi‐structured personal interviews performed in 2016 and 2017, their experiences and opinions regarding blood donation, barriers, and motivators to (not) become a blood donor and their suggestions to improve recruitment were explored. Data collection was continued until data saturation was achieved. The interviews revealed that although all participants knew about blood donation in general, only four had previously heard of the Dutch national blood bank organisation. Participants expected that if blood was needed, the blood bank would directly approach them, as in their country of origin. Other main blood donation barriers were fear (e.g., of needles, losing too much blood) and issues related to health and non‐eligibility to donate. Main motivators were mainly of altruistic nature (e.g., saving a life) and an increased awareness of the need via personal recruitment appeals. It is concluded that expectations regarding donor recruitment—derived from the country of origin—and unawareness of the need for blood can act as important barriers in blood donation among African migrants. Contrary to studies in the United States and Australia, perceived discrimination and social exclusion did not seem to be a donation deterrent among migrants in the Netherlands. Creating awareness of the need of blood by actively approaching, and informing migrants about the donation procedure in the host country, should be considered by blood banks.

Background In low and middle-income countries (LMIC), the total and LDL cholesterol and triglyceride levels of residents of urban areas are reported to be higher than those of rural areas. This may be due to differences in lifestyle behaviors between residents of urban areas and rural areas in LMIC. In this study, our aims were to (1) examine whether or not LDL cholesterol, total/HDL ratios and triglyceride levels of individuals in densely populated areas are higher than those of individuals living in less-densely populated areas in a high-income country (HIC) and (2) investigate the potential mediating roles of physical activity and sedentary behavior. Methods We used cross-sectional data from 2547 Dutch blood donors that participated in Donor InSight-III. Linear regression was used to analyze the association between population density and LDL cholesterol, total/HDL cholesterol ratio and HDL cholesterol. The mediating roles of moderate-to-vigorous physical activity (MVPA) and sedentary behavior were investigated in a subsample (n = 740) for which objectively measured MVPA/sedentary behavior data was available. Multiple mediation with linear regression analyses were performed and the product-of-coefficients method was used to calculate direct and indirect effects. Results Mean LDL cholesterol and median total cholesterol/HDL cholesterol ratio and triglyceride levels were 2.89, 3.43 and 1.29 mmol/L, respectively. Population density was not associated with LDL cholesterol [β 0.00 (− 0.01; 0.01)], log transformed total/HDL cholesterol ratio [β 1.00 (1.00; 1.00)] and triglyceride levels [β 1.00 (0.99; 1.00)]. No statistically significant direct or indirect effects were found. Conclusion Contrary to previous findings in LMIC, no evidence was found that population density is associated with blood lipid levels in blood donors in the Netherlands or that MVPA and sedentary behavior mediate this association. This may be the result of socioeconomic differences and, in part, may be due to the good health of the study population and the relatively high population density in the Netherlands. Also, compared to LMIC, differences in physical activity levels in more versus less populated areas may be less pronounced in HIC. Electronic supplementary material The online version of this article (10.1186/s12942-019-0167-y) contains supplementary material, which is available to authorized users.

Individual variations in erythrocyte parameters are influenced by factors like sex, age, diet and season. Genetic variations have also been associated with erythrocyte parameters. The aim of this systematic review is to provide an overview of associations between single nucleotide polymorphisms (SNPs) and erythrocyte parameters in humans. A systematic review protocol was published at the international prospective register of systematic reviews (registration number CRD42016053052). Literature searches were conducted in Medline and Embase. Studies were included if: investigating a(n) causality/association/correlation; population-based; investigating a human population of Caucasian/mixed-ethnic descent; and written in English, Dutch or German. Study quality was assessed using the quality of genetic association studies tool. In total, 4385 studies were screened on title/abstract and 194 studies were screened on full text. Inclusion criteria were met by 13 candidate gene studies (n = 126–49,488) and eight genome-wide association studies (GWASes, n = 1664–116,666). One moderate and six good quality GWAS(es) identified 1237 SNPs located in/near 241 genes. SNPs in/near ten genes were found to be associated with one or more erythrocyte parameter(s) by multiple GWASes, namely HIST1H2AC, MPST, SLC17A1 and SLC17A3 with mean cell hemoglobin (MCH), HIST1H1T and KCTD17 with MCH and mean cell volume (MCV), HBS1L and MYB with MCH, MCV and red cell count (RCC), HFE with MCH, MCV and hemoglobin, and TMPRSS6 with MCH, MCV, hemoglobin and mean cell hemoglobin concentration (MCHC). Four genes were found across multiple erythrocyte parameters by one study in each parameter. Fourteen SNPs were associated with one or more erythrocyte parameter(s) in multiple cohorts, namely rs129128, rs17342717, rs228129 and rs5756504 (MCH), rs4895441, rs7775698, rs9376092 and rs9494145 (MCH, MCV, RCC), rs6569992 (MCH, RCC), rs1800562 (hemoglobin, MCH, MCV), rs130624 and rs198846 (MCH, MCV), rs4820268 and rs855791 (MCH, MCV, MCHC). Further research on these fourteen genes in erythropoiesis is recommended, especially eight whose role in erythropoiesis is unclear.

Contains fulltext : 202649.pdf (Publisher’s version ) (Open Access) BACKGROUND AND OBJECTIVES: More insight into donor health and behaviour may contribute to more efficient and focused strategies regarding donor care and management. Donor InSight (DIS) is a Dutch cohort study of blood and plasma donors. We aimed to outline the objectives and methods of DIS, describe the cohort, and compare it to the active Dutch donor population. MATERIALS AND METHODS: In 2007-2009 (DIS-I, n = 31 338) and 2012-2013 (DIS-II, 34 826, of whom 22 132 also participated in DIS-I) questionnaire data on demographics, donation, lifestyle, family composition, health and disease were collected. A second follow-up (DIS-III, n = 3046), including donors with differing haemoglobin trajectories, was completed in 2015-2016. DIS-III includes data on genetic determinants, iron and red cell indices. Representativeness of the DIS-I sample for the entire Dutch donor population was assessed by comparing characteristics of both. RESULTS: Donor InSight was initially set up because of a need for more detailed information and evidence as a basis for decision-making in blood banks. DIS-I sample is comparable to the total Dutch donor population in terms of age, body mass index, haemoglobin level, blood pressure, blood type and donation behaviour. CONCLUSION: Donor InSight is a cohort study representative of the Dutch donor population. It provides evidence to support evidence-based decision making.

IntroductionThe built environment defines opportunities for healthy eating and physical activity and may thus be related to blood lipids. The aim of this study is to systematically analyse the scientific evidence on associations between built-environment characteristics and blood lipid levels in adults.MethodsPubMed, EMBASE and Web of Science were searched for peer-reviewed papers on population-based studies up to 9 October 2017. We included studies that reported on built-environment characteristics and blood lipid levels in adult populations (≥18 years). Two reviewers independently screened titles/abstracts and full-texts of papers and appraised the risk of bias of included studies using an adapted version of the Quality Assessment Tool for Quantitative Studies. We performed meta-analyses when five or more studies had sufficient homogeneity in determinant and outcome.ResultsAfter screening 6902 titles/abstracts and 141 potentially relevant full-text articles, we included 50 studies. Forty-seven studies explored associations between urban versus rural areas with blood lipid levels. Meta-analyses on urban versus rural areas included 133 966 subjects from 36 studies in total. Total cholesterol levels were significantly and consistently higher in urban areas as compared with rural areas (mean difference 0.37 mmol/L, 95% CI 0.27 to 0.48). Urban/rural differences in high density lipoprotein cholesterol were inconsistent across studies and the pooled estimate showed no difference (0.00 mmol/L 95% CI −0.03 to 0.04). Low density lipoprotein (LDL) cholesterol and triglyceride levels were higher in urban than in rural areas (mean difference 0.28, 95% CI 0.17 to 0.39 and 0.09, 95% CI 0.03 to 0.14, respectively).ConclusionsTotal and LDL cholesterol levels and triglycerides were consistently higher in residents of urban areas than those of rural areas. These results indicate that residents of urban areas generally have less favourable lipid profiles as compared with residents of rural areas.Prospero registration numberCRD42016043226.

BACKGROUND: Both donors and the blood bank rely on the result of the donor health interview. However, survey data suggest that substantial variability in deferral rates among interviewers exist. We studied whether variability remained after adjusting for conditional factors.STUDY DESIGN AND METHODS: The data set included Dutch interview data on whole blood donor visits in 2015, where one of their visits was selected randomly. We applied logistic regression and multilevel regression analyses with the donor visit, with the interviewer representing the levels. We set up four models: 1) all reasons deferral, 2) low-hemoglobin-level deferral, 3) infectious disease risk deferral and 4) other medical reasons deferral.RESULTS: In total, 138,398 visits were included in the study, of which 60,534 (43.7%) related to male donors. The overall deferral rate for men was 7.91% and for women 12.25%. Deferral rates among interviewers ranged from as low as 1.19% up to 28.8%. Models 2 (low hemoglobin level) and particularly 4 (other medical reasons), for both men and women, showed significant intraclass correlation coefficients, implying considerable deferral rate variability among interviewers. Donor age, the number of previous visits, and the season had relatively large effects. However, explained variances of the logistic regression models were relatively low, ranging from 2.53% to 7.35%.CONCLUSION: Deferral appears to be a random process, while substantial variability was found among interviewer deferral rates, suggesting that some interviewers are more cautious than others. Our results suggest heuristic and subjective diagnosing to be prevalent. Steps should be taken to improve interview result validity.

BACKGROUND Most donors do not like the invasive hemoglobin (Hb) measurement in fingerstick capillary samples. Alternative noninvasive devices have recently become available. In this study we assessed the precision and practicability of noninvasive devices and compared them with measurements in capillary and venous samples. STUDY DESIGN AND METHODS A total of 2589 blood donors were included in the study. Hb levels were measured with the noninvasive devices NBM 200 or Haemospect and compared with values obtained with the invasive devices HemoCue 201 and HemoCue 301 and with venous values. Precision was evaluated in terms of sensitivity and specificity for detection of Hb levels below the cutoff level for donation, taking venous values as “reference values.” RESULTS Hb levels measured with both invasive and noninvasive devices differed significantly from venous measurements. Measurements with invasive devices correlated stronger with venous values and were more precise. Sensitivity ranged from 30.1% (HemoCue 201) to 3.5% (Haemospect) in men and from 36.6% (HemoCue 201) to 10.8% (Haemospect) in women. Specificity ranged from 99.8% (HemoCue 201) to 95.5% (Haemospect) in men and from 98.9% (HemoCue 201) to 94.6% (NBM 200) in women. Most donors preferred the noninvasive measurement. CONCLUSION Measurements with invasive devices showed stronger correlation and better agreement with venous values than noninvasive devices. Sensitivity was low for all measurement devices, particularly the noninvasive ones. In terms of precision invasive measurement would be preferred for donor screening, although a majority of donors preferred the noninvasive measurement.

Background: Sex-specific prediction models for low hemoglobin (Hb) deferral have been developed in Dutch whole blood donors. In this study, we validated and updated the models in a cohort of Swiss whole blood donors. Methods: Prospectively collected data from 53,772 Swiss whole blood donors were used. The predictive performance of the Dutch models was assessed in terms of calibration (agreement between predicted probabilities and observed frequencies) and discrimination (ability to discriminate between deferred and approved donors). The models were updated by revising the strength of the individual predictors in the models. Results: A total of 1,065 men (3.3%) and 2,063 women (9.7%) were deferred from donation because of a low Hb level. Validation in Swiss donors demonstrated underestimation of predicted risks and significantly lower discriminative ability. The predictive effects of most predictors were weaker in Swiss donors. Updating the models increased the calibration for both men and women, and slightly increased the discriminative ability in men. Conclusion: Validation of the Dutch prediction models in Swiss whole blood donors showed lower, though adequate performance. In general, the Dutch prediction models can reliably predict the risk of Hb deferral, although for application in other countries small adaptations are necessary.

This paper examines how blood donation loyalty changes across the life course as a result of life events. Previous studies have shown that life events affect involvement in prosocial behavior, allegedly as a result of loss of human and social capital. Using registry data from the blood collection agency in the Netherlands, linked to longitudinal survey data from the Donor InSight study (n = 20,560), we examined whether life events are related to blood donor lapse. Childbirth, losing a job and starting a job increase the likelihood of lapse; health-related events (i.e., blood transfusion for a family member, death of a family member) decrease the likelihood of lapse. Increasing difficulty to plan a donation, decreasing perceived health status, and knowing fewer other donors partially explain why donors are more likely to lapse after the occurrence of life events. Blood donor identity did not mediate effects of life events on lapse.

ObjectiveTo investigate whether regular blood donation decreases cardiovascular risk.MethodsAll 159 934 Dutch whole-blood donors with an active donation career of at least 10 years were categorised into sex-specific donation tertiles based on the number of donations during this 10-year qualification period. Cardiovascular endpoints were based on hospital discharge diagnoses and death certificates from Dutch Hospital Data and Statistics Netherlands and occurring after the 10-year qualification period. Cox regression was used to estimate the age-adjusted and starting year-adjusted hazard rate ratio (HRR).ResultsFemale high-frequency blood donors had a reduced cardiovascular morbidity (HRR=0.91, 95% CI 0.85 to 0.98) compared with low-frequency blood donors. No effect was observed in men (HRR=1.00, 95% CI 0.95 to 1.05). To rule out a residual healthy donor effect (HDE), additional sensitivity analyses using a 5-year qualification period were conducted. The results supported the absence of a residual HDE.ConclusionsThis study showed a protective effect of long-term, high-frequency blood donation against cardiovascular disease. This effect was only observed in women and not in men.

Background and ObjectivesMigrant blood donors are underrepresented worldwide resulting in shortages of compatible blood products. Prior studies focused on individual barriers and motivators of potential blood donors, but no studies addressed organisational factors of the blood supply chain. This study explored the perceptions and experiences in recruitment and retention of migrant – and potentially rare‐blood donors among staff members within the blood supply chain and identified obstacles and solutions in this chain.Materials and MethodsThe study was conducted at Sanquin, the national blood supply organisation of the Netherlands. Qualitative in‐depth interviews were done among key staff members (N = 17). Expert validity was assessed in three feedback meetings.ResultsSeven staff members believed there is a shortage of migrant blood donors, while five believed there is not. However, there was a consensus that it may become a problem in the future due to demographic changes. The perceived obstacles to recruit and retain migrant donors were difficulties in determining how many migrant donors are needed and recruiting them, excluding potentially rare donors prior to donation, limited use of extended phenotyping and high blood typing and frozen storage costs. The possible solutions to increase blood pool diversity lay in registering donor ethnicity, specialised information provision for donors, reconsidering eligibility criteria and optimising blood typing strategies.ConclusionWhilst recruitment of migrant blood donors is perceived by staff as difficult, various organisational policies and guidelines seem to hinder retention. Improvements in the blood supply chain may be achieved by addressing logistics, current procedures and registration of ethnicity.

For rare blood groups the recruitment of donor relatives, for example siblings, is expected to be effective, since the probability of a similar rare blood group is likely. However, the likelihood differs between blood groups and is not commonly available. This paper provides a unified mathematical formulation to calculate such likelihoods. From a mathematical and probabilistic point of view, it is shown that these likelihoods can be obtained from the computation of a stationary genotype distribution. This, in turn, can be brought down to a system of quadratic stochastic operators. A generic mathematical approach is presented which directly leads to a stationary genotype distribution for arbitrary blood groups. The approach enables an exact computation for the effectiveness of recruiting next of kin for blood donorship. Next to an illustration of computations for ‘standard’ ABO and Rhesus-D blood groups, it is particularly illustrated for the extended Rhesus blood group system. Also other applications requiring next of kin blood group associations can be solved directly by using the unified mathematical formulation.

BACKGROUND Most donor deferrals are due to low hemoglobin (Hb) levels. Previously measured Hb levels and donation intervals are known to be associated with Hb deferral. However, this relationship has never been quantified. In this study, we related the prevalence of Hb deferral to previously measured Hb levels and donation intervals. STUDY DESIGN AND METHODS A total of 220,946 whole blood donors were categorized into groups based on their Hb level at the previous donation and on the time interval since the previous donation. For each group, the prevalence of Hb deferral was assessed. RESULTS Hb deferral rates were higher when Hb levels at the previous donation were lower and donation intervals were shorter. With a donation interval shorter than 3 months, the prevalence of Hb deferral was below the 10% threshold only when the previous Hb level was at least 0.3 mmol/L above the cutoff level for donation. CONCLUSION To maintain appropriate Hb levels, the minimum donation interval of 56 days is only sufficient for donors with Hb levels far above the cutoff level for donation. Protocols for minimum donation intervals should be reconsidered and may be based on previously measured Hb levels. This may result in a decrease of low Hb deferral.

Background A too short recovery time after blood donation Results in a gradual depletion of iron stores and a subsequent decline in hemoglobin (Hb) levels over time. This decline in Hb levels may depend on individual, unobserved characteristics of the donor. Study Design and Methods We used a data set of 5388 Dutch blood donors from the Donor InSight study. The statistical analysis is based on a Bayesian growth mixture model, which assumes that each donor belongs to one of several groups. Each group implies a different Hb trajectory, and donors with similar longitudinal trajectories belong to the same group. Analyses were performed for male and female donors separately. Results For both sexes the model identified four groups of donors. Stable Hb trajectories were found among 14% of male donors and 15% of female donors; declining Hb trajectories were observed in the remaining groups of donors. The percentage of donor deferrals differed strongly between groups. Conclusion The model can be used to predict to which group a donor belongs, and this prediction can be updated after each donation. This is of high practical importance because early identification of donors with declining Hb levels could help to tailor donation intervals and to prevent iron deficiency and donor deferrals.

Item does not contain fulltext This study investigated the shape of associations between climate parameters (mean daily temperature and humidity) and systolic and diastolic blood pressure in a large longitudinal cohort of healthy individuals. The study population comprised 101,377 Dutch whole blood and plasma donors (50% men), who made 691,107 visits to the blood bank between 2007 and 2009. Climate parameters were acquired from the Royal Netherlands Meteorological Institute. Associations with blood pressure, measured prior to each blood donation, were studied using (piecewise) linear regression analyses within Generalized Estimating Equation models. On average, systolic blood pressure was 0.18 mm Hg, and diastolic blood pressure was 0.11 mm Hg lower per one degree Celsius higher mean daily temperature. Higher daily temperatures were associated with lower blood pressure, independent of humidity and potentially confounding factors. These associations were stronger at older age and higher temperatures. Seasonality should therefore be taken into account when monitoring blood pressure, particularly in older individuals.

Introduction: In donor health research, the ‘Healthy Donor Effect’ (HDE) often biases study results and hampers their interpretation. This refers to the fact that donors are a selected ‘healthier’ subset of a population due to both donor selection procedures and self-selection. Donors with long versus short donor careers, or with high versus low donation intensities are often compared to avoid this HDE, but underlying health differences might also cause these differences in behaviour. Our aim was to estimate to what extent a donor´s perceived health status associates with donation cessation and intensity. Methods: All active whole blood donors participating in Donor InSight (2007–2009; 11,107 male; 12,616 female) were included in this prospective cohort study. We performed Cox survival and Poisson regression analyses to assess whether self-reported health status, medication use, disease diagnosed by a physician and recently having consulted a general practitioner (GP) or specialist were associated with (time to) donation cessation and donation intensity. Results: At the end of 2013, 44% of the donors in this study had stopped donating. Donors in self-rated good health had a 15% lower risk to stop donating compared to donors in perceived poorer health. Medication use, disease diagnoses and consulting a GP were associated with a 20–40% increased risk to stop donating and a lower donation intensity, when adjusting for age, number of donations and new donor status. Both men and women reporting good health made on average 10% more donations. Conclusion: Donors with a “good” health status were less likely to stop donating blood and tended to donate blood more often than donors with perceived poorer health status. This implies that the HDE is an important source of selection bias in studies on donor health and this includes studies where comparisons within donors are made. This HDE should be adjusted for appropriately when assessing health effects of donation and donors’ health status may provide estimates of future donation behavior.

Identifying the number of classes in Bayesian finite mixture models is a challenging problem. Several criteria have been proposed, such as adaptations of the deviance information criterion, marginal likelihoods, Bayes factors, and reversible jump MCMC techniques. It was recently shown that in overfitted mixture models, the overfitted latent classes will asymptotically become empty under specific conditions for the prior of the class proportions. This result may be used to construct a criterion for finding the true number of latent classes, based on the removal of latent classes that have negligible proportions. Unlike some alternative criteria, this criterion can easily be implemented in complex statistical models such as latent class mixed-effects models and multivariate mixture models using standard Bayesian software. We performed an extensive simulation study to develop practical guidelines to determine the appropriate number of latent classes based on the posterior distribution of the class proportions, and to compare this criterion with alternative criteria. The performance of the proposed criterion is illustrated using a data set of repeatedly measured hemoglobin values of blood donors.

IntroductionSeveral factors, including changed dynamics of erythrocyte formation and degradation, can influence the degree of hemoglobin A(1c) (HbA(1c)) formation thereby affecting its use in monitoring diabetes. This study determines the influence of whole blood donation on HbA(1c) in both non-diabetic blood donors and blood donors with type 2 diabetes.MethodsIn this observational study, 23 non-diabetic blood donors and 21 blood donors with type 2 diabetes donated 475 mL whole blood and were followed prospectively for nine weeks. Each week blood samples were collected and analyzed for changes in HbA(1c) using three secondary reference measurement procedures.ResultsTwelve non-diabetic blood donors (52.2%) and 10 (58.8%) blood donors with type 2 diabetes had a significant reduction in HbA(1c) following blood donation (reduction >-4.28%, P -4.28%, P ConclusionPatients with type 2 diabetes contributing to whole blood donation programs can be at risk of falsely lowered HbA(1c). This could lead to a wrong interpretation of their glycemic control by their general practitioner or internist.

BACKGROUND: Recently, prediction models for hemoglobin (Hb) deferral risk have been developed. These models consider the previous Hb level plus change in Hb. Here, we investigated if the performance of models could be improved by considering more information on Hb level history. STUDY DESIGN AND METHODS: Data of 166,497 Dutch whole blood donors with sequential Hb measurements during 2 years (760,444 in total) were used to develop and internally validate three different regression models: two simple linear models with Hb level history included as 1) Hb at the previous visit plus change in Hb or 2) mean of all previous Hb levels and one mixed-effect model including measurements of all previous Hb levels. RESULTS: Thirteen percent of men and 21% of women were deferred because of a low Hb level at least once in 2 years. The simple linear models and the mixed-effect model performed similar, if an estimate of the random intercept of the mixed-effect model was used for individual donors to calculate the predicted Hb level. In men, the concordance (c)-statistic ranged from 0.87 to 0.89 and the R(2) ranged from 0.42 to 0.45. In women, the c-statistic ranged from 0.81 to 0.84. Values of R(2) in women were higher for the simple linear models than for the mixed-effect model, 0.37 and 0.40 versus 0.30, respectively. CONCLUSION: Previous Hb levels could be summarized with one predictor as the mean value of all previous Hb levels. This predictor can be used in an easy-to-use simple linear regression model.

Background The cost-effectiveness of the donor health questionnaire (DHQ) as a tool to assess donor eligibility has not been quantified. This study focused on cost-effectiveness of the DHQ in preventing transfusion-transmitted infections (TTIs). Study Design and Methods Data on whole blood donor eligibility assessments in the Netherlands in 2008 to 2010 were analyzed. Based on test results and epidemiologic data on TTIs, the number of donor visits in their window phase was calculated. Subsequently, the incremental cost-effectiveness ratio (ICER) of the DHQ was calculated. Results The overall annual deferral rate in the study period was 9.6% (9.3%-10.0%). The annual deferral rate for TTI risk was 0.86% (0.82%-0.89%). Taking into account the number of self-deferrals, deferral rate for TTI risk in all donors was 1.90% (1.81%-2.02%). The calculated annual numbers of prevented cases of TTI were hepatitis B, 0.142; hepatitis C, 0.010; human immunodeficiency virus, 0.016; and syphilis, 0.135. The annual costs for TTI risk–related eligibility assessments, deferrals, and substitutions were €84,807 (€55,193-€123,811) for the blood establishment (BE) and €90,501 (€46,965-€159,571) for deferred donors. Annual savings were €991 (€276-€2325), while annual quality-adjusted life-years (QALYs) gained were 0.120 (0.059-0.226). Hence, the ICER for the DHQ on preventing TTIs was €696,744 (€315,422-€1,611,681) for BE costs only and €1,449,055 (€669,439-€3,145,961) including costs for deferred donors. Conclusion The DHQ enhances self-selection and should not be abandoned. However, the DHQ is not a cost-effective tool for further reducing TTIs. The high costs per case prevented and the small number of QALYs gained argue against maintaining deferral policy through the DHQ at the current level.

BACKGROUND: Recently, sex-specific prediction models for low hemoglobin (Hb) deferral have been developed in Dutch whole blood donors. In the present study, we validated and updated the models in a cohort of Irish whole blood donors. STUDY DESIGN AND METHODS: Prospectively collected data from 45,031 Irish whole blood donors were used. Hb cutoff levels for donation were approximately 0.35 mmol/L lower in Ireland than the Dutch cutoff levels (8.07 mmol/L vs. 8.40 mmol/L in men; 7.45 mmol/L vs. 7.80 mmol/L in women). The predictive performance of the models was assessed with calibration plots, calibration-in-the-large, and the concordance (c)-statistic. The models were updated by revising the strength of the individual predictors in the models. RESULTS: A total of 613 men (2.4%) and 1624 women (8.4%) were deferred from donation because of a low Hb level. Validation demonstrated underestimation of predicted risks and lower c-statistics for men and women compared to the Dutch cohort. The strength of most predictive factors, particularly previous Hb level, was lower in Irish donors. The updated models showed a c-statistic of 0.83 (95% confidence interval [CI], 0.81-0.84) for men and 0.76 (95% CI, 0.74-0.77) for women. CONCLUSION: The performance of Dutch prediction models for Hb deferral was limited when validated in Irish whole blood donors. Updating the models resulted in different predictor effects. This improved mainly the model calibration; the improvement in discrimination was small.

Clinical prediction models aim to predict individual clinical outcomes using multiple predictor variables. Prediction models are abundant in the medical literature and their number is increasing.[1][1]–[3][2] Established causal risk factors are often good predictors. For example, the Framingham

Background Blood donors that meet the hemoglobin (Hb) criteria for donation may have undetected subclinical iron deficiency. The aim of this study was to assess the prevalence of subclinical iron deficiency in whole blood donors with Hb levels above cutoff levels for donation by measuring zinc protoporphyrin (ZPP) levels. In addition, prevalence rates based on other iron variables were assessed for comparison. Study Design and Methods The study population comprised 5280 Dutch whole blood donors, who passed the Hb criteria for donation. During donor screening, Hb levels were measured in capillary samples (finger prick), and venous blood samples were taken for measurements of ZPP and other iron variables. These variables included ferritin, transferrin saturation, soluble transferrin receptor (sTfR), hepcidin, red blood cell mean corpuscular volume (MCV), and mean cell Hb (MCH). Results With a ZPP cutoff level of at least 100 μmol/mol heme, subclinical iron deficiency was present in 6.9% of male donors and in 9.8% of female donors. Based on other iron variables, iron deficiency was also observed. Prevalence rates ranged from 4.8% (based on transferrin saturation) to 27.4% (based on hepcidin concentration) in men and from 5.6% (based on sTfR concentration) to 24.7% (based on hepcidin concentration) in women. Conclusion Results from this study showed that subclinical iron deficiency is prevalent among blood donors that meet the Hb criteria for blood donation, based on ZPP levels and on other iron variables. This finding needs attention because these donors are at increased risk of developing iron deficiency affecting Hb formation and other cellular processes.

Background Increased zinc protoporphyrin (ZPP) levels can indicate iron deficiency and may be predictive for low hemoglobin (Hb) deferral in blood donors. Prediction models for Hb deferral in whole blood donors have already been developed. In this study, we examined if addition of ZPP to these prediction models improves risk estimation of Hb deferral. Study Design and Methods This study included 4598 Dutch whole blood donors. Information on ZPP levels measured at the previous visit was added to the existing prediction models to estimate the risk of Hb deferral. Models were compared using the following measures: concordance (c)-statistic, continuous net reclassification improvement (NRI), and clinical net benefit (NB). Results Seventy-six male donors (2.9%) and 69 female donors (3.5%) were deferred because of a low Hb level. Previous ZPP level was associated with risk of Hb deferral (odds ratio for interquartile range of previous ZPP level, men 2.0 [95% confidence interval {CI}, 1.7-2.3]; women 2.2 [95% CI, 1.9-2.4]) in a multivariable risk model. Addition of ZPP into the models resulted in an increase of the c-statistic from 0.93 to 0.94 for men and from 0.80 to 0.85 for women. The added value of ZPP was confirmed by measures of clinical usefulness. NRI for men was 0.42, and for women, 0.56. At relevant threshold probabilities between 10 and 15%, NB was higher for models considering ZPP. Conclusion This study shows that ZPP measurements obtained at the previous visit may have added value in the risk prediction of Hb deferral in whole blood donors.

Blood donors experience a temporary reduction in their hemoglobin (Hb) value after donation. At each visit, the Hb value is measured, and a too low Hb value leads to a deferral for donation. Because of the recovery process after each donation as well as state dependence and unobserved heterogeneity, longitudinal data of Hb values of blood donors provide unique statistical challenges. To estimate the shape and duration of the recovery process and to predict future Hb values, we employed three models for the Hb value: (i) a mixed-effects models; (ii) a latent-class mixed-effects model; and (iii) a latent-class mixed-effects transition model. In each model, a flexible function was used to model the recovery process after donation. The latent classes identify groups of donors with fast or slow recovery times and donors whose recovery time increases with the number of donations. The transition effect accounts for possible state dependence in the observed data. All models were estimated in a Bayesian way, using data of new entrant donors from the Donor InSight study. Informative priors were used for parameters of the recovery process that were not identified using the observed data, based on results from the clinical literature. The results show that the latent-class mixed-effects transition model fits the data best, which illustrates the importance of modeling state dependence, unobserved heterogeneity, and the recovery process after donation. The estimated recovery time is much longer than the current minimum interval between donations, suggesting that an increase of this interval may be warranted. Copyright (C) 2015 John Wiley & Sons, Ltd.

BACKGROUND: Each year, approximately 5% of the invited blood donors is eventually deferred from donation because of low hemoglobin (Hb) levels. Estimating the risk of Hb deferral in blood donors can be helpful in the management of the donation program. We developed and validated a prediction model for Hb deferral in whole blood donors, separately for men and women. STUDY DESIGN AND METHODS: Data from a Dutch prospective cohort of 220,946 whole blood donors were used to identify predictors for Hb deferral using multivariable logistic regression analyses. Validity of the prediction models was assessed with a cross-validation. RESULTS: A total of 12,865 donors (5.8%) were deferred because of a low Hb level. The strongest predictors of Hb deferral were Hb level measured at the previous visit, age, seasonality, difference in Hb levels between the previous two visits, time since the previous visit, deferral at the previous visit, and the total number of whole blood donations in the past 2 years for both men and women. The prediction models had an area under the receiver operating characteristic curve of 0.89 for men and 0.84 for women. Cross-validation showed similar results and good calibration. CONCLUSION: Using a limited number of easy-to-measure characteristics enables a good prediction of Hb deferral risk in whole blood donors. The prediction models may guide the decision which donors to invite for a next donation and for which donors the invitation should be postponed. Potentially, this could decrease the number of Hb deferrals in blood donors.

BACKGROUND: This study investigates the effect of a vasovagal reaction (VVR) or needle reaction (NR) on the risk of stopping as a blood donor, taking into account variables from the Theory of Planned Behavior (TPB). Is stopping risk solely related to the adverse reaction itself, or do the TPB variables play a role as well? Emphasis is placed on possible sex differences. STUDY DESIGN AND METHODS: TPB variables were assessed within 12,051 whole blood donors. Also, donors reported the occurrence of adverse reactions during or after their last donation. Blood bank records were used to determine whether donors stopped donating within the next 2 years. Logistic regression analyses were performed to estimate the effect of self-reported adverse reactions on stopping risk, adjusting for the TPB variables. Analyses were performed separately for both sexes. RESULTS: Men have a lower odds of reporting a NR or a VVR than women (odds ratio [OR] 0.34, 95% confidence interval [CI], 0.28-0.43; and OR 0.26, 95% CI 0.19-0.36, for NR and VVR, respectively). For both sexes, only a VVR was associated with stopping risk, which is higher in men (men, OR 3.95, 95% CI 2.19-7.11; women, OR 1.78, 95% CI 1.35-2.35). After adjusting for the TPB variables both ORs declined (men, OR 3.38, 95% CI 1.86-6.15; women, OR 1.58, 95% CI 1.17-2.14). Also, self-efficacy and affective attitude are negatively associated with adverse reactions. CONCLUSION: Female donors report more VVRs than male donors, but male donors have a higher stopping risk after a VVR than female donors. Coping differences and possible reporting tendencies might play a role. For donor retention purposes, prevention and coping techniques should take sex differences into account.

BACKGROUND: This study investigated the possibility of rerecruiting lapsed blood donors. Reasons for donation cessation, motivation to restart donation, and modifiable components of donation motivation were examined. We distinguished between lapsed donors who had passively withdrawn by merely not responding to donation invitations and donors who had contacted the blood bank to actively withdraw. STUDY DESIGN AND METHODS: A cross-sectional survey was sent to 400 actively lapsed donors and to 400 passively lapsed donors, measuring intention to restart donation and psychological correlates of restart intention. The data were analyzed using multiple regression analyses. RESULTS: The response rate among actively lapsed donors was higher than among passively lapsed donors (37% vs. 25%). Actively lapsed donors typically ceased donating because of physical reactions, while passively lapsed donors quit because of a busy lifestyle. Nonetheless, 51% of actively lapsed responders and 80% of passively lapsed responders were willing to restart donations. Multiple regression analysis showed that, for passively lapsed donors, cognitive attitude was the strongest correlate of intention to donate in the future (β=0.605, p

BACKGROUND: Using constructs from the Theory of Planned Behavior and theories of altruism, this article explores how multiple motivations and beliefs for blood donation are clustered and change across the donor career. In so doing important distinctions, for blood donation, between impure altruism, pure altruism, and warm glow are explored. STUDY DESIGN AND METHODS: Measures of intentions, cognitive and affective attitudes, role merger, pure altruism, trust, self-efficacy, subjective and moral norms, and habit formation were assessed in a sample of 12,580 whole blood donors. Analyses showed that a distinction between first-time, novice (one to four donations), and experienced donors (five or more donations) is justified. Principal components analysis and confirmatory factor analytic Multiple-Indicator Multiple-Causal models were used to compare models across these groups. RESULTS: A cognition-behavior (CB) factor, including intentions, was common to all groups. First-time and novice donors were marked by a newly identified motivational factor: "reluctant altruism" (i.e., the motivation to donate because of a lack of trust in others). First-time donors exhibited an impure altruism factor whereas for experienced donors warm glow and pure altruism factors were observed. For first-time donors impure altruism and reluctant altruism were both associated with the CB factor in females and impure altruism only in males. For both sexes reluctant altruism was associated of the CB factor in novice donors and warm glow and pure altruism for experienced donors. CONCLUSIONS: New avenues for intervention are suggested by the emergence of reluctant altruism for novice donors and warm glow for experienced donors. The importance of distinguishing aspects of altruism is highlighted.

BACKGROUND: This study investigates the influence of different variables from the theory of planned behavior (TPB) on intention within multiple donation categories, covering the entire range of lifetime number of donations (LND). Does the same set of variables predict intention equally strong throughout the donor career? STUDY DESIGN AND METHODS: Measures of intention, self-efficacy, cognitive and affective attitude, and subjective and moral norms were assessed within a sample of 11,480 whole blood donors. Donors were categorized into 65 donation classes using their LND; for example, all donors with one donation (n = 483) in the first donation class, all donors with two donations (n = 447) in the second donation class, and so on. For each donation class, separately for men and women, linear multiple regression models for intention were fitted using self-efficacy, cognitive attitude, affective attitude, subjective norm, and moral norm as predictor variables. RESULTS: During all stages of the donor career, self-efficacy is the main predictor of intention, with a relatively constant beta (beta = 0.64, p < 0.001). Cognitive attitude (beta = 0.11, p < 0.001) and moral norm (beta = 0.10, p < 0.001) contributed marginally to the prediction. Several sex effects were observed; self-efficacy is a stronger predictor of intention in women, whereas subjective norm predicts intention in men only. CONCLUSION: Regardless of the number of lifetime donations, the same set of TPB variables, both in composition and in relative strength, predicts intention. A feeling of self-efficacy remains equally important for all donors. It is worthwhile to study whether directed intervention strategies are necessary to target self-efficacy within donor groups with different levels of donation experience.

BACKGROUND: Blood donations resulting in “nontransparent turbid milky” plasma must be discarded. The aim of this study was to objectively determine opacity and to identify risk factors for turbid plasma donations. STUDY DESIGN AND METHODS: This case-control study included 238 whole blood donors who provided turbid plasma (cases) and 309 random control subjects with normal plasma. Participants filled in a questionnaire regarding cardiovascular risk factors. Fat intake was assessed using a validated questionnaire. Opacity and lipids were measured. Additional data were retrieved from the blood bank information system. Mean differences and odds ratios were calculated with 95% confidence intervals. RESULTS: Cases had a less favorable cardiovascular profile compared to control subjects. The usual intake of fat was not associated with turbid plasma donation. In a multivariate model, having dinner before donation (OR, 4.9; 95% CI, 2.2-11.1), triglyceride levels (OR, 7.1; 95% CI, 4.6-10.8), and smoking (ORyes vs. no, 2.5; 95% CI, 0.9-6.7; and ORever vs. no, 5.7; 95% CI, 1.8-18.4) were associated with an increased risk. Opacity was clearly increased in turbid plasma. Total cholesterol levels were 0.51 (95% CI, 0.35-0.66) mmol/L and triglyceride levels 4.28 (95% CI, 3.92-4.68) mmol/L higher in cases. High-density lipoprotein cholesterol levels were 0.34 (95% CI, −0.39 to −0.30) mmol/L lower. Forty-two percent of all cases had very high triglyceride levels (≥5.65 mmol/L) compared to less than 1% of control subjects. CONCLUSION: Donors who provided a turbid donation have a less favorable cardiovascular profile compared to other donors. Having dinner, high triglyceride levels, and smoking are independent risk factors for turbid plasma donations

BACKGROUND: The healthy donor effect has been mentioned as a methodologic problem in blood donor health research. The aim of this study was to investigate different elements of the healthy donor effect. STUDY DESIGN AND METHODS: First, recent donors ( 37 donations). Various health and lifestyle indicators were used as outcome measures. RESULTS: Compared to the general population, recent donors had a better self-rated health (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.27-1.61), visited the general practitioner (GP) less often (OR, 0.66; 95% CI, 0.60-0.72), and were less often treated by a specialist (OR, 0.83; 95% CI, 0.75-0.93). Recent donors also exhibited a healthier lifestyle compared to the general population. When examining active versus lapsed donors, similar results were found in favor of active donors. With respect to donation career, long-career donors were healthier than short-career donors, but effects were less strong; the ORs were 1.33 (95% CI, 1.15-1.54) for self-rated health, 0.85 (95% CI, 0.76-0.94) for GP visit, and 0.83 (95% CI, 0.68-1.00) for specialist treatment. When comparing long- and short-career donors on lifestyle indicators, there were barely any significant differences. CONCLUSIONS: The findings strongly point to the presence of a healthy donor effect when comparing donors with the general population and active versus lapsed donors. The healthy donor effect was less pronounced within active donors, when comparing long- and short-career donors. Therefore, health research should primarily be carried out within active donors.

BACKGROUND: Within blood establishments little comparative information is available about donors versus the general population. In this study, a description of the donor pool was made in terms of demographic factors and cardiovascular risk factors. The general Dutch population was used as a reference group. STUDY DESIGN AND METHODS: The Donor InSight study provided information on donors. Extensive information has been gathered by a self-administered questionnaire addressing various topics, like demographics, lifestyle, and health. Aggregated donor responses were compared with general population summary data. RESULTS: The study population consisted of 15,076 donors. The median age was 46.3 years and 47.3% were men. Donors were more likely to be highly educated (34.6%), married (71.7%), and of Dutch origin (97.4%), when compared to the general population. Donors were less often smokers (donors, 17.1%; general population, 31.8%), more often moderate drinkers (donors, 82.8%; general population, 74.7%), and physically more active (donors, 2.0 hr/week; general population, 1.0 hr/week). Male donors were more often moderately overweight (47.7%) than men from the general population (39.9%). In donors, 0.9% reported to have Type 2 diabetes versus 1.9% in the general population. In donors, 3.4% reported high cholesterol versus 4.6% in the general population. CONCLUSION: The study provided important knowledge about demographic distributions and cardiovascular risk factors within donors. A proper understanding of demographic characteristics of donors will help us to focus recruitment and retention strategies. The reported beneficial cardiovascular profile suggests a need for further research on the role of blood donation in cardiovascular risk reduction.