Impact of a post‐donation hemoglobin testing strategy on efficiency and safety of whole blood donation in England: A modeling study

Abstract

Background Deferrals due to low hemoglobin are time‐consuming and costly for blood donors and donation services. Furthermore, accepting donations from those with low hemoglobin could represent a significant safety issue. One approach to reduce them is to use hemoglobin concentration alongside donor characteristics to inform personalized inter‐donation intervals. Study Design and Methods We used data from 17,308 donors to inform a discrete event simulation model comparing personalized inter‐donation intervals using “post‐donation” testing (i.e., estimating current hemoglobin from that measured by a hematology analyzer at last donation) versus the current approach in England (i.e., pre‐donation testing with fixed intervals of 12‐weeks for men and 16‐weeks for women). We reported the impact on total donations, low hemoglobin deferrals, inappropriate bleeds, and blood service costs. Personalized inter‐donation intervals were defined using mixed‐effects modeling to estimate hemoglobin trajectories and probability of crossing hemoglobin donation thresholds. Results The model had generally good internal validation, with predicted events similar to those observed. Over 1 year, a personalized strategy requiring ≥90% probability of being over the hemoglobin threshold, minimized adverse events (low hemoglobin deferrals and inappropriate bleeds) in both sexes and costs in women. Donations per adverse event improved from 3.4 (95% uncertainty interval 2.8, 3.7) under the current strategy to 14.8 (11.6, 19.2) in women, and from 7.1 (6.1, 8.5) to 26.9 (20.8, 42.6) in men. In comparison, a strategy incorporating early returns for those with high certainty of being over the threshold maximized total donations in both men and women, but was less favorable in terms of adverse events, with 8.4 donations per adverse event in women (7.0, 10,1) and 14.8 (12.1, 21.0) in men. Discussion Personalized inter‐donation intervals using post‐donation testing combined with modeling of hemoglobin trajectories can help reduce deferrals, inappropriate bleeds, and costs.

Personalized medicine comes to a blood center near you

“…Kim et al used a simulation model to assess four different invitation strategies together with the current donation strategy 1 . Under the current policy in the UK (“strategy A"), donors are invited to return a minimum of 12 weeks (men) or 16 weeks (women) after each donation, up to four times per year.…”

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While personalized medicine has transformed healthcare over the last two decades, the blood donation process has remained basically unchanged. In this issue of TRANS-FUSION, the article by Kim et al 1 shows how discrete event simulation (DES) modeling 2 can be used to select the right donors and minimize deferrals, thus ensuring that the donor's experience is optimized to encourage repeat donation.Three important developments in blood banking preceded this study. First, until the last decade, it was very difficult to extract a large amount of data from donor records, as most were on paper.

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“…Kim et al used a simulation model to assess four different invitation strategies together with the current donation strategy. 1 Under the current policy in the UK ("strategy A"), donors are invited to return a minimum of 12 weeks (men) or 16 weeks (women) after each donation, up to four times per year. Three alternative strategies ("strategies B, C, D") based on post-donation hemoglobin testing were modeled and compared with current practice/ strategy A.…”

“…While personalized medicine has transformed healthcare over the last two decades, the blood donation process has remained basically unchanged. In this issue of TRANSFUSION, the article by Kim et al 1 shows how discrete event simulation (DES) modeling 2 can be used to select the right donors and minimize deferrals, thus ensuring that the donor's experience is optimized to encourage repeat donation.…”