Article

Regular blood donation may help in the management of hypertension: An observational study on 292 blood donors

December 2015
Transfusion 56(3)

DOI:10.1111/trf.13428

Authors:

Sundrela Kamhieh-Milz

Amboss

Julian Kamhieh-Milz

Charité Universitätsmedizin Berlin

Thomas Ostermann

Universität Witten/Herdecke

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Background: Hypertension is one of the leading global risks for cardiovascular events worldwide. There is preliminary evidence that regular blood donation may be beneficial. Study design and methods: Unselected blood donors were included in this observational study. Blood pressure (BP) was measured before and after blood donation, with participants donating between one and four occasions in a 1-year study period. Results: In this study, 292 donors were enrolled. At baseline, 146 had elevated BP (>140/90 mmHg). In hypertensives, after four blood donations, systolic and diastolic blood pressure (SBP and DBP, respectively) decreased from a mean of 155.9 ± 13.0 to 143.7 ± 15.0 mmHg and from 91.4 ± 9.2 to 84.5 ± 9.3 mmHg, respectively (each p < 0.001). There was a clear dose effect with decreasing BP by the increasing number of blood donations. After at least four blood donations, donors with Stage II hypertensive baseline values (≥160 mmHg SBP and/or ≥100 mmHg DBP) were found to have the most marked reduction in BP, with 17.1 mmHg (95% confidence interval [CI], -23.2 to -11.0; p < 0.0001) and 11.7 mmHg (95% CI, -17.1 to -6.1; p = 0.0006) for SBP and DBP, respectively. The decrease in BP was not significantly associated with changes of blood count or variables of iron metabolism. Conclusions: Regular blood donation is associated with pronounced decreases of BP in hypertensives. This beneficial effect of blood donation may open a new door regarding community health care and cost reduction in the treatment of hypertension.

Cohort Profile: The Shaanxi Blood Donor Cohort in China

Article

Full-text available

May 2022

Purpose The Shaanxi Blood Donor Cohort was set up to investigate the impact of blood donation on the health of donors compared with non-blood donors. The specific aims of the study include (1) identifying the geographical and temporal trends of incidence for diseases in both blood donors and non-blood donors; (2) assessing the impact of environmental exposures, lifestyle, body mass index (BMI) and blood type on disease burdens, stratified between blood donors and non-blood donors; and (3) among blood donors, investigating if regular blood donation has a positive impact on donors’ health profiles, based on a cohort with a mixed retrospective and prospective study design. Participants A total of 3.4 million adults, with an equal number and identical demographic characteristics (year of birth, sex and location of residence) of blood donors and non-blood donors, were enrolled on 2012. The one-to-one matching was conducted through a repeated random selection of individuals without any history of blood donation from the Shaanxi Electronic Health Records. The cohort has been so far followed up to the end of 2018, summing to nearly 24 million years of follow-up. The cohort will be followed up prospectively every 3 years until 2030. Findings to Date Of the 1.7 million blood donors, 418,312 (24.5%) and 332,569 (19.5%) individuals were outpatients and inpatients, accounting for 1,640,483(96.2%) outpatient and 496,061 (29.1%) inpatient visits. Of the same number of non-blood donors, 407,798 (23.9%) and 346,097 (20.3%) individuals were hospital outpatients and inpatients, accounting for 1,655,725 (97.1%) outpatient and 562,337 (33.0%) inpatient visits. The number of outpatient and inpatient visits by non-blood donors was 0.9 and 3.9% higher than those of the blood donors ( p < 0.01). Blood donors demonstrate significantly fewer inpatients visits than non-blood donors for major chronic disease categories ( p < 0.01). Future Plans We are currently exploring the long term benefits of blood donation on major chronic disease categories and multimorbidities in this large population cohort. The study results are adjusted by the “healthy donor effect.” This cohort study will continue until 2030.

Therapeutic Phlebotomy in Patients with Grade 1 Hypertension: A Randomized-Controlled Trial

Article

Mar 2022

Aim: Study aim was to investigate the effects of therapeutic phlebotomy on ambulatory blood pressure in patients with grade 1 hypertension. Methods: In this randomized-controlled intervention study, patients with unmedicated hypertension grade 1 were randomized into an intervention group (phlebotomy group; 500 mL bloodletting at baseline and after 6 weeks) and a control group (waiting list) and followed up for 8 weeks. Primary endpoint was the 24-h ambulatory mean arterial pressure between the intervention and control groups after 8 weeks. Secondary outcome parameters included ambulatory/resting systolic/diastolic blood pressure, heart rate, and selected laboratory parameters (e.g., hemoglobin, hematocrit, erythrocytes, and ferritin). Resting systolic/diastolic blood pressure/heart rate and blood count were also assessed at 6 weeks before the second phlebotomy to ensure safety. A per-protocol analysis was performed. Results: Fifty-three hypertension participants (56.7 ± 10.5 years) were included in the analysis (n = 25 intervention group, n = 28 control group). The ambulatory measured mean arterial pressure decreased by -1.12 ± 5.16 mmHg in the intervention group and increased by 0.43 ± 3.82 mmHg in the control group (between-group difference: -1.55 ± 4.46, p = 0.22). Hemoglobin, hematocrit, erythrocytes, and ferritin showed more pronounced reductions in the intervention group in comparison with the control group, with significant between-group differences. Subgroup analysis showed trends regarding the effects on different groups classified by serum ferritin concentration, body mass index, age, and sex. Two adverse events (AEs) (anemia and dizziness) occurred in association with the phlebotomy, but no serious AEs. Conclusions: Study results showed that therapeutic phlebotomy resulted in only minimal reductions of 24-h ambulatory blood pressure measurement values in patients with unmedicated grade 1 hypertension. Further high-quality clinical studies are warranted, as this finding contradicts the results of other studies.

Blutspende – Behandlungsoption bei Hypertonie?

Article

Oct 2018

Der Aderlass zählt zu den wichtigsten traditionellen Behandlungsverfahren der traditionellen Medizin in den unterschiedlichsten Kulturen. Das zwischenzeitlich durch missbräuchliche Anwendung in Ungnade gefallene Verfahren hat sich heute z.B. zur Behandlung von Patienten mit Hämochromatose und Polycythaemiaverawieder etabliert. In den letzten Jahren konnten positive Ergebnisse bei therapierefraktärem Hypertonus gezeigt werden. So konnte im Rahmen von Studien bei Patienten nach Nierentransplantation und bei Patienten mit metabolischem Syndrom der Blutdruck durch Aderlass erfolgreich gesenkt werden. Weitere Forschungsarbeit zu den vielversprechenden Ergebnissen ist allerdings notwendig, um die Ergebnisse zu untermauern. Perspektiven ergeben sich zudem in Anbetracht der zunehmenden Blutknappheit. Allerdings steht die Klärung ethischer Fragestellungen noch aus.

Donating blood on a regular basis reduces blood pressure (in hypertensives): appearances are not deceiving: LETTERS TO THE EDITOR

Article

Full-text available

Apr 2019

Medical and laboratory assessment for regular blood donors in Sulaimani Blood Bank, Iraq

Article

Full-text available

May 2018

Introduction It has been suggested that blood donation reduces risks of developing cardiovascular diseases such as heart failure, atherosclerosis, and stroke. Although there are known benefits of blood donation, the inclination of people of the Kurdistan Region of Iraq to donate blood is not known. Therefore, the aim of this study was to determine demograpic and blood biochemical profiles of regular and first-time blood donors in the Sulaimani province of North Iraq. Methods A cross-sectional study was conducted at the Sulaimani Blood Bank, during the period of April 1, 2016 to March 28, 2017, on convenient samples of 100 regular and 100 first-time blood donors. Donor particulars were obtained from blood bank records. The cholesterol, triglyceride, low-density lipoprotein, ferritin, vitamin D3, and uric acid concentrations of blood samples were determined. Results The main reason for blood donation by regular blood donors was headache (45%), while for the first-timers it was to help relatives (31%). The low-density lipoprotein and ferritin concentrations were significantly (p=0.001) lower in the blood of regular donors than first-timers. Conclusion The study shows that regular blood donation is beneficial for the maintenance of health of donors.

Impact of regular blood donation on the human body; donors’ perspective. Donors’ opinion on side effects of regular blood donation on human body

Article

Jun 2022

Lipid and Haematologic Profiling of Regular Blood Donors Revealed Health Benefits

Article

Full-text available

Jul 2022

Background: Blood banks have been suffering a shortage of blood worldwide due to limited donations. By and large, it is widely believed that blood donation has multiple health benefits. However, there are limited studies that support it. As a result, assessing the biochemical profiles of the regular blood donors is indispensable to evaluating an individual's risk for chronic inflammation. Objective: We strived to compare lipid and haematological profiles of the regular and first-time blood donors in the National Blood Bank Service of Ethiopia. Materials and methods: A comparative cross-sectional study, involving 104 blood samples (52 each of regular and first-time donors), was designed to analyze lipid and haematological profiles and anthropometric parameters were measured. Data were analyzed using SPSS version 25, Chi-square (χ 2) was used to compare the relationship between categorical variables and an independent Student's t-test was used to compare the mean of the two groups. A p-value <0.05 was considered statistically significant. Results: Regular blood donors had lower mean TC (144.3 ± 28 mg/dL), TG (159.3 ± 88.2 mg/dL), LDL-c (75.9 ± 25.9 mg/dL) than the first-time blood donors with values of TC (158.1 ± 38.94 mg/dL), TG (163.9 ± 82.7 mg/dL), LDL-c (93.1 ± 31.5 mg/dL), respectively. The ratio of LDL-c/HDL-c and TC/HDL-c was found to be lower in regular blood donors when compared to the first-time donors (P < 0.05). Even though the level of HDL-c was higher (39.8 ± 8.8 mg/dL) in regular blood donors compared to first-time blood donors (36.8 ± 7.7 mg/dL), it was not statistically significant. The mean of some haematologic parameters like a platelet, RDW, lymphocyte, and MCH was significantly lower in regular blood donors than in first-time blood donors. BMI and WHR in regular donors were less than the first-time donors, albeit statistically insignificant. Conclusion: Interestingly, blood donation has a significant health benefit by lowering TC, TG and LDL-c, which have the potential risk of developing chronic inflammation.

Assessment of the knowledge beliefs and associated factors among Saudi adults towards blood donation in Saudi Arabia

Article

Full-text available

Dec 2022
HEMATOLOGY

Background: Blood transfusion is essential in the treatment of a wide range of illnesses. There are two sorts of donors in the blood donation system voluntary and replacement donors. Objectives: In this study, we examined Saudi adults’ knowledge, beliefs, and associated factors towards blood donation in Saudi Arabia. Methods: A cross-sectional web-based survey was conducted over three months between November 2019 & January 2020 among the general public, using structured selfadministered 18-items online questionnaires. A descriptive analysis was performed, a chisquare test was conducted to determine the relationships between the variables. A p-value <0.05 was considered statistically significant. Results: A total of 364 respondents (93.1%) believed that blood donation is an important responsibility of every individual. When asked about the reason for previous donations 261 (66.8%) said voluntary while approximately 130 (33.2%) donated for their families and friends. Fear of needles 91 (23.3%), fear of infection 53 (13.6%) a lack of time 88 (22.5%) were common barriers, and 270 (69.1%) agreed that token gifts should be given to donors. In this study, 71.1% (n = 278) were found to have good knowledge, and 96.7% (n = 378) found positive beliefs towards blood donation. The knowledge is significantly associated with being a male gender (p < 0.049), and the educational level of the participants (p < 0.003). positive beliefs were significantly associated with young donors (p < 0.045) Conclusion: These outcomes indicate that the Saudi public has positive beliefs and acceptable knowledge about blood donation and its importance in the society and health care system. Furthermore, educational programs should be done to increase the level of awareness about blood donation and its significance

EFFECTIVENESS OF WET CUPPING VERSUS BLOOD DONATION IN REDUCING HYPERLIPIDAEMIA AMONG HYPERLIPIDEMIC INDIVIDUALS

Article

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Jan 2020

Knowledge and Attitudes towards Blood Donation among Students of the Faculty of Applied Medical Sciences at King Abdulaziz University

Article

Full-text available

Aug 2021
JRMDS

Objective: To look at current knowledge and attitude about blood donation and how much it is impacted by their demographic data, history of donation and field or level of study to help raising future awareness about blood donation. Methodology: A community-based cross-sectional study was conducted between November 2017 and July 2018. Participants (350 FAMS students) were randomly selected and completed electronic self-administered questionnaire. The questionnaire comprised demographic data, blood donation related knowledge, positive and negative attitude and past donation experience. Analysis of data regards history of donation, knowledge and attitude in relation to sociodemographic, field of study and level of study was then completed. Results: Almost 27% of the students donated blood previously. They were mostly male from MLT department and fourth year. Our results show good knowledge regards blood donation in FAMS students. Student’s attitude reflected how much they believe in the impact of awareness campaign, blood transfusion application and availability of blood centres that facilitate connection between donors and recipient, would motivate the community more than having a gift or money in return for donation. Finally, the fear of needles may be the main reason that demotivated the students’ from blood donation. Conclusion: Addressing the negative attitude that our students pointed to such misconceptions regards blood donation and implementing the positive attitude such utilization of blood transfusion applications must be the focus for future campaign that targets the particular group of the community to become regular voluntary donor. Key words Blood transfusion; Awareness; knowledge; Attitude; Blood donors

Correlation Between Blood Pressure and Body Mass Index for Transfusion Therapy Setup

Conference Paper

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May 2021

Overview and Comparative Analysis of Plasma Thawing System

Conference Paper

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May 2021

Health Behavior and Lifestyle Trends among Platelet Donors: Results from a Questionnaire-Based Survey in Norway

Article

Full-text available

Mar 2021
BMRI

Background. Blood donors are on average healthier than the general population, a phenomenon known as the “healthy donor effect.” Earlier studies have also pointed to healthier behaviors among whole blood donors than the general population. This study is aimed at assessing the prevalence of four healthy behaviors (sufficient physical activity, avoiding cigarette smoking, low to moderate alcohol use, and maintaining a healthy weight) among platelet donors and to compare the results with those in the general population of similar ages. Methods. Eighty-six platelet donors were asked to complete a questionnaire designed to assess physical activity, smoking, and alcohol use. Sociodemographic information including gender, age, and education was also collected from all participants. Chi-square statistics and logistic regression were used in statistical analysis. Results. The mean age of the study donors was 51 years, 56% were female. Most were employed (90%), and 48% hold a bachelor’s or higher degree. The prevalence of healthy behaviors differed by education gradients but not by gender and age. About 49% of the donors met the weekly physical activity recommendations, less than 5% were daily smokers, and~26% were classified as more frequent drinkers (≥1 to ≤5 times per week). The corresponding percentages for the general population were, respectively, 33%, 13%, and 35%. The prevalence of overweight and obesity, as assessed by body mass index (BMI), among donors were 50% and 29%, respectively, much higher than the current prevalence of overweight and obesity of 37% and 19%, respectively, among adults in the general population. Conclusions. The individual health behaviors of the majority of the study population could be characterized by a relatively high level of physical activity, low prevalence of daily smoking, and moderate alcohol drinking. The above-average overweight/obesity prevalence among platelet donors in this cohort is of concern because of the potential serious health consequences and it warrants further reflection. 1. Introduction Several decades ago, Sullivan [1] proposed that the decreased risk of cardiovascular diseases (CVD) in premenopausal women, as compared to postmenopausal women and age-matched men, could be attributed to lower levels of iron and serum ferritin due to menstrual bleeding. Sullivan suggested that the depletion of iron stores with repeated blood donation in postmenopausal women and men might also protect against CVD. In support of this “iron hypothesis,” early prospective studies comparing whole blood donors with nondonors reported an association between blood donation and reduced risk for CVD [2, 3]. More recent studies have also suggested that blood donation may confer cardiovascular and metabolic benefits for blood donors. For example, an observational study among German blood donors suggested that regular blood donation is associated with a marked reduction in systolic and diastolic blood pressures among hypertensive donors [4]. However, a study among American blood donors suggested that regression to the mean may have contributed to these positive results [5]. In another recent study conducted at two Mediterranean blood banks in Italy and Greece, it was observed that regular blood donation in Greek blood donors could positively affect total oxidative status, a measure of overall antioxidant capacity, as reflected in enhanced activity of antioxidant enzymes in serum [6]. The association between blood donation and potential health benefits, including a protective effect against CVD, may, however, be complicated by the phenomenon called the “healthy donor effect” (HDE). This is akin to the concept of the “healthy worker effect” in occupational cohort studies, whereby individuals who apply and enter the industry are healthier and have lower morbidity and mortality than the general population [7, 8]. The HDE is the selection bias due to donor eligibility criteria which select for individuals healthy enough to donate blood, and volunteer bias, because healthier individuals may be more likely to choose to become blood donor [9, 10]. The HDE poses therefore a problem when comparing blood donors with the general population, because blood donors are on average healthier than the general population, making the general population an inappropriate comparison group. Findings of a recent large study comparing two indicators of health, self-rated physical health status, and mental health status, between Danish blood donors with nondonors, which showed that blood donors had better-reported health than the comparison group members are consistent with the concept that blood donors are healthier than the general population [11]. Two recent studies have tried to circumvent this problem by using internal comparison groups. In an analysis of nearly 160 000 Dutch, whole blood donors with a history of at least 10 years of active donation in which high-frequency donors were compared with low-frequency donors, a study found out that high-frequency female, but not male, donors, had a 9% decreased risk for cardiovascular morbidity compared with low-frequency female donors (age-adjusted hazard rate ratio: 0.91, 95% CI: 0.85-0.98) [12]. Moreover, sensitivity analyses repeated with a 5-year qualification period yielded similar results, supporting the absence of a residual HDE. In another large study which included almost 1.2 million whole blood donors aged 18-64 years in Denmark and Sweden, current donors were compared with donors who had stopped donating blood due to advanced age. It was found that blood donation was positively related to greater life expectancy [13], suggesting that part of this gain may be due to the effects of blood donation. Shehu and colleagues [14] attempted to quantify the magnitude of the HDE among German blood donors and found that a large part (~82%) of the observed differences in health status between donors and nondonors could be explained by the HDE. There is also evidence that the magnitude (or strength) of the HDE is influenced by a number of factors, including sociodemographic and lifestyle variables. For instance, in a study of Dutch blood donors, researchers found that whole blood and plasma donors were more educated, were less likely to smoke, had a lower prevalence of alcohol consumption, had more self-reported physical activity, and were slightly more likely to engage in healthful food choices than the general population. Furthermore, compared to the general population, they had fewer reported health conditions, including a lower prevalence of type 2 diabetes and high cholesterol, had fewer recent (past three months) doctor visits, and were less likely to be treated at a specialist’s office during the past six months [10, 15]. Similarly, German blood donors were less likely to smoke and more likely to consume healthy diets and had a lower prevalence of overweight and lower prevalence of chronic diseases than nondonors and inactive donors [14]. These data suggest that whole blood and plasma donors may have healthier behaviors than the general population. Platelet donors represent a unique population of volunteer, unpaid blood donors because of the high demand for platelet concentrates to support transfusion therapy. Regular platelet donors are willing to give this life-saving gift every time they are able to donate and spend extra time, which is necessary for an apheresis platelet collection. However, studies published until now have not assessed health behaviors among platelet donors. This study is aimed (1) at assessing the prevalence of four positive health behaviors (i.e., sufficient physical activity (PA), avoiding cigarette smoking, low to moderate alcohol use, and maintaining a healthy weight) in a representative sample of platelet donors, (2) at examining how these healthy behaviors varied according to sociodemographic factors, and (3) at comparing these results with those reported in nationally representative surveys that include both men and women of similar age range. 2. Methods 2.1. Setting and Study Population The study was conducted at the Blood bank in Akershus University Hospital in Loerenskog, Norway, between April 4, 2019, and February 18, 2020. The study was approved by the local Institutional Review Board, and all participants provided written informed consent. Eighty-six apheresis platelet donors attending their donation appointment were asked to participate in the study by completing a questionnaire. There were no exclusion criteria for donors, other than being ineligible to donate platelets. The questionnaire was designed to collect data on donor sociodemographics (gender, age, relationship status, education level, employment status, weight, and height) and health behaviors (physical activity, cigarette smoking, and alcohol use). Each questionnaire was given a unique research identification number to guarantee anonymity. The questionnaire was pilot-tested among five donors and based on comments from donors and interviewing/apheresis staff; questions were modified to improve clarity. The questionnaire took 10-15 minutes to complete. Self-reported weight and height were cross-checked with the collection protocol data and used to calculate the body mass index (BMI) and weight in kilograms divided by height in meters squared (kg/m²). Educational attainment was assessed by the highest self-reported grade completed and categorized into four education levels: middle school (at least 9 years of education completed), high school degree or equivalent (12 years of education completed), bachelor’s degree (had completed 3-4 years of education beyond high school), and higher degree (had completed 5 or more years of education beyond high school). 2.2. Questions on Self-Reported Health Behaviors 2.2.1. Physical Activity Frequency and duration of PA question asked “How often during leisure time are you engaged in at least 30 minutes physical activity?” The question had 6 responses of (1) never, (2) sometimes, (3) once per week, (4) 2 times per week, (5) 3-4 times per week, and (6) 5-7 times per week. The participants were then asked to state their PA intensity levels as light intensity (breathing approximately normal, equivalent in effort to slow walking/leisurely walk), (2) moderate intensity (activities that cause light sweating or slight to moderate increases in breathing, equivalent in effort to brisk walking), or (3) vigorous intensity (activities that cause heavy sweating or breathing much harder than normal, equivalent in effort to running, jogging and bicycling). In addition, they were asked whether they were engaged in training in gyms or fitness centers/studios (yes/no) and then whether they have had physical activity in the past 24 hours (yes/no). 2.2.2. Smoking For smoking habits, participants were asked “Do you smoke?” with the following response options: never smoked, former smokers, daily smokers, and occasional smokers. Those who smoked were further asked whether they had smoked in the past 24 hours (yes/no). 2.2.3. Alcohol Consumption The frequency of alcohol consumption question asked “How often do you drink alcohol?” In all, eight response options were available: (1) never, (2) less than once per month, (3) once per month, (4) 2-3 times per month, (5) once per week, (6) 2-3 times per week, (7) 4-5 times per week, and (8) every day or almost every day. The participants were then asked: “How many drinks they consume on a typical drinking occasion?” This question was answered using a 4-point scale with response options ranging from 1 to 4+ drinks per occasion. Study participants were also asked whether they had consumed alcohol in the past 24 hours (yes/no). 2.2.4. Self-Reported Sleep Measures The questionnaire also included a single-item measure of subjective sleep quality in which donors were asked to rate their sleep quality on a five-point scale from very good to very poor. In addition, donors were asked about their habitual bedtimes and duration of sleep. 2.2.5. Engagement in Multiple Healthy Behaviors The number of positive health behaviors (i.e., sufficient PA, avoiding cigarette smoking, low to moderate alcohol consumption, and maintaining a healthy weight) was summed for each donor. Donors were categorized as having 0, 1, 2, 3, or 4 positive health behaviors. 2.3. Statistical Analysis For the purpose of our analysis, sociodemographic and health behavioral variables were mostly dichotomized: gender (male, female), age (22-50 vs. 51-69 years), relationship status (married/cohabiting vs. single), and education level (high school or less vs. bachelor’s or higher degree). Participants were also classified as employed if they were in paid employment; otherwise, classified as “other”. Sleep quality was dichotomized as very good/good vs. fair. Smoking status was categorized into nonsmokers () and current smokers (). An indicator of PA levels per week was calculated as the product of frequency and intensity of PA reported by each donor. For current drinkers, we calculated the average “typical” number of drinks consumed per month by combining frequency and quantity (i.e., ) into a single continuous variable. For comparison with the general population, current drinkers were also categorized as less frequent drinkers (≤3 times per month) or more frequent drinkers (≥1 to ≤5 times per week), because no equivalent data were available in the most recently published statistics for alcohol consumption. Finally, for bivariate comparison of the number of positive health behaviors, a dichotomized variable was produced by combining the scores 1 and 2 and scores 3 and 4. Because the majority of participants were employed and married/cohabiting and rated their sleep quality as very good/good, differences in these variables could not be evaluated. Data were summarized with descriptive statistics and expressed as number and percentage/proportion for categorical variables and (SD) for continuous variables. Cross-tabulation, a chi-square test, or the Fisher’s exact test were used to analyze differences between groups. Multivariate logistic regressions were used to estimate adjusted odds ratios (OR) and associated 95% confidence intervals (CI). Independent samples -test was used to compare differences in means of continuous variables and the Pearson correlation coefficient (Pearson’s ) to evaluate their correlations. Statistical testing was 2-sided, with . Analyses were performed with IBM SPSS Statistics, version 25. The data set did not have any missing values. 3. Results 3.1. Sociodemographic and Health Behavioral Characteristics of the Study Population We asked 86 donors (~80% of the platelet donor pool at our blood bank) to participate in the study. All of the donors asked to participate agreed to do so and completed the questionnaire. The number and percentage distribution of responses to questionnaire items are shown in Table 1. The mean age was years (range: 22-69 years), 55.8% were female, and 78% were married or cohabiting (53.5% and 24.5%, respectively). Most (89.5%) were employed; the remainder were recently retired (5.8%) or students (2.3%). Only one donor was presently unemployed and only a 47-year-old donor reported receiving a temporary disability benefit. Slightly more than half of the donors had high school or less education (46.5% and 5.8%, respectively), and 47.7% hold a bachelor’s or higher degree (33.7% and 14%, respectively). Regarding ethnicity, only one donor had an ethnic minority background. Male and female donors did not differ in age ( vs. years, ), but more males (61%) than females (38%) hold a bachelor’s or higher degree (). Variable Number (%) Age group 22-50 42 (48.8) 51-69 44 (51.2) Gender Male 38 (44.2) Female 48 (55.8) Relationship status Married/cohabiting 67 (78) Single 19 (22) Employment status Employed 77 (90) Other† 9 (10) Education level ≤High school 45 (52) Bachelor’s or higher degree 41 (48) Sleep quality Very good/good 73 (85) Fair 13 (15) Physical activity frequency <Once per week 10 (11.6) Once per week 5 (5.8) Twice per week 16 (18.6) 3-4 times per week 25 (29.1) 5-7 times per week 30 (34.9) Physical activity intensity Light 14 (16.3) Moderate 40 (46.5) Vigorous 32 (37.2) Smoking Never 50 (58.1) Former smoker 25 (29.1) Daily 4 (4.7) Occasional 7 (8.1) Drinking frequency‡ Less than once per month 19 (22.9) Once per month 16 (19.3) 2-3 times a month 26 (31.3) Once per week 4 (4.7) 2-3 times per week 15 (18.1) 4-5 times per week 3 (3.6) Typical drinks per occasion 1 10 (11.6) 2 34 (41.0) 3 27 (32.5) 4+ 12 (14.5) Data are presented as number (percentage). Column percentages are given. †Other: unemployed, retired, and students. ‡Only includes current drinkers.

Frequency and Causes of Deferral among Blood Donors Presenting to Combined Military Hospital Multan

Article

Full-text available

Jan 2020

Background & Aim It is of great importance to carefully choose appropriate donors according to strict eligibility criteria, so as to guarantee an adequate and safe blood supply. The aim of this study was to determine the rate of deferral in blood donors and evaluate the different causes of deferral in Multan. Materials & Methods This prospective study was carried out at the Blood Bank of Combined Military Hospital (CMH) Multan. All donors who came for the donation of blood from 1st February to 30th September 2019 were evaluated after taking their consent. The data was analyzed to determine the frequency and causes of deferral using Statistical Package for the Social Sciences (SPSS) version 20. Results Among 3348 individuals presenting for blood donation, 433 (12.9%) were deferred (427 males and only six females). The mean age of deferred individuals was 28.96 + 6.42 years. The youngest individual was 18 years, while the eldest one was 51 years of age. Almost 65% of the individuals were less than 30 years of age. The most frequent cause of deferral was low hemoglobin. Anemia was the leading cause of deferral in more than half of the individuals (n = 221). Hepatitis C virus (HCV) infection was the second most frequent cause of deferral, seen in 83 (19.2%), followed by hepatitis B virus (HBV) infection (n = 49, 11.3%), syphilis (n = 36, 8.3%), thrombocytopenia (n = 18, 4.2%), and active infection (n = 14, 3.2%). Other rarer causes included early donation, thrombocytosis, polycythemia, pancytopenia, malaria, allergies, insulin, and tuberculosis. Conclusion Deferral for blood donation is a significant problem in Multan and accounts for almost 13% of all prospective blood donors. Our results stress the importance of addressing the problem of anemia which is the most prevalent cause of temporary deferral for blood donation in this region of the world.

Blood donation and health status based on SF-36: The mediating effect of cognition in blood donation

Article

Full-text available

Oct 2019
PLOS ONE

Objective: The relationship among blood donation, cognition in blood donation and health condition of blood donors remains unclear. Based on our hypothesis, this study aimed to explore the mediating effect of cognition in blood donation on the relationship between blood donation and blood donors' health status. Methods: A total of 837 participants who had prior experience in donating whole blood were recruited into a cross-sectional survey. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Questionnaire on Cognition in Non-remunerated Blood Donation were used to evaluate the health status and the level of cognition in blood donation, respectively. Blood donation referred to the cumulative times of blood donation. The mediating effect of cognition in blood donation was analyzed by applying a path model. Results: The results revealed that blood donation was positively related to the physical component summary (PCS) and mental component summary (MCS) of SF-36, and cognition in blood donation was shown to have a partial mediating effect on the relationship between blood donation and both PCS and MCS. The effect size of cognition in blood donation was 24.63% in PCS and 26.72% in MCS. Conclusions: Blood donation is positively correlated with SF-36 outcomes (PCS and MCS) of blood donors, and cognition in blood donation plays a partial mediating effect in the relationship between blood donation and PCS and MCS.

Assessment of lipid and hematological profile among blood donors in European Gaza Hospital, Palestine

Article

Full-text available

Jul 2019

Assessment of Lipid and Hematological Profile among Blood Donors in European Gaza Hospital, Palestine

Article

Full-text available

Jul 2019

Abu-Eid I Sameer

Background: There is an important shortage of blood in the greatest blood banks worldwide to meet up with requirements for numerous medical interventions. Limited studies have associated regular blood donation to the lowering of lipid function parameters. Assessing the lipid function is a classical method of evaluating an individual’s risk for coronary heart disease. Objective: The general goal of the study is to determine lipid and hematological profile among blood donors in European Gaza Hospital, Palestine. Materials and Methods: This study was a case-control study that involved 120 males, 40 of whom were regular blood donors (study group), 40 first time donors and 40 non- donors (control group) aged between 18–60 years. A volume of 5ml venous blood was drawn from each fasting participant into a dry biochemistry screw-capped tube. This was allowed to clot and the serum was used to determine total cholesterol (TC), triglycerides, High-density lipoprotein cholesterol (HDL-C), Low-density lipoprotein cholesterol (HDL-C), while HDL-C/LDL-C and TC/LDL ratio were calculated by using the following formula. Anthropometric parameters (weight, height) of donors were measured using standard protocol. The height (in meter), weight (in kilogram) were used to calculate the body mass index (BMI) using the following formula. BMI= weight (kg)/ (height in meter)² and blood was collected from each participant in EDTA (for hematocrit, ESR). Three groups were matched for age and BMI. Data were analyzed using SPSS version 23. Chi-square (χ²) was used to compare the relationship between categorical variables, ANOVA was used to measure the difference between means. Data were summarized using tables, pie charts, histograms. A P-value < 0.05 was considered to be statistically significant for all tests conducted. Results: The mean total cholesterol (169±10.85 mg/dl), triglycerides (116±9.73 mg/dl), HDL (54±2.5 mg/dl ), LDL (92±11.4mg/dl), LDL/HDL ratio (1.73±0.25) and TC/HDL ratio (3.16±0.26) were lower in the regular blood donors than the first time donors(198±10.13, 179±5.82, 42.33±1.6, 120±11.2, 2.85±0.36, 4.7±0.40) and non- donors (202±10.19, 180±12.68, 41.75±1.4, 125±11.7, 2.99±0.33, 4.86±0.32) respectively and statistically significant (P < 0.05).The mean ESR (6.63±0.87mm/hr) was lower statistically significant in the regular blood donors than the first time donors (7.40±1.17) and non- donors (7.60±1.48) respectively (P < 0.05). The mean HCT (42.98±0.86%) was lower statistically significant in the regular blood donors than the first time donors (44.63±0.90) and non- donors (44.75±0.74, P < 0.05). Conclusions: Regular donors have reduced risk of developing coronary heart disease as reflected by lower total cholesterol, triglycerides, LDL-c, LDL-c/HDL-c ratio, TC/HDL-c ratio and HCT and high HDL. BMI in regular donor was less than the donor for the first time and did not donate, but did not reach the statistical significance. Also in our study regular donors have reduced risk of developing inflammation as reflected by low ESR.

Assessment of Lipid and Hematological Profile among Blood Donors in European Gaza Hospital, Palestine

Article

Full-text available

Jan 2019

An introduction to the special issue Blood Donor Research

Article

Full-text available

Dec 2018

Determinants of Blood Donation Status in Malaysia: Profiling the Non-Donors, Occasional Donors and Regular Donors

Article

Apr 2018

The blood shortage situation is a perennial concern in Malaysia. This study examines the sociodemographic and lifestyle related factors associated with blood donation status of non-donors, occasional donors, and regular donors. Discerning the donation status of blood donors is important as studies have noted that it is more cost-effective to reactivate occasional (consisting of existing or former) donors than to recruit new donors. Based on stratified random sampling measures, primary data were obtained from 550 Malaysian adults aged 18–60 years from Pulau Pinang, Malaysia. Ordered probit analysis was conducted and marginal effects of various factors on blood donation status calculated. Results indicate that sociodemographic factors associated with donor status include gender, marital status, education level, and income level. Lifestyle related factors affecting donor status comprise working hours, family history, and fear of the donation process. It is concluded that donor awareness and education programs should be focused on females, singles, and individuals in the lower socioeconomic echelons. Donor retention strategies should be aimed at those with previous family history of blood recipients. Measures should be implemented to accommodate busy people and those fearful of the donation process. These strategies could be undertaken not only in Malaysia but also in other countries with comparable sociodemographic and health care settings.

Associations of health status with subsequent blood donor behavior—An alternative perspective on the Healthy Donor Effect from Donor InSight

Article

Full-text available

Oct 2017
PLOS ONE

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.

Blood donors' physical characteristics are associated with pre- and postdonation symptoms - Donor InSight

Article

Jul 2016

Background: Observational data suggest that some donors might benefit from donating while others may be harmed. The aim of this study was to investigate the prevalence and potential, routinely measured, determinants of pre- and post-donation symptoms. Materials and methods: In Donor InSight, questionnaire data from 23,064 whole blood donors (53% female) were linked to routinely measured data on donors' physical characteristics (haemoglobin, blood pressure, body mass index and estimated blood volume) from the Dutch donor database. Absolute and relative associations between donors' physical donor and the presence of pre- and post-donation symptoms were studied using multivariable logistic regression. Results: Pre-donation symptoms (lack of energy, headaches) were reported by 3% of men and 3% of women. Five percent of men and 4% of women reported positive post-donation symptoms (feeling fit, fewer headaches). Negative symptoms (fatigue, dizziness) were more common, occurring in 8% of men and 19% of women. All the studied donors' physical characteristics were positively associated with pre- and positive post-donation symptoms and negatively associated with negative symptoms. Body mass index was most consistently and independently associated with symptoms. Discussion: Donors' physical characteristics, in particular body mass index, were consistently associated with pre- and post-donation symptoms. This indicates that subgroups of donors more and less tolerant to donation might be identifiable using routinely measured data. Further research is warranted to study underlying mechanisms and potential strategies to predict and prevent donor reactions.

Therapeutischer AderlassTherapeutic bloodletting

Article

Oct 2023

Thomas Rampp

Healthful Practices Among Blood Donors in A Low- Income Setting

Article

Full-text available

Jan 2023

Background: Blood donation is sustained by the availability of healthy donors. It does not only require recruiting new healthy donors, but also maintaining existing ones in optimal health. As recruitment of new donors is not guaranteed, it is essential that existing donors are always in good shape. The study therefore assesses the lifestyles and healthy habits of a sample of recurrent blood donors, their demographic characteristics, and motivations for donation. Methods: This was a cross-sectional study involving 127 blood donors between the ages of 17 and 60 years in Korle-bu, Ghana. Participants were sampled by the snowball method and administered pre-tested electronic questionnaires. The data was summarised using the Numbers software by Apple Inc. and then analysed. Results: All were non-smokers and engaged conscientiously in at least one healthy habit of a sort, with 60.3% actively following fitness schedules. There were no lifestyle-related health conditions or substance addictions. Up to 94% of the respondents had attained university education. Motivations for donations revolved mostly around altruism and almost half (46.5%) of the respondents conceded that being blood donors had made them live healthier. Conclusion: Voluntary blood donors in the selected low-income setting were mostly health conscious, and the donor status significantly affected this way of life, only more indirectly than directly. More indirectly because the healthy habits practised were predominantly personal well-being oriented but reinforced by the desire to donate blood in many situations.

Blood donation improves skin aging through the reduction of iron deposits and the increase of TGF-β1 in elderly skin

Article

Jun 2022
MECH AGEING DEV

Skin aging is characterized by a wide range of physiological and structural changes, including wrinkling, dyschromia, and roughness, as well as the reduction of dermal thickness and collagen content. Here, we showed that blood donation increased dermal thickness and collagen content and decreased the number of senescent cells in old mice. Transcriptomic and metabolomic studies revealed blood donation significantly altered aging-related pathways in the skin of old mice. Molecular genes analysis indicated blood donation decreased the expression of genes associated with inflammation such as Fols1, Cox-2, and IL-1β, and increased the expression of collagen-associated genes including TGF-β1, TGF-β2, and Col3a1. The improvement of skin aging by blood donation was associated with the reduction of iron deposits and the increase of TGF-β1 in elderly skin. Our results suggested that appropriate blood donation could promote collagen re-synthesis and improve skin aging.

Cardiovascular Benefits for Blood Donors? A Systematic Review

Article

Apr 2022
TRANSFUS MED REV

It has been proposed that blood donation could be protective against cardiovascular disease (CVD). The aim of this study is to systematically summarize and evaluate existing observational and experimental studies on effects of blood donation on cardiovascular risk and disease in donor and general populations. The electronic databases PubMed and EMBASE were searched until March 2019 for experimental and observational studies on blood donation and cardiovascular risk or disease. Excluded were studies performed in patient populations or with controls compared to a patient population, and studies performed in individuals aged <18 or >70. All identified studies were independently screened for eligibility and quality using validated scoring systems by two reviewers. A total of 44 studies met all criteria. We included 41 observational studies and 3 experimental studies. 14 studies had a quality assessment score of 7 or higher. Of those, a majority of 9 studies reported a protective effect of blood donation, while 5 studies found no effects on cardiovascular risk factors. Results on other various outcomes were inconsistent and study quality was generally poor. Whether or not blood donation protects against cardiovascular disease remains unclear. Studies showing beneficial effects may have inadequately dealt with the healthy donor effect. High quality studies are lacking and therefore definite conclusions cannot be drawn. Large RCTs or cohort studies of high quality with sufficient follow-up should be conducted to provide evidence on the possible association between blood donation and CVD.

Whole blood donors' post‐donation symptoms diminish quickly but are discouraging: Results from 6‐day symptom diaries

Article

Jan 2021

Background Whole blood donors may experience post‐donation symptoms such as fatigue, dizziness, or headache after blood donation, which could influence donor retention. We aimed to examine post‐donation symptoms during 1 week after whole blood donation, investigate donor characteristics associated with symptoms, and evaluate associations between symptoms and donor return. Methods During 1 week, whole blood donors who donated successfully at one of the collection centers in The Netherlands were invited to participate. Three thousand seventy six donors filled in a diary, assessing post‐donation symptoms during days 1 to 6 after donation. We used linear mixed models analyses to determine the change in post‐donation symptoms after donation for male and female donors separately. Furthermore, we investigated associations between post‐donation symptoms and donors' physical characteristics using multivariable regression and determined associations between symptoms and donor return. Results Donors reported fatigue as the most common symptom, with approximately 3% of donors experiencing severe problems at the first day after donation. Multiple symptoms improved significantly up to day 3 after whole blood donation. Age, BMI, blood pressure (male donors), and blood volume (female donors) were significantly associated with post‐donation symptoms. Donors with less fatigue after whole blood donation were more likely to return for their next donation within 31 days after receiving an invitation. Conclusion Post‐symptoms improve up to 3 days after whole blood donation. Our results may help blood collection centers to identify donors more prone to post‐donation symptoms and provide personalized information about the presence and course of post‐donation symptoms, possibly increasing donor return rates.

Naturheilkundliche Ansätze bei Herzinsuffizienz

Article

May 2018

Gustav J Dobos

Bill Clinton ist ein prominentes Fallbeispiel, wenn es um das Potenzial der Naturheilkunde bei Herzerkrankungen geht. Trotz mehrerer Stents und Bypass-Operationen musste der ehemalige Präsident feststellen, dass seine Herzleistung nachließ — bis er Patient des naturheilkundlichen Kardiologen Dean Ornish wurde.

Donating blood on a regular basis appears to reduce blood pressure, but appearances can be deceiving: DONATION AND BLOOD PRESSURE

Article

Jan 2017
TRANSFUSION

Background: Previous studies have reported a relationship between blood donation and decreased risk for cardiovascular events, and it has been proposed that this may be due to a lowering of blood pressure among hypertensive individuals who donate on a regular basis. Study design and methods: With the use of a retrospective longitudinal analysis, predonation blood pressure readings were examined across consecutive whole blood donations for New York Blood Center donors. With blood pressure levels recorded at the first, second, third, and fourth donations, the sample was divided into three subgroups including high (≥140 mmHg), intermediate (>100 and <40 mmHg), and low (≤100 mmHg) systolic blood pressure (SBP). In addition, a computational approach was used to estimate regression to the mean effects for donors with high SBP or high diastolic blood pressure (DBP) at their first, second, or third donation. Results: Visual examination of SBP and DBP patterns across donations revealed that, on average, donors with extreme values at one donation had relatively normal values at the other donations. Further, comparison of computed expected versus observed blood pressure decreases supported the notion of a subsequent regression to the mean among donors with elevated SBP or DBP at Donation 1, 2, or 3. Conclusion: Among individuals who are hypertensive at initial donation, reductions in blood pressure at subsequent donations appear to result from regression to the mean as opposed to a salutary physiologic process.

Hilft Aderlass bei arterieller Hypertonie?

Article

Feb 2016

Zwei Fliegen mit einer Klappe: In einer neuen Beobachtungsstudie korrelieren regelmäßige Blutspenden bei hypertensiven Spendern mit einem deutlichen Abfall des Blutdrucks.

Roles of Inflammation, Oxidative Stress, and Vascular Dysfunction in Hypertension

Article

Full-text available

Jul 2014
BMRI

Hypertension is a complex condition and is the most common cardiovascular risk factor, contributing to widespread morbidity and mortality. Approximately 90% of hypertension cases are classified as essential hypertension, where the precise cause is unknown. Hypertension is associated with inflammation; however, whether inflammation is a cause or effect of hypertension is not well understood. The purpose of this review is to describe evidence from human and animal studies that inflammation leads to the development of hypertension, as well as the evidence for involvement of oxidative stress and endothelial dysfunction-both thought to be key steps in the development of hypertension. Other potential proinflammatory conditions that contribute to hypertension-such as activation of the sympathetic nervous system, aging, and elevated aldosterone-are also discussed. Finally, we consider the potential benefit of anti-inflammatory drugs and statins for antihypertensive therapy. The evidence reviewed suggests that inflammation can lead to the development of hypertension and that oxidative stress and endothelial dysfunction are involved in the inflammatory cascade. Aging and aldosterone may also both be involved in inflammation and hypertension. Hence, in the absence of serious side effects, anti-inflammatory drugs could potentially be used to treat hypertension in the future.

Cardiovascular benefits of phlebotomy: Relationship to changes in hemorheological variables

Article

Full-text available

Sep 2013
Perfusion

Renewed interest in the age-old concept of "bloodletting", a therapeutic approach practiced until as recently as the 19th century, has been stimulated by the knowledge that blood loss, such as following regular donation, is associated with significant reductions in key hemorheological variables, including whole blood viscosity (WBV), plasma viscosity, hematocrit and fibrinogen. An elevated WBV appears to be both a strong predictor of cardiovascular disease and an important factor in the development of atherosclerosis. Elevated WBV through wall shear stress is the most direct physiological parameter that influences the rupture and erosion of vulnerable plaques. In addition to WBV reduction, phlebotomy may reduce an individual's cardiovascular risk through reductions in excessive iron, oxidative stress and inflammation. Reflecting these findings, blood donation in males has shown significant drops in the incidence of cardiovascular events, as well as in procedures such as percutaneous transluminal coronary angioplasty and coronary artery bypass grafting. Collectively, the available data on the benefits of therapeutic phlebotomy point to the importance of monitoring WBV as part of a cardiovascular risk factor, along with other risk-modifying measures, whenever an increased cardiovascular risk is detected. The development of a scanning capillary tube viscometer allows the measurement of WBV in a clinical setting, which can prove to be valuable in providing an early warning sign of an increased risk of cardiovascular disease.

Effects of phlebotomy-induced reduction of body iron stores on metabolic syndrome: Results from a randomized clinical trial

Article

Full-text available

May 2012
BMC MED

Metabolic syndrome (METS) is an increasingly prevalent but poorly understood clinical condition characterized by insulin resistance, glucose intolerance, dyslipidemia, hypertension, and obesity. Increased oxidative stress catalyzed by accumulation of iron in excess of physiologic requirements has been implicated in the pathogenesis of METS, but the relationships between cause and effect remain uncertain. We tested the hypothesis that phlebotomy-induced reduction of body iron stores would alter the clinical presentation of METS, using a randomized trial. In a randomized, controlled, single-blind clinical trial, 64 patients with METS were randomly assigned to iron reduction by phlebotomy (n = 33) or to a control group (n = 31), which was offered phlebotomy at the end of the study (waiting-list design). The iron-reduction patients had 300 ml of blood removed at entry and between 250 and 500 ml removed after 4 weeks, depending on ferritin levels at study entry. Primary outcomes were change in systolic blood pressure (SBP) and insulin sensitivity as measured by Homeostatic Model Assessment (HOMA) index after 6 weeks. Secondary outcomes included HbA1c, plasma glucose, blood lipids, and heart rate (HR). SBP decreased from 148.5 ± 12.3 mmHg to 130.5 ± 11.8 mmHg in the phlebotomy group, and from 144.7 ± 14.4 mmHg to 143.8 ± 11.9 mmHg in the control group (difference -16.6 mmHg; 95% CI -20.7 to -12.5; P < 0.001). No significant effect on HOMA index was seen. With regard to secondary outcomes, blood glucose, HbA1c, low-density lipoprotein/high-density lipoprotein ratio, and HR were significantly decreased by phlebotomy. Changes in BP and HOMA index correlated with ferritin reduction. In patients with METS, phlebotomy, with consecutive reduction of body iron stores, lowered BP and resulted in improvements in markers of cardiovascular risk and glycemic control. Blood donation may have beneficial effects for blood donors with METS. ClinicalTrials.gov: NCT01328210 Please see related article: http://www.biomedcentral.com/1741-7015/10/53.

Sufficient blood, safe blood: Can we have both?

Article

Full-text available

Mar 2012
BMC MED

The decision in September 2011 in the UK to accept blood donations from non-practicing men who have sex with men (MSM) has received significant public attention. Will this rule change substantially boost the number of blood donations or will it make our blood less safe? Clearly, most European countries have a blood procurement problem. Fewer young people are donating, while the population is aging and more invasive therapies are requiring more blood. Yet if that was the reason for allowing non-practicing MSM to donate, clearly re-admission of some other, much larger populations that are currently deferred from donation should likewise be considered. As far as risks for blood safety are concerned, evidence has been provided that the current quality of infectious disease marker testing significantly mitigates against, although does not completely eradicate, risks associated with admission of donors with a high risk of carrying certain blood-transmissible agents. However, it could be argued that more effective recruitment of the non-donor pool, which is substantially larger than the group of currently ineligible donors, would be a better strategy. Recruitment of this group will benefit the availability of blood without jeopardizing the current excellent safety profile of blood.

Donation of Blood Is Associated with Reduced Risk of Myocardial Infarction The Kuopio Ischaemic Heart Disease Risk Factor Study

Article

Full-text available

Oct 1998
AM J EPIDEMIOL

Because high body iron stores have been suggested as a risk factor for acute myocardial infarction, donation of blood could theoretically reduce the risk by lowering body iron stores. For this reason, the authors tested the hypothesis that voluntary blood donation is associated with reduced risk of acute myocardial infarction in a prospective epidemiologic follow-up study in men from eastern Finland. The subjects are all participants of the Kuopio Ischaemic Heart Disease Risk Factor Study. A cohort of 2, 862 men aged 42–60 years were followed for an average of almost 9 years. One man (0.7%) out of 153 men who had donated blood in 24 months preceding the baseline examination experienced an acute myocardial infarction during 1984 to 1995, whereas 316 men (12.5%) of 2, 529 non-blood donors had an acute myocardial infarction (p < 0.0001 for difference between proportions). In a Cox proportional hazards model adjusting for age, examination years and all other predictive coronary disease risk factors, blood donors had a 88% reduced risk (relative hazard = 0.12, 95% confidence interval 0.02–0.86, p = 0.035) of acute myocardial infarction, compared with non-blood donors. These findings suggest that frequent blood loss through voluntary blood donations may be associated with a reduced risk of acute myocardial infarction in middle-aged men. Am J Epidemiol 1998; 148: 445–51.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Article

Full-text available

Dec 2003
Hypertension

The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies

Article

Jan 2002

The age-specific relevance of blood pressure to cause-specific mortality is best assessed by collaborative meta-analysis of individual participant data from the separate prospective studies. Methods Information was obtained on each of one million adults with no previous vascular disease recorded at baseline in 61 prospective observational studies of blood pressure and mortality. During 12.7 million person-years at risk, there were about 56 000 vascular deaths (12 000 stroke, 34000 ischaemic heart disease [IHD], 10000 other vascular) and 66 000 other deaths at ages 40-89 years. Meta-analyses, involving "time-dependent" correction for regression dilution, related mortality during each decade of age at death to the estimated usual blood pressure at the start of that decade. Findings Within each decade of age at death, the proportional difference in the risk of vascular death associated with a given absolute difference in usual blood pressure is about the same down to at least 115 mm Hg usual systolic blood pressure (SBP) and 75 mm Hg usual diastolic blood pressure (DBP), below which there is little evidence. At ages 40-69 years, each difference of 20 mm Hg usual SBP (or, approximately equivalently, 10 mm Hg usual DBP) is associated with more than a twofold difference in the stroke death rate, and with twofold differences in the death rates from IHD and from other vascular causes. All of these proportional differences in vascular mortality are about half as extreme at ages 80-89 years as at,ages 40-49 years, but the annual absolute differences in risk are greater in old age. The age-specific associations are similar for men and women, and for cerebral haemorrhage and cerebral ischaemia. For predicting vascular mortality from a single blood pressure measurement, the average of SBP and DBP is slightly more informative than either alone, and pulse pressure is much less informative. Interpretation Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.

Regional variations in hypertension prevalence and management in Germany: Results from the German Health Interview and Examination Survey (DEGS1)

Article

May 2014

Objective: This study analyzed regional differences in blood pressure (BP) distribution and management in Germany 2008-2011 in a nationwide study. Methods: The analyses were based on standardized BP measurements and anatomical therapeutic chemical classification-coded medication from the population-based German Health Interview and Examination Survey (DEGS1) 2008-2011 (N = 7074, 18-79 years, 180 study points, five regions: Central-East, South, Central-West, North-West, and North-East). Regional differences were tested between the region with the highest and lowest values. Results: Regional variations were observed in mean SBP, mean DBP, and the prevalence of hypertension in both sexes, as well as awareness, treatment, and control in men. Differences in blood pressure (in mmHg) between Central-East, the region with the highest BP level and the region with the lowest BP level, were SBP 3.2 and DBP 2.5 in men and SBP 4.5 and DBP 2.4 in women. In Central-East 39% of men and 40% of women had hypertension, versus 30% of men in the North-West and 26% of women in the South. The percentage of aware, treated, and controlled men ranged between 92, 78, and 56% in the North-East and 74, 59, and 41% in the South, respectively. After multivariate adjustment for sociodemographic variables and hypertension risk factors, geographical differences persisted for hypertension prevalence in women and hypertension awareness and treatment in men. Conclusion: So far, national surveys allowed only BP comparisons along the former East-West border and showed more elevated BP in the East. New analyses suggest regional differences with both the most and the least favorable results in the two neighboring parts of former East Germany.

The success of our patient blood management program depended on institution-wide change in transfusion practices

Article

Jan 2014
TRANSFUSION

Patient blood management (PBM) programs seek to optimize the utilization of blood components. Since our institution's program started, the annual number of red blood cell (RBC) units transfused has decreased by 27% overall. We collected data for 6 months in 2007 (pre-PBM) compared with the same months in 2011 (post-PBM) to determine which changes in practice decreased RBC utilization. Indications for transfusion of nonsurgical patients were collected from the electronic medical records, while surgical indications were assigned to the admitting physician's specialty. Pre-PBM, we transfused 19,888 RBC units for a mean of 0.96 units per patient discharged, compared with 14,472 post-PBM, for a mean of 0.55 units per discharge. This represents a 43% reduction in RBC units transfused per patient discharged. While transfusion episodes decreased only slightly from 9519 to 9261, the success can be explained by the overall reduction in mean number of units per transfusion from 2 to 1.5 (p < 0.0001). Pre-PBM, 22 and 48% of patients received 1 or 2 units of RBCs per transfusion episode, respectively, while in 2011, the percentages were 51 and 33%, respectively (p < 0.0001). The mean number of RBC units per transfusion decreased significantly for approximately 50% of the indications. Our success was achieved through hospital-wide physician buy-in toward a restrictive transfusion approach. We hope to encourage others to consider PBM for improved patient outcomes and blood conservation.

Innate Immunity in Hypertension

Article

Feb 2014
Curr Hypertens Rep

Despite intensive research, the exact cause of hypertension remains unknown. Low-grade inflammation has been proposed to play a key role in the pathogenesis of hypertension. Both innate and adaptive immune responses may participate in this process. Several studies have addressed the contribution of adaptive immunity to the pathophysiology of high blood pressure; however, the role of innate immunity is less clear. Innate immunity may be an important mediator of chronic inflammation in hypertension. Slight elevation of blood pressure due to increased sympathetic and/or decreased parasympathetic outflow, or low-grade infections may generate neoantigens and damage-activated molecular patterns (DAMPs) or pathogen-activated molecular patterns (PAMPs), which can trigger Toll-like receptors on innate effector cells. Innate responses, mediated by monocytes, macrophages, dendritic cells and natural killer cells, may contribute to inflammation either directly or by activating adaptive immune responses mediated by T lymphocytes. In this review, we discuss the recent evidence regarding the contribution of different innate effector cells, their response and their mechanisms of activation in hypertension.

Patient blood management - A new paradigm for transfusion medicine?

Article

Oct 2009

The saving of many lives in history has been duly credited to blood transfusions. What is frequently overlooked is the fact that, in light of a wealth of evidence as well as other management options, a therapy deemed suitable yesterday may no longer be the first choice today. Use of blood has not been based upon scientific evaluation of benefits, but mostly on anecdotal experience and a variety of factors are challenging current practice. Blood is a precious resource with an ever limiting supply due to the aging population. Costs have also continually increased due to advances (and complexities) in collection, testing, processing and administration of transfusion, which could make up 5% of the total health service budget. Risks of transfusions remain a major concern, with advances in blood screening and processing shifting the profile from infectious to non-infectious risks. Most worrying though, is the accumulating literature demonstrating a strong (often dose-dependent) association between transfusion and adverse outcomes. These include increased length of stay, postoperative infection, morbidity and mortality. To this end, a recent international consensus conference on transfusion outcomes (ICCTO) concluded that there was little evidence to corroborate that blood would improve patients’ outcomes in the vast majority of clinical scenarios in which transfusions are currently routinely considered; more appropriate clinical management options should be adopted and transfusion avoided wherever possible. On the other hand, there are patients for whom the perceived benefits of transfusion are likely to outweigh the potential risks. Consensus guidelines for blood component therapy have been developed to assist clinicians in identifying these patients and most of these guidelines have long advocated more conservative ‘triggers’ for transfusion. However, significant variation in practice and inappropriate transfusions are still prevalent. The ‘blood must always be good philosophy’ continues to permeate clinical practice. An alternative approach, however, is being adopted in an increasing number of centres. Experience in managing Jehovah’s Witness patients has shown that complex care without transfusion is possible and results are comparable with, if not better than those of transfused patients. These experiences and rising awareness of downsides of transfusion helped create what has become known as ‘patient blood management’. Principles of this approach include optimizing erythropoiesis, reducing surgical blood loss and harnessing the patient’s physiological tolerance of anaemia. Treatment is tailored to the individual patient, using a multidisciplinary team approach and employing a combination of modalities. Results have demonstrated reduction of transfusion, improved patient outcomes and patient satisfaction. Significant healthcare cost savings have also followed. Despite the success of patient blood management programmes and calls for practice change, the potential and actual harm to patients caused through inappropriate transfusion is still not sufficiently tangible for the public and many clinicians. This has to change. The medical, ethical, legal and economic evidence cannot be ignored. Patient blood management needs to be implemented as the standard of care for all patients.

Demographic changes: the impact for safe blood supply

Article

Jun 2010

The population structure in most European countries is currently changing with a shift from younger to older age groups. Only sparse data exist on the impact of these demographic changes on future blood demand and supply. Data on blood recipients are sparse and unconnected to data on blood donors. Based on studies in North America and Europe on the impact of demographic changes on future blood supply, the demographic trends will affect many regions in the Western world similarly. These effects are most pronounced in the new member states of the European Union where birth rates declined abruptly after 1989. Co-ordinated efforts will be required to prevent blood shortages based upon these demographic trends in Western societies. The second part of this review provides examples of different methodological approaches to obtain data on the sociodemographic background of the blood donor population.

Novel therapeutic strategies in the management of arterial hypertension

Article

May 2012

Essential hypertension is a disease with a major impact on health worldwide, thus control of blood pressure seems to be a key component of cardiovascular disease prevention. Despite considerable advances in the treatment of hypertension, effective management remains poor and new strategies to control high blood pressure and cardiovascular risk reduction are required. These seem to be divided into two major categories: those seeking to advance blood pressure-lowering efficacy of already existing agents, and others related to novel approaches, both pharmacological and non-pharmacological. Moreover, numerous clinical trials have evaluated the use of nutritional supplements in the prevention of cardiovascular diseases and in achievement of optimal blood pressure control. Additionally, the advent of interventional techniques, such as carotid baroreceptor stimulation and renal ablation of sympathetic nerve activity, seems to be proved effective in cases where medical management and lifestyle modifications are insufficient. Genetic technology, which has advanced tremendously over the past few years, could assist novel treatment options in hypertensive patients, such as RNA interference targeting hypertension-related genes. However, continued efforts must progress in these areas and the effects of therapeutic strategies in hypertensive patients need to be further explored in larger trials over a longer period of time.

Effect of controlled reduction of body iron stores on clinical outcomes in peripheral arterial disease

Article

Nov 2011

Published results from a controlled clinical trial in patients with peripheral arterial disease found improved outcomes with iron (ferritin) reduction among middle-aged subjects but not the entire cohort. The mechanism of the age-specific effect was explored. Randomization to iron reduction (phlebotomy, n = 636) or control (n = 641) stratified by prognostic variables permitted analysis of effects of age and ferritin on primary (all-cause mortality) and secondary (death, nonfatal myocardial infarction, and stroke) outcomes. Iron reduction improved outcomes in youngest age quartile patients (primary outcome hazard ratio [HR] 0.44, 95% CI 0.21-0.92, P = .028; secondary outcome HR 0.34, 95% CI 0.19-0.61, P < .001). Mean follow-up ferritin levels (MFFL) declined with increasing entry age in controls. Older age (P = .035) and higher ferritin (P < .001) at entry predicted poorer compliance with phlebotomy and rising MFFL in iron-reduction patients. Intervention produced greater ferritin reduction in younger patients. Improved outcomes with lower MFFL were found in iron-reduction patients (primary outcome HR 1.11, 95% CI 1.01-1.23, P = .028; secondary outcome HR 1.10, 95% CI 1.0-1.20, P = .044) and the entire cohort (primary outcome HR 1.11, 95% CI 1.01-1.23, P = .037). Improved outcomes occurred with MFFL below versus above the median of the entire cohort means (primary outcome HR 1.48, 95% CI 1.14-1.92, P = .003; secondary outcome HR 1.22, 95% CI 0.99-1.50, P = .067). Lower iron burden predicted improved outcomes overall and was enhanced by phlebotomy. Controlling iron burden may improve survival and prevent or delay nonfatal myocardial infarction and stroke.

Mixed Messages on Blood Pressure Goals

Article

Jun 2011
Hypertension

Aram V. Chobanian

See related article, pp 1061–1068 The management of hypertension has represented one of the most important therapeutic successes of the past 50 to 60 years. The capability now exists to lower blood pressure (BP) effectively and with relatively minimal adverse effects in most hypertensive individuals. The debate regarding therapy has shifted from whether lowering BP is beneficial to such issues as the relative benefits and risks of individual antihypertensive medications, their long-term effects on cardiovascular disease (CVD) and chronic renal disease outcomes, and the optimal BP goals of therapy in different clinical conditions. Based on extensive clinical trial data, general agreement has existed that lowering elevated BP to <140 mm Hg systolic and 90 mm Hg diastolic BP is beneficial. Lower BP goals have been suggested on the basis of epidemiological and observational data indicating that CVD risk increases progressively from BP levels as low as 115/75 mm Hg.1 The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommended a goal BP of ≤130/80 mm Hg in hypertensive patients with chronic renal disease or diabetes mellitus,2 consistent with the recommendations of the National Kidney Foundation and the American Diabetes Association. Subsequently, the American Heart Association expanded this list by recommending BP targets <130/80 mm Hg for patients with preexisting coronary heart diseases, angina pectoris, and acute coronary syndromes or those at high risk for CVD, and BP <120/80 mm Hg for those with left ventricular dysfunction.3 Generally similar recommendations have been made by other national or international groups as well. However, the available evidence may not justify such an aggressive approach. For example, the African American Study of Kidney Disease and Hypertension compared the effects of goal BP of ≤140/90 …

Boom or bust? Estimating blood demand and supply as the baby boomers age

Article

Apr 2011
TRANSFUSION

How much blood is needed?

Article

Jan 2011
VOX SANG

Demographic changes in developed countries as their populations age lead to a steady increase in the consumption of standard blood components. Complex therapeutic procedures like haematopoietic stem cell transplantation, cardiovascular surgery and solid organ transplantation are options for an increasing proportion of older patients nowadays. This trend is likely to continue in coming years. On the other hand, novel aspects in transplant regimens, therapies for malignant diseases, surgical procedures and perioperative patient management have led to a moderate decrease in blood product consumption per individual procedure. The ageing of populations in developed countries, intra-society changes in the attitude towards blood donation as an important altruistic behaviour and the overall alterations in our societies will lead to a decline in regular blood donations over the next decades in many developed countries. Artificial blood substitutes or in vitro stem cell-derived blood components might also become alternatives in the future. However, such substitutes are still in early stages of development and will therefore probably not alleviate this problem within the next few years. Taken together, a declining donation rate and an increase in the consumption of blood components require novel approaches on both sides of the blood supply chain. Different blood donor groups require specific approaches and, for example, inactive or deferred donors must be re-activated. Optimal use of blood components requires even more attention.

Implications of demographics on future blood supply: A population-based cross-sectional study

Article

Apr 2011
TRANSFUSION

Data on blood recipients are sparse and unconnected to data on blood donors. The objective was to analyze the impact of the demographic change on future blood demand and supply in a German federal state. A population-based cross-sectional study was conducted. For all in-hospital transfused red blood cells (RBCs; n = 95,477), in the German federal state Mecklenburg-Pomerania in 2005, characteristics of the patient and the blood donor (118,406 blood donations) were obtained. Population data were used to predict blood demand and supply until 2020. By 2020 the population increase of those aged 65 years or more (+26.4%) in Mecklenburg-Pomerania will be paralleled by a decrease of the potential donor population (18-68 years; -16.1%). Assuming stable rates per age group until 2020, the demand for in-hospital blood transfusions will increase by approximately 25% (24,000 RBC units) while blood donations will decrease by approximately 27% (32,000 RBC units). The resulting, predicted shortfall is 47% of demand for in-hospital patients (56,000 RBC units). Validation using historical data (1997-2007) showed that the model predicted the RBC demand with a deviation of only 1.2%. Demographic changes are particularly pronounced in former East Germany, but by 2030 most European countries will face a similar situation. The decrease of younger age groups requires an increase of blood donation rates and interdisciplinary approaches to reduce the need for transfusion to maintain sufficient blood supply. Demography is a major determinant of future transfusion demand. All efforts should be made by Western societies to systematically obtain data on blood donors and recipients to develop strategies to meet future blood demand.

Demographic Changes: The Impact for Safe Blood Supply

Article

Jun 2010
TRANSFUS MED HEMOTH

The population structure in most European countries is currently changing, with a shift from younger to older age groups. Only sparse data exist on the impact of these demographic changes on future blood demand and supply. Data on blood recipients are sparse and unconnected to data on blood donors. The first part of this review summarizes studies on the effect of the demographic change on blood supply and demand. With respect to studies in North America and Europe on the impact of demographic changes on future blood supply, the demographic trends will affect many regions in the Western world similarly. These effects are most pronounced in the new member states of the European Union where birth rates declined abruptly after 1989. Coordinated efforts will be required to prevent blood shortages based upon these demographic trends in Western societies. The second part of this review is an overview of methodological approaches to obtain data on the sociodemographic background of the blood donor population.

The Hypertension Paradox — More Uncontrolled Disease despite Improved Therapy

Article

Sep 2009
NEW ENGL J MED

Aram V. Chobanian

In the 2009 Shattuck Lecture, Aram Chobanian describes the tremendous progress that has been made in the recognition and treatment of hypertension in the past 60 years. He lays out the basis of an apparent paradox: despite better recognition and treatment, the prevalence of untreated hypertension continues to increase.

Treatment of resistant hypertension by phlebotomy

Article

Sep 1985
Klin Wochenschr

In 15 essential hypertensives resistant against a standard triple combination of antihypertensive drugs phlebotomy was performed. Mean arterial pressure was lowered from 140.1 +/- 12.2 mm Hg to 123.8 +/- 14.9 mm Hg after 14 days. No serious side effects were observed. The duration of the hypotensive effect of phlebotomy was about 4 weeks. Phlebotomy can be used in addition to drug treatment in resistant essential hypertension.

Therapeutic efficiency of phlebotomy in posttransplant hypertension associated with erythrocytosis

Article

Oct 1993
CLIN NEPHROL

Hypertension is a major complication in kidney transplantation and contributes to the high cardiovascular mortality of renal transplanted recipients. The aim of the present study was to evaluate the therapeutic effect of phlebotomy on blood pressure in posttransplant hypertension associated with erythrocytosis. In 12 renal transplanted patients (7 male, 5 female, aged 29-52 years) with erythrocytosis (defined by hematocrit > 52% or hemoglobin > 170 g/l), a 24-hour-monitoring of blood-pressure and heart rate (SpaceLabs SL90207) was performed before, 2 and 6 weeks after phlebotomy. Patients with iron-deficiency and/or transplant rejection were excluded from the study. Ten of 12 patients were on antihypertensive treatment before phlebotomy. Phlebotomy (500 ml) was repeated three times on average within the first two weeks, until hematocrit decreased below 45%. The phlebotomy therapy lowered the hematocrit after two weeks from 54.8 +/- 2.8% to 44.3 +/- 4.2% and 43.0 +/- 5.6% after six weeks. Before phlebotomy, the blood pressure was systolic 153.2 +/- 15.1 mmHg and diastolic 95.2 +/- 9.5 mmHg. After repeated phlebotomy, there was a significant decrease of blood pressure to systolic 139.0 +/- 14.1 and diastolic 85.3 +/- 8.2 mmHg (p < 0.01). Without change of hematocrit and hemoglobin, there was no further change of blood pressure after six weeks (systolic 140.1 +/- 9.9 mmHg, diastolic 86.3 +/- 9.5 mmHg). The heart rate did not change significantly during the therapy. The antihypertensive treatment could be reduced in most of the patients. The present study demonstrates the therapeutic effect of phlebotomy in posttransplant hypertension associated with erythrocytosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Cohort study of relation between donating blood and risk of myocardial infarction in 2682 men in eastern Finland

Article

Apr 1997

Mild iron deficiency has been hypothesised to reduce risk of heart disease risk,1 while a high concentration of body iron has been suggested as a risk factor for myocardial infarction.1 2 Menstruation in women and voluntary blood donations are the most important causes of blood loss and thus modulators of stores of body iron. We prospectively investigated the association of donating blood with the risk of acute myocardial infarction in a random population sample of middle aged men. We investigated the incidence of acute myocardial infarctions in participants in the Kuopio ischaemic heart disease risk factor study.3 During 1984-9 we carried out baseline examinations of 2682 (83%) of the 3235 men aged 42, 48, 54, or 60 whom …

Whole Blood Viscosity, Blood Pressure and Cardiovascular Risk Factors in Healthy Blood Donors

Article

May 1997

Whole blood viscosity contributes to the total peripheral resistance and has been suggested to be a risk factor for cardiovascular disease. Whole blood viscosity was measured using a direct technique in 105 healthy blood donors and in addition to establishing our reference values, the relationship to blood pressure and other cardiovascular risk factors was assessed. Whole blood viscosity correlated with systolic blood pressure (r = 0.29, p = 0.003), cholesterol (r = 0.21, p = 0.034), cholesterol/HDL cholesterol ratio (r = 0.33, p = 0.01), triglycerides (r = 0.37, p < 0.0005), body mass index (r = 0.29, p = 0.003) and waist-hip ratio (r = 0.30, p = 0.002). Subjects with systolic blood pressure > 130 mmHg (n = 16) had higher whole blood viscosity (p = 0.017) than those with lower blood pressure. Whole blood viscosity was significantly lower in women (n = 52) than in men at all shear rates (0.045 > p > 0.001). These results suggest that even in a population of healthy normotensive blood donors of a wide age range and either gender, there are positive correlations between directly assessed whole blood viscosity and a number of the components of the metabolic cardiovascular syndrome including systolic blood pressure, weight and blood lipids.

Possible association of a reduction in cardiovascular events with blood donation

Article

Aug 1997

The iron hypothesis suggests that females are protected from atherosclerosis by having lower iron stores than men, thus limiting oxidation of lipids. To test the iron hypothesis by comparing cardiovascular event rates in whole blood donors compared with nondonors. Prospective cohort with telephone survey follow up. The State of Nebraska, USA. A sample was selected from the Nebraska Diet Heart Survey (NDHS) restricting for age > or = 40 years and absence of clinically apparent vascular diseases at time of enrollment in to NDHS (1985-87). The occurrence of cardiovascular events (myocardial infarction, angina, stroke), procedures (angioplasty, bypass surgery, claudication, endarterectomy), nitroglycerin use, or death (all cause mortality), and level of blood donation. Participants were 655 blood donors and 3200 non-donors who differed in education, physical activity, diabetes, and frequency of antihypertensive treatment; 889 were lost to follow up. Sixty four donors and 567 non-donors reported cardiovascular events (crude odds ratio = 0.50, 95% confidence interval (CI) 0.38-0.66). The benefit of donation was confined to non-smoking males (adjusted odds ratio 0.67, 95% CI 0.45-0.99). Benefit was limited to current donors (the most recent three years). No additional benefit resulted from donating more than once or twice over three years. In support of the iron hypothesis, blood donation in non-smoking men in this cohort was associated with reduced risk of cardiovascular events. A randomised clinical trial is warranted to confirm these findings as the observed personal health benefit of donation has public policy ramifications.

Blood from patients with hereditary hemochromatosis - A wasted resource?

Article

Jul 1999

Blood Donations and Risk of Coronary Heart Disease in Men

Article

Feb 2001
CIRCULATION

In experimental animals, iron overload appears to promote atherosclerosis and ischemic myocardial damage, but the results of epidemiological studies that relate iron stores to risk of coronary heart disease (CHD) have been inconsistent. We prospectively studied blood donations, which effectively reduce body iron stores, in relation to the risk of CHD among participants in the Health Professionals Follow-up Study. The lifetime history of blood donation was assessed with a questionnaire in 1992. The 38 244 men who were free of diagnosed cardiovascular disease at that time were included in the analyses. During 4 years of follow-up, we documented 328 nonfatal myocardial infarctions and 131 coronary deaths. Although the number of lifetime blood donations was strongly associated with lower plasma ferritin levels in a subsample, the blood donation was not associated with risk of myocardial infarction or fatal CHD. The age-adjusted relative risk (RR) of myocardial infarction for men in the highest category of blood donations (>/=30) compared with never donors was 1.2 (95% CI 0. 8 to 1.8), and this RR was not materially changed after adjustment for several coronary risk factors. No significant associations were found between blood donation and the risk of myocardial infarction in analyses restricted to men with hypercholesterolemia or those who never used antioxidant supplements or aspirin. The study results do not support the hypothesis that reduced body iron stores lower CHD risk.

Phlebotomy, blood donation, and hereditary hemochromatosis

Article

May 2001
TRANSFUS MED REV

C Conry-Cantilena

Permitting the use of blood from HH patients without a disease-state labeling has been a controversial topic. Another issue has been the safety of HH blood. If otherwise qualified to be a blood donor in the US, HH patients will be allowed to make contributions to the blood supply if they donate at a collection facility that has been granted an exemption to their FDA license. The amount of additional blood made available by using HH patient/donors is uncertain. Gathering data from HH patients/donors regarding management, safety, and augmentation of supply is essential in assessing the success of recent changes.

A historical cohort study of the effect of lowering body iron through on incident cardiac events

Article

Sep 2002

Low body iron may protect against atherosclerotic cardiovascular disease through limiting oxidation of low-density lipoprotein cholesterol. Observational studies suggest that donation of whole blood might be associated with reduced risk of cardiovascular events. In this retrospective cohort study, a total of 1508 adults who donated more than 1 unit of whole blood each year between 1988 and 1990 (frequent donors) and 1508 age- and sex-matched adults who donated only a single unit in that 3-year period (casual donors) were studied. A standardized questionnaire ascertained participant characteristics and occurrence of incident acute myocardial infarction, coronary angioplasty, coronary bypass surgery, and deaths between 1990 and 2000. Hospital records confirmed events. Cause of death was determined from death certificates. A total of 643 subjects were lost, 113 declined, 156 were deceased but were included in the analysis, and 2104 were surveyed a median of 10 years after the index donation. Frequent donors weighed less and were less likely to be currently taking antihypertensive and lipid-modifying drugs. Events occurred in 6.3 percent of frequent and 10.5 percent of casual donors. After adjustment for group differences, the OR was D.60 (85% CIs 0.43, 0.83; p < 0.001). Events were less frequent in female donors than in male donors and less frequent in subjects who had donated before 1988 than in those who had not donated before 1988. Frequent and long-term whole blood donation is associated with a lower risk of cardiovascular events.

Lewington S, Clarke R, Qizilbash N, Peto R, Collins R and Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet 2002; 360: 1903-1913

Article

Jan 2003

The age-specific relevance of blood pressure to cause-specific mortality is best assessed by collaborative meta-analysis of individual participant data from the separate prospective studies. Information was obtained on each of one million adults with no previous vascular disease recorded at baseline in 61 prospective observational studies of blood pressure and mortality. During 12.7 million person-years at risk, there were about 56000 vascular deaths (12000 stroke, 34000 ischaemic heart disease [IHD], 10000 other vascular) and 66000 other deaths at ages 40-89 years. Meta-analyses, involving "time-dependent" correction for regression dilution, related mortality during each decade of age at death to the estimated usual blood pressure at the start of that decade. Within each decade of age at death, the proportional difference in the risk of vascular death associated with a given absolute difference in usual blood pressure is about the same down to at least 115 mm Hg usual systolic blood pressure (SBP) and 75 mm Hg usual diastolic blood pressure (DBP), below which there is little evidence. At ages 40-69 years, each difference of 20 mm Hg usual SBP (or, approximately equivalently, 10 mm Hg usual DBP) is associated with more than a twofold difference in the stroke death rate, and with twofold differences in the death rates from IHD and from other vascular causes. All of these proportional differences in vascular mortality are about half as extreme at ages 80-89 years as at ages 40-49 years, but the annual absolute differences in risk are greater in old age. The age-specific associations are similar for men and women, and for cerebral haemorrhage and cerebral ischaemia. For predicting vascular mortality from a single blood pressure measurement, the average of SBP and DBP is slightly more informative than either alone, and pulse pressure is much less informative. Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.

Global Burden of Hypertension: Analysis of Worldwide Data

Article

Jan 2005
LANCET

Reliable information about the prevalence of hypertension in different world regions is essential to the development of national and international health policies for prevention and control of this condition. We aimed to pool data from different regions of the world to estimate the overall prevalence and absolute burden of hypertension in 2000, and to estimate the global burden in 2025. We searched the published literature from Jan 1, 1980, to Dec 31, 2002, using MEDLINE, supplemented by a manual search of bibliographies of retrieved articles. We included studies that reported sex-specific and age-specific prevalence of hypertension in representative population samples. All data were obtained independently by two investigators with a standardised protocol and data-collection form. Overall, 26.4% (95% CI 26.0-26.8%) of the adult population in 2000 had hypertension (26.6% of men [26.0-27.2%] and 26.1% of women [25.5-26.6%]), and 29.2% (28.8-29.7%) were projected to have this condition by 2025 (29.0% of men [28.6-29.4%] and 29.5% of women [29.1-29.9%]). The estimated total number of adults with hypertension in 2000 was 972 million (957-987 million); 333 million (329-336 million) in economically developed countries and 639 million (625-654 million) in economically developing countries. The number of adults with hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion (1.54-1.58 billion). Hypertension is an important public-health challenge worldwide. Prevention, detection, treatment, and control of this condition should receive high priority.

Predictors of transfusion requirements for cardiac surgical procedures at a blood conservation center

Article

Mar 2004
ANN THORAC SURG

Previous studies defining perioperative risk factors for allogeneic transfusion requirements in cardiac surgery were limited to highly selected cardiac surgery populations or were associated with high transfusion rates. The purpose of this study was to determine perioperative risk factors and create a formula to predict transfusion requirements for major cardiac surgical procedures in a center that practices a multimodality approach to blood conservation. We performed an observational study on 307 consecutive patients undergoing coronary artery bypass grafting, valve, and combined (coronary artery bypass grafting and valve) procedures. An equation was derived to estimate the risk of transfusion based on preoperative risk factors using multivariate analysis. In patients with a calculated probability of transfusion of at least 5%, intraoperative predictors of transfusion were identified by multivariate analysis. Thirty-five patients (11%) required intraoperative or postoperative allogeneic transfusions. Preoperative factors as independent predictors for transfusions included red blood cell mass, type of operation, urgency of operation, number of diseased vessels, serum creatinine of at least 1.3 mg/dL, and preoperative prothrombin time. Intraoperative factors included cardiopulmonary bypass time, three or fewer bypass grafts, lesser volume of acute normovolemic hemodilution removed, and total crystalloid infusion of at least 2,500 mL. The derived formula was applied to a validation cohort of 246 patients, and the observed transfusion rates conformed well to the predicted risks. A multimodality approach to blood conservation in cardiac surgery resulted in a low transfusion rate. Identifying patients' risks for transfusion should alter patient management perioperatively to decrease their transfusion rate and make more efficient use of blood resources.

The blood centre as a community health resource

Article

Nov 2006

Richard J. Davey

Blood centres in the USA encounter over 35,000 blood donors every day, a number that is far exceeded worldwide. This daily encounter of thousands of people with the healthcare system offers an unusual opportunity for blood centres to engage these donors in ways that contribute to individual and community health. In addition, a positive interaction at the blood centre may encourage donors to return more often, thus enhancing the blood supply. The wealth of medical information gathered by blood centres also presents an opportunity for epidemiological studies of health and illness that affect the community at large. Donors receive a 'mini-physical' as part of the donor qualification process. Required procedures include blood pressure measurement and haemoglobin determination. Targeted education, counselling and referral of donors with hypertension and/or low haemoglobin engages them in the care of critical personal health issues. Carbonyl iron supplied to female donors of child-bearing age replaces iron lost in the donation and can retain them as active blood donors. A range of optional screening tests and procedures offer enhanced interactions between the donor and the blood centre. Inexpensive tests, such as cholesterol and random blood glucose determination, can detect abnormalities that may initiate further medical interventions to address cardiovascular and diabetic risks. These enhanced medical interactions with donors must be undertaken with care and appropriate medical supervision. However, the opportunity, indeed the responsibility, to act on important medical information enhances the range of medical support for donors and is an opening for blood centres to expand their involvement in the health of the community.

Reduction of Iron Stores and Cardiovascular Outcomes in Patients With Peripheral Arterial Disease

Article

Mar 2007
J Am Med Assoc

Accumulation of iron in excess of physiologic requirements has been implicated in risk of cardiovascular disease because of increased iron-catalyzed free radical-mediated oxidative stress. To test the hypothesis that reducing body iron stores through phlebotomy will influence clinical outcomes in a cohort of patients with symptomatic peripheral arterial disease (PAD). Design, Setting, and Multicenter, randomized, controlled, single-blinded clinical trial based on the Iron (Fe) and Atherosclerosis Study (FeAST) (VA Cooperative Study #410) and conducted between May 1, 1999, and April 30, 2005, within the Department of Veterans Affairs Cooperative Studies Program and enrolling 1277 patients with symptomatic but stable PAD. Those with conditions likely to cause acute-phase increase of the ferritin level or with a diagnosis of visceral malignancy within the preceding 5 years were excluded. Analysis was by intent-to-treat. Patients were assigned to a control group (n = 641) or to a group undergoing reduction of iron stores by phlebotomy with removal of defined volumes of blood at 6-month intervals (avoiding iron deficiency) (n = 636), stratified by hospital, age, and baseline smoking status, diagnosis of diabetes mellitus, ratio of high-density to low-density lipoprotein cholesterol level, and ferritin level. The primary end point was all-cause mortality; the secondary end point was death plus nonfatal myocardial infarction and stroke. There were no significant differences between treatment groups for the primary or secondary study end points. All-cause deaths occurred in 148 patients (23%) in the control group and in 125 (20%) in the iron-reduction group (hazard ratio (HR), 0.85; 95% confidence interval (CI), 0.67-1.08; P = .17). Death plus nonfatal myocardial infarction and stroke occurred in 205 patients (32%) in the control group and in 180 (28%) in the iron-reduction group (HR, 0.88; 95% CI, 0.72-1.07; P = .20). Reduction of body iron stores in patients with symptomatic PAD did not significantly decrease all-cause mortality or death plus nonfatal myocardial infarction and stroke. Clinicaltrials.gov Identifier: NCT00032357.

Impact of demographic changes on the blood supply: Mecklenburg-West Pomerania as a model region for Europe

Article

Apr 2007

The population structure in most European countries is currently changing with a shift from younger to older age groups. This study analyzed how demography will determine future blood demand and supply in a well-characterized region. The population of the main catchment area of the University Hospital Greifswald (415,000 inhabitants) was projected to the year 2015 based on 1-year age groups provided by the population registry, based on 2002 rates assuming stable death rates and migration patterns. Data on donors and recipients for the years 1996 through 2004 were extracted from the database of the Department of Transfusion Medicine. Until 2015, the increase in the older population will result in an 11.8 to 13.9 percent increase of blood transfusions. Assuming constant motivation to donate blood as in 2004, the decrease in the younger population will cause a 27.5 to 32.6 percent decrease of blood donations until 2015. The increased demand for blood coincides with a significant reduction in blood donations. From 2008 the shortfalls will grow to 32 to 35 percent of the total demand in 2015 in the area studied. The demographic trends will affect many regions in Europe similarly. Coordinated efforts will be required to prevent blood shortages based on these demographic trends in western societies.

Experience of a network of transfusion coordinators for blood conservation (Ontario Transfusion Coordinators [ONTraC])

Article

Feb 2008

The experiences of the development of a provincial program to promote blood conservation are herein reported. Transfusion coordinators were placed in 23 Ontario hospitals. Anonymized laboratory and clinical information was collected in a defined number of all consecutive patients admitted for three designated procedures: knee arthroplasty, abdominal aortic aneurysm (AAA), and coronary artery bypass graft (CABG) surgery (n approximately 1100, 300, and 300 at each time period, respectively). Considerable interinstitutional variation was observed in the proportion of patients who received transfusions. At 12 months, and over the 24-month period of the project, most hospitals demonstrated decreased use of allogeneic blood; at 12 months an approximate 24 percent reduction in patients undergoing knee surgery, 14 percent in AAA, and 23 percent in CABG was obtained. In addition, patients who received transfusions received less allogeneic blood. Patients who did not receive allogeneic transfusions had lower postoperative infection rates (p < 0.05) and length of stay (p < 0.0001); allogeneic transfusion was an independent predictor of increased length of stay. The main blood conservation measures employed during this time were education, preoperative autologous donation, erythropoietin, and cell salvage. The implementation of a provincial network of transfusion coordinators was feasible and allogeneic transfusion rates declined over the period the program has been in place.

Ornish lifestyle modification program continues to produce impressive outcomes for CHD

Jan 1997
59-61

[No authors listed]. Ornish lifestyle modification program continues to produce impressive outcomes for CHD. Healthc Demand Dis Manag 1997;3:59-61.

Ontario Transfusion Coordinators

Jan 2008
237-250

(Ontario Transfusion Coordinators [ONTraC]). Transfusion 2008;48:237-50.

Global burden of hypertension: analysis of worldwide data

Jan 2005
217

Kearney

Regular blood donation may help in the management of hypertension: An observational study on 292 blood donors

Abstract

No full-text available

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