Does hemoglobin analysis taken from venous blood of the previous plasmapheresis ensure donor safety at the next plasmapheresis?

Background

According to the German Guideline "Hemotherapy" the blood donor hemoglobin (Hb) is a pre-requisite to ensure donor safety and should be analysed within the first 15 minutes of donation. Gold standard for Hb analysis is the measurement of venous blood using automated blood cell analyzer. Since 2008, in France, Hb measurement prior whole blood donation is not required if values of the previous donation meet the given specification.

Methods

Four plasma centers assessed Hb of venous blood using Sysmex XP300 within 15 minutes after start of donation. 382,461 Hb values (43% female vs 57% male) from 13,983 donors (50% vs 50%) between 2020-2022 were exported in a calculation tool, sorted by gender. The difference between two consecutive Hb values were calculated to analyze whether the value prior the previous donation was comparable with the result of the next donation. Differences with the same result were grouped, unplausible high differences were followed up in several cases. Additionally, these results were sorted by days between two donations to analyze whether the timeframe between two donations had an influence on Hb levels.

Results

In 90.0% (female) vs 93.8% (male) the second Hb values lied above the acceptance limit; the values were equal or higher, or, if lower compared to the previous one, they did not fall below the limit. In 2.9% vs. 1.3% of the donors the results were under the limit. In 6.1% vs 4.8% the consecutive value was under limit particularly with negative differences more than 0.6 mmol/l. The follow up of those differences showed that the consecutive values were higher again and comparable to other values of the donors. The timeframe between two donations showed no influence on Hb difference in the first 6 months.

Conclusion

Most results demonstrated that an actual Hb should not be a prerequisite to ensure donor safety. Alert limits to control Hb before donation should be higher than exclusion limits to avoid donation with low Hb. The new approach to allow plasma donation with Hb from a previous donation was efficient, and a safe practice. Further avoid the automated measurement in a central lab pre-analytic and handling failures compared to the practice today with a decentral single measurement.

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