56. Jahrestagung der Deutschen Gesellschaft für Transfusionsmedizin und Immunhämatologie

Prof. Dr.

Vorsitz

Comparison of different strategies for a generalized risk assessment of blood donors for sexual transmittable diseases independent of donor and partner gender

Background Current German guidelines differentiate in risk assessment for sexual transmittable diseases (STD) according to donor and partner sex. This differentiation is currently revised. A recent FDA draft guidance recommends deferral of donors with a new sexual partner or more than 1 partner in the past 3 months only, if the donor had had anal sex. In Austria, only donors with more than 3 partners in the last 3 months or unprotected sex with a new partner are deferred.Methods All 21,570 donors with known email address were asked to fill in an anonymous online survey on risk factors for STD and on their attitude towards questions about sexual practices as part of donor risk assessment. Donors were allowed to skip single questions. Presumed eligibility was determined according to (A) current guidelines, (B) FDA draft guidance, (C) considering ineligible all donors with a new or more than 2 partners during the last 3 months or (D) donors with unprotected sex with a new partner during the last month or more than 2 partners during the last 3 months, or (E) donors with more than 2 partners or with more than one partner and anal sex or with anal sex with a new partner during the last 4 months.Results 6387 donors (29.6%) answered the survey. The proportion of ineligible donors was about 1% for strategy B, 2% for strategies A, D and E, and 8% for C. 15% of donors aged 18-29 years reported a new sexual partner during the last 4 months (6% had unprotected sex and 1% anal sex with the new partner). 1950 donors (28.3% of all donors) disliked questions about anal sex, and 371 (5.4%) would stop donating if those were asked. 372 donors (5.4%) reported that they would not answer truthfully about having anal sex. This proportion was increased in donors with many partners (e.g. 15.4% of donors with 3 or more partners during the last 3 months) and in donors having anal sex or unprotected sex with a new partner in the last month (12% and 10%).Conclusion A generalized deferral of donors with new partners would significantly decrease the number of eligible donors. Detailed questions about sexual activities should be omitted or restricted to subgroups of donors with increased risk (e. g. new or multiple partners) to avoid unnecessary deterrence of other donors. Extensive measures to convince donors of the necessity and effectiveness of such questions would be needed, as especially donors with high risk for STD tend not to answer truthfully.Offenlegung Interessenkonflikt: No conflict of interests.

Blood Donation

Freier Vortrag (Reinhold-Eckstein-Investigator-Award)

Securing the blood supply - demographic aspects

Background The population in Germany is aging and so is the donor population. Already, most whole blood donations are made by individuals older than 45 years with 9.3% of donations given by donors aged 65+ in 2021. Due to these demographic changes, recruiting and retaining blood donors becomes increasingly challenging. Detailed knowledge of the demographic profile and donation behavior of donor populations are therefore essential to secure an adequate blood supply.Methods Surveillance data from the national donor surveillance system and population data from the federal states statistical offices were used to assess changes in demography and donation frequencies of whole blood donors aged 18-68 between 2012 and 2021.Results From 2012 to 2021, the general population aged 18 to 68 increased by 2%. At the same time, the number of first time and repeat whole blood donors dropped by 13% and 36%, respectively. In 2021, 2.5% of the population aged 18-68 was active as repeat whole blood donors (2012: 4.3%). The highest proportion of donors was observed in 2021 among those aged 18 to 24 (4.5%). As the age structure of whole blood repeat donors roughly resembled that of the general population, the greatest number of donors were 55-64 years of age in 2021 (45-54 years in 2012). While in 2012 48% of all whole blood donations came from new and repeat donors younger than 45 years, this proportion dropped to 44% in 2021. As observed in previous years, the number of donations per year (2.0 on average) increased with age in both male and female donors: from 1.9 and 1.6 respectively among the youngest donors (18 to 24 years) to 2.6 and 2.1 for donors 65 years and older. Conclusion The substantial drop in whole blood donors and the demographic shift in the age structure of the current donor population is alarming. With only 1 in 40 potentially eligible individuals donating strong efforts must be made to increase the pool of regular and repeat donors to overcome seasonal fluctuation or other effects which might negatively influence the blood supply. A coordinated and collective approach including all stakeholders should be pursued. The National Advisory Committee (AK Blut) has initiated a working group focusing on donor recruitment as part of an integrative concept to ensure the future blood supply in 2022. Societal recognition of blood donations must be increased, barriers to donation lowered and use of blood must always be appropriate to secure the high standard of care for patients. Offenlegung Interessenkonflikt: The authors declare no conflict of interest.Invited talks abstract/summary

Freier Vortrag

Prof.

Impact of demographic changes on whole blood donations between 2005 and 2020

Background The German reunification in 1990 resulted in a decline in birth rates, particularly in the Eastern federal states. On the other hand, the baby boomer generation (born 1955-1969), the largest contributor to whole blood donations (WBD) during the last decades, is aging and will exit the donor pool in the coming years. To analyze the impact of these demographic changes on blood supply, we perform a prospective, longitudinal study on all WBD in Mecklenburg-Western Pomerania since 2005.Methods The four blood donation services in Mecklenburg-Western Pomerania (German Red Cross, Haema, and the university blood donation services Greifswald and Rostock) provided data on date of the donation, sex, and age of the donors for all WBD in the years 2005, 2010, 2015, 2019 and 2020. Donation rates per 1,000 inhabitants were calculated based on the population registry of Mecklenburg-Western Pomerania. The population prognosis of the Federal Statistical Office was used to build projections of blood supply for the year 2030, assuming constant age-related blood donation rates as in 2020.Results The absolute number of WBD (Figure 1A) continuously declined from 118,419 WBD in 2005 to 83,871 WBD (-29.2%) in 2019, and 76,912 WBD (-35.1%) in 2020. The decline in 2020 might have been slightly amplified by an effect of the SARS-CoV-2 pandemic (83,871 WBD in 2019 vs. 76,912 WBD in 2020, -8.3%). The donation rates per 1,000 inhabitants (Figure 1B) decreased by 31.3 % between 2005 (69.4/1,000) and 2020 (47.7/1,000). Assuming constant age-related donor frequencies as in 2020, the projected number of WBD in 2030 will further decrease to 67,724 WBD (-11.9% compared to 2020). Conclusion The demographic change after 1990 caused a pronounced decrease in WBD in Mecklenburg-Western Pomerania over the last 15 years. This decline continues but seems to slowly stabilize. However, as the baby-boom generation enters the age groups with higher blood demand, ensuring an adequate future blood supply remains a major challenge. Blood donation numbers and blood transfusion demand should be regularly monitored to recognize trends towards a supply-demand mismatch over time.Offenlegung Interessenkonflikt: Andreas Greinacher reports grants and non-financial support from Aspen, Boehringer Ingelheim, MSD, Bristol Myers Squibb (BMS), Paringenix, Bayer Healthcare, Gore Inc., Rovi, Sagent, Biomarin/Prosensa, personal fees from Aspen, Boehringer Ingelheim, MSD, Macopharma, BMS, Chromatec, Werfen (Instrumentation Laboratory), and non-financial support from Boehringer Ingelheim, Portola, Ergomed, GTH e.V., Universitätsmedizin Greifswald is one of the owners of a patent for a solid phase assay to detect HIT and VITT antibodies. Linda Schönborn was supported by the Gerhard-Domagk-Program of the Universitätsmedizin Greifswald. All other authors declare no conflict of interest.

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

Background According to the German Guideline &quot;Hemotherapy&quot; 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.Offenlegung Interessenkonflikt: keine

The supply of blood in fragile times - A comparison of international approaches based on interviews and literature study

Background Due to its important role in treatment, it is particularly important to ensure the availability of blood in emergency care. However, shortages of blood products becomes increasingly common even in normal times. In exceptional situations (e.g. alliance/defence emergencies), an acute and sharp increase in demand for blood (products) can be expected. At present, only isolated and mostly uncoordinated concepts among the actors in Germany for securing the blood supply in special situations exist.Methods A research project funded by the Federal Office for Civil Protection and Disaster Management (BBK) aims to develop a concept for ensuring the supply of blood and blood products in the event of an alliance or defence situation in coordination with the blood donation services. The results presented here are based on an intensive literature search in relevant journals and databases (Pubmed, Ebsco, etc.) as well as on interviews with authorities of the producing companies and public administration in Germany and other countries.Results The literature review did not identify any policies that address coping strategies of blood and blood product shortages in alliance and defence situations. It was possible to identify instructions for action that deal with blood shortages in disasters. From international measures, plans and the armed forces, measures can be derived that seem worth to be included into a German concept discussion – (including legal aspects). These cover clear structures, contact persons and information channels. In addition, there should be continuous planning, exercises, and close cooperation with the authorities and responsible actors at federal and state level. Direct link of IT systems of hospitals and blood transfusion services will be essential.Conclusion Product-specific characteristics such as short shelf-life and storage requirements (e.g. plasma -40°) do not allow large stocks and blood transfusion services depend on an existing infrastructure at all stages of production, storage and distribution. There is no coordinated approach to cope blood shortages yet. Staff for the service might be on duty for other healthcare issues. It is therefore essential to develop solutions among all steps of the supply chain – including international actors.Offenlegung Interessenkonflikt: KEINEInvited talks abstract/summary

Blood Donation

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