Demographics of successful, unsuccessful and deferral visits at six blood centers over a 4-year period

B L O O D D O N O R S A N D B L O O D C O L L E C T I O N

Demographics of successful, unsuccessful and deferral visits atsix blood centers over a 4-year period_3353 712..721

Brian Custer, Karen Schlumpf, Toby L. Simon, Bryan R. Spencer, David J. Wright, and

Susan L. Wilkinson, for the NHLBI Retrovirus Epidemiology Donor Study-II (REDS-II)

BACKGROUND: Descriptions of donor demographicsare of value in formulating recruitment and retentionstrategies. The demographics of successful (SV),unsuccessful (UV; meaning a nonuseable unit), anddeferred (DV) donor visits over a 4-year period wereinvestigated using Retrovirus Epidemiology DonorStudy (REDS)-II databases.STUDY DESIGN AND METHODS: Fourteen deferralcategories were created that included low hematocrit(Hct) or hemoglobin (Hb), feeling unwell, malaria travel,malaria other, couldn’t wait, blood pressure or pulse,medical diagnosis, medication, test results, higher-riskbehavior, variant Creutzfeldt-Jakob disease (CJD), CJD,needle exposure or tattoo, and other. Rates per 10,000donor presentations were determined for each categoryglobally and for six subcategorizations (first-time orrepeat donor status, sex, race/ethnicity, age, education,and fixed or mobile donation location). Deferral rateswere also calculated on simultaneous stratifications ofdonor status, sex, and race/ethnicity.RESULTS: Of 5,607,922 donor presentations therewere 4,553,145 SVs (81.2%), 302,828 UVs (5.4%), and751,381 DVs (13.4%). Overall rates of deferral rangedfrom 0.6 per 10,000 presentations for CJD, humangrowth hormone, or dura mater exposure to 777 per10,000 presentations for low Hct or Hb. Deferral rateswere remarkably different by first-time or repeat donorstatus, sex, race/ethnicity, and other demographics. Thehighest overall deferral rate was 3953 per 10,000 pre-sentations, or nearly 40% in first-time, female, Asiandonors, and the lowest rate was 5.6% in repeat, male,white donors.CONCLUSION: Successful donation visits according todemographic characteristics need to be placed withinthe context of all donor visits. Deferral rates indicatethat the burden of donor deferral is high. Efforts toexpand the diversity of the donor base through recruit-ment of minority donors may bring additional challengesbecause certain deferral reasons were proportionallymuch higher in these groups.

While it has been estimated that 37% of theUS population is eligible to donate blood,only 5% provide the approximately 16million units available for transfusion

each year.1,2 Although current supplies seem adequate tomeet demand, transfusion needs are expected to increasesubstantially as the US baby boomer population begins toage and current donors become ineligible to donate.3,4

Contemporary descriptions of the donor demograph-ics of donation visits are of value in formulating recruit-ment and retention strategies to assure an adequate bloodsupply. These data also identify the demographics ofthose not currently engaged, or engaged to a lesser degree,in community blood donation programs and providedirection for recruitment campaigns. In a recent reportusing the Retrovirus Epidemiology Donor Study (REDS)-IIdonation database, Murphy and colleagues5 noted apotential demographic shift in the donor population, withminority donors being substantially younger than whitedonors. Black and Hispanic donors were more likelyfemale, and Asian donors were more likely male. In this

ABBREVIATIONS: DV(s) = deferred donor visit(s); SV =successful donor visit(s); UV = unsuccessful donor visit(s).

From the Blood Systems Research Institute and UCSF, San Fran-

cisco, California; Westat, Rockville, Maryland; CSL Behring,

Boca Raton, Florida; American Red Cross, New England Blood

Services Region, Dedham, Massachusetts; and the Hoxworth

Blood Center, University of Cincinnati Academic Health Center,

Cincinnati, Ohio.

Address reprint requests to: Brian Custer, PhD, MPH, Blood

Systems Research Institute, 270 Masonic Avenue, San Francisco,

CA 94118; e-mail: [email protected].

This work was supported by NHLBI Contracts N01-HB-

47168, -47169, -47170, -47171, -47172, -47174, -47175, and

-57181.

Received for publication April 22, 2011; revision received

August 2, 2011; and accepted August 2, 2011.

doi: 10.1111/j.1537-2995.2011.03353.x

TRANSFUSION 2012;52:712-721.

712 TRANSFUSION Volume 52, April 2012

same study, repeat donors were more likely to be over 40years of age and male and have greater than a high schooleducation.

Donors who are eligible to donate but, for a varietyreasons, such as unsuccessful needle-stick, an adversevasovagal reaction during donation, blood flow too slow tocomplete the collection in a defined time frame, bloodflow ceases, or a collection volume that exceeds theallowed container amount, do not provide blood that canbe used, represent a second group of the presenting donorpopulation. Generally, these miscollection events orunsuccessful visits (UVs) would be expected to berandomly distributed unless there are specific pre-disposing demographic factors or blood center phle-botomy procedures that might be associated with the riskof unsuccessful collection.

Donors who are deferred before or after donation (inthe case of a positive test result) represent a third group.Demographics of a deferral visit (DV) identify those whoattempted to donate or did donate and the reason fortheir deferral. In a previous study from one blood center,13.6% of all presenting donors in a 1-year period weredeferred and approximately 89% of these deferrals weretemporary.6

We know of no large studies that have quantified thedemographic characteristics of deferred donors by defer-ral category. Understanding the demographics of indi-viduals who attempted donation may identify areas whereblood collection establishments can improve predonationeducation to minimize the presentation of individuals at ablood drive who are unable to donate. Understandingthese demographics may also improve strategies toencourage deferred donor return and serve as a basis fortargeted recruitment following deferral expiration byexplaining more clearly the temporary nature of a particu-lar deferral. In this analysis we investigated the demo-graphic characteristics of successful, unsuccessful, anddeferred donor visits over a 4-year time period using theREDS-II databases.

MATERIALS AND METHODS

Data sourcesData came from six blood centers participating in REDS-II. These centers represent geographically and demo-graphically diverse areas in the United States and includeBlood Centers of the Pacific, San Francisco, California;BloodCenter of Wisconsin, Milwaukee, Wisconsin;Hoxworth Blood Center, University of Cincinnati, Cincin-nati, Ohio; Institute for Transfusion Medicine, Pittsburgh,Pennsylvania; American Red Cross, New England Region,Dedham, Massachusetts; and the American Red Cross,Southern Region, Atlanta, Georgia. The REDS-II centerscollectively account for more than 8% of annual bloodcollections in the United States.2

The REDS-II blood centers provided information onall donation and deferral visits to the coordinating center(Westat, Rockville, MD) for compilation into the REDS-IIdonation and deferral databases. As part of the qualitycontrol process, monthly data files were sent to the coor-dinating center and reviewed for discrepancies. Datawere collected from January 2006 through December2009. Data collection was approved by all of the bloodcenters’ and the coordinating center’s institutionalreview boards. Demographic characteristics were col-lected on each blood donor. Three of the REDS-II bloodcenters (Blood Centers of the Pacific, Hoxworth BloodCenter, and Institute for Transfusion Medicine) collectedadditional research demographic information by inte-grating these questions into the self-reported healthhistory questions routinely asked to all blood donors. Atthe two American Red Cross blood centers and at theBloodCenter of Wisconsin, the same research questionswere administered to the donors via a supplementalpaper questionnaire that was completed by the donorsbefore or during the health history interview. Onlydonors who returned the supplemental questionnaireare included in this analysis. However, inclusion of donordata was not dependent on donors completing all of thequestions on the supplemental questionnaire. Depend-ing on each blood center’s standard operating proce-dures, donors who were deferred may or may not haveprovided complete demographic information before thedeferral. For that reason, the category of missing for spe-cific demographic characteristics may be large and isincluded in the results. At all centers, donors were askedto complete the additional research questions at eachdonation therefore increasing the likelihood that repeatdonors would have more complete responses comparedto first-time donors.

This analysis focused on the demographic and dona-tion factors associated with each successful donor visit(SV), UV, and DV. These factors included donor status(first time, repeat); sex; race/ethnicity (white, non-Hispanic; Asian; Hispanic; Black, non-Hispanic; other,non-Hispanic); age (�22; 23 < 29; 30 < 39; 40 < 49;50 < 59; or �60 years); highest education level (up to highschool graduate or GED; some college or an associate’sdegree; bachelor’s degree or higher) for persons 23 yearsof age or older; and donation site (fixed; mobile). Highesteducation level was determined for persons 23 years ofage or older based on the premise that persons youngerthan this age could currently be in school. Among all ofthe reasons for deferral, 14 broad categories were con-structed including low hematocrit (Hct) or hemoglobin(Hb), feeling unwell, malaria travel, malaria other,couldn’t wait, blood pressure or pulse, medical diagno-sis, medication, test results for infectious markers,higher-risk behavior, variant Creutzfeldt-Jakob disease(CJD), CJD, needle exposure or tattoo, and other. Several

DONATION DEMOGRAPHICS

Volume 52, April 2012 TRANSFUSION 713

of these categories include deferrals that representsimilar exposures or risks. For example, feeling unwellincludes having a cold, elevated temperature, or othersigns of potential infection. The other category is acatch-all for deferrals that could not be grouped intoone of the previous categories and includes unableto locate vein for phlebotomy, irregular collectionvolume, and at one REDS-II center a nonspecific 1-daydeferral category. Therefore, each of the REDS-II centersmay not have the same deferrals represented in thiscategory.

Rates for each of the 14 categories of deferral werecalculated as the proportion of deferrals out of the com-bined denominator of all successful and unsuccessfulallogeneic donation and deferral visits according to demo-graphic characteristics and expressed per 10,000 donorpresentations. The study is a descriptive analysis of theproportions of unsuccessful donation and deferral usingall of the data from each of the six REDS-II centers for a4-year period. Statistical comparisons of proportions andp values were not calculated. The size of the database usedensures that nearly any difference observed between cat-egories of deferral or within levels of demographic factorswould be expected to be significant. Conventional analy-sis (considering the data to be a sample from a popula-tion) would not properly account for year-to-yearvariation in future time periods, nor account for demo-graphic or behavioral trends of donors over time. While wepurport that other blood centers will see similar patterns,we do not assert that such patterns will be statisticallyequivalent.

To further investigate how multiple demographiccharacteristics may be related to donor visits and deferral,we conducted stratified analyses. First, we compared theproportion of UVs between first time and repeat, whiteand black donors more than 23 years of age to see if therewere large differences in UVs for these groups. Second wecalculated rates of deferral within strata of the presentingdonor population simultaneously defined by first-time orrepeat donor status, sex, and race/ethnicity: Each of thethree factors represents an important donor or demo-graphic characteristic that is independently associatedwith different categories of deferral and so we thought theresults obtained from the three-way stratification had thepotential to provide new insights into donor deferral.These analyses were necessarily restricted to presentingdonors for which we had complete information on thethree characteristics. Deferral for risk of CJD, humangrowth hormone, or dura mater exposure was included inthe overall analysis, but was not included in subsequentstratified analyses due to the small number of deferrals inthis category. Analyses were conducted using computersoftware (SAS/STAT, Version 9.1.2, SAS Institute, Inc., Cary,NC; and Excel, Version 2010, Microsoft, Inc., Redmond,WA).

RESULTS

Over the 4 years, of 5,607,922 donor presentations therewere 4,552,197 SVs (81.2%), 306,175 UVs (5.4%), and749,550 DVs (13.4%). Among the deferred visits, 716,834visits (95.6%) were deferred for temporary reasons and32,664 visits (4.4%) were deferred for permanent reasons.The demographic characteristics of donors with SVs, UVs,and DVs are provided (Table 1). UVs were overrepresentedin first-time donors, black donors, and donors not morethan 22 years of age. DVs were overrepresented in first-time donors, female donors, all race/ethnicity categoriesother than white, and younger donors. When we examinedUVs in more detail we found that the proportion of UVs inblack first-time donors more than 23 years of age (1213 per10,000 visits) was much higher than in white donors (657per 10,000). Similar results were found comparing repeatblack (902 per 10,000 visits) and white (445 per 10,000)donors. Twofold differences in the proportions of UV areclearly clinically relevant and would also be significantdifferences because of the large number of observations inthe REDS-II database.

The overall rates of deferral varied from a low of0.6 per 10,000 presentations for CJD, human growthhormone, or dura mater exposure to a high of 777 per10,000 presentations for low Hct or Hb (Table 2). Atthis bivariate level of analysis, many of the previouslyobserved factors associated with specific deferral wereobserved. For each of the 13 deferral categories (excludesthe CJD category) the rates of deferral show notable dif-ferences according to the six demographic classificationcharacteristics. For most deferral categories, first-timedonors had much higher deferral rates than repeatdonors. There was one notable exception to this pattern;the rate of low Hct or Hb deferral was slightly higher inrepeat donors. For low Hct or Hb, the rate of deferralfor women was 10-fold higher than that of men, and blackor Hispanic donors had higher rates than other race/ethnicity groups. For the other demographic or donationfactors we examined, low Hct or Hb deferral rates weregenerally similar. The highest rates of deferral for eithertravel to a malaria endemic area or for other malariadeferrals were evident in Asian donors. One of the moststriking results at this level of analysis was deferral forpositive test results in Asian donors, which was 155 per10,000 presentations.

The three-way stratified deferral rates that includedfirst-time or repeat donor status, sex, and race/ethnicityprovide additional insight into the burden of deferral.Overall the burden of donor deferral is high with strongevidence that different categories of deferral are morelikely to affect different groups. Higher rates for all defer-rals combined are apparent in first-time female donorsregardless of race followed by repeat female donors(Fig. 1A). The highest rate for all deferrals combined is

CUSTER ET AL.


3953 per 10,000 presentations or nearly 40% in first-time,female, Asian donors and the lowest rate is 5.6% in repeat,male, white donors, indicating a sevenfold difference inthe chances of deferral between these two groups ofdonors. The higher rate of low Hct or Hb deferral seen inrepeat female donors is evident in every race/ethnicitygroup (Fig. 1B).

The stratified deferral rate graphs indicate that Asiandonors appear to be disproportionately affected by donordeferral and receive many types of deferral in excess ofother groups (Figs. 1C-1F and 1H). Particularly notable,elevated deferral rates in Asian male and female donorsare found for malaria-related reasons, test results, and thecombined category of “other” in female Asian donors.Even for the category of couldn’t wait or changed mind,Asian donors have some of the highest deferral rates. Fortest results deferral, more than 85% of all disease marker–positive donations in Asian donors were for markers ofhepatitis B virus infection.

For each individual category of deferral, a specificgroup can be identified as having the highest rate of defer-ral. The group with the highest rate of deferral varies. For

example, the rate for blood pressure or pulse deferral ishighest for repeat, male, black donors whereas the rate ofdeferral for feeling unwell or having a cold, infection, orelevated temperature is found in first-time, female, whitedonors.

DISCUSSION

Eighty-one percent of all donation visits resulted in a suc-cessful donation, a number similar to that reported in aprevious study.6 The distribution of these successful visitsaccording to demographic variables noted for these 4.5million successful donations is similar to those reported inprevious studies.7-9 For example, a number of studiesreported as part of REDS considered the demographics ofblood donors.7,8,10 The five REDS blood centers were theAmerican Red Cross Greater Chesapeake and Potomac(Baltimore, MD, and Washington, DC), SoutheasternMichigan (Detroit), and Southern California (Los Angeles)Regions; Blood Centers of the Pacific in San Francisco; andOklahoma Blood Institute in Oklahoma City. Sex distribu-tion seen in our study was identical to results published

TABLE 1. Number of presenting donors at REDS-II blood centers, 2006 to 2009, and outcome

Demographic characteristicNumber of donor

presentationsSuccessful donation

visits (%)Unsuccessful† donation

visits (%)Deferralvisits (%)

Overall 5,607,922 81.2 5.4 13.4Donor status

FT 613,901 70.7 9.0 20.3Repeat 4,802,103 82.7 5.0 12.3Missing 191,918 77.2 5.1 17.7

SexMale 2,742,285 89.2 4.1 6.7Female 2,865,525 73.6 6.7 19.7Missing 112 28.3 5.3 66.4

Race/ethnicityWhite 4,918,500 82.5 5.1 12.4Asian 127,267 72.4 6.3 21.3Black 262,411 69.4 10.9 19.7Hispanic 185,596 74.4 6.1 19.5Other 87,230 74.7 7.0 18.3Missing 26,918 58.8 5.1 36.1

Age (years)�22 1,039,871 74.1 8.6 17.323-29 472,770 78.7 6.3 15.030-39 718,054 81.0 5.2 13.840-49 1,220,665 82.6 4.5 12.950-59 1,298,913 84.9 4.4 10.7�60 857,557 83.6 4.3 12.1Missing 92 7.6 0.0 92.4

Education*�High school/GED 754,299 82.1 4.5 13.4Some college or associates degree 1,476,529 82.1 4.9 13.0Bachelor’s degree or higher 2,189,330 83.6 4.7 11.7Missing 147,893 80.6 4.4 15.0

Donation siteFixed 2,175,931 82.6 4.1 13.3Mobile 3,429,945 80.3 6.3 13.4Missing 2,046 80.8 6.0 13.2

* Education is reported for donors 23 years old and older.† “Unsuccessful” donation visits include quantity not sufficient and other reasons.



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CUSTER ET AL.


All deferrals Hematocrit/hemoglobin

Other malaria

Couldn't wait/changed mind

Other deferral reasons

Malaria travel

Test results

High-risk exposure

Fig. 1. Three-way stratified deferral rates by deferral category for REDS-II presenting donors 2006 to 2009. (A) Overall rate of

deferral; (B) low Hct or Hb; (C) malaria travel; (D) malaria other; (E) test results; (F) couldn’t wait or changed mind; (G) high-risk

behavior or exposure; (H) other reasons; (I) variant CJD, European travel, or bovine insulin; (J) needle exposure; (K) medication

and vaccination; (L) medical diagnoses and conditions; (M) blood pressure or pulse; (N) unwell, cold, infection, or temperature.

FT = first time; Rpt = repeat; F = female; M = male.



from REDS and approximately 70% of donors in bothstudies had some college/technical school or higherlevel of education.7 The REDS-II donation database dem-onstrated a slightly higher percentage of white, non-Hispanic donors when compared to the REDS database,89 and 81%, respectively.7 Concomitantly, there wereslightly more minority donors in the REDS data, reflectiveof the different demographic characteristics of the popu-lations from the participating blood centers in REDS andREDS-II.

In our study, approximately 46% of all successfuldonations were made by individuals 41 to 60 years of age.This finding is consistent with data reported by Zou andcoworkers11 where 47% of blood donors were between theages of 41 and 60 years. However, in the REDS study,donors 45 years of age or older accounted for only 17% to31% of donors depending on the center.7 Other studies

have noted a higher proportion of donors in the 30- to40-year-old age range.6,12 The previous studies used data-bases from a number of years ago. Therefore, the REDS-IIdata may more accurately indicate the current age of theUS donor population and the need to better engageyounger donors. As noted in the Progress Review fromHealthy People 2010, persons aged 25 years or older whohad at least some college gave blood at a rate of7.9%, compared with a rate of 1.8% of those who had notcompleted high school13 and so the issue of enhancingdonation in younger ages appears to be related to both agecohort effects and educational attainment.

Apparent underrepresentation of minorities as blooddonors when compared to white, non-Hispanic donors isalso a finding consistent with other studies.5,12,13 Whiletwo of the six centers achieved a higher proportion ofminority donors (data not shown), the remaining four

Needle exposure

Medical diagnoses

Fig. 1. Continued.

CUSTER ET AL.


centers had very small percentages of minority donors.13

Murphy and coworkers5 have previously reported on therepresentation of race/ethnicity groups at the REDS-IIcenters compared to the census data from the samecommunities and found that minority donors wereunderrepresented as donors and less likely to be repeatdonors, but first-time donor representation was increas-ing. In a recent article by Shaz and colleagues,16 donorrates in the Atlanta metropolitan area were 11 per 1000population for whites, 6 per 1000 for blacks, and 3 per1000 population for Hispanics. Census data for theUnited States continues to demonstrate substantialincreases in the proportion of the population defined asminorities, yet these individuals continue to be under-represented in the blood donor pool.4 For example, blackand Hispanic populations in the Atlanta area increasedby 22 and 21%, respectively, between 2004 and 2007. TheAmerican Red Cross Southern Region in Atlanta recog-nizes the changing demographics of their populationbase and has developed programs to recruit black donorsnow and in the future, with planned expansion to recruitHispanic donors (M. Sedlock, personal communication,2011).

The results for unsuccessful donation visits also high-light an additional insight. Out of all donor presentations,nearly 11% of black donors had unsuccessful visits. Ifdeferrals were excluded from the analysis and only eligiblevisits considered, the proportion of unsuccessful visits inblack donors would increase to nearly 14%. The reasonsfor the unsuccessful donation attempts are not availablein the REDS-II data set, but given lower rates of adversereactions in black donors,14,15 it is likely that many unsuc-cessful collections are attributable to the inability to locateor palpate a vein for phlebotomy. The blood collectionprocess is dependent on skilled phlebotomists. As Shazand colleagues16 have noted, to help improve successfuldonation rates in racial minorities, additional phleboto-mist education efforts may be necessary. Our study lendsfurther support to the need to address this issue becauseunsuccessful visits in black donors remained dispropor-tionately high even in repeat donors 24 years of age orolder.

The vast majority of deferral visits resulted in a tem-porary deferral. However, it is well known that manydonors treat this information as if it is a permanent defer-ral and are likely not to return for future blooddonation.9,17-20 Temporarily deferred donors took the ini-tiative to become a blood donor, something that themajority of the US population never does, and attempts toassure return are vital to the future adequacy of the bloodsupply. Additional postdeferral education and informa-tion provided by the blood collection agency at the time ofdeferral, coupled with enhanced rerecruitment effortswhen the deferral has expired, may improve future donorreturn.

We considered several combinations of the availabledemographic factors for inclusion in the three-way strati-fied analyses. For example, another factor known to beassociated with different deferral rates is age. However, thedeferral rates according to donor age are largely knownand not as variable as for sex, race/ethnicity, and first-timeor repeat status. In addition, due to the number of stratathat would have been created it was not feasible to includea fourth stratifying variable.

The stratified deferral rates may raise some importantimplications for blood collection. First, there is a very highburden of deferral in Asian donors. There are several cat-egories where Asians have the highest proportion of defer-rals. Cumulatively, these result in Asian women and menhaving the highest deferral rates within categories definedby first-time and repeat donor status. Second, the highestdeferral rates for low Hct or Hb were found in repeat, notfirst-time, female donor visits within each race/ethnicitygroup, adding further weight to results from emergingstudies suggesting that repeat donation leads to increasedrisk of deferral likely attributable to reduced iron stores.21

Each of the previous observations contributes to theneed to reconsider a broader perception, the belief thatwhite males are more willing to donate blood than anyother group. The deferral data we report indicate that avery large proportion of presenting donors within specificsex and race/ethnicity groups do present to donate but aredeferred or unsuccessful during donation. The stratifieddeferral rates lend further support to the need to ensurethat deferral is based on scientific evidence to support thenecessity for such deferrals and also calls attention to theneed to focus not only on the donors that are allowed todonate but also the persons who willingly present but arenot allowed to donate. Many blood centers are concernedabout the representation of minority groups in the donorpopulation and have active campaigns to recruit minoritydonors. However, it appears that deferral may contributeto a misperception regarding minorities’ willingness todonate. Often social or cultural reasons are suggested asthe reasons minorities do not donate. An underappreci-ated factor may be the fact that blood centers simply deferlarger proportions of potential donors in these groups.

This study has several limitations. The six bloodcenters participating in REDS-II may not be representa-tive of all US blood centers. While these six blood centersare geographically diverse, large populations of Hispanicdonors are not well represented. While this could compro-mise the gereralizability of the data, these contemporaryresults give a snapshot of who is donating and who isdeferred from donating. Also, missing demographic infor-mation for key characteristics included in this analysis,such as first-time or repeat status, bears further consider-ation. This is a source of information bias in our analysis.For that reason, the rates of deferral for first-time donorsthat we report here may be underestimated.



The deferral data presented here are also limitedwhen one recognizes that most centers will defer a donorbased on the first reported deferrable characteristics orbehavior during the health history interview. Typically theinterview is then stopped and the donor is deferred. Forthat reason, these results are not a complete census of alldeferrable characteristics or behaviors in each presentingdonor. Donors who may have multiple deferrals havelikely only been counted once in this analysis. This furthersuggests that the rates of deferral presented here areunderestimates of the true rate of deferral for each indi-vidual deferral category. However, the overall rate of thedeferral is likely an accurate reflection of the burden ofdeferral in the presenting donor population.

Another limitation is that centers record unsuccessfulvisits in different ways. Some centers code these as defer-rals and others provided information in donation recordsthat indicates the phlebotomy was unsuccessful. For thisreason, a quantity not sufficient or inability to locate orpalpate a vein for phlebotomy may be represented aseither an unsuccessful visit or as a deferral visit in ouranalysis depending on the blood center. Such visits havenot been double counted in our analysis, but unfortu-nately we could not use the REDS-II databases to groupthese same underlying reasons together across all centers.These visits are either counted as unsuccessful or as defer-ral visits in the “other” category of deferral.

An additional set of factors that could influence UVare those related to the collection needles and phle-botomy procedures used at each of the centers. Unfortu-nately we do not have information on these variables butrecognize that this could play a role in the likelihood of anUV. We are unaware of any studies that have examined UVaccording to factors such as needle configuration, butknow that advances in phlebotomy such as the use of but-terfly needles have improved the experience for donors.

Successful donation visits according to demographiccharacteristics need to be placed within the context ofthe donation attempts that are unsuccessful and thedonors who are deferred. The data reported here indicatethat a very large proportion of presenting donors aredeferred or unsuccessful during donation. Overall, thesedata may help blood collection agencies focus onimproved recruitment of donors and to strategize addi-tional ways to communicate with those who are mostlikely to be temporarily deferred from donation. While itis easy to state that new recruitment strategies areneeded to increase minority participation in blood dona-tion, it is far more difficult to identify and implementstrategies that are effective and that will assure donationrates that better reflect actual population demographics.In addition, recruitment of minority donors may bringadditional challenges, as at least in our data, certaindeferral reasons were proportionally much higher forspecific race/ethnicity groups.

ACKNOWLEDGMENTS

The authors thank the staff at the REDS-II blood centers. Without

their help, this study would not have been possible.

The Retrovirus Epidemiology Donor Study (REDS)-II is presently

the responsibility of the following persons:

Blood centers:

American Red Cross Blood Services, New England Region: R.

Cable, J.A. Rios, R.J. Benjamin

American Red Cross Blood Services, Southern Region/Emory

University: J.D. Roback

BloodCenter of Wisconsin: J.L. Gottschall, A.E. Mast

Hoxworth Blood Center, University of Cincinnati Academic

Health Center: R.A. Sacher, S.L. Wilkinson, P.M. Carey

Regents of the University of California/Blood Centers of the

Pacific/BSRI: E.L. Murphy, M.P. Busch, B. Custer

The Institute for Transfusion Medicine (ITxM)/LifeSource Blood

Services: D.J. Triulzi, R.M. Kakaiya, J. Kiss

Central laboratory:

Blood Systems Research Institute: M.P. Busch, P.J. Norris

Coordinating center:

Westat, Inc.: J Schulman, M.R. King, D.J. Wright, T.L. Simon, S.H.

Kleinman, P.M. Ness

National Heart, Lung, and Blood Institute, NIH:

G. Nemo, S. Glynn, T.H. Mondoro

Steering committee chairman:

R.Y. Dodd

CONFLICT OF INTEREST

None.

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Documents

Demographics of successful, unsuccessful and deferral visits at six blood centers over a 4-year period