Letters to the Editor
Hepatitis B virus vaccination of voluntary blood
donors and immunization status assessment by
Anti-Hepatitis B Surface (HBs) antibody titer
Sir,
The study was conducted at the Prathama Blood Centre,
Ahmedabad from 14/06/2009 to 31/03/2010. In our study hepatitis
B virus (HBV) negative voluntary blood donors were enrolled and
vaccinated. The sero-conversion rate was determined by anti- Anti-
Hepatitis B Surface HBs-antibody titer measurement on a small
numbers of vaccines’ who received all three doses.
All blood donors were thoroughly assessed with detailed history
including past exposure or jaundice. The HBV infection status was
also confirmed by Hepatitis B Surface Antigen HBsAg antigen
testing by Biorad Enzyme Linked Immuno Sorbent Assay ELISA
kits on automated Evolis system, Biorad, USA along with Hepatitis
B Virus DNA testing on Cobas s 201, Roche, USA by Taqscreen
test kit. For HBV vaccination, recombinant hepatitis B vaccine
of Bharat Biotech International Limited, Hyderabad (India) was
used. For post-hepatitis B vaccination titer assessment, 2 ml of
blood sample was collected in a plain vacutainer and anti HBsAg
antibody (anti HBsAg antibody) titration was done by microparticle
enzyme immunoassay (MEIA), Abbott, Germany.
A total of 4036 (3990 male and 46 female) voluntary blood
donors with mean age of 35.5 years (ranged between 22 years and
59 years) were studied. All enrolled donors were HBsAg non-
reactive by the ELISA method and among them 446 donors were
also found negative for HBV DNA by Polymerase chain reaction
(PCR) method.
Anti-HBs antibodies titers were done on limited number of donors
who had completed all three HBV vaccination doses. All of the
samples were collected between 1 month and 3 months of last (3rd)
dose of hepatitis B vaccination. Of 4036 vaccines’, 2555, 894 and
587 donors were received one, two and three doses respectively.
Out of 587 donors who received all three doses were called for anti
HBsAg antibody testing but only 40 donors were reported. Of these
40 vaccinated donors, 38 (95%) donors had >1000 mIU/ml anti HBs
antibody titer, while two (5%) donors samples had low titer, 1.4
mIU/ml and 10.4 mIU/ml, respectively. These two donors were
recalled and revaccinated again on the counseling day and advised
to return after 1 month for a repeat test. The antibody response to
HBV surface antigen (anti-HBs) is an important serological marker
for vaccine induced immunity to HBV.[1]
The immune response to specific antigens is a complex system with
high variability between individuals, the antibodies were directed
against a variety of epitopes present in variable concentrations.[2]
An adequate vaccine response is defined as an anti HBs level ≥100
mIU/ml 4 weeks after the last dose. Vaccinated individuals with
anti HBs level <20 mIU/ml should receive a booster dose and
should be tested 4 weeks in order to know whether they were
true responders or not.[3]
We concluded that “immunization” does not fight against
accidental exposure” rather it prevents vaccines’ from being
infected if exposed. Voluntary blood donor HBV vaccination is
the right approach to prevent this infection.
160 Asian Journal of Transfusion Science - Vol 7, Issue 2, July - December 2013
R. P. Singh, V. Harimoorthy, K. Maheswari, K. Vaidya
Department of Immunohematology, Prathama Advanced
Transfusion Medicine & Research Centre,
Ahmadabad, India
Correspondence to: Dr. R. P. Singh,
Medical Director, Red Cross Blood Bank,
Red Cross Building,
Near Kundaliya College, Rajkot-360 005, India
E-mail: rpsingh008@gmail.com
References
1. James V., McClelland B. Additional microbiological testing of
selected donors: antibody to hepatitis B surface antigen (HBs).
Guidelines of UK Blood Services. 7th ed. Chap. 10, section 10.4.
The Stationary Shop, Edinburgh: U.K.; 2007. p. 142.
2. Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli
L, et al. A comprehensive immunization strategy to eliminate
transmission of hepatitis B virus infection in the United States:
Recommendations of the Advisory Committee on Immunization
Practices (ACIP) Part II: Immunization of adults. MMWR Recomm
Rep 2006;55:1-33.
3. Huzly D, Schenk T, Jilg W, Neumann-Haefelin D. Comparison of
nine commercially available assays for quantification of antibody
response to hepatitis B virus surface antigen. J Clin Microbol
2008;46:1298-1306.
Access this article online
Website: www. ajts. org Quick Response Code:
DOI: 10.4103/0973-6247.115592
Analysis of blood donor deferral
pattern: Scenario in a Tertiary Health Care
Hospital in India
Sir,
Paucity of healthy safe donors has always been a serious problem
for blood banks all over the world.To quantify the losses due to
deferred donors and to understand the rate, reasons and problems
of donor population coming to private, tertiary care hospital,
a record-based study was conducted encompassing three and
half years (1 Jan 2007-30 June 2010). During this period, 22404
potential donors were screened, of which 19005 (82.12%) were
successful donors. Demographic profile of donors is shown in
Table 1. 3399 donors were found to be unfit giving an overall
incidence of 17.88%. Of the total deferrals, 2705 (79.58%) were
male donors and 694 were female donors (20.42%) [Table 2].
Deferral incidence of 17.88% was similar to other studies.[1-3]
However, study by Rabeya et al [4] showed low incidence (5.6%)
and Charles et al [5] showed deferral incidence of as high as 35.6%,
 Letters to the Editor

Table 1: Demographic profile of the donors community health was good in 1st quarter, whereas 3rd quarter;
No. of Total No. of Total being the rainy season, health of community seems to be at its
donations donations donations donations lowest level due to sizeable number of water-borne diseases leading
% % to temporary deferrals; a finding not observed by any other worker
Voluntary 322 1.69 Male 18327 96.43 in the past which needs to be further evaluated.
Replacement 18683 98.31 Female 678 3.57
Total 19005 100 Total 19005 100
As anemia, history of medication, and alcohol are causes of
temporary deferral (63.21%), deferred donors can be recruited back
Table 2: Gender wise deferrals into the donor pool. Deferral due to history of alcohol consumption
Male Female accounted to 15.0% of total deferrals; a finding not observed by any
No. % No. % other worker in the past making the reason as 4th commonest cause.
Donation 18327 87.14 678 49.42
Deferral 2705 12.86 694 50.58 To conclude, analysis of rejection patterns will help medical
Total/screened 21032 100 1372 100 personnel to be more focused on donor screening so that
donors deferred due to temporary reasons like anemia, history
of medication, and alcohol consumption can be recruited in
Table 3: Reasons of deferrals donor registry after managing temporary reasons. Thus, effective
No. of cases %
measures need to be initiated to address the issues like lost donors
Total deferrals 3399
and retention, and registry of perspective donors.
Low Haemoglobin 873 25.68
History of drug intake 638 18.77
Hypertension 536 15.77 Sadhana Mangwana
*H/O alcohol 510 15.0 Department of Blood Transfusion Services,
*H/O jaundice 104 3.06 Sri Balaji Action Medical Institute,
Vaccination 51 1.50 Paschim Vihar, New Delhi, India
Low body weight 41 1.21
*H/O periods 42 1.24
Major surgery 44 1.29
Asthma 34 1.0 Correspondence to: Dr. Sadhana Mangwana,
Endocrine disorder 34 1.0 G-17, Pocket – II, Naraina Vihar,
Tuberculosis 14 0.41 New Delhi - 110 028, India.
Others** 478 14.07 E-mail: sadhanamangwana@yahoo.co.in
*H/O: History of Hb: Hemoglobin, **Others includes previous blood donation,
transfusion history, fasting, vein not prominent etc.,

signifying that rate of deferral may not change whether donors
are regular volunteers or replacement donors.
Reasons of deferrals are shown in Table 3. Low hemoglobin was
the leading cause of total deferrals and in female donors (68.01%
in female donors versus 14.82% in male donors), followed by
history of medication, hypertension. and alcohol consumption
(common in men) implying that deferral in female donors due
to anemia is nearly 4.6 times higher than in male donors; a
finding similar to other studies[1,3,4] emphasizing that a sizeable
population, especially female donors in this part of world is
anemic reflecting the impact of low socioeconomic status on
health. Effects are needed to address the issue of anemia in
prospective donors at all levels Health of blood donors can be
improved by educating and motivating them to seek necessary
guidance for anemia. Simultaneously, adolescents and youth
should be targeted for eradication of anemia by different, yet
coordinated initiatives. The most common cause of permanent
deferral was hypertension (15.76%).
References
1. Bahadur S, Jain S, Goel RK, Pahuja S, Jain M. Analysis of blood
donor deferral characteristics in Delhi, India. Southeast Asian J
Trop Med Public Health 2009;40:1087-91.
2. Chaudhary RK, Gupta D, Gupta RK. Analysis of donor-deferral
pattern in a voluntary blood donor population. Transfus Med
1995;5:209-12.
3. Agnihotri N. Whole blood donor deferral analysis at a center in
Western India. Asian J Transfus Sci 2010;4:116-22.
4. Rabeya Y, Rapiaah M, Rosline H, Ahmed SA, Zaidah WA, Roshan TM.
Blood pre-donation deferrals–a teaching hospital experience.
Southeast Asian J Trop Med Public Health 2008;39:571-4.
5. Charles KS, Hughes P, Gadd R, Bodkyn CJ, Rodriguez M.
Evaluation of blood donor deferral causes in the Trinidad and
Tobago National Blood Transfusion Service. Transfus Med
2010;20:11-4.
Access this article online
Website: www. ajts. org Quick Response Code:
DOI: 10.4103/0973-6247.115595

On comparing deferral rates in various quarters of the year

between 2007 and 2009, deferral rate was lowest (16.98%) in 1st
quarter with highest (32.55%) in the 3rd quarter signifying that

Asian Journal of Transfusion Science - Vol 7, Issue 2, July - December 2013 161
Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.