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Advising the blood donor who failed the hematocrit test; this blood center offers rejected donors constructive advice on how to try again - to both parties' benefit.

"Sorry, we can't accept you. Your blood count is too low." This is what more than 3 per cent of our potential blood donors are told. These rejected donors may leave believing that they have been permanently rejected and may never try to donate again.

Two years ago we decided that our responsibility does not end with the dismissal of these Good Samaritans. Now we offer them a complete blood count at our expense, then advise them what to do about their deficiency. The new policy is paying off, both for the rejected donor and for the blood assurance program of this 320-bed hospital. Rejected donors are improving their diets or seeking medical attention, and many are returning with acceptable hematocrits.

The protocol is simple. When donors' fingerstick hematocrits are too low, the phlebotomist suggests that the laboratory perform a CBC on their venous blood without charge. If they consent, the hematology department performs the CBC after the donor leaves.

If any of the red cell values--RBC, hemoglobin, hematocrit--are below our laboratory's reference range, the donor is informed by letter that anemia was found. We enclose a copy of the complete blood count and recommend that the donor contact a physician.

We send a slightly different letter to donors who fail to qualify by AABB standards but fall without our laboratory's normal range. The minimum acceptable hematocrit for blood donors is higher than most laboratories' lowest normal level; for example, the AABB minimum hematocrit is 41 per cent for men and 38 per cent for women, while our lab's lower limits are 39 per cent for men and 35 per cent for women. We assure would-be donors in this category that they are not anemic, but we recommend a high-iron diet because of the likelihood of borderline or low iron levels. Their letter includes a list of iron-rich foods such as bran cereal, liver, peas, beans, and prune juice.

After six months of this new policy, 71 of our registered donors, or about 3 per cent of the total, had been rejected because of low hematocrits, as Figure I shows. Sixty-three per cent of these rejected donors accepted the offer of a free CBC, and their complete blood count results are presented in Figure II.

Two-thirds of these rejected donors were not anemic according to our criteria. Incidentally, we were gratified to find that in every instance the hematocrit determined on an automated cell counter verified the readings obtained on our spun hematocrit of fingerstick blood.

There was no significant sex difference in the incidence of anemia revealed among rejected donors by the CBC. But there was a striking difference between red cell indices. Ninety-one per cent of the anemic women had microcytosis and/or hypochromia; none of the men did. (Microcytosis was declared when the mean corpuscular volume was below 82 cu. microns; hypochromia was indicated by a mean corpuscular hemoglobin less than 28 pg.)

Seven of the 10 women with microcytosis or hypochromia had donated blood within the previous six months. The combination of menstrual blood loss and frequent blood donations often causes iron-deficiency anemia, an observation that has spurred a search for better screening methods for borderline iron deficiencies. In addition, women who repeatedly donate blood are now generally advised to take iron supplements.

Thrhough follow-up letters to the anemic donors, we found that most did consult a physician and were being treated. Of those 30 rejected donors in the study group who weren't really anemic, 10 returned--and only one failed the hematrocrit test on this second try.

We believe that our new policy helped persuade these donors to give it another try. The cost are nominal: a CBC and the mailing of one form letter with the individual's CBC results. In return, the blood center has the opportunity to turn rejection into constructive health advice--and to increase our potential donor pool.
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Author:Umicker, William O.
Publication:Medical Laboratory Observer
Date:Sep 1, 1985
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