Analysis of Trends in Look-back Units Based on Post-Donation Information in Plasma Shipments for Contract Fractionation, 2018-2021

Background and ObjectivesIn 2006, the Iranian Blood Transfusion Organization (IBTO) mandated the look-back process as a critical measure to improve blood safety.A fundamental aspect of this process is post-donation information (PDI), which focuses on identifying high-risk donor behaviors that may not be recognized during the donor selection process.This study examines trends in the number of look-back units associated with high-risk donor behaviors in plasma used for the production of plasma-derived medicines (PDMPs). Materials and MethodsIn this cross-sectional study, we collected retrospective data from Blood Transfusion Centers authorized to supply plasma for the production of PDMPs.The data included information on blood donations, deferred blood donors, plasma units designated for fractionation, and Look-back units related to PDI, as well as associated risk factors.These data were categorized based on various risk factors.The Cochran-Armitage test was employed to assess the linear trend in Look-back risk over time.The risk ratio was reported as the effect size, accompanied by a 95% confidence interval.All statistical calculations were performed using the 'epitools' package in R software. ResultsFrom 2018 to 2021, voluntary non-remunerated blood donors contributed a total of 8,035,586 units of blood.Of these, 46% were sent to plasma fractionators to produce PDMPs.During this period, the number of Look-backs related to PDI decreased from 24.4 (2,191 units) to 17.7 (1,727 units) per 10,000 plasma units intended for medicine production (RR: 0.73; 95% CI: 0.68-0.78;p< 0.001).The key risk factors associated with Look-back cases based on PDI were injection drug use (p= 0.001) and high-risk sexual behavior (p< 0.001), both of which showed a significant decreasing trend over the study period.In contrast, factors such as tattooing (p= 0.01) and traditional practices including wet cupping (Hijama), and acupuncture (p< 0.001) showed an increasing trend and significant changes. ConclusionsThis study emphasizes the critical role of evaluating high-risk behaviors in blood donor selection to enhance blood safety.High-risk behaviors include practices such as injection drug use, high-risk sexual behaviors, as well as getting tattoos, wet cupping (Hijama), and acupuncture.Strengthening donor selection may minimize the number of Look-back units and improve overall blood safety.