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Year : 2013 | Volume : 1 | Issue : 2 | Page : 57 - 60  


Original Articles
Study of various Physiological, Biochemical and Hematological parameters in Repeated Blood Donors
  1. S. Dhanasree Naidu1, Raghu Sundarachari2, Vikram kumar Naidu 3, Sai Sankalp Naidu4, Anudeepthi Neelagiri5, Meghana Reddy6

1&2 Associate Professor of Physiology, Malla Reddy Medical College for Women, Hyderabad. 3, 4 & 5MBBS Scholars

 

Abstract:

Background: Blood donation is a humanitarian act to save the lives of sick and needy patients. Repeated blood donation can have some adverse effects on overall health of repeated blood donors.

Objective: To evaluate cardiovascular, respiratory and lipid profiles and study the effects of repeated blood donation among repeated blood donors. To compare these parameters with persons who never donated blood.

Method: A Hospital based, comparative, cross sectional study was conducted. Twenty males, who donated blood every three months in a year were compared against 20 age matched males who never donated blood in last one year as well as they were never been the repeated blood donors before that.

Results: The weight (Wt), heart rate (HR), systolic blood pressure (SBP), respiratory rate (RR), peak expiratory flow rate (PEFR), chest expansion (CE), hemoglobin (Hb), packed cell volume (PCV), red blood cell count (RBC), and high density lipoproteins (HDL) were significantly lower among repeated blood donors compared to non donors. Whereas erythrocyte sedimentation rate (ESR) was significantly higher among repeated blood donors compared to non donors.

Conclusion: Thus out of 25 parameters studied, 11 were found to be statistically significant. Out of these 11 parameters, Wt, PEFR, CE, Hb, PCV, RBC, and ESR have lower values and ESR and HDL has higher value and is adverse for the health of the repeated blood donors. On the other hand, HR, SBP, and RR lower values may be beneficial for them.

Keywords: Blood Donation, Lipid profile, Repeated Blood Donors.

Corresponding Author: Dr V.S. Dhanashree Naidu, Associate Professor of Physioilogy, Malla Reddy Medical College for Women, Hyderabad.AP.              e-mail- drvsdnaidu@yahoo.co.in

 

Introduction:

Donation of blood is a humanitarian act to save the lives of the sick and needy patients during emergencies. The AIDS epidemic and the transmission of other infectious agents through blood transfusion have revolutionized the practice of Transfusion Medicine. Increasing public awareness of the risks of transfusion has resulted in a more stringent approach to donor selection and testing and preparation of blood and its components, and has led to an increase in the use of autologous blood. The first transfusion of blood occurred in 1667.

The donors can be grouped as Voluntary (unpaid) donors and Commercial (paid) donors.

These commercial donors can further be categorized as Regular donors and Occasional donors

Voluntary donors donate blood on their own and will not receive any payment. The primary motivation is to help unknown recipients and they donate regularly to maintain adequate supply of blood. They are aware of the importance of safe blood.

Commercial donors are paid donors, and are usually from economically poorer section of the society and donate their blood whenever they fall short of money. Such commercial donors do not bother about their health and suffer from various ailments and they are usually a source for transmissible diseases.

After donating the blood the donor requires approximately three months to get back the required quantities of iron stores. The most common complication of blood donation is the hematoma formation, which may be striking, but resolves spontaneously. The body system of most donors will tolerate the blood donation very well by compensating the acute loss of blood volume by increasing the heart rate and vascular resistance. Approximately 2-5% donors, however, experience vaso-vagal reactions, with syncope occurring in 0.3%.

The direct effect on repeated blood donation in on the iron stores of the repeated blood donors. Various studies have documented the reduced hemoglobin and iron stores among regular or repeated blood donors. [1, 2, 3, 4, 5, 6, and 7] Blood donation at regular intervals is also found to have effect on blood pressure and heart rate. Studies have shown that among repeated or regular blood donors, there is decrease in blood pressure and heart rate. [8, 9] Blood donation is also found to be associated with reduction in cardiovascular risk factors. [10, 11, 12, 13, and 14]

With this background present comparative study has been undertaken to study various physiological, biochemical and hematological parameters among repeated blood donors and non donors.

 

Material and methods:

Present study is a hospital based comparative cross sectional study. It was conducted at blood bank of Gandhi Medical College and Hospital, Hyderabad from August 2003 to September 2004. Twenty repeated blood donors and 20 non donors were included in the study. Repeated blood donors were considered as individuals who donated blood at least once in three months during the last year i.e. more than four times in the last year. Non donors were defined as individuals who never donated blood in the last year.

Institutional Ethics Committee permission was obtained. Permission from Medical Superintendent of Gandhi Hospital was sought. Blood bank technician was asked to give inform whenever any repeated blood donor visited the blood bank. On receiving such information, the individual was contacted and his consent was obtained. Age matched non donor was selected from patient relative. The study subjects (repeated blood donors and controls (non-donors) were included in the study based on following inclusion and exclusion criteria.

Inclusion criteria:

  1. Willing to give consent for the study
  2. Age 20 – 50 years
  3. Only males

Exclusion criteria:

  1. Age less than 20 years and more than 50 years
  2. Suffering from diseases and is on medication

It was possible to include 20 male repeated blood donors in the age group of 20 – 50 years who consented to participate in the study during the study period. Twenty age group matched healthy controls were also included in the study after their consent as comparison group. The data was recorded in a pre-designed questionnaire.

Height and weight were recorded as per the standard guidelines laid down by World Health Organization. [15] Body Mass Index was calculated based on height and weight as weight in kg divided by height in meter square.

Cardiovascular parameters like heart rate (HR), systolic blood pressure, and diastolic blood pressure, Respiratory parameters like respiratory rate (RR), peak expiratory flow rate (PEFR), and chest expansion, [16] Hematological parameters like hemoglobin (Hb), packed cell volume (PCV), red blood cell count (RBC), total leucocyte count (TLC), differential leucocyte count, and erythrocyte sedimentation rate (ESR), [17] and Lipid profile like total cholesterol (TC), high density lipoproteins (HDL), triglycerides (TG), very low density lipoproteins (VLDL), low density lipoproteins (LDL) [18] were measured accurately as per the procedures laid down.

Statistical analysis: The data was analyzed using unpaired‘t’ test and a p value of less than 0.05 is considered significant.

 

Results:

A comparative cross sectional study was carried out among age matched 20 repeated blood donors (will be termed as study group) and 20 non donors (will be termed as control group) at Gandhi Medical College and Hospital, Hyderabad.

Table 1 shows the physical parameters of study and control group. Physical parameters like age, weight (wt), height (ht), body surface area (BSA), and body mass index (BMI) were compared between study and control group. There was no significant difference between two groups in case of mean age. This is due to matching of two groups for age. Mean wt was significantly lower among study group as compared to control group (p = 0.0001).

Comparison of cardiovascular parameters like heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) among two groups is shown in table 2. Out of these, HR and SBP were significantly lower among study group than control group (p < 0.001). Mean DBP was more among study group which was statistically not significant (p = 0.2751).

In table 3, comparison of respiratory parameters like respiratory rate (RR), peak expiratory flow rate (PEFR), and chest expansion is shown. Mean RR and chest expansion were significantly lower in study group whereas PEFR was significantly higher in control group (p < 0.001).

Table 4 shows mean values of hematological parameters like hemoglobin (Hb), packed cell volume (PCV), total leucocyte count (TLC), neutrophils, lymphocytes, monocytes, eosinophils, erythrocyte sedimentation rate (ESR), and red blood cell count (RBC) for study and control group. Out of these studied parameters, the mean values of Hb, PCV, and RBC were found to be significantly lower among study group (p < 0.001). The mean ESR value was significantly lower in control group (p = 0.0001).

Mean values of lipid parameters like total cholesterol (TC), triglycerides (TG), very low density lipoproteins (VLDL), and low density lipoproteins (LDL) for study and control group can be observed from table 5. Among all these parameters studied only HDL was found to be significantly higher in control group than study group (p = 0.0343). Mean values of TC, TG, VLDL were lower and LDL was higher in study group than control group but the difference was statistically not significant (p > 0.05).

 

Discussion:

A hospital based cross sectional comparative study was carried out among age matched 20 repeated blood donors (study group) and 20 non donors (control group). It was found that mean age in study group was 36.7+11.4 years and 33.76+9.2 years in control group. This difference in mean age group was not significant. This is due to the age group matching done. Body weight was significantly lower among study group compared to control group (p = 0.0001). This shows that repeated blood donors are at risk of becoming underweight as repeated blood donation may lead to loss of weight. In India, these repeated blood donors are mostly from low income group and they go for repeated blood donation for earning the money. They are also negligent and unaware about health. Hence they do not take sufficient nutrition required after such repeated blood donations. The mean values of ht and BSA were similar in both the groups. Mean BMI was 23.4+4.8 kg/m2 in study group and 25.6+4.6 kg/m2 in control group. But the difference was not significant.

Cardiovascular parameters were compared and it was found that HR and SBP were significantly lower among study group (p < 0.001). Bellitti P et al [8] in their study noted that blood pressure remained stable throughout donations, while HR significantly decreased (from 78 to 68 beats/min; p < 0.001). Casiglia E et al [9] observed that adjusted SBP significantly decreased by 2.1% and 2.7%. Whereas they found that DBP tended to increase insignificantly, while adjusted one did not change at all. In our study also, the mean value of DBP was 78.3+6.9 in study group and 76.3+4.2 in control group. But this difference was statistically not significant (p = 0.2751).

We also studied some respiratory parameters like RR, PEFR and chest expansion. All these mean values were significantly lower among study group (p < 0.001). Mean PEFR was significantly lower in the repeated blood donors (study group). But this finding can be said as inconclusive as there may be a confounding bias. The other factors which affect PEFR like smoking, exposure to dust etc were not matched between the two groups in this study.

Hematological parameters like Hb, PCV, TLC, neutrophils, lymphocytes, monocytes, eosinophils, ESR and RBC were studied. Out of these, only Hb, PCV and RBC were significantly lower among repeated blood donors (study group) as compared to non donors; while only ESR was significantly higher (p < 0.001). Many studies [1, 2, 3, 4, 5, 6, 7, and 13] have documented the effect of blood donation on hemoglobin, iron stores in the form of lowering of serum iron, hemoglobin levels and serum ferritin levels among regular or repeated blood donors. Our study also shows the low mean value of Hb among repeated blood donors (study group).

Our study has shown that repeated blood donation has no beneficial effect on lipid profile of repeated blood donors. As the mean values of TC, TG and VLDL were higher among study group; but not significant. HDL mean value was significantly lower among repeated blood donors. Whereas van Jaarsveld H et al [14] found that blood donation has various beneficial effect such as increasing HDL and apoA; a higher oxidative potential of LDL; a lower level of LDL peroxidation resulting in a LDL particle with a higher oxidative potential, and a higher NO (3) concentration. Kumar H [11] also in their study found that ten patients of hyperlipidemia who donated blood 300 ml every month for 3 months and received gemfibrozil 1200 mg/day had nearly two fold greater fall in serum total cholesterol, LDL and TG levels in comparison to 17 patients of group A who were treated with gemfibrozil alone in similar dose for the same period. HDL level remained almost unchanged. He commented that a non-pharmacological way of treating hyperlipidemia can be blood donation especially suitable in obese persons.

In contrast to above mentioned two studies, our study does not support this notion that regular blood donation can have beneficial effect on lipid profile of person. But at the same time, we would like to interpret our findings very cautiously as there may be confounding bias in the present study. Hence a well planned study in this regard on sufficient and representative sample is warranted.

Thus out of 25 parameters studied, 11 were found to be statistically significant. Out of these 11 parameters, Wt, PEFR, CE, Hb, PCV, RBC, and ESR have lower values and ESR and HDL have higher value and is adverse for the health of the repeated blood donors. On the other hand, HR, SBP, and RR lower values may be beneficial for them.

 

References:

  1. Abdullah SM. The effect of repeated blood donations on the iron status of male Saudi blood donors. Blood Transfus 2011;9(2):167-71.
  2. Finch CA, Cook JD, Labbe RF, Culala M. effect of blood donation on iron stores as evaluated by serum ferritin. Blood 1977;50(3):441-7.
  3. Garry PJ, VanderJagt DJ, Wyne SJ, Koehler KH, Rhyne RL, Simon TL. A prospective study of blood donations in healthy elderly persons. Transfusion 1991;31(8):686-92.
  4. Brittenham GM. Iron deficiency in whole blood donors. Transfusion 2011;51(3):458-61.
  5. Garry PJ, Koehler KH, Simon TL. Iron stores and iron absorption: effects of repeated blood donations. Am J Clin Nutr 1995;62(3):611-20.
  6. Nadarajan VS, Eow GI. Anemia and iron status among blood donors in a blood transfusion unit in Malaysia. Malays J Pathol 2002;24(2):99-102.
  7. Silber MH, Richardson JW. Multiple blood donations associated with iron deficiency in patients with restless legs syndrome. Mayo Clin Proc 2003;78(1):52-4.
  8. Bellitti P, Valeriano R, Gasperi M, Sodini L, Barletta D. cortisol and heart rate changes in first- and fourth-time donors. Vox Sang 1994;67(1):42-5.
  9. Casiglia E, Biasin R, Cavatton G, Capuani M, Marotti A, Onesto C et al. lower blood pressure values in blood donors? Jpn Heart J 1996;37(6):897-903.
  10. Fossum E, Hieggen A, Moan A, Nordby G, Velund TL, Kjeldsen SE. whole blood viscosity, blood pressure and cardiovascular risk factors in healthy blood donors. Blood Press 1997;6(3):161-2.
  11. Kumar H. repeated blood donation effective in treating hyperlipidemia. J Assoc Physicians India 1994;42(6):468-9.
  12. Meyers DG, Strickland D, Maloley PA, Seburg JK, Wilson JE, McManus BF. Possible association of a reduction in cardiovascular events with blood donation. Heart 1997;78(2):188-93.
  13. Sherman LA, Lippmann MB. Ahmed P, Buchholz DH. Effect on cardiovascular function and iron metabolism of the acute removal of 2 units of red cells. Transfusion 1994;34(7):573-7.
  14. Van Jaarsveld H, Pool GF. Beneficial effects of blood donation on high density lipoprotein concentration and the oxidative potential of low density lipoprotein. Atherosclerosis 2002;161(2):395-402.
  15. World Health Organization: Physical Status: The use and interpretation of anthropometry. WHO Tech Rep Series 1995;854:424-38
  16. Pal GK, Pal P. hematology. In Textbook of Practical Physiology. 2001, 1st ed, Orient Longman, Hyderabad. 147-270.
  17. Pal GK, Pal P. hematology. In Textbook of Practical Physiology. 2001, 1st ed, Orient Longman, Hyderabad: 1-146.
  18. Verly H, Gowen L, Allen H, Bell M. In. Practice Clinical Biochemistry. 1980, 5th ed, William Heinemann Medical Books Ltd, London: 625-84.

 

 Tables:

Table 1: Comparison of Physical Parameters between study group and control group

 

 

Parameter                    study group                 control group               t value             p value

Age                             36.7+11.4*                  33.76+9.2                    0.8853             0.3816

Weight                         56.06+7.7                    69.33+11.8                  4.2118             0.0001

Height                         164.8+9.9                    165.1+6.6                    0.1128             0.9108

Body surface area            1.7+.1                       1.73+0.2                    0.60                 0.5521

Body mass index            23.4+4.8                      25.6+4.6                   1.4799              0.1471

            *values are in mean+SD

 

Table 2: Comparison of Cardio-vascular Parameters between study group and control group

 

Parameter                    study group                 control group               t value             p value

Heart rate                    69.2+2.6*                    72.3+4.3                      2.7590             0.0089

SBP                             103.9+8.3                    119.1+7.7                    6.0041             0.0001

DBP                            78.3+6.9                      76.3+4.2                      1.1073             0.2751

SBP = systolic blood pressure, DBP = diastolic blood pressure

*values are in mean+SD

 

 Table 3: Comparison of Respiratory Parameters between study group and control group

 

Parameter                    study group                 control group               t value             p value

RR                               14+1.3*                       17.2+1.5                      7.2097             0.0001

PEFR                          301.3+32.8                  402.8+27.3                  10.6368           0.0001

Chest expansion          2.9+0.8                        3.7+0.9                        2.9711             0.0051

RR = respiratory rate, PEFR = peak expiratory flow rate

*values are in mean+SD

 

 Table 4: Comparison of Hematological Parameters between study group and control group

 

Parameter                    study group                 control group               t value             p value

Hemoglobin                11.3+1.7*                    15.8+1.2                      9.6713             0.0001

PCV                            37.9+4.2                      47.7+3.37                    8.8319             0.0001

TLC                             8252+872.7                 8480+624.1                 0.9504             0.3479

Neutrophils                 63.9+5.1                      61.8+7.3                      1.0546             0.2983

Lymphocytes              30.9+5.5                      31.9+7.8                      0.4686             0.6420

Monocytes                  1.7+1.2                        2.4+1.1                        1.9230             0.0620

Eosinophils                  3.8+1.5                        2.6+1.1                        2.8851             0.064

ESR                             14.6+3.9                      3.8+1.4                        11.6561           0.0001

RBC                            4.8+0.5                        5.6+1.2                        2.7521             0.0090

PCV = packed cell volume, TLC = total leucocyte count, ESR = erythrocyte sedimentation rate, RBC = red blood cell count

*values are in mean+SD

 

 Table 5: Comparison of Lipid Parameters between study group and control group

 Parameter                    study group                 control group               t value             p value

TC                               161.8+34.87*              156.6+14.4                  0.6164             0.5413

HDL                            32.5+5.2                      36.9+7.3                      2.1955             0.0343

TG                               142.2+80.2                  152.6+54.7                  0.9731             0.3367

VLDL                         25.9+13.4                    29.7+11.2                    0.4791             0.6346

LDL                            107.5+22.6                  100.6+27.6                  0.8650             0.3124

TC = total cholesterol, HDL = high density lipoprotein, TG = triglycerides, VLDL = very low density lipoproteins, LDL = low density lipoproteins

*values are in mean+SD

Source of Support: Nil. Conflict of Interest: None.





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