- Email: [email protected]
Awareness of blood group and blood donation among medical students
G Model
ARTICLE IN PRESS
TRASCI-2252; No. of Pages 7
Transfusion and Apheresis Science xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
Transfusion and Apheresis Science journal homepage: www.elsevier.com/locate/transci
Awareness of blood group and blood donation among medical students Olga Ciepiela a,∗ , Anna Jaworska b , Dominika Łacheta b , Natalia Falkowska b , Katarzyna Popko a , Urszula Demkow a a b
Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Zwirki i Wigury 63a 02-091, Poland Students Scientific Group at Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Poland
a r t i c l e
i n f o
Article history: Received 24 April 2017 Received in revised form 10 October 2017 Accepted 11 October 2017 Available online xxx Keywords: Blood donation Frequency of blood type Medical students Survey
a b s t r a c t Background: Transfusion of blood-derived products is often used as a life-saving treatment, and being a blood donor should be common, especially among medical professionals. Thus, an awareness of one’s own blood type in medical students should be common. Our aim was to assess if students of the Medical University of Warsaw know their blood type and how many of them are registered blood donors. Material and methods: A survey was conducted in a group of 1121 students. The survey included questions addressing awareness of the students’ blood type, the frequency of blood types in Poland, being a blood donor, and willingness to become a blood donor. Results: Of all students, 86.8% knew their blood type and 13.2% did not. Approximately 30.2% of students in the survey declared that they are blood donors, 57.9% had only considered becoming a blood donor and 11.9% had not even considered becoming a blood donor. Of all non-donors, 48.2% had contraindications to becoming a blood donor, 11.5% were afraid of blood collection and 21.9% did not have time to register as a blood donor. Most students (81%) declared that they could become a blood donor if someone closelyrelated needed a transfusion, and 5.2% declared that there is nothing that could force them to become a blood donor. Conclusion: Compared to Polish society medical students are significantly more aware of the necessity of blood donation. The majority know their blood type, but they do not know what is the most common blood type in Poland. © 2017 Elsevier Ltd. All rights reserved.
1. Introduction The Polish Center for Blood Donation consists of 21 Regional Blood Donation Centers. In 2010, approximately 2% of the people of the Polish Society were registered blood donors, and in 2013 a total of 1,186,299 blood donations were performed [1]. It is less as compared with for example, United States or United Kingdom, wherein nearly 6% of the population is registered as blood donors [2]. The blood donation system in Poland allows donations solely from the adult (≥18 years old) volunteers. There is no substantial remuneration for the people who are regular blood donors, other than that in terms of some services in medical care, which are provided to the individuals after a long period of being active donors. The candidates for blood donation are examined considering their
∗ Corresponding author. E-mail address: [email protected] (O. Ciepiela).
physical and mental conditions. They are also asked to fill in a questionnaire with numerous questions about their present and past health, which is crucial for the donors’ qualification. There exist numerous clinical conditions and diseases that may temporarily or permanently disqualify a candidate, owing to menstruation, piercing or tattooing during the last 6 months, severe diseases, acute allergic syndromes, skin abscesses, blood-borne diseases, visiting countries endemic for tropical diseases, imprisonment, blood system disorders, hemostasis disorders, infectious diseases, cancers, or drug and alcohol abuse. After a preliminary qualification test, a blood sample is taken to carry out required hematological, biochemical, and viral tests. Volunteers who pass successfully through all the qualification steps is allowed to donate 450 ml of blood: men—6 times a year and women—4 times a year. In the course of the blood donation procedure, the blood type of all the candidates is identified. There are no definite reminding procedures that exhort donors to give blood. Only in case of increased demand donors with rare or currently needed blood type are informed and requested for donation. Current availability and quantity of all blood types
https://doi.org/10.1016/j.transci.2017.10.002 1473-0502/© 2017 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002
G Model TRASCI-2252; No. of Pages 7
ARTICLE IN PRESS O. Ciepiela et al. / Transfusion and Apheresis Science xxx (2017) xxx–xxx
2
are presented and published on the blood bank website. It may help volunteers to make decision about blood donation, if a specific phenotype is presently needed [3]. Awareness of blood donation is uncommon in society. The World Health Organization recommended an increase of voluntary blood donation units [4], and widespread awareness of blood donation, especially among young people who are training to be health science specialists. The need to increase the blood donor pool among youth has already been underlined [5], and different methods of blood donor recruitment are still under development [5–8]. The active participation of young people seems to be a very important part of donors’ recruitment. It is a group less commonly afflicted with some popular diseases because of the presence of which the other, older candidates can be disqualified. Immunization as well as production of alloantibodies and autoantibodies are more likely in older people. The other important reason is the easy access to this group through modern information sources for instance, social media and the Internet. This problem should be also considered in a broader, more serious social context. It seems to be relevant to involve young people in social issues and allow them to feel the responsibility toward the society [9]. The problem of involvement of young people in the blood donation process has been analyzed several times. Blood donation is considered to be a “good, health habit,” which, if started in adolescence, might be continued throughout the life span [9,10]. But, in Polish donation system only adults, aged 18–65 years old, could be registered as volunteer blood donors [3]. The small number of registered blood donors in Poland might be because of misinterpretation, public opinion, and lack of knowledge with regard to possible adverse reactions and the risk of bloodborne infections during the blood donation process [11]. Medical science students, as a group of people who are willing to work in the field of health science with patients, should be more aware of the necessity of donation of blood, plasma, platelets, stem cells, or different organs [12,13]. It is often highlighted that awareness of one’s own blood type is important, mainly because it is essential to know it in case an urgent transfusion is needed. An awareness of blood type is different among different countries or cultures. In Japan, more than 97% people know their blood type, but only 50% know their blood type in the United Kingdom. There have been no studies regarding the knowledge of one’s blood type in Poland. The aim of the current survey was to estimate the distribution of blood donors among students from the Medical University of Warsaw, their awareness of their own blood group type, and their reasons for refusing to be a blood donor. 2. Materials and methods 2.1. Survey The survey consisted of 11 questions which are as follows: A Description of the study group 1 Faculty 2 Year of study B Questions regarding students’ awareness of own blood group types and attitudes toward blood donation 3 Do you know your blood group type? 4 How did you learn about your blood type? 5 How can you examine your blood type? 6 Have you ever considered becoming a blood donor? 7 If you are not a blood donor, please indicate a reason for your decision. 8 What may prompt you to donate blood?
C General knowledge in blood transfusion 9 Which blood type in your opinion is the most common blood type in Poland? 10 What is your blood type (if it is known)? 11 An individual possessing which blood type is considered as a universal donor? The entire survey is presented in Fig. 1. The survey was distributed among the students of the Medical University of Warsaw. It was completed by 1,121 students from different faculties and years of study (Fig. 1). The survey was distributed in the paper form (182 surveys) and electronically (939 surveys). All answers were collected and analyzed using Microsoft Excel.
2.2. Participants A total of 1,121 surveys were distributed among students from the Medical University of Warsaw, Poland from 5 different faculties and different years of study (Fig. 2) and 15 different fields of study, including medicine (n = 508, 45.3%), laboratory medicine (n = 100, 8.9%), nursing (n = 94, 8.4%), pharmacy (n = 85, 7.6%), dietetics (n = 66, 5.9%), physiotherapy (n = 64, 5.7%), emergency medicine (n = 55, 4.9%), obstetrics (n = 38, 3.4%), electroradiology (n = 33, 2.9%), dentistry (n = 30, 2.7%), public health (n = 21, 1.8%), audiophonology (n = 13, 1.2%), logopedics (n = 11, 1%), dentistry hygiene and techniques (n = 2; 0.2% and n = 1; 0.1%, respectively). All surveys were completed and returned.
3. Results 3.1. Students’ awareness of own blood group and attitudes toward donation Of the 1,121 students, 86.8% (n = 973) knew their blood group. The main sources of data were the Personal Child Health Record (n = 347, 35.2%), the results of laboratory examinations performed by the students’ choice (n = 163, 18.7%), results obtained from the Blood Donation Center after blood donation (n = 163, 16.5%), oral information from parents/caregivers (n = 131, 13.3%), the results of laboratory examinations performed on a doctor’s recommendations (n = 108, 10.9%), the results of analyzes performed during university classes (n = 43, 4.4%), or from an annual educational event organized by the Medical University of Warsaw (n = 10, 1.0%). Of all the responders, 339 (30.2%) were already registered blood donors, 649 (57.9%) students considered becoming a donor but decided against it, and 133 (11.9%) did not consider being a blood donor at all. There was no question about the frequency of blood donation and the last time of donation, which might limit the value of the obtained results regarding the number of registered blood donors. We did not distinguish one-time blood donors from returning donors. The number of registered donors was the highest among students of last years of studies (Fig. 3A). Of the 782 respondents who were not blood donors, various reasons for their decision were indicated, which mainly included contraindications and lack of time. All the reasons are listed in Table 1. Multiple answers were accepted. Analysis of the question regarding possible reasons for blood donation, with the possibility of multiple answers, showed that students were more likely to donate blood when someone closely related needed a transfusion (908, 36.4% of all answers). Interestingly, in the group of nondonors, a high number of respondents were more likely to donate when they would get a remuneration for donation. In the groups of students who considered becoming a blood donor and the already registered blood donors, increased demand for blood was more often pointed as a
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002
G Model
ARTICLE IN PRESS
TRASCI-2252; No. of Pages 7
O. Ciepiela et al. / Transfusion and Apheresis Science xxx (2017) xxx–xxx
3
Fig. 1. Survey distributed among respondents. Dotted lines indicate the space to write an individual response (not listed in the survey) by the respondents.
Table 1 Questions for non-donors regarding reasons for not donating blood. Multiple answers were accepted. Reason for not donating blood
Number of answers (%)
Medical contraindications Anemia Low weight Heart disease Hypothyroidism Other health problem Fear of needles Fear of complications Swoon Transmission of blood-borne diseases Tiredness Overstimulation of bone marrow Pressure surges Lack of time for blood donation Have never seen a reason to donate Did not feel that their blood would be useful Other I am afraid of going alone to blood donation center “Weak veins” I don’t know why I did not decide It should be paid I had contraindications every time I came to the blood donation center I smoke Parents do not agree The blood is never on time when it is needed I was disqualified for 10 years I do not tolerate the blood collection process Religious beliefs
361 (45.7%) 5 5 1 1 1 951 (11.5%) 48 (6.1%) 18 7 1 2 1 171 (21.6%) 46 (5.8%) 8 (1.0%) 65 (8.2%) 1 5 3 1 3 1 2 1 1 1 1
reason for blood donation than need of some colleagues (Fig. 3B). Other reasons are shown in Table 2. 3.2. General knowledge in blood transfusion A further part of the survey included questions regarding the basic knowledge of blood types and transfusion medicine. Only
Table 2 Answers for the question “What may convince you to donate blood?”. Multiple answers were accepted. The table also shows the number and percentages of answers. Reasons for blood donation If someone closely-related needed a transfusion If a colleague needed a transfusion Increased demand for blood Rewards for donating Nothing could force me to donate blood
908 (36.4%) 636 (25.5%) 680 (27.3%) 211 (8.5%) 58 (2.3%)
637 (56.8%) of respondents knew the most common blood type in Poland (Fig. 4). According to the data from the Polish Regional Center for Blood Donation (Fig. 5A), the most common blood type in Poland is A Rh (+), which is the blood type of 32% of the population. In the studied population (n = 973; 86.8%), distribution of blood types was similar to the general Polish population, as shown in Fig. 5B. For the next question addressing the blood type of the universal whole blood donor, only 667 (59.5%) of the respondents answered correctly (O Rh-negative). For O Rh (+) blood type pointed 397 (35.4%) respondents and 52 (4.6%) respondents chose AB Rh (+). Five students chose other blood types (A Rh-positive, B Rh-positive, and AB Rh-negative). 4. Discussion Our survey showed that medical students are aware of the necessity of blood donation and are an important group registered with the Regional Center for Blood Donation as blood donors. The relatively high awareness was probably associated with a medical background, which proves the important role of education in the donor recruitment process. Nonetheless, it should be taken into consideration that this group of donors is professionally at a higher risk of blood-borne infections. But, there is still a significant group of people who do not even know their own group type. Compared
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002
G Model TRASCI-2252; No. of Pages 7 4
ARTICLE IN PRESS O. Ciepiela et al. / Transfusion and Apheresis Science xxx (2017) xxx–xxx
Fig. 2. Distribution of faculties (A) and years of study (B) of students who conducted the survey.
with the percentage of responders who knew their blood type in a study performed on American pregnant women aged 18–46 years old (33.2%) and Canadians from Ontario (56%), the percentage of responders who knew their blood type in this study is very high (86.8%) [14,15]. In general, popular sources indicate that approximately 50% of the British, 97% of the Japanese, and 30% of the American populations know their blood type. There are no studies regarding the Polish population’s awareness of its blood type. This is the first evaluation of awareness of blood donation among Polish medical students. A similar study regarding awareness of bone marrow donation was performed in 2013 in Lublin among nonmedical students. The percentage of registered bone marrow donors among the studied group (16%) was significantly higher compared with that of the general Polish society (approximately 1.5%) [16]. This indicates that university students are more aware of the advantages of transfusion medicine. In a similar study performed in India, only 13.21% donated blood compared with 30.2% in our studied population [17]. In a study performed among medical students in Serbia, the number of blood donors was even higher than that in our study [18]. In Europe, people who have been studying at age 20 or more are the group with a higher percentage of declared blood donors [19]. Interestingly, in an Indian study, 22.8%
of nondonors declared a negative attitude toward blood donation compared with 11.9% in our study [17]. Causes of rejecting blood donation found in our study were similar to those found in other studies: nondonors were afraid of suffering anemia, blood-borne infections or decreased immunity [4,17]. None of our respondents stated they did not know about the possibility of blood donation. The results of survey Eurobarometer 72.3 performed in 2009 for the European Commission reported the highest percentage of blood donors among European countries in Austria (66%). Countries from Eastern Europe like Latvia, Estonia, Lithuania, and Slovenia had recorded blood donation levels higher than 40%. In contrast, Poland was found to be a country with one of the lowest percentages of declared blood donors, with 25% of respondents who declared being a blood donor. A lower number of blood donors was reported for Portugal and Italy alone. The average percentage of blood donors among the European Society (27 countries of EU in 2009) was estimated for 37% [19]. With regard to this number, the amount of declared blood donors among the respondents of our survey is not at all impressive. But, data regarding the number of blood donors among the Polish society ( < 2%) provided by the Regional Blood Donation Center in Warsaw are much less optimistic.
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002
G Model TRASCI-2252; No. of Pages 7
ARTICLE IN PRESS O. Ciepiela et al. / Transfusion and Apheresis Science xxx (2017) xxx–xxx
5
Fig. 3. Percentages of donors and nondonors belonging to different age (year of study) groups of respondents (A), and numbers of answers regarding possible causes of blood donation among donors, nondonors, and those who consider becoming a blood donor (B).
Fig. 4. Percentage of answers regarding the most common blood type in Poland. Green bars indicate the correct answer.
On the other hand, a European Union (EU) report includes responses from people aged 14 to 55 and above. In our study, a significant group (26.3%) consisted of first-year students aged 19–20 years. Moreover, almost 95% of our respondents were aged 19–24, which corresponds with the first age group analyzed in Eurobarometer 72.3. The first-year respondents just reached the age at which they could start donating and they form a group with low number of declared blood donors compared with the last-years students. Many of our youngest respondents, who moved to a bigger city from smaller towns and villages, might never have had an opportunity to donate. This might have influenced the number of nondonors, who intended to donate in future. Similarly to the EU respondents, the number of blood donors increases with the age of students.
Interestingly, in our studied population the distribution of blood types was similar to the distribution in the general Polish population; however, 24% of respondents who knew their blood type were Rh-negative, compared with the general population where Rh negativity is estimated for only 15% of individuals. It seems to be important to estimate if this variance was associated with the growth of the Rh-negative population or group misidentification in early childhood. Almost 12% of students have never considered becoming a blood donor; however, a great majority of respondents considered the possibility of blood donation in the case of increased demand or a need of blood by someone closely related. Despite being medical health personnel, who are aware of the advantages of transfusion medicine, more than 2% of respondents stated that there is nothing that could convince them to become a blood donor. The reasons for the statement was probably based on one’s conviction that the blood is useless or is never available on time when needed. Surprisingly, despite performing the surveys among adults, there were some responses indicating that a student does not donate blood because their parents do not agree. The frequency of such a reason was significantly higher in the Indian study [17]. There are several studies regarding motivation and behavior of whole blood donors and nondonors. The psychological models study and predict the attitude of nondonors, first-time donors, and repeated donors and analyze the most common causes of refusing blood donation [20]. The decision to donate may be based on altruism and behavioral intentions—both typical mainly for blood donors; or anxiety and practical difficulties—typical for nondonors
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002
G Model TRASCI-2252; No. of Pages 7 6
ARTICLE IN PRESS O. Ciepiela et al. / Transfusion and Apheresis Science xxx (2017) xxx–xxx
Fig. 5. Distribution of blood types in the general Polish population—data from the Regional Center for Blood Donation, Mazovian district (A), and the studied population (B).
[2,20,21]. Interestingly, in our survey students were more likely to donate whole blood in case of increased demand, because they realized that blood transfusion might save someone’s life. It indicates that they present a first psychological model based on altruism. But, the minority of respondents who had declared to be nondonors presented nonaltruistic behavior—they were more likely to donate if it were associated with some benefits. A study by Moussaoui et al. showed that social companies relied on “saving lives” argument, the intention of which is to increase the number of blood donors that may not be as effective as it is thought. They found that the motivational letter including the statement “The blood you give is used to save lives” did not result in higher rates of responses and donors registration than a letter that did not contain such a statement [22]. Probably, our respondents presented a higher dose of empathy compared with that shown by the entire society. There are many motivational programs dedicated to increasing the number of blood donors in the society. As shown in our study, an increased blood demand is only one of the factors that can encourage blood donation. Some studies show that the majority of blood donors donate only for altruistic reasons [7], and this group does not need any motivational program. For these volunteers, convenience of monitoring blood demand and the time interval between donations was proposed. A mobile application that could be installed on a smart phone has been found to be use-
ful for the same, especially among young people aged less than 45 years [5,6]. A motivational factor that is attractive for donor candidates is rewards for donations, including money as well as movie tickets, snacks, etc. [7,23,24]. On the other hand, the factor that influences the reduced frequency of repeated donors is quite similar to the reasons given by nondonors as causes for not becoming a donor (e.g., health reasons, fear of needles, a painful experience of blood collection). The distance from a blood donation center and forgetting to donate were significant causes of reductions in blood donation [25]. The last issue could be easily eliminated if donation reminders were commonly used [5,8,26]. In general, young people know about the advantages of blood donation with regard to benefits to the blood recipient. Less is known about the benefits to themselves such as controlling the state of health of the population [27]. Worth mentioning is one of the findings of our study that among medical students there are still about 58% who have never donated \ blood, but do not refuse that they might become a donor in the future. If there were any social campaigns, modern devices constructed for blood donors’ motivation and uniting, they should be targeted at such a group of possible donors. Moreover, we found that many of the possible blood donors do not know contraindication and exclusion criteria for blood donating. Thus, we suggest, that all campaigns that aim at increasing the number of blood donors, should include clear and concise information—what
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002
G Model
ARTICLE IN PRESS
TRASCI-2252; No. of Pages 7
O. Ciepiela et al. / Transfusion and Apheresis Science xxx (2017) xxx–xxx
is and what is not an exclusion criterion for blood donation, using an attractive form of communication for young, educated people. Our results show that most medical students know the contraindications for blood donation; however, there is still a group of people who do not know the exclusion criteria and think that they do not meet the criteria for being a donor. Educational efforts undertaken during academic activities could be useful for sharing and spreading the knowledge of blood donation advantages and to dispel doubts about the donation process. Authorship contribution OC developed a survey, performed analysis, and wrote a manuscript. AJ developed a survey, collected answers, and performed analysis. DŁ collected answers, and performed analysis. NF performed analysis and took part in manuscript preparation. KP wrote and approved the manuscript. UD developed a survey and finally approved the manuscript. Conflict of interest Authors declare no conflict of interest. Acknowledgements Authors wish to thank all participants of the Students Scientific Group at the Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age who helped to distribute the survey among students. References [1] Rosiek APR. Donor adverse reactions related to collection of blood and blood components by manual method and by apheresis. J Transfus Med 2014;7(3):10. [2] McVittie C, Harris L, Tiliopoulos N. I intend to donate but . . .: non-donors’ views of blood donation in the UK. Psychol Health Med 2006;11(1):1–6. [3] M L, Medyczne zasady pobierania krwi, oddzielania jej składników i ˛ ˛ w jednostkach organizacyjnych publicznej słuzby ˙ ace wydawania, obowiazuj krwi. 3 ed. (2014), Warsaw: Instytut Hematologii I Transfuzjologii. [4] Sampath S, Ramsaran V, Parasram S, Mohammed S, Latchman S, Khunja R, et al. Attitudes towards blood donation in Trinidad and Tobago. Transfus Med 2007;17(2):83–7. [5] Yuan S, Chang S, Uyeno K, Almquist G, Wang S. Blood donation mobile applications: are donors ready? Transfusion 2016;56(3):614–21. [6] Ouhbi S, Fernández-Alemán JL, Toval A, Idri A, Pozo JR. Free blood donation mobile applications. J Med Syst 2015;39(5):52. [7] Finck R, Ziman A, Hoffman M, Phan-Tang M, Yuan S. Motivating factors and potential deterrents to blood donation in high school aged blood donors. J Blood Transfus 2016;2016:8624230.
7
[8] Moog R, Fourne K. Recruitment of prospective donors: what do they expect from a homepage of a blood transfusion service? Transfus Med 2007;17(4):279–84. [9] Zito E, Alfieri S, Marconi M, Saturni V, Cremonesi G. Adolescents and blood donation: motivations, hurdles and possible recruitment strategies. Blood Transfus 2012;10(1):45–58. [10] Alfieri S, Saturni V, Marta E. Looking to the future by acting on the present. Intention to donate blood and risk behavior: a research on adolescents. Asian J Transfus Sci 2013;7(2):130–4. [11] Balegh S, Marcus N, Dubuc S, Godin G, France CR, Ditto B. Increasing nondonors’ intention to give blood: addressing common barriers. Transfusion 2016;56(2):433–9. [12] Narayanan P, Wolanskyj A, Ehlers SL, Litzow MR, Patnaik MS, Hogan WJ, et al. Medical students’ knowledge, familiarity, and attitudes towards hematopoietic stem cell donation: stem cell donation behaviors. Biol Blood Marrow Transplant 2016;22(9):1710–6. [13] Charbonneau J, Cloutier MS, Carrier E. Motivational differences between whole blood and apheresis donors in quebec, canada: a questionnaire-based survey in a voluntary nonremunerated context. J Blood Transfus 2015;2015:568259. [14] Shah KH, Cavallo E, Paisley J, Kurobe A, Newman DH. Can we defer/omit a type and screen blood test for pregnant women who know their blood type? J Emerg Med 2011;41(2):223–7. [15] Bider-Canfield Z, Cotterchio M. Self-reported ABO blood type compared with DNA-derived blood group. Epidemiology 2014;25(6):936–7. [16] Sikora A, Wiorkowski K, Szara P, Drabko K. Knowledge and attitude of Lublin universities students’ toward the opportunity of becoming unrelated bone marrow donor. Folia Med Cracov 2014;54(2):27–33. [17] Kowsalya V, Vijayakumar R, Chidambaram R, Srikumar R, Reddy EP, Latha S, et al. A study on knowledge, attitude and practice regarding voluntary blood donation among medical students in Puducherry, India. Pak J Biol Sci 2013;16(9):439–42. [18] Gazibara T, Kovacevic N, Maric G, Kurtagic I, Nurkovic S, Kisic-Tepavcevic D, et al. Factors associated with positive attitude towards blood donation among medical students. Transfus Apher Sci 2015;53(3):381–5. [19] Social TO. Eurobarometer 73. In: Comission E, editor. Blood Donation and Blood Transfusions. 2010. Brussels, Belgium. [20] Masser BM, White KM, Hyde MK, Terry DJ, Robinson NG. Predicting blood donation intentions and behavior among Australian blood donors: testing an extended theory of planned behavior model. Transfusion 2009;49(2):320–9. [21] Ferguson E. Mechanism of altruism approach to blood donor recruitment and retention: a review and future directions. Transfus Med 2015;25(4):211–26. [22] Moussaoui LS, Naef D, Tissot JD, Desrichard O. “Save lives” arguments might not be as effective as you think: A randomized field experiment on blood donation. Transfus Clin Biol 2016;23(2):59–63. [23] Jones RP, Prasad V, Kuruvatti J, Tahir N, Whitaker P, Dawson AS, et al. Remuneration for blood donation and attitudes towards blood donation and receipt in Leeds. Transfus Med 2003;13(3):131–40. [24] Koster J, Hassall OW. Attitudes towards blood donation and transfusion in Bamenda, Republic of Cameroon. Transfus Med 2011;21(5):301–7. [25] Charbonneau J, Cloutier MS, Carrier E. Why do blood donors lapse or reduce their donation’s frequency? Transfus Med Rev 2016;30(1):1–5. [26] Davison KL, Reynolds CA, Andrews N, Brailsford SR, UK Blood Donor Survey Steering Group. Getting personal with blood donors - the rationale for, methodology of and an overview of participants in the UK blood donor survey. Transfus Med 2015;25(4):265–75. [27] Hao J, McAvoy J, Wickberg L, Kerrigan C, Kreiger L, Sikavi C, et al. Is blood donation an opportunity for hypertension awareness? Transfus Med 2016;26(2):89–98.
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002
ARTICLE IN PRESS
TRASCI-2252; No. of Pages 7
Transfusion and Apheresis Science xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
Transfusion and Apheresis Science journal homepage: www.elsevier.com/locate/transci
Awareness of blood group and blood donation among medical students Olga Ciepiela a,∗ , Anna Jaworska b , Dominika Łacheta b , Natalia Falkowska b , Katarzyna Popko a , Urszula Demkow a a b
Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Zwirki i Wigury 63a 02-091, Poland Students Scientific Group at Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Poland
a r t i c l e
i n f o
Article history: Received 24 April 2017 Received in revised form 10 October 2017 Accepted 11 October 2017 Available online xxx Keywords: Blood donation Frequency of blood type Medical students Survey
a b s t r a c t Background: Transfusion of blood-derived products is often used as a life-saving treatment, and being a blood donor should be common, especially among medical professionals. Thus, an awareness of one’s own blood type in medical students should be common. Our aim was to assess if students of the Medical University of Warsaw know their blood type and how many of them are registered blood donors. Material and methods: A survey was conducted in a group of 1121 students. The survey included questions addressing awareness of the students’ blood type, the frequency of blood types in Poland, being a blood donor, and willingness to become a blood donor. Results: Of all students, 86.8% knew their blood type and 13.2% did not. Approximately 30.2% of students in the survey declared that they are blood donors, 57.9% had only considered becoming a blood donor and 11.9% had not even considered becoming a blood donor. Of all non-donors, 48.2% had contraindications to becoming a blood donor, 11.5% were afraid of blood collection and 21.9% did not have time to register as a blood donor. Most students (81%) declared that they could become a blood donor if someone closelyrelated needed a transfusion, and 5.2% declared that there is nothing that could force them to become a blood donor. Conclusion: Compared to Polish society medical students are significantly more aware of the necessity of blood donation. The majority know their blood type, but they do not know what is the most common blood type in Poland. © 2017 Elsevier Ltd. All rights reserved.
1. Introduction The Polish Center for Blood Donation consists of 21 Regional Blood Donation Centers. In 2010, approximately 2% of the people of the Polish Society were registered blood donors, and in 2013 a total of 1,186,299 blood donations were performed [1]. It is less as compared with for example, United States or United Kingdom, wherein nearly 6% of the population is registered as blood donors [2]. The blood donation system in Poland allows donations solely from the adult (≥18 years old) volunteers. There is no substantial remuneration for the people who are regular blood donors, other than that in terms of some services in medical care, which are provided to the individuals after a long period of being active donors. The candidates for blood donation are examined considering their
∗ Corresponding author. E-mail address: [email protected] (O. Ciepiela).
physical and mental conditions. They are also asked to fill in a questionnaire with numerous questions about their present and past health, which is crucial for the donors’ qualification. There exist numerous clinical conditions and diseases that may temporarily or permanently disqualify a candidate, owing to menstruation, piercing or tattooing during the last 6 months, severe diseases, acute allergic syndromes, skin abscesses, blood-borne diseases, visiting countries endemic for tropical diseases, imprisonment, blood system disorders, hemostasis disorders, infectious diseases, cancers, or drug and alcohol abuse. After a preliminary qualification test, a blood sample is taken to carry out required hematological, biochemical, and viral tests. Volunteers who pass successfully through all the qualification steps is allowed to donate 450 ml of blood: men—6 times a year and women—4 times a year. In the course of the blood donation procedure, the blood type of all the candidates is identified. There are no definite reminding procedures that exhort donors to give blood. Only in case of increased demand donors with rare or currently needed blood type are informed and requested for donation. Current availability and quantity of all blood types
https://doi.org/10.1016/j.transci.2017.10.002 1473-0502/© 2017 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002
G Model TRASCI-2252; No. of Pages 7
ARTICLE IN PRESS O. Ciepiela et al. / Transfusion and Apheresis Science xxx (2017) xxx–xxx
2
are presented and published on the blood bank website. It may help volunteers to make decision about blood donation, if a specific phenotype is presently needed [3]. Awareness of blood donation is uncommon in society. The World Health Organization recommended an increase of voluntary blood donation units [4], and widespread awareness of blood donation, especially among young people who are training to be health science specialists. The need to increase the blood donor pool among youth has already been underlined [5], and different methods of blood donor recruitment are still under development [5–8]. The active participation of young people seems to be a very important part of donors’ recruitment. It is a group less commonly afflicted with some popular diseases because of the presence of which the other, older candidates can be disqualified. Immunization as well as production of alloantibodies and autoantibodies are more likely in older people. The other important reason is the easy access to this group through modern information sources for instance, social media and the Internet. This problem should be also considered in a broader, more serious social context. It seems to be relevant to involve young people in social issues and allow them to feel the responsibility toward the society [9]. The problem of involvement of young people in the blood donation process has been analyzed several times. Blood donation is considered to be a “good, health habit,” which, if started in adolescence, might be continued throughout the life span [9,10]. But, in Polish donation system only adults, aged 18–65 years old, could be registered as volunteer blood donors [3]. The small number of registered blood donors in Poland might be because of misinterpretation, public opinion, and lack of knowledge with regard to possible adverse reactions and the risk of bloodborne infections during the blood donation process [11]. Medical science students, as a group of people who are willing to work in the field of health science with patients, should be more aware of the necessity of donation of blood, plasma, platelets, stem cells, or different organs [12,13]. It is often highlighted that awareness of one’s own blood type is important, mainly because it is essential to know it in case an urgent transfusion is needed. An awareness of blood type is different among different countries or cultures. In Japan, more than 97% people know their blood type, but only 50% know their blood type in the United Kingdom. There have been no studies regarding the knowledge of one’s blood type in Poland. The aim of the current survey was to estimate the distribution of blood donors among students from the Medical University of Warsaw, their awareness of their own blood group type, and their reasons for refusing to be a blood donor. 2. Materials and methods 2.1. Survey The survey consisted of 11 questions which are as follows: A Description of the study group 1 Faculty 2 Year of study B Questions regarding students’ awareness of own blood group types and attitudes toward blood donation 3 Do you know your blood group type? 4 How did you learn about your blood type? 5 How can you examine your blood type? 6 Have you ever considered becoming a blood donor? 7 If you are not a blood donor, please indicate a reason for your decision. 8 What may prompt you to donate blood?
C General knowledge in blood transfusion 9 Which blood type in your opinion is the most common blood type in Poland? 10 What is your blood type (if it is known)? 11 An individual possessing which blood type is considered as a universal donor? The entire survey is presented in Fig. 1. The survey was distributed among the students of the Medical University of Warsaw. It was completed by 1,121 students from different faculties and years of study (Fig. 1). The survey was distributed in the paper form (182 surveys) and electronically (939 surveys). All answers were collected and analyzed using Microsoft Excel.
2.2. Participants A total of 1,121 surveys were distributed among students from the Medical University of Warsaw, Poland from 5 different faculties and different years of study (Fig. 2) and 15 different fields of study, including medicine (n = 508, 45.3%), laboratory medicine (n = 100, 8.9%), nursing (n = 94, 8.4%), pharmacy (n = 85, 7.6%), dietetics (n = 66, 5.9%), physiotherapy (n = 64, 5.7%), emergency medicine (n = 55, 4.9%), obstetrics (n = 38, 3.4%), electroradiology (n = 33, 2.9%), dentistry (n = 30, 2.7%), public health (n = 21, 1.8%), audiophonology (n = 13, 1.2%), logopedics (n = 11, 1%), dentistry hygiene and techniques (n = 2; 0.2% and n = 1; 0.1%, respectively). All surveys were completed and returned.
3. Results 3.1. Students’ awareness of own blood group and attitudes toward donation Of the 1,121 students, 86.8% (n = 973) knew their blood group. The main sources of data were the Personal Child Health Record (n = 347, 35.2%), the results of laboratory examinations performed by the students’ choice (n = 163, 18.7%), results obtained from the Blood Donation Center after blood donation (n = 163, 16.5%), oral information from parents/caregivers (n = 131, 13.3%), the results of laboratory examinations performed on a doctor’s recommendations (n = 108, 10.9%), the results of analyzes performed during university classes (n = 43, 4.4%), or from an annual educational event organized by the Medical University of Warsaw (n = 10, 1.0%). Of all the responders, 339 (30.2%) were already registered blood donors, 649 (57.9%) students considered becoming a donor but decided against it, and 133 (11.9%) did not consider being a blood donor at all. There was no question about the frequency of blood donation and the last time of donation, which might limit the value of the obtained results regarding the number of registered blood donors. We did not distinguish one-time blood donors from returning donors. The number of registered donors was the highest among students of last years of studies (Fig. 3A). Of the 782 respondents who were not blood donors, various reasons for their decision were indicated, which mainly included contraindications and lack of time. All the reasons are listed in Table 1. Multiple answers were accepted. Analysis of the question regarding possible reasons for blood donation, with the possibility of multiple answers, showed that students were more likely to donate blood when someone closely related needed a transfusion (908, 36.4% of all answers). Interestingly, in the group of nondonors, a high number of respondents were more likely to donate when they would get a remuneration for donation. In the groups of students who considered becoming a blood donor and the already registered blood donors, increased demand for blood was more often pointed as a
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002
G Model
ARTICLE IN PRESS
TRASCI-2252; No. of Pages 7
O. Ciepiela et al. / Transfusion and Apheresis Science xxx (2017) xxx–xxx
3
Fig. 1. Survey distributed among respondents. Dotted lines indicate the space to write an individual response (not listed in the survey) by the respondents.
Table 1 Questions for non-donors regarding reasons for not donating blood. Multiple answers were accepted. Reason for not donating blood
Number of answers (%)
Medical contraindications Anemia Low weight Heart disease Hypothyroidism Other health problem Fear of needles Fear of complications Swoon Transmission of blood-borne diseases Tiredness Overstimulation of bone marrow Pressure surges Lack of time for blood donation Have never seen a reason to donate Did not feel that their blood would be useful Other I am afraid of going alone to blood donation center “Weak veins” I don’t know why I did not decide It should be paid I had contraindications every time I came to the blood donation center I smoke Parents do not agree The blood is never on time when it is needed I was disqualified for 10 years I do not tolerate the blood collection process Religious beliefs
361 (45.7%) 5 5 1 1 1 951 (11.5%) 48 (6.1%) 18 7 1 2 1 171 (21.6%) 46 (5.8%) 8 (1.0%) 65 (8.2%) 1 5 3 1 3 1 2 1 1 1 1
reason for blood donation than need of some colleagues (Fig. 3B). Other reasons are shown in Table 2. 3.2. General knowledge in blood transfusion A further part of the survey included questions regarding the basic knowledge of blood types and transfusion medicine. Only
Table 2 Answers for the question “What may convince you to donate blood?”. Multiple answers were accepted. The table also shows the number and percentages of answers. Reasons for blood donation If someone closely-related needed a transfusion If a colleague needed a transfusion Increased demand for blood Rewards for donating Nothing could force me to donate blood
908 (36.4%) 636 (25.5%) 680 (27.3%) 211 (8.5%) 58 (2.3%)
637 (56.8%) of respondents knew the most common blood type in Poland (Fig. 4). According to the data from the Polish Regional Center for Blood Donation (Fig. 5A), the most common blood type in Poland is A Rh (+), which is the blood type of 32% of the population. In the studied population (n = 973; 86.8%), distribution of blood types was similar to the general Polish population, as shown in Fig. 5B. For the next question addressing the blood type of the universal whole blood donor, only 667 (59.5%) of the respondents answered correctly (O Rh-negative). For O Rh (+) blood type pointed 397 (35.4%) respondents and 52 (4.6%) respondents chose AB Rh (+). Five students chose other blood types (A Rh-positive, B Rh-positive, and AB Rh-negative). 4. Discussion Our survey showed that medical students are aware of the necessity of blood donation and are an important group registered with the Regional Center for Blood Donation as blood donors. The relatively high awareness was probably associated with a medical background, which proves the important role of education in the donor recruitment process. Nonetheless, it should be taken into consideration that this group of donors is professionally at a higher risk of blood-borne infections. But, there is still a significant group of people who do not even know their own group type. Compared
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002
G Model TRASCI-2252; No. of Pages 7 4
ARTICLE IN PRESS O. Ciepiela et al. / Transfusion and Apheresis Science xxx (2017) xxx–xxx
Fig. 2. Distribution of faculties (A) and years of study (B) of students who conducted the survey.
with the percentage of responders who knew their blood type in a study performed on American pregnant women aged 18–46 years old (33.2%) and Canadians from Ontario (56%), the percentage of responders who knew their blood type in this study is very high (86.8%) [14,15]. In general, popular sources indicate that approximately 50% of the British, 97% of the Japanese, and 30% of the American populations know their blood type. There are no studies regarding the Polish population’s awareness of its blood type. This is the first evaluation of awareness of blood donation among Polish medical students. A similar study regarding awareness of bone marrow donation was performed in 2013 in Lublin among nonmedical students. The percentage of registered bone marrow donors among the studied group (16%) was significantly higher compared with that of the general Polish society (approximately 1.5%) [16]. This indicates that university students are more aware of the advantages of transfusion medicine. In a similar study performed in India, only 13.21% donated blood compared with 30.2% in our studied population [17]. In a study performed among medical students in Serbia, the number of blood donors was even higher than that in our study [18]. In Europe, people who have been studying at age 20 or more are the group with a higher percentage of declared blood donors [19]. Interestingly, in an Indian study, 22.8%
of nondonors declared a negative attitude toward blood donation compared with 11.9% in our study [17]. Causes of rejecting blood donation found in our study were similar to those found in other studies: nondonors were afraid of suffering anemia, blood-borne infections or decreased immunity [4,17]. None of our respondents stated they did not know about the possibility of blood donation. The results of survey Eurobarometer 72.3 performed in 2009 for the European Commission reported the highest percentage of blood donors among European countries in Austria (66%). Countries from Eastern Europe like Latvia, Estonia, Lithuania, and Slovenia had recorded blood donation levels higher than 40%. In contrast, Poland was found to be a country with one of the lowest percentages of declared blood donors, with 25% of respondents who declared being a blood donor. A lower number of blood donors was reported for Portugal and Italy alone. The average percentage of blood donors among the European Society (27 countries of EU in 2009) was estimated for 37% [19]. With regard to this number, the amount of declared blood donors among the respondents of our survey is not at all impressive. But, data regarding the number of blood donors among the Polish society ( < 2%) provided by the Regional Blood Donation Center in Warsaw are much less optimistic.
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002
G Model TRASCI-2252; No. of Pages 7
ARTICLE IN PRESS O. Ciepiela et al. / Transfusion and Apheresis Science xxx (2017) xxx–xxx
5
Fig. 3. Percentages of donors and nondonors belonging to different age (year of study) groups of respondents (A), and numbers of answers regarding possible causes of blood donation among donors, nondonors, and those who consider becoming a blood donor (B).
Fig. 4. Percentage of answers regarding the most common blood type in Poland. Green bars indicate the correct answer.
On the other hand, a European Union (EU) report includes responses from people aged 14 to 55 and above. In our study, a significant group (26.3%) consisted of first-year students aged 19–20 years. Moreover, almost 95% of our respondents were aged 19–24, which corresponds with the first age group analyzed in Eurobarometer 72.3. The first-year respondents just reached the age at which they could start donating and they form a group with low number of declared blood donors compared with the last-years students. Many of our youngest respondents, who moved to a bigger city from smaller towns and villages, might never have had an opportunity to donate. This might have influenced the number of nondonors, who intended to donate in future. Similarly to the EU respondents, the number of blood donors increases with the age of students.
Interestingly, in our studied population the distribution of blood types was similar to the distribution in the general Polish population; however, 24% of respondents who knew their blood type were Rh-negative, compared with the general population where Rh negativity is estimated for only 15% of individuals. It seems to be important to estimate if this variance was associated with the growth of the Rh-negative population or group misidentification in early childhood. Almost 12% of students have never considered becoming a blood donor; however, a great majority of respondents considered the possibility of blood donation in the case of increased demand or a need of blood by someone closely related. Despite being medical health personnel, who are aware of the advantages of transfusion medicine, more than 2% of respondents stated that there is nothing that could convince them to become a blood donor. The reasons for the statement was probably based on one’s conviction that the blood is useless or is never available on time when needed. Surprisingly, despite performing the surveys among adults, there were some responses indicating that a student does not donate blood because their parents do not agree. The frequency of such a reason was significantly higher in the Indian study [17]. There are several studies regarding motivation and behavior of whole blood donors and nondonors. The psychological models study and predict the attitude of nondonors, first-time donors, and repeated donors and analyze the most common causes of refusing blood donation [20]. The decision to donate may be based on altruism and behavioral intentions—both typical mainly for blood donors; or anxiety and practical difficulties—typical for nondonors
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002
G Model TRASCI-2252; No. of Pages 7 6
ARTICLE IN PRESS O. Ciepiela et al. / Transfusion and Apheresis Science xxx (2017) xxx–xxx
Fig. 5. Distribution of blood types in the general Polish population—data from the Regional Center for Blood Donation, Mazovian district (A), and the studied population (B).
[2,20,21]. Interestingly, in our survey students were more likely to donate whole blood in case of increased demand, because they realized that blood transfusion might save someone’s life. It indicates that they present a first psychological model based on altruism. But, the minority of respondents who had declared to be nondonors presented nonaltruistic behavior—they were more likely to donate if it were associated with some benefits. A study by Moussaoui et al. showed that social companies relied on “saving lives” argument, the intention of which is to increase the number of blood donors that may not be as effective as it is thought. They found that the motivational letter including the statement “The blood you give is used to save lives” did not result in higher rates of responses and donors registration than a letter that did not contain such a statement [22]. Probably, our respondents presented a higher dose of empathy compared with that shown by the entire society. There are many motivational programs dedicated to increasing the number of blood donors in the society. As shown in our study, an increased blood demand is only one of the factors that can encourage blood donation. Some studies show that the majority of blood donors donate only for altruistic reasons [7], and this group does not need any motivational program. For these volunteers, convenience of monitoring blood demand and the time interval between donations was proposed. A mobile application that could be installed on a smart phone has been found to be use-
ful for the same, especially among young people aged less than 45 years [5,6]. A motivational factor that is attractive for donor candidates is rewards for donations, including money as well as movie tickets, snacks, etc. [7,23,24]. On the other hand, the factor that influences the reduced frequency of repeated donors is quite similar to the reasons given by nondonors as causes for not becoming a donor (e.g., health reasons, fear of needles, a painful experience of blood collection). The distance from a blood donation center and forgetting to donate were significant causes of reductions in blood donation [25]. The last issue could be easily eliminated if donation reminders were commonly used [5,8,26]. In general, young people know about the advantages of blood donation with regard to benefits to the blood recipient. Less is known about the benefits to themselves such as controlling the state of health of the population [27]. Worth mentioning is one of the findings of our study that among medical students there are still about 58% who have never donated \ blood, but do not refuse that they might become a donor in the future. If there were any social campaigns, modern devices constructed for blood donors’ motivation and uniting, they should be targeted at such a group of possible donors. Moreover, we found that many of the possible blood donors do not know contraindication and exclusion criteria for blood donating. Thus, we suggest, that all campaigns that aim at increasing the number of blood donors, should include clear and concise information—what
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002
G Model
ARTICLE IN PRESS
TRASCI-2252; No. of Pages 7
O. Ciepiela et al. / Transfusion and Apheresis Science xxx (2017) xxx–xxx
is and what is not an exclusion criterion for blood donation, using an attractive form of communication for young, educated people. Our results show that most medical students know the contraindications for blood donation; however, there is still a group of people who do not know the exclusion criteria and think that they do not meet the criteria for being a donor. Educational efforts undertaken during academic activities could be useful for sharing and spreading the knowledge of blood donation advantages and to dispel doubts about the donation process. Authorship contribution OC developed a survey, performed analysis, and wrote a manuscript. AJ developed a survey, collected answers, and performed analysis. DŁ collected answers, and performed analysis. NF performed analysis and took part in manuscript preparation. KP wrote and approved the manuscript. UD developed a survey and finally approved the manuscript. Conflict of interest Authors declare no conflict of interest. Acknowledgements Authors wish to thank all participants of the Students Scientific Group at the Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age who helped to distribute the survey among students. References [1] Rosiek APR. Donor adverse reactions related to collection of blood and blood components by manual method and by apheresis. J Transfus Med 2014;7(3):10. [2] McVittie C, Harris L, Tiliopoulos N. I intend to donate but . . .: non-donors’ views of blood donation in the UK. Psychol Health Med 2006;11(1):1–6. [3] M L, Medyczne zasady pobierania krwi, oddzielania jej składników i ˛ ˛ w jednostkach organizacyjnych publicznej słuzby ˙ ace wydawania, obowiazuj krwi. 3 ed. (2014), Warsaw: Instytut Hematologii I Transfuzjologii. [4] Sampath S, Ramsaran V, Parasram S, Mohammed S, Latchman S, Khunja R, et al. Attitudes towards blood donation in Trinidad and Tobago. Transfus Med 2007;17(2):83–7. [5] Yuan S, Chang S, Uyeno K, Almquist G, Wang S. Blood donation mobile applications: are donors ready? Transfusion 2016;56(3):614–21. [6] Ouhbi S, Fernández-Alemán JL, Toval A, Idri A, Pozo JR. Free blood donation mobile applications. J Med Syst 2015;39(5):52. [7] Finck R, Ziman A, Hoffman M, Phan-Tang M, Yuan S. Motivating factors and potential deterrents to blood donation in high school aged blood donors. J Blood Transfus 2016;2016:8624230.
7
[8] Moog R, Fourne K. Recruitment of prospective donors: what do they expect from a homepage of a blood transfusion service? Transfus Med 2007;17(4):279–84. [9] Zito E, Alfieri S, Marconi M, Saturni V, Cremonesi G. Adolescents and blood donation: motivations, hurdles and possible recruitment strategies. Blood Transfus 2012;10(1):45–58. [10] Alfieri S, Saturni V, Marta E. Looking to the future by acting on the present. Intention to donate blood and risk behavior: a research on adolescents. Asian J Transfus Sci 2013;7(2):130–4. [11] Balegh S, Marcus N, Dubuc S, Godin G, France CR, Ditto B. Increasing nondonors’ intention to give blood: addressing common barriers. Transfusion 2016;56(2):433–9. [12] Narayanan P, Wolanskyj A, Ehlers SL, Litzow MR, Patnaik MS, Hogan WJ, et al. Medical students’ knowledge, familiarity, and attitudes towards hematopoietic stem cell donation: stem cell donation behaviors. Biol Blood Marrow Transplant 2016;22(9):1710–6. [13] Charbonneau J, Cloutier MS, Carrier E. Motivational differences between whole blood and apheresis donors in quebec, canada: a questionnaire-based survey in a voluntary nonremunerated context. J Blood Transfus 2015;2015:568259. [14] Shah KH, Cavallo E, Paisley J, Kurobe A, Newman DH. Can we defer/omit a type and screen blood test for pregnant women who know their blood type? J Emerg Med 2011;41(2):223–7. [15] Bider-Canfield Z, Cotterchio M. Self-reported ABO blood type compared with DNA-derived blood group. Epidemiology 2014;25(6):936–7. [16] Sikora A, Wiorkowski K, Szara P, Drabko K. Knowledge and attitude of Lublin universities students’ toward the opportunity of becoming unrelated bone marrow donor. Folia Med Cracov 2014;54(2):27–33. [17] Kowsalya V, Vijayakumar R, Chidambaram R, Srikumar R, Reddy EP, Latha S, et al. A study on knowledge, attitude and practice regarding voluntary blood donation among medical students in Puducherry, India. Pak J Biol Sci 2013;16(9):439–42. [18] Gazibara T, Kovacevic N, Maric G, Kurtagic I, Nurkovic S, Kisic-Tepavcevic D, et al. Factors associated with positive attitude towards blood donation among medical students. Transfus Apher Sci 2015;53(3):381–5. [19] Social TO. Eurobarometer 73. In: Comission E, editor. Blood Donation and Blood Transfusions. 2010. Brussels, Belgium. [20] Masser BM, White KM, Hyde MK, Terry DJ, Robinson NG. Predicting blood donation intentions and behavior among Australian blood donors: testing an extended theory of planned behavior model. Transfusion 2009;49(2):320–9. [21] Ferguson E. Mechanism of altruism approach to blood donor recruitment and retention: a review and future directions. Transfus Med 2015;25(4):211–26. [22] Moussaoui LS, Naef D, Tissot JD, Desrichard O. “Save lives” arguments might not be as effective as you think: A randomized field experiment on blood donation. Transfus Clin Biol 2016;23(2):59–63. [23] Jones RP, Prasad V, Kuruvatti J, Tahir N, Whitaker P, Dawson AS, et al. Remuneration for blood donation and attitudes towards blood donation and receipt in Leeds. Transfus Med 2003;13(3):131–40. [24] Koster J, Hassall OW. Attitudes towards blood donation and transfusion in Bamenda, Republic of Cameroon. Transfus Med 2011;21(5):301–7. [25] Charbonneau J, Cloutier MS, Carrier E. Why do blood donors lapse or reduce their donation’s frequency? Transfus Med Rev 2016;30(1):1–5. [26] Davison KL, Reynolds CA, Andrews N, Brailsford SR, UK Blood Donor Survey Steering Group. Getting personal with blood donors - the rationale for, methodology of and an overview of participants in the UK blood donor survey. Transfus Med 2015;25(4):265–75. [27] Hao J, McAvoy J, Wickberg L, Kerrigan C, Kreiger L, Sikavi C, et al. Is blood donation an opportunity for hypertension awareness? Transfus Med 2016;26(2):89–98.
Please cite this article in press as: Ciepiela O, et al. Awareness of blood group and blood donation among medical students. Transfus Apheresis Sci (2017), https://doi.org/10.1016/j.transci.2017.10.002