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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Comparative Analysis of Red Cell Parameters of First-time and Repeat Blood Donors: A Descriptive Study
Correspondence Address :
Dr. Mayank Kumar,
Assistant Professor, Department of Pathology, Rajarshi Dashrath Autonomous State Medical College, Ayodhya-224133, Uttar Pradesh, India.
E-mail: mayankkumar1618@gmail.com
Introduction: Blood transfusion services form an essential component of any healthcare system and it is imperative to provide adequate and safe blood for management of patients. Voluntary blood donors form the backbone of this service. However, regular donation by such voluntary donors may cause significant depletion of iron stores in the body. This has the potential to adversely affect the donor’s health, and also to lower the quality of blood being collected subsequently. The temporary deferral of such donors also causes reluctance to return for future blood donations, leading to decrease in size of the donor pool. The prompt detection of subclinical iron deficiency in voluntary blood donors is the need of the hour.
Aim: To compare and analyse the difference in red cell parameters of first-time and repeat blood donors.
Materials and Methods: A descriptive study was conducted by the Department of Blood Bank and Pathology at Rajarshi Dashrath Autonomous State Medical College, Ayodhya, Uttar Pradesh, India, from July 2021 to December 2022. After prospective donors were assessed for suitability of blood donation, written informed consent was obtained, and 5 mL venous blood was collected into an Ethylenediaminetetraacetic Acid (EDTA)-anticoagulated vial via the antecubital fossa. Complete blood count was performed within one hour of collection using an automated haematology analyser. The parameters analysed in the study were Red Blood Cell (RBC) count, haemoglobin, Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC), and Red cell Distribution Width (RDW). The generated data was compiled and statistical analysis, with Kruskal-Wallis test (at a p-value of 0.05) and post-hoc Dunn test was performed to determine the significant differences, if any.
Results: The study included 455 participants, out of which 210 were repeat blood donors. The significant differences for MCV, MCH and RDW between groups defined by number of donations (p-value <0.001) were observed. The difference was most significant between the donors having five or more donations compared to donors having no previous donations. No significant differences were observed for other parameters, with p-values for RBC count, haemoglobin, and MCHC being 0.3, 0.07, and 0.09, respectively.
Conclusion: Repeat blood donors having low MCV and MCH along with high RDW, with haemoglobin values within normal range, are most susceptible to having subclinical iron deficiency, which needs to be identified and managed pre-emptively, before development of Iron Deficiency Anaemia (IDA). This is necessary in order to retain regular and repeat voluntary blood donors, and also to ensure adequate quality of collected blood.
Anaemia, Blood bank, Blood donation, Iron deficiency
Blood transfusion services form a very essential component of the healthcare system and play an important role in the management of patients, both surgical and medical (1). The purpose of blood banks is to provide safe and adequate blood and blood products. The World Health Organisation (WHO) recommends voluntary non remunerated blood donations by healthy individuals for the same (2). The selection of prospective donors for blood donation is one of the most important steps in the process. Strict guidelines are followed to assess suitable donors, to safeguard the health of both the recipient and the donor (3). This is done in order to ensure the quality of blood and blood products. Also, their sufficient supply of blood as per local requirement has to be maintained. So certain steps need to be taken to prevent unnecessary loss of healthy donors. Individuals who are found unsuitable for blood donation are deferred, either temporarily or permanently. The most frequent cause for temporary donor deferral is low haemoglobin level, which in majority of the cases is due to IDA (4).
Repeat blood donors are particularly at risk for developing IDA, for which they will be temporarily deferred in the future. This avoidable temporary deferral leads to loss of the individual from the pool of potential donors, due to reluctance to return for blood donation. Individuals who have been temporarily deferred for this reason donate 30% less blood over the next five years, even after their haemoglobin levels return to normal range (5),(6). The frequency of blood donation has been regulated to prevent the development of anaemia in repeat donors, with an interval of three months necessary after the previous donation. Routinely, haemoglobin level is tested to determine the suitability of the prospective donor. However, this is insufficient by itself for identifying iron deficiency as lowering of haemoglobin level is the last stage in the pathogenesis of body iron depletion.
The alteration in red cell indices and RDW can be useful in the early detection of IDA. The present study aimed to study the relation of these parameters with the number of blood donations, in order to identify repeat blood donors who are at an increased risk of developing iron deficiency. This is necessary for a relatively newer blood bank, and findings of the study can be used to frame institutional and regional guidelines.
A descriptive study was conducted at the Department of Blood Bank and the Department of Pathology at Rajarshi Dashrath Autonomous State Medical College, Ayodhya, Uttar Pradesh, India, from July 2021 to December 2022. Ethical clearance for the study was obtained as per institutional guidelines (RDASMC/IEC/2022/427). The prospective donors were assessed for suitability of blood donation and were asked specific questions as per the standard technical manual of the Directorate General of Health Services (DGHS) (7). Written informed consent was obtained from all participants.
Inclusion criteria: The donors were in the age range of 18 to 60 years and had haemoglobin values above 12.5 g/dL. They were healthy individuals with no clinical manifestations of any disease, and repeat donors had previously donated blood more than three months ago. The number of such previous blood donations was enquired from each donor.
Exclusion criteria: The donors who did not fulfil the inclusion criteria, provided history of chronic illnesses, or had donated blood within the previous three months were not included in the study. Also, those donors who did not provide consent for the study were excluded from the study.
The donors were grouped on the basis of number of previous blood donations into five categories, which were as follows: Group I-comprising of first-time donors; Group II-comprising those who had donated once previously; Group III-comprising those who had donated two to three times previously; Group IV-comprising those who had donated four to five times previously; and Group V-those who had donated six or more times previously (1),(8).
The salient features of the study were explained to the participants and written informed consent was obtained. A 5 mL venous blood was collected into an EDTA-anticoagulated vial via the antecubital fossa, from the opposing arm intended for the actual blood donation. Complete blood count was performed within one hour of sample collection using an automated haematology analyser Medonic M-series M20M-GP.
The reference ranges for the parameters evaluated in the study are as follows (for adult males, adult females) (9): RBC count- 5.0±0.5×106/cu mm, 4.3±0.5×106/cu mm; haemoglobin- 15±2 g/dL, 13.5±1.5 g/dL; MCV- 92±9 fL; MCH- 29.5±2.5 pg; MCHC- 33±1.5 g/dL; RDW- 12.8%±1.2%.
Statistical Analysis
The parameters analysed in the study- RBC count, haemoglobin, MCV, MCH, MCHC, and RDW- were tabulated and statistically analysed using Statistical Package for the Social Sciences (SPSS) Statistics version 28.0. Kruskal-Wallis test, with statistical significance at a p-value of 0.05, and post-hoc Dunn test were performed.
A total of 455 blood donors participated in the study, out of which 430 were males and 25 were females. Out of the total participants, 210 (46.15%) were repeat blood donors, which included 202 male and eight female participants. The age of participants ranged from 19 to 51 years, with more than 50% of the donors being in the range of 30 to 40 years. The distribution of participants by gender and number of blood donations is shown in (Table/Fig 1),(Table/Fig 2), respectively.
(Table/Fig 3) shows the comparison of analysed haematological parameters among the participants, as grouped on the basis of number of blood donations. Statistical analyses showed significant differences for MCV, MCH and RDW between groups defined by number of blood donations (p-values <0.001). These differences were observed between Groups IV and V as compared to Group I for MCV and MCH, and between Group-V as compared to Group I for RDW. The mean values of MCH for Groups I, IV, and V were 30.4, 30.2, and 28.1 (in pg); of MCV for Groups I, IV, and V were 88.4, 84.1, and 82.2 (in fL); of RDW for Groups I and V were 13.8% and 15.5%. No significant differences were observed for other parameters studied across the pre-defined groups. The p-value for RBC count was 0.3, for haemoglobin it was 0.07, and for MCHC it was 0.09.
Voluntary non remunerated blood donors form the basis of blood donation services in India. Donation-induced iron deficiency is the most common complication of repeated blood donations (10). Nearly 250 mg iron is present in 450 mL of blood (one unit), which constitutes nearly one-thirds of the average body iron stores in males and more than two-thirds in females (11). It is the responsibility of the blood bank to protect donors from iron deficiency and also to impart awareness regarding iron supplementation. The development of iron deficiency occurs in three steps: iron depletion, iron-deficient erythropoiesis, and IDA. This continues until the haemoglobin level decreases below the reference range for age and gender, and the anaemia becomes evident clinically. It is postulated that after donating blood, the donor requires atleast three months to replenish their body iron stores (10),(12). Most of the studies from the country have reported anaemia as the commonest cause for temporary donor deferral (13). Less than 10% of the temporarily deferred individuals return later for voluntary blood donation after the period of deferment (4). This leads to an unnecessary loss of donors from the prospective pool which is already deficient in number. There is shortage of almost three million units of blood and blood products in India per year. In a system that is dependent on voluntary non remunerated donors, it is imperative to maintain a pool of individuals who are willing to donate blood on humanitarian grounds. Care must be taken to safeguard their well-being, which includes the diagnosis of depletion of iron stores at the earliest possible stage, so that it can be proactively managed. This will have a positive psychological impact on the individual and ensure their availability for future blood donations.
The primary finding of this study is that repeat donors who have previously donated blood more than four times have significantly lower MCV and MCH values as compared to first time blood donors. Also, the RDW is significantly increased in donors who have donated blood six or more times previously. Various studies have highlighted the role of red cell indices and RDW in the early detection and prevention of IDA across different settings (14),(15). In a study by Jain A et al., on the role of altered red cell indices in repeat blood donors, significant differences were found for MCH, MCV, and haemoglobin in donors having six or more donations (8). Ogar CO et al., have demonstrated significant differences in MCH, MCHC, and RDW in their study on repeat blood donors, the findings of which match with the current study (1).
Using these parameters, it is possible to prevent the development of overt IDA in repeat donors. By early and prompt detection of iron deficiency, necessary supplementation and dietary modification can be done. This will reduce the number of temporary deferrals and ensure a healthy donor pool for subsequent donations.
Limitation(s)
The limitation of the study was that the findings were not compared with serum ferritin, which is the confirmatory test for analysis of body iron stores. Also, the time duration between successive blood donations was not be included in the study. The minimum duration for repeat blood donation was strictly followed in all cases, as it the time required for replenishment of body iron stores.
MCV, MCH and RDW are useful tools for detection of iron deficiency at an early stage, much before the decrease in haemoglobin level below the lower limit for age and gender. Proper use of these parameters will be helpful to prevent the development of clinically evident IDA. This will play a very important role in the assessment and management of repeat blood donors, who are at high-risk for developing iron deficiency.
DOI: 10.7860/JCDR/2023/63179.17814
Date of Submission: Jan 31, 2023
Date of Peer Review: Feb 17, 2023
Date of Acceptance: Mar 31, 2023
Date of Publishing: May 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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