Single donor plateletpheresis is an important component of modern transfusion support, as a single procedure can provide a therapeutic dose of platelets from one donor while reducing recipient exposure to multiple donors. Its increasing use in hematology, oncology, organ transplant, surgery, and critical care has created a growing need for a reliable plateletpheresis donor pool. High-yield platelet collections may further improve inventory management when performed in appropriately selected donors.[1] Advances in apheresis technology have improved collection efficiency and donor monitoring,[2] while predonation platelet count remains an important factor influencing platelet yield.[3] Plateletpheresis donors must meet the general eligibility requirements for blood donation along with additional criteria related to platelet count, hemoglobin level, venous access, donation history, medication use, and suitability for the apheresis procedure. These requirements are essential for donor and recipient safety but may also result in donor deferral. Indian studies have identified low platelet count, low hemoglobin, and unsuitable venous access as common causes of plateletpheresis donor deferral.[4] Recent data from North India have highlighted low hemoglobin as an important cause of temporary deferral,[5] while earlier studies have shown that a large proportion of apheresis donor deferrals are temporary and potentially reversible.[6] Low platelet count and low hemoglobin are particularly important because affected donors may become eligible again after appropriate evaluation or correction. Platelet counts may vary even among apparently healthy donors,[7] and plateletpheresis is associated with an expected temporary reduction in platelet count in appropriately selected individuals.[8,9] Similarly, selected donors with hemoglobin levels below conventional thresholds have undergone plateletpheresis safely in previous studies.[10] However, any change in donor eligibility criteria should be supported by regulatory guidance and adequate evidence regarding donor safety and product quality. Adequate venous access is also important because plateletpheresis requires stable vascular access throughout a relatively prolonged procedure.[11,12] Donor deferral has important operational implications because plateletpheresis services often depend on a limited pool of motivated and repeat donors. Temporary deferral may lead to unnecessary loss of otherwise suitable donors if the reason for deferral, duration of ineligibility, and date of re-eligibility are not clearly communicated. Understanding centre-specific deferral patterns can therefore help to identify potentially recoverable donors and improve counselling, documentation, and donor recall. The present study evaluated four consecutive years of plateletpheresis donor screening at a tertiary care centre in North India. The objectives were to determine the overall and annual deferral rates, identify the major temporary and permanent causes of deferral, and examine year-wise and gender-related patterns, with particular emphasis on potentially recoverable donor loss.

This retrospective observational study was conducted in the Department of Immunohematology and Blood Transfusion, PGIMS Rohtak, a tertiary care teaching hospital in North India. Departmental records of all plateletpheresis donors screened between January 2022 and December 2025 were reviewed. All donors who presented for plateletpheresis and completed predonation screening during the study period were included. Donors were selected according to the standard operating procedure and in accordance with the Drug and Cosmetic Act of India.[13] A detailed medical history, physical examination, including assessment of venous access, and ABO blood grouping were performed. Only ABO-identical donors were selected for plateletpheresis after completion of the donor screening. Blood samples were collected from eligible donors for complete blood count and TTI. A complete blood count is performed using an automated hematology analyzer. The hematological criteria for plateletpheresis donation include hemoglobin >12.5 g/dL, hematocrit >38%, white blood cell count of 4–11 × 10³/µL, and platelet count >150 × 10⁹/L. Screening for HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) were performed by chemiluminescence immunoassay (CLIA). Screening for syphilis was performed using the rapid plasma reagin (RPR) test, while malaria screening was performed using a rapid diagnostic test. Donors fulfilling the required hematological criteria and having nonreactive TTI screening results were considered eligible for plateletpheresis. Platelet collection was carried out using an automated cell separator COM.TEC (Fresenius HemoCare GmbH, Bad Homburg, Germany). The total number of donors screened, plateletpheresis procedures performed, and donors deferred were recorded year-wise. Deferred donors were categorized into temporary and permanent deferrals, and their gender and principal reasons for deferral were documented. When more than one reason for deferral was documented, the principal recorded reason was considered for analysis. Permanent deferrals related to reactive TTI screening were classified according to the information available in the departmental records. Categorical data were expressed as frequencies and percentages. The annual deferral rate was calculated by dividing the number of deferred donors by the total number of donors screened during that year. Annual deferral rates were compared using the Pearson chi-square test, and changes in deferral rates over time were assessed using the Cochran–Armitage trend test. Fisher’s exact test was used for selected comparisons between male and female deferred donors because of the small number of observations in some categories.

During the four-year study period, 480 prospective plateletpheresis donors were screened. Of these, 378 (78.75%) proceeded to plateletpheresis and 102 (21.25%) were deferred. The annual deferral rate ranged from 19.23% in 2023 to 23.81% in 2025. The year-to-year difference was not statistically significant, and there was no significant linear temporal trend [Table 1]. Table 1. Year-wise plateletpheresis donor screening and deferral Year Screened SDP performed Deferred, n (%) P value* 2022 83 65 18 (21.69) 0.841 2023 104 84 20 (19.23) 2024 167 133 34 (20.36) 2025 126 96 30 (23.81) Total 480 378 102 (21.25) — *Pearson chi-square test comparing annual deferral proportions. Cochran-Armitage trend test: P=0.622. Among the 102 deferred donors, 73 (71.57%) were male and 29 (28.43%) were female. Temporary deferrals accounted for 88 (86.27%) cases, whereas 14 (13.73%) were permanent. The distribution of temporary and permanent deferrals did not differ significantly across the four study years [Table 2]. Table 2. Temporary and permanent deferral pattern by year Year Temporary, n (%) Permanent, n (%) Total P value* 2022 17 (94.44) 1 (5.56) 18 0.457 2023 18 (90.00) 2 (10.00) 20 2024 27 (79.41) 7 (20.59) 34 2025 26 (86.67) 4 (13.33) 30 Total 88 (86.27) 14 (13.73) 102 — *Pearson chi-square test comparing temporary versus permanent deferral across years. Low platelet count was the most frequent individual cause of deferral (28/102, 27.45%), followed by low hemoglobin (22/102, 21.57%) and poor venous access (8/102, 7.84%). Medication/ antibiotic use accounted for 7 deferrals, while recent tattooing and recent donation each accounted for 5. All 14 permanent deferrals were related to sero-reactive transfusion-transmitted infection screening [Table 3]. Table 3. Causes of plateletpheresis donor deferral (n=102) Cause N % Type Low platelet count 28 27.45 Temporary Low hemoglobin 22 21.57 Temporary Poor venous access 8 7.84 Temporary Medication/antibiotic use 7 6.86 Temporary Recent tattoo 5 4.90 Temporary Recent donation 5 4.90 Temporary HBsAg reactive 4 3.92 Permanent Syphilis reactive 4 3.92 Permanent HCV reactive 3 2.94 Permanent Donor refusal 2 1.96 Temporary HIV reactive 2 1.96 Permanent Fever/on antibiotics 2 1.96 Temporary High hemoglobin 2 1.96 Temporary Rabies vaccination 2 1.96 Temporary Menstruation 2 1.96 Temporary Underweight 2 1.96 Temporary Skin infection 1 0.98 Temporary HBsAg + syphilis reactive 1 0.98 Permanent Exploratory gender-stratified analysis within the deferred cohort showed clear differences in selected recorded causes. Low hemoglobin and poor venous access were proportionally more frequent among deferred women, whereas low platelet count and permanent deferral were observed predominantly among deferred men [Table 4]. Table 4. Selected deferral causes by sex among deferred donors Variable Male (n=73), n (%) Female (n=29), n (%) P value Low hemoglobin 2 (2.74) 20 (68.97) <0.001 Low platelet count 28 (38.36) 0 (0) <0.001 Thin/unsuitable veins 1 (1.37) 7 (24.14) <0.001 Permanent deferral 14 (19.18) 0 (0) 0.009

The present study demonstrated an overall plateletpheresis donor deferral rate of 21.25%, with no statistically significant variation across the four study years or significant temporal trend. Temporary deferrals accounted for 86.27% of all deferrals, indicating that a substantial proportion of deferred donors may be eligible for future plateletpheresis. These findings highlight the importance of appropriate donor counselling, follow-up, and retention strategies to maintain an adequate plateletpheresis donor pool. The deferral rate observed in our study was lower than that reported by Yadav et al., who documented an overall deferral rate of 43.2%, with temporary deferrals accounting for 96.5% of cases. Their study identified low platelet count as the leading cause of deferral, followed by inadequate venous access and low hemoglobin.[14] Similarly, low platelet count was the most frequent cause in our study (27.45%), followed by low hemoglobin (21.57%) and poor venous access (7.84%). Differences in deferral rates between studies may reflect variations in donor characteristics, selection criteria, institutional practices, and screening protocols. Low platelet count emerged as the predominant cause of deferral in the present study. Platelet counts may exhibit physiological variation among otherwise healthy individuals, and a single low measurement does not necessarily indicate persistent thrombocytopenia. Nevertheless, predonation platelet-count requirements are essential for ensuring donor safety and obtaining an adequate platelet yield. Any proposed modification of the existing eligibility threshold should therefore be supported by prospective studies evaluating both donor safety and collection outcomes. Low hemoglobin was the second most common cause, accounting for more than one-fifth of all deferrals. As hemoglobin levels may improve following appropriate evaluation and management of underlying causes, some donors deferred for this reason may subsequently become eligible. Providing suitable counselling and recommending medical evaluation when indicated may facilitate their return. However, any modification of hemoglobin eligibility criteria must be based on adequate evidence regarding donor safety. Unsuitable venous access was another notable cause of deferral. Plateletpheresis requires reliable vascular access to maintain an adequate blood flow throughout the procedure. Inadequate venous access may compromise collection efficiency and increase the likelihood of procedural difficulties. Careful predonation assessment of vascular access is therefore important for ensuring successful and safe plateletpheresis procedures. All permanent deferrals in the present study were attributed to reactive screening for transfusion-transmitted infections (TTIs). Unlike temporary hematological or procedural deferrals, TTI-related deferrals are necessary to safeguard recipients and must be managed in accordance with applicable regulatory requirements and institutional protocols. Strategies aimed at improving donor availability should therefore prioritize the appropriate follow-up and retention of temporarily deferred donors without compromising established safety standards. Temporary donor deferral may adversely influence subsequent donation behaviour. Previous studies have demonstrated that temporarily deferred donors may be less likely to return for future donations.[15] Similarly, adverse experiences during plateletpheresis may negatively affect donor retention.[16] Effective communication, appropriate counselling, and clear information regarding the reason for deferral and subsequent eligibility may encourage donors to return when they become eligible.[17] Donor education, motivation, and recruitment are also important components of maintaining a sustainable plateletpheresis donor pool. Indian studies have highlighted the potential benefits of awareness and recruitment initiatives in promoting voluntary platelet donation.[18] Furthermore, effective communication and a positive donation experience may contribute to improved donor retention.[19] In this context, maintaining a structured deferral register documenting the reason for deferral, expected date of re-eligibility, counselling provided, and subsequent donation status may facilitate systematic follow-up and donor recall. Although donor retention is important, donor safety must remain the primary consideration. Previous studies have demonstrated that high-yield platelet collection can be performed safely in appropriately selected donors.[20,21] However, repeated plateletpheresis has raised concerns regarding potential long-term effects, including iron depletion and lymphopenia among frequent donors.[22,23] These findings emphasize the need for continued attention to both immediate procedural safety and the long-term health of repeat plateletpheresis donors. Overall, the findings of the present study suggest that improving plateletpheresis donor availability should not focus solely on reducing deferral rates, as many deferrals are essential for donor and recipient safety. Instead, greater emphasis should be placed on minimizing the avoidable loss of temporarily deferred donors. Structured documentation, individualized counselling, communication of re-eligibility dates, and active donor recall may help improve donor retention while maintaining established safety standards

The present study demonstrated an overall plateletpheresis donor deferral rate of 21.25%, with temporary deferrals accounting for the majority (86.27%). Low platelet count, low hemoglobin, and inadequate venous access were the predominant causes of deferral, whereas all permanent deferrals were associated with reactive screening for transfusion-transmitted infections. Deferral rates remained stable over the four-year study period, with no significant temporal variation. These findings emphasize the need for effective donor counselling, systematic documentation, and structured follow-up of temporarily deferred donors to facilitate their return and support a sustainable plateletpheresis donor pool without compromising donor and recipient safety

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