Abstract: Objective To investigate the present situation of Alanine Aminotransferase (ALT) testing in blood collection and supply institutions across China and offer insights for decision-making by management authorities. Methods We conducted a literature review, and developed a survey questionnaire based on evidence-based practices. Electronic questionnaires were distributed to 51 blood collection and supply institutions across the country to gather information on ALT testing practices from January 2023 to September 2024. The collected data were systematically analyzed. Results All domestic blood collection and supply institutions have implemented the ALT screening project before blood donation, with a 100% coverage rate of ALT screening before blood donation. The main method for ALT testing before blood donation is dry chemical method (66.62%), while the main method for ALT testing after blood donation is rate method (82.35%). There are differences in the repeatability of the test results. Screening periods of unqualified ALT tests before blood donation varied, ranging from 1 day to 180 days, with a median period of 7 days. The voluntary recall rate after the the shielding period expired was low (39.22%). A significant number of blood donors were eliminated due to failed ALT tests, with nearly 225 000 individuals rejected across 51 institutions during the survey period. Conclusion The current ALT testing criteria exclude a large number of potential blood donors, resulting in unnecessary waste nationwide. Clinical research based on China's specific situation is needed to to evaluate the necessity of the ALT test, consider adjusting the ALT reference range, and optimize blood donation qualifications. Such measures could improve donor participation, reduce blood loss, and ensure the safety and stability of the national blood supply.

Key words: ALT, Incubation period, Recall, Blood collection and supply institutions, Methodology of detection