Adverse effects in blood donors after whole-blood donation: a study of 1000 blood donors interviewed 3 weeks after whole-blood donation

BACKGROUND: There are no reports in the transfusion medicine literature that describe adverse reactions and donor arm injuries after whole-blood donation based on solicited information. STUDY DESIGN AND METHODS: The present study solicited adverse reaction and donor arm injury information from 1000 randomly selected whole-blood donors approximately 3 weeks after the whole-blood donation. Two 16-gauge phlebotomy needles in use were also compared. RESULTS: Thirty-six percent of the donors had one or more adverse effects (AEs). The most common systemic AEs were fatigue (7.8%), vasovagal symptoms (5.3%), and nausea and vomiting (1.1%). The most common arm findings were bruise (22.7%), arm soreness (10.0%), and hematoma (1.7%). Men were half as likely as women to have an AE (23% AE vs. 48% AE, p < 0.0001). Repeat blood donors had fewer AEs than first-time blood donors (36% AE vs. 47% AE, p < 0.007), and African-American donors had numbers of AEs similar to those of Caucasian donors (31% AE vs. 38% AE, p = 0.30). The two phlebotomy needles did not differ in causing blood donor AEs. CONCLUSION: AEs after donation and complaints may be more common than previously thought. The postdonation interview is a good tool for defining the blood donor's experience. It can also be used to evaluate and potentially improve blood donor safety and comfort.     

Arterial puncture phlebotomy in whole-blood donors

BACKGROUND: An arterial puncture during whole-blood phlebotomy is a rare event. A series of arterial punctures was evaluated to determine the clinical findings and the incidence of complications. STUDY DESIGN AND METHODS: Arterial punctures reported by staff between January 1, 1999, and February 28, 2001, were evaluated. Follow-up interviews were done with the phlebotomy nurses to determine what the clinical findings were and what the incidence of complications was. RESULTS: Twelve cases of arterial punctures were identified from 410,000 blood donations (0.0029%; 1/34,000). Eleven cases had a fast blood-flow rate of <4 minutes; 9 units (75%) were bright red; and in 4 cases (33%), the needle was pulsating. One case was diagnosed because the donor developed a brachial artery pseudoaneurysm 3 days after donation. Four hematomas occurred, for an occurence rate of 33 percent (0.35% in the general donor population). There was also an association with newly trained staff. CONCLUSION: Fast blood-flow rate is the most common clinical feature after an arterial puncture. Bright red blood is usually, but not always, present, and a pulsating needle is sometimes present. Hematoma is a relatively common complication, and brachial artery pseudoaneurysms are rare, although one case was seen in this study.     

Platelet function in donors undergoing intermittent-flow centrifugation plateletpheresis or leukapheresis

Platelet dysfunction and prolonged bleeding have been seen in man when glucose polymer solutions, such as dextran, are used to volume replacement. Hydroxyethyl starch (HES) is a glucose polymer slightly different from dextran, which is used as a sedimenting agent in leukapheresis procedures. This controlled study was performed to evaluate the effect of HES on platelet function in centrifugation leukapheresis donors. Plateletpheresis using the same machines and techniques but without HES was the control. Platelet function was assessed by bleeding time, platelet count, adhesiveness to glass beads and aggregation to collagen, epinephrine and several concentrations of ADP, before and after the pheresis procedures. Except for a decrease in platelet count after both procedures, no other major changes in platelet function were seen. After one exposure in previously unpheresed donors, HES does not induce platelet dysfunction.     

Leukoreduction filtration of whole-blood units from sickle trait donors: effects of a metered citrate anticoagulant system

BACKGROUND: Polymerization of hemoglobin (Hb) S is exacerbated by acidic and hyperosmotic citrate anticoagulant solutions and often results in occlusion of leukoreduction filters by red blood cells (RBCs) from sickle cell trait (Hb AS) donors. This study evaluates a blood collection instrument that adds citrate anticoagulant in a metered fashion, thus mitigating adverse citrate effects. STUDY DESIGN AND METHODS: Collection of whole blood by a metered anticoagulant system was compared to traditional phlebotomy in 12 Hb AS and 12 non-sickle trait (Hb AA) donors. Each donated twice; on one occasion, units were filtered after 4-hour storage at 20 to 24 degrees C, and on the other, units were stored at 1 to 6 degrees C for 24 hours before filtration. RESULTS: Filtration times, RBC recoveries, and residual white blood cell (WBC) counts met defined criteria more often in Hb AS units collected by a metered anticoagulant system (9 of 12, 8 of 12, and 4 of 12, respectively) compared to traditional phlebotomy (1 of 12, 2 of 12, and 0 of 12, respectively). Overall, Hb AS units filtered better after storage at 1 to 6 degrees C for 24 hours, with units collected by a metered anticoagulant system undergoing filtration most effectively (5 of 6 had >85% RBC recovery, 3 of 6 had <5 x 10(6) residual WBC). Units exhibited similar changes in RBC storage parameters. CONCLUSION: Use of a metered anticoagulation instrument demonstrates potential for successful leukoreduction and acceptable storage of Hb AS units; however, the system needs further modifications and improvements before it can be utilized to collect and leukoreduce Hb AS blood.     

Platelet transfusion: automated selection of donors

The selection of platelet donors, according to HLA antigens, has been computerized using a method based on the calculation of incompatibilities and risk of immunization between donors and recipients. Since the risk that an antigen present in a donor will immunize an incompatible recipient of known HLA phenotype, an incompatibility score is established and a donor file printed out, ranked according to the degree of incompatibility. The principle of this method is valuable for any other compatibility system and can be easily extended according to the computer potency. The method allows a rapid selection of the most appropriate plateletpheresis donors to avoid immunizing unsensitized patients or to achieve the best degree of compatibility in previously sensitized patients.     

Platelet glutathione peroxidase activity is impaired in patients with coronary heart disease

Platelet glutathione peroxidase (GSH-Px) activity was measured in 25 healthy individuals and in 25 patients affected with well-documented coronary artery stenosis. In parallel, malondialdehyde (MDA) production was assayed on platelets following stimulation with sodium arachidonate. Mean platelet GSH-Px activity was significantly reduced and mean platelet MDA production was significantly increased in the patient group. The difference observed in the GSH-Px activity might be a consequence of different nutritional habits, suggesting an impaired intake of selenium, the inorganic moiety of GSH-Px. As low GSH-Px activities in human platelets may be associated with increased MDA and thromboxane production, we hypothesize that a low enzyme activity may be a risk factor for the development of coronary artery disease.     

Voluntary whole-blood donors, and compensated platelet donors and plasma donors: motivation to donate, altruism and aggression.

BACKGROUND AND OBJECTIVES: To establish if voluntary whole-blood donors and compensated platelet donors and plasma donors may differ in their motivation to donate, altruism, aggression and autoaggression. MATERIAL AND METHODS: Whole-blood (n=51), platelet (n=52) and plasma donors (n=48) completed a battery of validated questionnaires while waiting to donate. Bivariate and multivariate analyses of variance and t-tests were performed to detect differences between groups as noted. RESULTS: Altruism (mean=40.2) was slightly higher in whole-blood donors than in platelet (mean=38.3) and plasma donors (mean=39.1) (p=0.07). Blood donors (mean=2.8) scored lower in the spontaneous aggression measure than platelet (mean=4.1) and plasma donors (mean=4.4) (p=0.01). Plasma donors (mean=4.9) had higher auto-aggression than whole-blood donors and platelet donors (mean for both groups=3.4) (p=0.01). Differences between the three groups were mediated by sociodemographic variables (MANCOVA). Whole-blood donors donated to help others, platelet and plasma donors mostly to receive the compensation. However, those platelet and plasma donors, who would continue to donate without compensation were similar in altruism and aggression to whole-blood donors. CONCLUSION: While most platelet donors and plasma donors were motivated by the compensation, those who stated that they would continue to donate without compensation had altruism and aggression scores similar to voluntary whole-blood donors.     

Platelet melatonin levels in healthy donors

A convenient and reliable enzyme immunoassay of platelet melatonin has been developed using the Melatonin ELISA kits (IBL Hamburg GmBH). The proposed methods permit the quantitative determination of platelet melatonin, which opens up new prospects for using this indicator for diagnostic purposes.     

Concurrent comparison of the safety of paid cytapheresis and volunteer whole-blood donors

BACKGROUND: Historically, paid blood donors were found to transmit hepatitis at higher rates than volunteers. In those older studies, paid donors frequently were recruited from prisons or slum areas–a finding consistent with the belief that monetary payment in itself did not necessarily lead to the high-risk status of commercial blood. Instead, it was the population base from which the donors were recruited that was important. STUDY DESIGN AND METHODS: Today, cytapheresis donors are in great demand. Because payment is one incentive that might entice donors to undertake the increased commitment of repeated cytapheresis donation, the results were studied of infectious disease history and laboratory testing performed concurrently in 917 volunteer whole-blood donors and 1240 paid cytapheresis donors, who were enrolled in distinct programs at the DeGowin Blood Center from October 7, 1987, through November 30, 1990. RESULTS: When first, repeat, and overall donations made by these donors were evaluated separately, paid cytapheresis donors were found to exhibit no increase in infectious disease history or test results beyond those of volunteer whole-blood donors. CONCLUSION: Thus, paid cytapheresis donors, when managed within a formal program, should not necessarily be presumed to be more dangerous than volunteers, from an infectious disease aspect. However, definitive proof of safety (comparison of transfusion-transmitted infection rates in two groups of patients receiving blood components exclusively from either paid cytapheresis or volunteer donors) was not pursued by long- term follow-up studies.     

献血400ml后献血者血液学指标观察

目的了解献血400ml后献血者相关血液学指标恢复情况。方法选择年龄、体格检查及献血前血液检验指标均符合我国现行法规要求的各种年龄的自愿无偿献血者123名,每人采血400ml,在献血后24h、7d、1个月和3个月时各采集血样1次,观察其白细胞、红细胞、血红蛋白、红细胞比积、血小板、血浆总蛋白、白蛋白和血清铁的动态变化与恢复情况。结果献血者献血400ml后,其白细胞、血小板、血浆总蛋白和白蛋白水平,同献血前比较变化无统计学意义(P>0.05);献血400ml后,其红细胞、血红蛋白、红细胞比积和血清铁在3个月内均可恢复到献血前水平。结论无论男女,只要符合我国现行规定的年龄与健康标准,每人每次献血400ml,且间隔3个月献1次血是安全的。     

Seasonal influences on hemoglobin levels and deferral rates in whole-blood and plasma donors

BACKGROUND: Indications exist that deferral rates in blood donors are highest in summer. However, a detailed quantitative analysis is not available. The association between Hb values, deferral rates, and daily temperatures was investigated in a large data set of blood donors. STUDY DESIGN AND METHODS: The study population consisted of both plasma and whole-blood donors from the southeast region of the Netherlands. Individual Hb levels and other examination data between January 2002 and December 2004 were extracted from the donor file. Data on daily maximum temperatures were related to Hb levels and Hb deferrals. Results are reported separately for plasma and whole-blood donors as well as for men and women. RESULTS: Data were available from 106,398 whole blood donors and 6983 plasma donors, resulting in data of more than 600,000 examinations. Hb levels decreased with increasing daily temperature. Highest deferral rates were observed in summer months, which were consistent over the several groups and over the three years. The highest Hb deferral of 11.1 percent was observed for female whole-blood donors on days with a maximum temperature of 25 degrees and above. In all four donor categories a gradual increase with temperature was observed with 1.7-2.2 times higher deferral rates on hot days (> or = 25 degrees C) compared to cold days (<5 degrees C). CONCLUSION: A clear seasonal pattern in Hb levels and in the percentage of Hb deferrals was observed. The observed seasonal effect could not be explained by differences in donor characteristics. Our observations might have practical implications for donor management.     

Faint and prefaint reactions in whole-blood donors: an analysis of predonation measurements and their predictive value

BACKGROUND: A small proportion of blood donors have adverse reactions. The purpose of this study was to determine predictors of faint and significant hypotensive reactions that could serve as targets for interventions to reduce reactions, thus improving the blood donation experience for those at higher risk of reactions and reducing the risk of serious adverse events. STUDY DESIGN AND METHODS: The records of 422,231 allogeneic whole‐blood donations from a 9‐month period were assessed for adverse reactions. Incidents related to needle insertion, such as hematoma, were excluded. Demographic, biometric, and clinical measurements were collected. Reactions were analyzed by multivariate logistic regression analysis comparing donors with any adverse reaction to donors without reactions and by stratified rates according to reaction severity. RESULTS: The overall reaction prevalence was 1.43 percent. Of the reactions, 63, 29, and 8 percent were classified as mild, moderate, and severe, respectively. Markers of reactions were age, sex, race, blood volume, blood pressure, pulse, and body mass index. Compared to donors without reactions, the strongest predictor of a reaction was a donor's blood volume of less than 3500 mL (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.57‐3.23). Age and first‐time status were also associated with a significantly higher risk of reaction with 17‐ to 18‐year‐olds (OR, 2.8; 95% CI, 2.59‐2.98) and 19‐ to 24‐year‐olds (OR, 2.39; 95% CI, 2.23‐2.56) at higher risk compared to 25‐ to 65‐year‐olds and first‐time donors at higher risk compared to repeat donors (OR, 2.2; 95% CI, 2.07‐2.33). CONCLUSION: The results of this study are helpful in identifying donors at risk for adverse reactions and in understanding the contributors to reactions. Donor blood volume was an unexpectedly strong predictor of reaction. Potential interventions to reduce the frequency of reaction are discussed.     

Platelet function testing: state of the art

Platelet function testing has evolved from crude tests, such as the bleeding time, to tests that permit a relatively sophisticated evaluation of platelet activity. Nonetheless, these tests are hampered by lack of specificity and sensitivity, and poor standardization of methods and techniques. The bleeding time, which has long been a staple of hemostasis testing, has been dropped from the test menu at many laboratories. In its place, tests such as the Platelet Function Analyzer-100? are increasingly used to screen patients with possible bleeding disorders. Older tests, such as platelet aggregometry and lumiaggregometry, are still used frequently because they provide insight into receptor, signaling pathway and granule release mechanisms. Flow cytometry is available in some specialized laboratories and allows for quantitative and qualititative assessment of some platelet functions, although the expense of testing is often prohibitive. Finally, the wider availability of platelet function testing has stimulated interest and demand for monitoring the effect of platelet inhibitory drugs, such as aspirin and clopidogrel. As platelet function pathways become better understood, the demand for these type of monitoring tests is likely to increase.     

Platelet function testing: state of the art

Platelet function testing has evolved from crude tests, such as the bleeding time, to tests that permit a relatively sophisticated evaluation of platelet activity. Nonetheless, these tests are hampered by lack of specificity and sensitivity, and poor standardization of methods and techniques. The bleeding time, which has long been a staple of hemostasis testing, has been dropped from the test menu at many laboratories. In its place, tests such as the Platelet Function Analyzer-100 are increasingly used to screen patients with possible bleeding disorders. Older tests, such as platelet aggregometry and lumiaggregometry, are still used frequently because they provide insight into receptor, signaling pathway and granule release mechanisms. Flow cytometry is available in some specialized laboratories and allows for quantitative and qualitative assessment of some platelet functions, although the expense of testing is often prohibitive. Finally, the wider availability of platelet function testing has stimulated interest and demand for monitoring the effect of platelet inhibitory drugs, such as aspirin and clopidogrel. As platelet function pathways become better understood, the demand for these type of monitoring tests is likely to increase.     

Selection of whole-blood donors for hemoglobin testing by use of historical hemoglobin values

BACKGROUND: Usually, a predonation hemoglobin (Hb) measurement must precede blood donation. Hb values of a donor's previous donation might be used for selecting a subgroup in which predonation Hb measurements are unnecessary. STUDY DESIGN AND METHODS: Only donors with historical Hb values below 129 or 139 g per L for female and male donors, respectively, underwent venous Hb measurement before phlebotomy with an automated hematology analyzer. All other donor phlebotomies were collected without initial Hb testing. Hb values from diversion samples from 81,913 consecutive donors between May 2003 and November 2005 were subsequently analyzed as representing their present values. Donors were grouped according to interdonation intervals of less than 6, 6 to 11, 12 to 23, and 24 months or more. RESULTS: The arithmetic mean deviation between historical and present Hb values was between -0.3 and +1.8 g per L for each group (mean deviation, 5.2-6.7 g/L). Not testing selected donors spared 77.7 percent from a prephlebotomy Hb measurement and showed a specificity of 29 percent. Sensitivities for detection of donors below Hb limits (between 56% and 67% for the different subgroups) and donors with Hb values below 110 g per L (82%-88%) were at least comparable to capillary Hb screening. A total of 4.8 percent of donors were phlebotomized with values below 125 and 135 g per L, whereas only 0.016 percent of donors were bled despite Hb levels below 110 g per L. CONCLUSION: Selecting donors for a current Hb measurement based upon their last whole-blood predonation Hb value is a useful method, even after prolonged interdonation intervals.     

Platelet function in the postprandial period

ABSTRACT: BACKGROUND: Postprandial hyperlipidemia and hyperglycemia have been related to cardiovascular events. Among different underlying mechanisms platelet activation seems to be responsible too. No comparable data between various tests in normo- vs. hyperlipidemics before and at different time intervals are available after a fat meal. We aimed to compare 9 of them within the same patients at several time points in postprandial hyperlipidemia. RESULTS: For some tests baseline values between the groups were significantly different (TXB2, platelet sensitivity, sedimentation and WU-test). However, hyperlipidemia revealed a variable influence on the tests examined. Some of the available tests apparently sensitive to show platelet activation reflect the increase in triglycerides (TG), such as the sedimentation index. ADP-induced platelet aggregatory activity in count adjusted washed isolated platelet samples during postprandial hyperlipidemia indicates mildly enhanced platelet activity, but does not seem to induce significant changes in aggregation. In patients with severe hypertriglyceridemia (> 400 mg/dl fasting) changes in platelet function are more pronounced due to delayed decay and may last up to 16 hours paralleling TG reaching the prevalue. The overwhelming majority of platelet function tests do not significantly respond to postprandial hyperlipidemia. The correlation between the tests applied is poor. For standardization purpose, platelet aggregation tests, aimed to examine proaggregatory capacity in atherosclerosis, should only be performed at the same time of the day after a fasting period > 6 hours. The great variation in preanalytical work-up on comparison of various tests, large number of platelet tests available and their respective potential value are discussed. CONCLUSIONS: At present, the suspicion that platelet function is significantly activated in the postprandial period cannot be supported by any of the tests used. The information provided is valuable to know for which test and group of patients a fasting period of which duration is recommendable.     

Estimating the probability of a blood donation adverse event based on 1000 interviewed whole-blood donors

BACKGROUND: Estimating the probability that a donor will have or not have an adverse event is useful for staff knowledge to give blood donors reassurance upon request. STUDY DESIGN AND METHODS: One-thousand donors from the general donor pool were interviewed for seven potential adverse events 3 weeks after a 525-mL whole-blood phlebotomy. The four most common adverse events were bruise (22.7%), sore arm (10.0%), fatigue (7.8%), and donor reaction (7.0%). A stepwise logistic regression analysis was performed based on five donor characteristics that were studied: age, weight, sex, race, and first-time donor status. The contribution of each significant or marginally significant factor to each adverse event was quantified. RESULTS: For donor reaction, weight (p < 0.0001) and age (p = 0.015) were significant contributors, and first-time donor status (p = 0.054) was a marginally significant contributor. An equation was derived, and the donor reaction rate can be estimated for a group based on the donor's weight, age, and first-time donor status. Similar analyses were performed for fatigue, sore arm, and bruise. CONCLUSION: Based on the derived formulas and with the use of a spreadsheet, data can be entered and the probability that a donor will have (or not have) a donor reaction, fatigue, sore arm, or bruise can be estimated.     

Hyperhomocysteinaemia in young adults is not associated with impaired endothelial function

A mild to moderate elevation of the total homocysteine concentration (tHcy) is now recognized as a risk factor for vascular disease. It is also associated with endothelial dysfunction in middle-aged and elderly individuals without overt atherosclerotic vascular disease. This is important, as endothelial dysfunction is a well recognized early and potentially reversible marker of the atherosclerotic process. We investigated whether mild hyperhomocysteinaemia was associated with endothelial dysfunction in otherwise healthy young males. We compared endothelial function, by measuring forearm blood flow, in 17 males with mild hyperhomocysteinaemia (defined as tHcy >10 micromol/l) and 14 controls with low tHcy (defined as <5 micromol/l). Forearm blood flow was measured in response to the intra-arterial infusion of acetylcholine (endothelial-dependent response) or sodium nitroprusside (endothelial-independent response). Responses to the vasoactive substances were expressed as the area under the curve of the change in forearm blood flow from baseline. Data are given as mean (95% confidence interval). The two groups were well matched for age, body mass index, pulse rate and blood pressure. tHcy was significantly different between the groups [12.3 (10.4-14.2) micromol/l compared with 4.9 (4.6-5.1) micromol/l; P<0.001]. Concentrations of vitamin B(12) and folate were significantly higher in the control group. There was no difference in basal forearm blood flow between the group with mild hyperhomocysteinaemia and the controls, and both the endothelial-dependent [37.5 (26.2-38.8) and 35.3 (26.1-44.4) arbitrary units respectively] and -independent [26.1 (22.2-29.9) and 25.9 (21.0-30.8) units respectively] responses were not significantly different between the groups. Thus the present study demonstrates that, in healthy adults, mild elevation of tHcy was not associated with impaired endothelial-dependent vasodilation. These data suggest an age effect with regard to homocysteine and endothelial dysfunction. The development of vascular disease in individuals with hyperhomocysteinaemia may only result with higher concentrations or after prolonged exposure.