Donor reactions in high-school donors: the effects of sex, weight, and collection volume

BACKGROUND: The high incidence of donor reactions in first-time, 17-year-old Caucasian whole-blood donors makes this group ideal for the study of donor reactions. STUDY DESIGN and METHODS: Donor reaction rates were retrospectively evaluated in 7274 first-time, 17-year-old Caucasian whole-blood donors based on observations recorded at the collection sites. The effect of sex and weight on donor reactions was determined. In addition, a model was developed to estimate how different blood collection volumes would affect donor reaction rates. RESULTS: The donor reaction rate was 12.0 percent (870/7274). Female donors overall had a higher donor reaction rate than male donors (16.7% vs. 7.3%) and also had a higher donor reaction rate than male donors at each 20-lb weight interval in the range from 110 to 189 lb. A model suggested that a change in the blood-unit volume from 450 to 500 mL would increase donor reaction rates by 18 percent in either female or male donors, whereas a reduction in the blood-unit volume from 500 to 400 mL would decrease donor reaction rates by 29 and 27 percent in female and male donors, respectively. CONCLUSION: First-time, 17-year-old Caucasian female donors had a higher donor reaction rate than male donors overall and at equivalent donor weights. In the range of present US blood-unit volumes, a change in collection of as little as 50 mL could have a significant impact on blood donor reaction rates in high-school students.     

Donation reactions among autologous donors

Studies of risk factors associated with reactions among autologous blood donors have been limited. Therefore, 2091 autologous and 4737 homologous donations were examined. Donors at greatest risk for reaction were autologous donors who had reactions at first donation; among 45 who made repeat donations for the same surgery, 17 (38%) had repeat reactions. The group least likely to experience reactions were the autologous donors greater than or equal to 66 years old; they experienced a 1.9 greater than or equal to percent (6/310) incidence of reactions. More reactions were seen in both autologous and homologous donors in the categories of first-time donor, female gender, decreasing age, and lower weight. Multiple logistic regression analysis showed that all of these variables were independent predictors of donor reaction, with first-time donation (odds ratio, 2.4) and female gender (odds ratio, 1.9) being the strongest predictors of reaction. Donor room personnel should be alerted that autologous donors who react at first donation are very likely to react at subsequent donations. Contrary to common concern, elderly autologous donors are least likely to have reactions.     

Vasovagal reaction rates and body weight: findings in high- and low-risk populations

BACKGROUND: The effect of weight on vasovagal reaction rates has not been evaluated in high- and low-risk populations or in first-time versus repeat blood donors. In addition, vasovagal reaction rates and weight have not been evaluated based on solicited information. STUDY DESIGN AND METHODS: A total of 1073 Caucasian high school students from randomly selected whole-blood drives in 2001 and 949 randomly selected Caucasian donors from the general donor population in 2001 and 2002 were subdivided into weight groups and evaluated for vasovagal reaction rates. RESULTS: The high school population had a much higher vasovagal reaction rate than the general donor population (8.0 vs. 2.6%). The vasovagal reaction rate was inversely proportional to body weight in first-time blood donors in both populations, but the trend was not as well defined in repeat blood donors. Solicitation of information from the general donor population increased the vasovagal reaction detection rate by 2.5 times (from 2.6% to 6.5%), and it is suggested that the vasovagal reaction rate might be as high as 27 percent in first-time general donors who weighed between 110 and 139 pounds. CONCLUSION: Body weight is a very important determinant of vasovagal reaction rates in first-time donors, but previous successful blood donation appears to mitigate the effect of body weight on vasovagal reaction rates. Solicitation of information from blood donors increases the number of vasovagal reactions detected and enhances the data.     

A case-controlled multicenter study of vasovagal reactions in blood donors: influence of sex, age, donation status, weight, blood pressure, and pulse

BACKGROUND: Vasovagal reactions occur in a small, but significant number of blood donors. These reactions may decrease return donation and disrupt blood collection activities. The purpose of this study was to define the contributory role of sex, age, weight, blood pressure, and pulse in vasovagal reactions with syncope in blood donors. STUDY DESIGN AND METHODS: A retrospective case-control study involved 1890 blood donors with syncope from three large United States blood centers during 1994 and 1995. Case controls and random population controls were used in a logistic regression analysis to determine the significance of individual variables to syncopal reactions. RESULTS: Female donors, young donors, first-time donors, low-weight donors, and donors with low predonation blood pressure had higher absolute donation reaction rates than other donors. When each variable was adjusted for other variables by regression analysis, age, weight, and donation status (first-time or repeat donor) were significant (p<0.0001), and sex, predonation blood pressure, and predonation pulse were not. The most important variables, in descending order, were age, weight, and donation status (first-time or repeat donor). CONCLUSIONS: Donation-related vasovagal syncopal reactions are a multifactorial process determined largely by age, weight, and first-time donor status.     

Vasovagal reactions in high school students: findings relative to race,risk factor synergism,female sex,and non-high school participants

BACKGROUND: High school (HS) students have a high incidence of vasovagal reactions and are a good population for the study of vasovagal reactions. STUDY DESIGN AND METHODS: Data from 1,076 Caucasian students, 226 African-American students, and 157 nonstudents from HS blood drives in 2001 were entered into a database. Race, high-risk-factor synergism, the phenomenon of "survivorship," and female sex were evaluated. In addition, non-HS student participants were described. RESULTS: Vasovagal reactions were 84 percent lower in African-American HS students than in Caucasian HS students (3 of 226 vs. 88 of 1,076; 1.3 vs. 8.2 percent; p = 0.0001; relative risk, 6.2). In Caucasian HS students, first-time donor status increased the vasovagal reaction rate to 9.4 percent (vs. 3.6% in repeat donors, p < 0.004). Low weight ( 81.2 kg, p < 0.001). Together they increased the reaction rate to 16.0 percent (vs. 3.2%, p < 0.0001). Females had more reactions than males (11.3 vs. 4.8%, p < 0.001), but the reaction rates equalized when donors under 150 lb were excluded (5.7 vs. 4.6%, p = 0.66). CONCLUSION: African-American HS students had a significantly lower vasovagal reaction rate than Caucasian HS students. There was synergy among high-risk factors in Caucasian HS students. Female and male vasovagal reaction rates were similar when low-weight donors were excluded.     

How Can We Improve Retention of the First-Time Donor? A Systematic Review of the Current Evidence

Blood products are critical to health systems and donations by voluntary nonremunerated donors are recommended. Worldwide, however, only around 5% of those eligible to donate do so and around half of those never return to donate again. This review focuses on what deters first-time donors, what predicts their retention, and what interventions may promote retention of this group. A comprehensive search of relevant databases identified 9 studies investigating motives and deterrents of first-time donors, 14 studies investigating predictors for first-time donors (13 whole blood [WB] and 2 plasmapheresis), and 15 studies (in 14 published articles) detailing interventions conducted on first-time donors. Drawing on an established blood donation taxonomy, studies were classified by 2 independent raters. Interventions were also classified into traditional, behavioral, or social science interventions. With only 2 eligible studies among first-time plasmapheresis donors, analyses focused on WB donors. First-time WB donors reported benevolent and collectivistic motivations, as well as personal benefits to commence WB donation. Self-reported deterrents have typically not been examined. Intention predicted first-time donor retention with intention determined by attitudes and a sense of (perceived behavioral) control. However, anxiety, adverse events, and deferrals all deterred retention. Traditional interventions, such as reminders and incentives, are widespread yet had only a small effect on return of first-time donors. Although behavioral science interventions such as fluid loading are effective, the strongest effect for the return of first-time donors was found when individual psychological support was provided. The purpose of this analysis was to identify the factors associated with the commencement and continuation of first WB donations. The current review revealed that self-reported motivators are typically not effective, and most successful predictive factors identified have not been translated into interventions. Future work would do well to identify, manage, and meet donors' expectations along with developing more individualized donation experiences. Blood donor research should delineate donor career stages; addressing first-time donor retention will support stable panels for blood collection agencies.     

First-time blood donors: demographic trends

BACKGROUND: With changing demographics of the United States population and the continuous need to recruit new donors, it is important to monitor the demographic profile of first-time donors and to evaluate changes in the donor pool to improve recruitment targeting. STUDY DESIGN AND METHODS: First-time whole blood (n = 901,862) donors at five United States blood centers between 1991 and 1996 were analyzed. RESULTS: The total number of first-time donors appears to be decreasing. Over the 6-year period, there was an overall increase in the proportion of Hispanic and other minority first-time donors and a concurrent decrease in the proportion of white donors at Retrovirus Epidemiology Donor Study centers. Other variables, including age, sex, and education, did not show a consistent trend. CONCLUSION: The demographic profile of first-time donors is changing. These data highlight the importance for blood centers to continuously monitor the donor population. A better understanding of the donor population may help blood centers adjust their donor outreach, recruitment, and retention programs. New recruitment efforts appear needed to counter general apathy toward donating blood, and minority groups appear to be receptive to becoming blood donors.     

Donor retention as a function of donor reactions to whole-blood and automated double red cell collections

BACKGROUND: Although reactions to whole-blood (WB) donation are known to decrease donor retention, potential effects of reactions to automated double red cell (2RBC) donation upon retention have not been investigated. STUDY DESIGN AND METHODS: The authors investigated effects of donor status (first-time, experienced) and reactions (absent, present) upon retention of all male allogeneic WB and 2RBC donors (n = 45,296) donating within the American Red Cross Central Ohio Region during a 12-month period. Donor age, race, and status (first-time, experienced); phlebotomist's reaction rating; and phlebotomy procedure (WB, 2RBC) were collected for the initial donation by each donor. Dates of any donation attempts in the 12 months starting from the donor's first eligible date after the initial donation were also collected. RESULTS: On average, WB donors were less likely to react and more likely to donate again and returned more quickly to donate than 2RBC donors, even after accounting for differential delays in eligibility. Reactions decreased the likelihood of repeat donation among all first-time donors regardless of initial phlebotomy procedure. Among experienced donors, however, reactions depressed retention of WB donors by 27.6 percent, whereas reactions lowered retention of 2RBC donors by just 3.6 percent. CONCLUSION: Although 2RBC donors were more likely to react, first-time 2RBC donors were no more affected by reactions than first-time WB donors. Experienced WB donors suffered a larger drop in retention as a function of reactions, in fact, than did experienced donors who gave 2RBC donations. Potential reasons for this data pattern require further investigation.     

Correlates of hepatitis C virus (HCV) RNA negativity among HCV-seropositive blood donors

BACKGROUND: Approximately 20 percent of persons infected with hepatitis C virus (HCV) clear viremia. Factors associated with resolution of viremia are not well defined. Implementation of routine nucleic acid testing (NAT) of blood donors has yielded a large data set for analysis of demographic correlates of resolved viremia. STUDY DESIGN AND METHODS: HCV antibody and NAT data, liver enzyme (alanine aminotransferase [ALT]) results, and donor demographic characteristics were compiled for 2,579,290 allogeneic donations given at five large blood centers after NAT implementation in 1999 through December 2001. Donation HCV RNA status was compared between first-time donors categorized by ALT levels, sex, age, race and/or ethnicity, country of birth, level of education, blood center location, and blood group, with chi-square tests and multivariable logistic regression methods. RESULTS: Of 35 confirmed-seropositive repeat donors, 19 (54.3%) tested negative for the presence of HCV RNA; there was no association between RNA status and preseroconversion intervals (p = 0.74). Of 2105 RIBA-positive, first-time donors, 402 (19.1%) tested negative for the presence of HCV RNA by NAT (presumptive resolved infections). There were significant differences in the frequency of RNA negativity among first-time donors categorized by ALT levels and by race and/or ethnicity. ALT levels were more likely to be elevated in RNA-positive, first-time donors (p < 0.0001). Viremia was less likely to resolve in Asian (8.2%) and black non-Hispanic (14.4%) donors than in white non-Hispanic (20.7%), Hispanic (22.1%), and other race and/or ethnicity (22.1%) donors (p = 0.02). No significant associations were found for age, sex, country of origin, level of education, blood type, and donor center location. CONCLUSION: These results confirm that the frequency of HCV RNA negativity among seropositive persons differs by race and/or ethnicity. Follow-up studies of donors with resolved viremia are warranted to further elucidate viral, immunologic, and genetic factors underlying spontaneous viral clearance.     

The effect of a 473-mL (16-oz) water drink on vasovagal donor reaction rates in high-school students

BACKGROUND: Recent clinical studies found that a water drink prevented orthostatic hypotension in healthy subjects subjected to a tilt-table test. A water drink was tested as a method to decrease vasovagal donor reactions in high-school students. STUDY DESIGN AND METHODS: A total of 8894 high-school donations in Fall 2004 and 2005 were assigned to groups receiving or not receiving a 473-mL water drink after acceptance for whole-blood donation. In addition, 4340 donations in 2004 were reduced to 2895 donations ("balanced 2004 group") with an algorithm that equally balanced the donors between the water and no water arms. RESULTS: The donor reaction rate was 9.9 percent (349 reactions/3534 donations) in donors given a water drink versus 12.5 percent (668 reactions/5360 donations; p = 0.0002) in donors not given a water drink. Donors given a water drink had a 21 percent reduction in their donor reaction rate. The main benefit of water was in Caucasian, first-time donors. In the balanced 2004 group, the donor reaction rate was 10.6 percent (153 reactions/1438 donations) in donors given a water drink versus 14.8 percent (216 reactions/1457 donations; p = 0.0008) in donors not given a water drink. Donors given a water drink in the balanced 2004 group had a 28 percent reduction in their donor reaction rate. The use of water did not interfere with donor processing and was judged by collection staff as easy to implement. CONCLUSION: A 473-mL water drink decreased the vasovagal donor reaction rate in high-school donors by 21 percent, but to varying degrees in different subpopulations.     

Vasovagal reactions in blood donors during or immediately after blood donation

The aim of the study was to estimate the type, incidence and causes of donor adverse reactions during and after blood donation in a Greek Blood Bank, where medical staff is responsible for donor selection. 12 173 blood donors were studied for adverse reactions. One-hundred and seven (0.87%) donors had a vasovagal reaction during or after blood donation. Donors who gave blood occasionally had a significant greater incidence of reactions compared with volunteer donors (1.15 versus 0.53%) (P < 0.001). There was no significant difference between men and women (0.85 versus 0.95%). First-time donors (1.7 versus 0.68%) and those under 30 years (1.15 versus 0.71%] had a significant greater possibility to have a reaction (P < 0.001). Twenty-two of 107 (20.5%) donors had a syncopal reaction. There was not a causative correlation of haematocrit, haemoglobin, systolic and diastolic blood pressure, pulse rate and weight in women (except weight in men) in developing a reaction. The stressing experience of phlebotomy was the reason for the higher frequency of a reaction. The incidence of reactions in our donors is lower than in other studies, and the possible reason for this is that only physicians are responsible for the selection of donors and trained personnel are careful of them during the donation process.     

Demographic characteristics and risks for transfusion-transmissible infection among blood donors in Xinjiang autonomous region, People's Republic of China

BACKGROUND: The recruitment and retention of voluntary, nonremunerated blood donors continues to be a challenge in China. Understanding donor demographics and donor characteristics is crucial for any blood center in developing strategies to recruit potential donors. STUDY DESIGN and METHODS: The study population included all 29,784 whole blood donors from January 1 to December 31, 2003, at the Urumqi City Blood Center or one of its mobile blood collection buses. Demographic data, location, and frequency of donation and results of testing for transfusion-transmissible infection (TTI) were evaluated. RESULTS: The typical blood donor in Urumqi is male, less than 36 years of age, and Han Chinese; has at least a high school education; is a first-time donor; and donated at a mobile blood collection bus. The majority, 71 percent, were first-time donors. Among all donors, the seroprevalence rate of TTI was 3.5 percent for first-time donors, 2.7 percent for donors who donated twice, and 2.1 percent for donors who had donated three or more times. Han Chinese had lower seroprevalence rates of TTIs than ethnic minorities. Lower seroprevalence rates of TTIs were found among donors at mobile buses than at the blood centers. CONCLUSION: Similar to other donor populations, higher rates of TTIs were observed among first-time donors, and the prevalence decreased among repeated donors. One possible strategy for improving the safety of the blood supply might be for the blood center to recruit a cadre of donors who donate repeatedly, instead of relying on campaigns to recruit new donors from workplaces at each donation cycle.     

Adverse reactions and other factors that impact subsequent blood donation visits

BACKGROUND: The importance of adverse reactions in terms of donor safety recently has received significant attention, but their role in subsequent donation behavior has not been thoroughly investigated. STUDY DESIGN AND METHODS: Six REDS‐II blood centers provided data for this analysis. Summary minor and major adverse reaction categories were created. The influence of adverse reactions on donation was examined in two ways: Kaplan‐Meier curves were generated to determine the cumulative pattern of first return, and adjusted odds ratios (AORs) for demographic and other factors positively and negatively associated with return were estimated using multivariable logistic regression. RESULTS: Donors who had major reactions had longer times to return than donors with minor or no reactions. The AOR of returning for donors with major reactions was 0.32 (95% confidence interval [CI], 0.28‐0.37) and with minor reactions 0.59 (95% CI, 0.56‐0.62) when compared to donors who did not have reactions. Conversely, the most important factors positively associated with return were the number of donations in the previous year and increasing age. Subsequent return, whether a major, minor, or no reaction occurred, varied by blood center. Factors that are associated with the risk of having adverse reactions were not substantial influences on the return after adverse reactions. CONCLUSION: Having an adverse reaction leads to significantly lower odds of subsequent donation irrespective of previous donation history. Factors that have been associated with a greater risk of adverse reactions were not important positive or negative predictors of return after a reaction.     

How afraid are you of having blood drawn from your arm? A simple fear question predicts vasovagal reactions without causing them among high school donors

BACKGROUND: We previously demonstrated in a group of mostly experienced blood donors that fear of blood draws was a significant predictor of vasovagal reactions. Importantly, being asked about one's fear immediately before donation did not increase reaction rates. This study further evaluates the relationship between fear and reactions among high school blood donors, who are known to be at a relatively greater risk for vasovagal reactions. STUDY DESIGN AND METHODS: Immediately after completing the blood donor health screening, 17‐ and 18‐year‐old high school students were asked about their fear of having blood drawn. Based on a random selection, the fear question was administered in approximately half of the schools, resulting in a final sample of 1715 donors who did and 1692 donors who did not answer the fear question. RESULTS: Fear was a significant predictor of donor reactions and remained a significant independent predictor (along with estimated blood volume and donor sex) in a logistic regression analysis. There was no difference in the proportion of reactions observed between those who did and did not answer the predonation fear question. CONCLUSION: Consistent with previous evidence in older and more experienced blood donors, these findings indicate that assessing fear of blood draws may help to identify those who are most likely to experience vasovagal reactions among young donors without increasing the frequency of such reactions.     

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.     

音乐对初次无偿献血者的干预效果观察

目的:探讨音乐对初次无偿献血者静脉穿刺疼痛、一次自愿采集400m l献血量及降低献血反应的影响。方法:将初次无偿献血者随机分为对照组与实验组各240名,两组采血程序相同,实验组加用音乐进行干预,观察每组静脉穿刺疼痛及一次自愿采集400m l献血量的比例。结果:实验组献血者疼痛献血反应发生率明显低于对照组,一次自愿献血400m l采集率明显高于对照组(P<0.01)。结论:音乐能分散无偿献血者的注意力,减轻疼痛,降低献血反应,提高400m l采集率,对保留、招募献血者,促进无偿献血事业顺利发展有重要意义。     

Improving safety for young blood donors

Young blood donors between the ages of 16 and 18 years contribute substantially to the blood supply in the United States, accounting for about 14% of the allogeneic whole blood collected by the American Red Cross in 2010. However, studies have consistently demonstrated that the donors' age, total blood volume, and first-time donation status independently contribute to the risk of syncopal reactions after whole blood donation. Efforts to improve the donation experience are crucial not only to ensure the health and well-being of blood donors but also to sustain an adequate blood supply. Even minor reactions or temporary deferrals discourage individuals from donating blood again. Shifting population demographics and advances in medical care in the United States and other countries predict that the need for blood will increase, whereas blood donation by the older generations declines each year. Broad deferral strategies and precautionary measures have further winnowed the eligible donor pool, but their contribution to transfusion safety remains controversial. Consequently, blood centers that depend on recruiting and retaining adolescent blood donors have made concerted efforts to improve safety, especially on high school blood drives. Population-based operational tactics to improve donation safety focus on donor education, the drive environment, or recruiting individuals who are less likely to have reactions. Physiologic strategies modulate the donors' response to blood loss, decreasing their susceptibility to a donation-related reaction. This review examines the published data supporting the measures recently taken by blood centers to reduce the risk of syncopal reactions among young, whole blood donors.     

Blood Donor Eligibility, Recruitment, and Retention

To study the motivation and actions of potential and active blood donors, a literature search, a limited survey, and associated analytic efforts were undertaken. It is estimated that 61 million of the 114 million age-eligible donors meet Red Cross criteria of health-eligibility. The 1971 donor participation rate, calculated as the percentage ratio of active donors to eligible donors, was estimated to be between 8 and 9 per cent. Total collections appear to be increasing at a stable rate of 1 per cent per year and 15 per cent of each year's collections apparently come from first-time donors. Thus, 14 per cent of those who donate blood in any given year must replace other donors who have stopped donating. Roughly 25 per cent of those who are health-eligible to donate blood have done so in the last ten years. Literature and survey analyses indicate that donor reaction rates are considerably underestimated by most collectors. A limited survey showed that the main reason for nonparticipation is fear, while common reasons for discontinuing participation are adverse reaction and medical disqualification.     

Convenience, the bane of our existence, and other barriers to donating

BACKGROUND: To prevent donor loss and improve retention, it is important to understand the major deterrents to blood donation and to identify factors that can be effectively addressed by blood centers. STUDY DESIGN AND METHODS: A 30-item self-administered questionnaire was completed in 2003 by 1705 first-time and 2437 repeat US donors who had not donated in 2 to 3 years. Asian, Hispanic, black, and white first-time and repeat donors rated the importance of deterrents to donation in their decision to not return with a 1 to 5 scale. Categorical analysis of variance methods were used to compare the importance of deterrents between first-time and repeat donors of different race or ethnicity. RESULTS: Not having a convenient place to donate was most commonly cited as an important or very important reason for not returning by 32 to 42 percent of first-time and 26 to 43 percent of repeat respondents. Although bad treatment and poor staff skills were less of a barrier than convenience, they were more important for minority donors. Other factors such as physical side effects, foreign travel, or length of the process appeared less important. CONCLUSION: Inconvenience is a major barrier to donating, suggesting that mobile collections and increased hours of operation might help recapture lapsed donors. The finding that lapsed minority donors were more likely to give bad treatment and poor staff skills as important reasons to not donate is disconcerting in light of the changing donor demographics and increased efforts to recruit these donors.