Adverse events and safety issues in blood donation--a comprehensive review

Predictors of bleeding complications during catHeter-dirEcted thrombolysis for peripheral arterial occlusions (POCHET)

INTRODUCTION

The risk of major bleeding complications in catheter directed thrombolysis (CDT) for acute limb ischemia (ALI) remains high, with reported major bleeding complication rates in up to 1 in every 10 treated patients. Fibrinogen was the only predictive marker used for bleeding complications in CDT, despite the lack of high quality evidence to support this. Therefore, recent international guidelines recommend against the use of fibrinogen during CDT. However, no alternative biomarkers exist to effectively predict CDT-related bleeding complications. The aim of the POCHET biobank is to prospectively assess the rate and etiology of bleeding complications during CDT and to provide a biobank of blood samples to investigate potential novel biomarkers to predict bleeding complications during CDT.

METHODS

The POCHET biobank is a multicentre prospective biobank. After informed consent, all consecutive patients with lower extremity ALI eligible for CDT are included. All patients are treated according to a predefined standard operating procedure which is aligned in all participating centres. Baseline and follow-up data are collected. Prior to CDT and subsequently every six hours, venous blood samples are obtained and stored in the biobank for future analyses. The primary outcome is the occurrence of non-access related major bleeding complications, which is assessed by an independent adjudication committee. Secondary outcomes are non-major bleeding complications and other CDT related complications. Proposed biomarkers to be investigated include fibrinogen, to end the debate on its usefulness, anti-plasmin and D-Dimer.

DISCUSSION AND CONCLUSION

The POCHET biobank provides contemporary data and outcomes of patients during CDT for ALI, coupled with their blood samples taken prior and during CDT. Thereby, the POCHET biobank is a real world monitor on biomarkers during CDT, supporting a broad spectrum of future research for the identification of patients at high risk for bleeding complications during CDT and to identify new biomarkers to enhance safety in CDT treatment.

Prevention strategies for vasovagal reaction in whole blood donors: A quadri-armed randomised control trial

INTRODUCTION

Vasovagal reaction (VVR) is a frequently encountered generalised donor adverse reaction, associated with donor deterrence towards future donation. Several mitigation strategies for prevention of VVR were tried but still not standardised. This quadri-armed randomised study evaluated the utility of water ingestion, applied muscle tension (AMT) and combination of both in preventing the VVR among blood donors.

METHODS

A quadri-armed randomised controlled trial was performed on 4320 whole blood donors. Blood donors of 18-65 years of age were randomised into four groups based on the interventions performed i.e., control with no intervention (Group 1, n = 1081), water ingestion (Group 2, n = 1082), AMT (Group 3, n = 1070) and combined intervention (Group 4, n = 1087). VVR during and immediately after blood donation were observed along with assessment of risk factors in blood donors and the effectiveness of interventions were analysed.

RESULTS

The incidence of VVR observed 1.6% in our study, with the highest occurrence in the control group (2.5%) and the lowest in the combined intervention group (0.9%). Multivariable logistic regression revealed that the control group donors faced a 1.38-fold greater risk of VVR compared to those receiving interventions (OR: 1.38, 95% CI: 1.10-1.75). Other risk factors included younger age (OR: 1.5, 95% CI: 1.05-2.17), first-time donation (OR: 5.7, 95% CI: 1.66-5.74), prior history of VVR (OR: 2.5, 95% CI: 10.4-101.52).

DISCUSSION/CONCLUSION

The combined approach of water ingestion and AMT proved significantly more effective in VVR prevention compared to individual interventions.

A new risk predictive scoring system of vasovagal reactions in patients with preoperative autologous blood donation

BACKGROUND AND OBJECTIVES

Vasovagal response (VVR) is the most common adverse reaction during blood donation and it is the main element for the safety of the patients with preoperative autologous blood donation (PABD). Accurate identification high-risk group is of great significance for PABD. Our study aimed to establish a scoring system based on the nomogram to screen the high-risk population and provide evidence for preventing the occurrence of VVRs.

MATERIALS AND METHODS

A number of 4829 patients underwent PABD between July 2017 and June 2020 in the first medical center of Chinese PLA Hospital were recruited, 3387 of whom were included in the training group (70 %; 108 VVRs patients vs 3279 Non-VVRs patients), 1442 were included in the validation group (30 %; 46 VVRs patients vs 1396 Non-VVRs patients). The data were analyzed by univariate and multivariate logistic regression. The nomogram of the scoring system was created by using the RMS tool in R software.

RESULTS

Seven variables including BMI, hematocrit, pre-phlebotomy heart rate and systolic blood pressure, history of blood donation, age group and primary disease were selected to build the nomogram, which was shown as prediction model. And the score was 0-1 for BMI, 0-2 for hematocrit, systolic blood pressure, heart rate and no blood donation history, 0-10 for age, 0-3 for primary disease. When the total cutoff score was 11, the predictive system for identifying VVRs displayed higher diagnostic accuracy. The area under the curve, specificity, and sensitivity of the training group were 0.942, 82.41 % and 97.17 %, respectively, whereas those of the validation group were 0.836, 78.26 % and 78.15 %, respectively.

CONCLUSION

A risk predictive scoring system was successfully developed to identify high-risk VVRs group form PABD patients that performed well.

Development and validation of a nomogram for predicting the risk of vasovagal reactions after plasma donation

BACKGROUND AND OBJECTIVES

Vasovagal reactions (VVRs) are the most common adverse reactions and are frequently associated with serious donor adverse events. Even mild VVRs can lead to a significant reduction in the likelihood of subsequent donations. The purpose of this study is to explore the factors related to the occurrence of VVRs after plasma donation and to construct a nomogram to identify individuals at risk for VVRs to improve the safety of plasma donors.

MATERIALS AND METHODS

We collected the donation data from July 2019 to June 2020 from a plasma center in Sichuan, China, to explore the independent risk factors for vasovagal reactions. From these data, we constructed and validated a predictive model for vasovagal reactions.

RESULTS

VVRs after plasma donation occurred 737 times in 120 448 plasma donations (0.66%). Gender, season, donor status, weight, pulse, duration of donation, and cycle were independent risk factors for VVRs (P< 0.05). The concordance index (C-index) of a logistic model in the derivation cohort was 0.916, with a Hosmer-Lemeshow goodness-of-fit probability of 0.795. The C-index of a logistic model in the validation cohort was 0.916, with a Hosmer-Lemeshow goodness-of-fit probability of 0.224. The calibration curve showed that the predicted results were in good agreement with the actual observed results.

CONCLUSION

This study preliminarily constructed and verified a prediction model for VVRs after plasma donation. The model nomogram is practical and can identify high-risk donors.

Predicting vasovagal reactions to needles with anticipatory facial temperature profiles

Around one-third of adults are scared of needles, which can result in adverse emotional and physical responses such as dizziness and fainting (e.g. vasovagal reactions; VVR) and consequently, avoidance of healthcare, treatments, and immunizations. Unfortunately, most people are not aware of vasovagal reactions until they escalate, at which time it is too late to intervene. This study aims to investigate whether facial temperature profiles measured in the waiting room, prior to a blood donation, can be used to classify who will and will not experience VVR during the donation. Average temperature profiles from six facial regions were extracted from pre-donation recordings of 193 blood donors, and machine learning was used to classify whether a donor would experience low or high levels of VVR during the donation. An XGBoost classifier was able to classify vasovagal groups from an adverse reaction during a blood donation based on this early facial temperature data, with a sensitivity of 0.87, specificity of 0.84, F1 score of 0.86, and PR-AUC of 0.93. Temperature fluctuations in the area under the nose, chin and forehead have the highest predictive value. This study is the first to demonstrate that it is possible to classify vasovagal responses during a blood donation using temperature profiles.

A study on blood donor characteristics and preferred environment of South Koreans during the COVID-19 pandemic: A conjoint analysis

Objective

The COVID-19 pandemic has caused a decrease in the number of blood donors worldwide, posing a global problem. Therefore, this study investigates people who have continuously participated in blood donation during the COVID-19 pandemic and collects basic information as a reference for maintaining stable amounts of blood during future pandemics.

Methods

The participants of this study were selected from the population of South Korea through stratified sampling considering region and age distributions. Owing to the COVID-19 pandemic, the participants were recruited online through Embrain, an online research and survey company, from June 1 to June 28, 2021. Data were collected from a total of 1,043 participants and used in the study.

Results

The results of this study showed that there was a difference between the donors group and non-donors group in factors such as donation attitude (F = 73.342, p &lt; 0.001), donation knowledge (F = 6.530, p &lt; 0.01), and preventive health behavior (F = 12.352, p &lt; 0.001). Overall, blood donors showed favorable attitude toward and considerable knowledge of blood donation as well as a high level of preventive health behavior. The environment most preferred by people who participated in blood donation during the COVID-19 pandemic was “going with family to a blood donation center that gives out free gifts in a region far away with no confirmed cases,” which showed the highest utility (utility = 0.734).

Conclusion

Even during pandemics, donation attitude, donation knowledge, and preventive health behavior can serve as key factors affecting participation in blood donation. Additionally, blood donation centers that donors can visit with their families represent a favorable environment for the promotion of blood donation during pandemics.

Predicting Vasovagal Reactions to Needles from Facial Action Units

BACKGROUND

Merely the sight of needles can cause extreme emotional and physical (vasovagal) reactions (VVRs). However, needle fear and VVRs are not easy to measure nor prevent as they are automatic and difficult to self-report. This study aims to investigate whether a blood donors' unconscious facial microexpressions in the waiting room, prior to actual blood donation, can be used to predict who will experience a VVR later, during the donation.

METHODS

The presence and intensity of 17 facial action units were extracted from video recordings of 227 blood donors and were used to classify low and high VVR levels using machine-learning algorithms. We included three groups of blood donors as follows: (1) a control group, who had never experienced a VVR in the past (n = 81); (2) a 'sensitive' group, who experienced a VVR at their last donation (n = 51); and (3) new donors, who are at increased risk of experiencing a VVR (n = 95).

RESULTS

The model performed very well, with an F1 (=the weighted average of precision and recall) score of 0.82. The most predictive feature was the intensity of facial action units in the eye regions.

CONCLUSIONS

To our knowledge, this study is the first to demonstrate that it is possible to predict who will experience a vasovagal response during blood donation through facial microexpression analyses prior to donation.

Prevalence and factors associated with vasovagal reaction among whole blood donors in hospital Universiti Sains Malaysia

Adverse donor reactions (ADR) are common to occur during the blood donation process. The most common is vasovagal reactions (VVR) and it cause negative impact in the donor return rate. The aim of this study is to determine the prevalence of VVR among blood donors and to study its associated factors, at Hospital University Sains Malaysia (USM). This retrospective case-control study was conducted from June 2018, until June 2021. Data was extracted from the blood bank database system and from donor adverse reaction form. Donors who developed adverse donor reactions were chosen and without VVR were chosen at random as controls. A total of 159 donors, out of 35 134 donors were reported to have VVR which resulted in an overall prevalence of 0.45 %. Dizziness or mild VVR were the most frequently observed adverse reactions, accounting for approximately 87/159 (54.7 %) of all adverse reactions. Multiple logistic regression (MLR) analysis showed VVR were significantly associated with age, female gender, first-time donor, and 450 ml volume of blood collected. The prevalence of vasovagal reactions among blood donors in this study was low which was similar to a few previous studies. Although it was low, still it is very important to reduce risks to a minimum so that the donor return rate could be maintained. The information regarding its associated factors can be used to identify high-risk donors to prevent the incidence in the future.

Pre-donation water and salty snacks to prevent vasovagal reactions among blood donors

BACKGROUND

Minimizing the risk of vasovagal reactions (VVRs) can prevent donor harms and improve donor return. We report the results of a program to reduce VVR rates.

STUDY DESIGN AND METHODS

The program was implemented on June 11, 2017 and consisted in drinking water and eating a salty snack before donating blood, plasma, or platelets. All donations made during the "pre-program period" (October 11, 2015-June 10, 2017) and "post-program period" (June 11, 2017-May 11, 2019) were included. Study outcomes comprised VVRs (any severity) and syncopal VVRs, whether employee- or donor-reported. An interrupted time series (ITS) analysis proxied causality based on the "pre-program trend," the "immediate trend" (i.e., immediately before versus after the program), and the "post-program trend". The relative risk (RR) of VVR (along with confidence intervals [CIs]) was reported, overall and stratified by subgroups based on age, sex, donor type (i.e., first-time versus repeat), and donation type (i.e., whole blood versus apheresis).

RESULTS

The monthly VVR rate (any severity) dropped from 4.6% in the pre-program period to 4.3% in the post-program period, and never reached its pre-program level. The ITS analysis revealed a statistically significant and increasing pre-program trend (RR [95% CI] = 1.011 [1.002-1.020]), a statistically significant and decreasing immediate trend (RR [95% CI] = 0.848 [0.743-0.969]), and a non-statistically-significant and stable post-program trend (RR [95% CI] = 0.999 [0.993-1.006]). Similar trends were observed for nearly all high- and low-risk subgroups. No statistically significant trend was observed for syncopal VVRs.

DISCUSSION

These results suggest that the herein-described program durably reduced the incidence of VVRs (any severity) by ~15%.

Beyond fear: A longitudinal investigation of emotions and risk of a vasovagal reaction in first-time whole-blood donors

BACKGROUND

Fear is a recognized predictor of vasovagal reactions (VVRs) in blood donors. However, less is known about the role of other emotions, including positive emotions, that donors might experience. The aim of this study was to identify the emotions experienced in center that predict onsite VVRs, and to determine at what point during the donation appointment, the experience of these emotions is most influential.

STUDY DESIGN AND METHODS

A sample of 442 first-time whole-blood donors (57.7% female; mean ± SD age 30.7 ± 11.7 years) completed a survey in the waiting area and before venepuncture in the donation chair to assess their current emotional experience. The survey data were matched with routinely-collected demographic, donation, and donor adverse event information. A generalized estimating equations model was used to identify emotions associated with the occurrence of a VVR.

RESULTS

A total of 56 (12.7%) participants experienced a VVR. The occurrence of a VVR was significantly associated with lower love/closeness/trust (OR: 0.53, 95%CI: 0.34-0.82) and higher scared/fearful/afraid (OR: 1.96, 95%CI: 1.18-3.25) states. Significant interaction effects suggested that the effect of scared/fearful/afraid decreased while stressed/nervous/overwhelmed increased from the waiting area to before venepuncture on the likelihood of a VVR.

DISCUSSION

To effectively reduce donor VVR risk, blood collection agencies need to address a broader range of emotions at different points during the donation process.

Analysis of influencing factors of serum total protein and serum calcium content in plasma donors

Background and objectives

The adverse effects of plasma donation on the body has lowered the odds of donation. The aim of this study was to investigate the prevalence of abnormal serum calcium and total serum protein related to plasma donation, identify the influencing factors, and come up with suggestions to make plasma donation safer.

Methods

Donors from 10 plasmapheresis centers in five provinces of China participated in this study. Serum samples were collected before donation. Serum calcium was measured by arsenazo III colorimetry, and the biuret method was used for total serum protein assay. An automatic biochemical analyzer was used to conduct serum calcium and total serum protein tests.

Results

The mean serum calcium was 2.3 ± 0.15 mmol/L and total serum protein was 67.75 ± 6.02 g/L. The proportions of plasma donors whose serum calcium and total serum protein were lower than normal were 20.55% (815/3,966) and 27.99% (1,111/3,969), respectively. There were significant differences in mean serum calcium and total serum protein of plasma donors with different plasma donation frequencies, gender, age, regions, and body mass index (BMI), (all p < 0.05). Logistic regression analysis revealed that donation frequencies, age, BMI and regions were significantly associated with a higher risk of low serum calcium level, and donation frequencies, gender, age and regions were significant determinants factors of odds of abnormal total serum protein.

Conclusions

Donation frequencies, gender, age, regions, and BMI showed different effects on serum calcium and total serum protein. More attention should be paid to the age, donation frequency and region of plasma donors to reduce the probability of low serum calcium and low total serum protein.

Patient Blood Management: Improving Outcomes for Millions While Saving Billions. What Is Holding It Up?

Patient blood management (PBM) offers significantly improved outcomes for almost all medical and surgical patient populations, pregnant women, and individuals with micronutrient deficiencies, anemia, or bleeding. It holds enormous financial benefits for hospitals and payers, improves performance of health care providers, and supports public authorities to improve population health. Despite this extraordinary combination of benefits, PBM has hardly been noticed in the world of health care. In response, the World Health Organization (WHO) called for its 194 member states, in its recent Policy Brief, to act quickly and decidedly to adopt national PBM policies. To further support the WHO's call to action, this article addresses 3 aspects in more detail. The first is the urgency from a health economic perspective. For many years, growth in health care spending has outpaced overall economic growth, particularly in aging societies. Due to competing economic needs, the continuation of disproportionate growth in health care spending is unsustainable. Therefore, the imperative for health care leaders and policy makers is not only to curb the current spending rate relative to the gross domestic product (GDP) but also to simultaneously improve productivity, quality, safety of patient care, and the health status of populations. Second, while PBM meets these requirements on an exceptional scale, uptake remains slow. Thus, it is vital to identify and understand the impediments to broad implementation. This includes systemic challenges such as the so-called "waste domains" of failure of care delivery caused by malfunctions of health care systems, failure of care coordination, overtreatment, and low-value care. Other impediments more specific to PBM are the misperception of PBM and deeply rooted cultural patterns. Third, understanding how the 3Es-evidence, economics, and ethics-can effectively be used to motivate relevant stakeholders to take on their respective roles and responsibilities and follow the urgent call to implement PBM as a standard of care.

A Cross-Sectional Study of Blood Donors' Psychological Characteristics over 8 Weeks

Background

Previous studies suggest that blood donation impacts blood donors' psychological state, with either positive or negative effects, such as feeling more energetic or more exhausted. It has not yet been described how long these effects last.

Materials and Methods

This prospective cohort study consisted of a qualitative and a quantitative part: (1) Psychological characteristics which changed after blood donation were identified by structured interviews of regular whole blood donors (n = 42). Based on this, a questionnaire addressing 7 psychological dimensions was established. (2) The psychological state of 100 blood donors was assessed after blood donation by applying the questionnaire 15-30 min before and during donation, as well as 15-30 min, 6 h, 24 h, 72 h, 1 week, and 8 weeks after donation. The resulting changes were summarized to a score. Furthermore, potential correlations of the score with pre-donation blood pressure, hemoglobin, or body mass index were calculated.

Results

Seven items were identified which changed in at least 25% of blood donors (mood, concentration, satisfaction, resilience, spirit of initiative, physical well-being, energy level). In the 100 blood donors, the well-being score increased (positive effects, n = 23), showed minor changes (n = 53), or decreased (negative effects, n = 24). The positive effects lasted for about 1 week and the negative effects for 3 days.

Conclusion

While the frequency of psychological effects following blood donation identified by our study was comparable to others, the changes of the psychological state in our donors were traceable for a longer period than previously acknowledged.

Feline blood donation adverse reactions: classification and description of acute and delayed reactions in a donor population

OBJECTIVES

This article aims to analyse the safety of feline blood donation by describing the frequency and nature of any adverse reactions and their causes, as well as propose measures to decrease the incidence of adverse reactions.

METHODS

In this prospective study, any blood donor adverse reactions detected by the clinical staff during and immediately after donation were recorded. The owners of the cats were also surveyed by a veterinary practitioner or veterinary nurse 5 days after donation, using a predefined questionnaire to assess for any clinical or behavioural changes. Data were collected between January 2019 and March 2020 from blood donors enrolled in an animal blood bank programme.

RESULTS

Of 3690 blood donations from 1792 feline donors assessed, post-donation reactions were reported in 1.14% (n = 42): 0.22% (n = 8) were acute reactions, which included weakness, pallor, tachypnoea and open-mouth breathing; and 0.92% (n = 34) were delayed post-donation reactions, with 0.16% involving cutaneous (haematomas and skin rashes, n = 6), 0.68% involving behavioural (n = 25) and 0.08% involving digestive (emesis and inappetence, n = 3) signs.

CONCLUSIONS AND RELEVANCE

The low incidence of post-donation reactions in this study is encouraging, suggesting that a well-established protocol and competent staff can help to ensure a high level of safety in a feline donor programme and, in turn, increase the confidence of cat owners.

Optimierung der Depotführung für Erythrozytenkonzentrate in Krankenhäusern

Blutdepots ohne eigene Herstellung müssen Versorgungssicherheit garantieren, dabei aber auch eine möglichst geringe Verfallsrate sicherstellen. Für die Anzahl der zu bevorratenden Erythrozytenkonzentrate (EK) der verschiedenen Blutgruppen wird folgendes Berechnungsmodell gefunden: 1. Die örtliche Verteilung der AB0-Blutgruppen im Patientenkollektiv kann mit dem Hardy-Weinberg-Gesetz auf Plausibilität überprüft werden. 2. Der Beobachtungszeitraum ist die durchschnittliche Restlaufzeit von der Lieferung bis zum Ende der Haltbarkeit. 3. Der Erwartungswert für die Fallzahl transfundierter Patienten einer bestimmten Blutgruppe gehorcht einer Binomialverteilung. 4. Die Anzahl transfundierter Erythrozytenkonzentrate pro Patient ist geometrisch verteilt. 5. Eine Matrix wird gebildet, deren Zellen das Produkt aus Fallzahl (3.) und EK pro Fall (4.) und somit die Anzahl der benötigten EK enthalten. Nur letztgenannte sind für die Führung des Blutdepots interessant. Subtrahiert man die Zahl der im Beobachtungszeitraum (2.) benötigten EK von der Depotgröße, erhält man den Verfall. Der Vorrat von EK der Blutgruppe 0 bemisst sich an der maximal zu erwartenden Zahl benötigter Konserven für einen Fall bis zur nächstmöglichen Lieferung, wenn der durchschnittliche Depotumsatz diesen Wert nicht übersteigt. Er kann somit insbesondere in peripheren Krankenhäusern mit Akutversorgung die oben beschriebene Kalkulation deutlich überschreiten. Für Blutgruppe A gilt dieser Grundsatz nicht, wenn auch kompatible (0 auf A) Transfusionen stattfinden sollen. Binomial ist bei kleiner Anzahl nach links – das heißt gegen Null – schief verteilt. Dies betrifft in jedem Fall AB, bei jährlichem Depotumsatz unter ungefähr 1000 EK aber auch Blutgruppe B. Möchte man den Verfall vermeiden, darf man die betroffenen Blutgruppen nicht – zumindest nicht in dem notwendigen Umfang – bevorraten und muss dann majorkompatibel transfundieren. Die Unterschiede der einzelnen AB0-Blutgruppen in Herstellung (Blutgruppenverteilung in der Spenderpopulation) und der Bevorratung in Krankenhaus-Blutdepots sind hierin begründet. Entsprechende Überlegungen gelten gleichermaßen für den Rhesusfaktor D. Die oft emotional geführte Debatte über die zu bevorratende Anzahl an EK kann mittels dieses mathematischen Modells auf eine rationale Grundlage zurückgeführt werden. Das Rechenmodell ist mit einem einfachen Tabellenkalkulationsprogramm möglich. Das Blutdepot bestimmt damit den optimalen Bestand. Für die Blutspendedienste ergibt sich hieraus die Möglichkeit, die Kunden individuell, das heißt umsatzabhängig, zu beraten und gegebenenfalls den Preis entsprechend zu gestalten. Im Rahmen der Qualitätssicherung können abteilungs- oder krankenhausspezifische Besonderheiten im Transfusionsverhalten dargestellt werden.

Blood Donation-Related Adverse Reactions: Results of an Online Survey among Donors in Germany (2018)

Introduction

According to German legislation, reports of suspected serious adverse reactions (AR) associated with the donation of blood and its components are continuously being evaluated by the Paul-Ehrlich-Institut. This survey aimed at providing a more complete picture of the AR associated with the donation of blood and blood components.

Materials and Methods

Eligible donors had the opportunity to anonymously report all AR occurring during or after their last donation by completing an online questionnaire. Reported AR were classified according to the Standard for Surveillance of Complications Related to Blood Donation. Donors' self-assessment of AR seriousness was compared with the official severity classification as laid down by German legislation. Besides a descriptive statistical analysis, a multiple logistic analysis was performed to identify risk factors for AR.

Results

A total of 8,138 data records were evaluated. Slightly more males (57.9%) participated in the survey and, except for donors aged ≥60 years, all age groups were equally represented. The majority of participants were whole blood donors (85.4%), repeat donors (97.2%), and stayed under observation in the blood establishment (BE) for more than 5 min (63.1%) after donation. Most participants did not report any reaction (72.5%), whereas 2,237 reported at least one AR (27.5%), 475 of whom underwent apheresis and 1,762 donated whole blood. Most AR occurred after leaving the BE (64.4%). Only a minority of participants required medical treatment (5.1%) or assessed the experienced AR as serious (3.9%). The most frequently reported donor AR were haematoma and other local reactions (57.6%). Vasovagal reactions without and with loss of consciousness were developed in 17 and 2% of the participants, respectively, whilst 7.6% experienced citrate reactions. New AR (i.e., allergic reactions and symptoms associated with iron deficiency) were reported as well. The occurrence of AR was linked to risk factors (i.e., female gender, young age, first-time donation, and thrombocytapheresis).

Discussion

This survey yielded a more comprehensive AR spectrum, revealed a prolonged time to symptom onset, and identified risk factors for AR. This novel information could be implemented in an amended informed consent addressing common and rare AR.

Are Bradycardic Donors More Likely to Have Adverse Outcomes During Blood Donation?

INTRODUCTION

In order to decrease adverse donor reactions during blood donation, volunteers are screened to safely donate according to the U.S. Food and Drug Administration standards. Volunteers must be normocardic, with a pulse between 50 and 100 beats per minute. Bradycardic volunteers with a pulse lower than 50 beats per minute who otherwise meet requirements may donate with physician approval. Blood donors in military settings tend to be younger and more physically fit than the average donor population, resulting in a higher percentage of bradycardic donors. The relationship between bradycardia and adverse donor reactions has not been well studied. Herein, we aim to compare post-donation adverse reactions and the ability to complete donation between normocardic and bradycardic donors.

MATERIALS AND METHODS

Institutional review board approval was obtained. Records from a single blood donor center located on a large military installation in 2019 were retrospectively reviewed for vital signs, demographics, hemoglobin, and donor reactions. Donors were categorized as normocardic or bradycardic. The two groups were statistically compared using a χ2 test.

RESULTS

Of the 1,601 donors in the study period, 1,514 qualified for donation. Mean age was 26.6 years (range, 17-72 years), with a male to female ratio of 2.1:1. Of these, 1,478 were normocardic and 26 were bradycardic. There was no significant difference in adverse reactions between the two groups (5.6% in bradycardic donors versus 3.6% in normocardic donors, n = 1,514, χ21 = 0.39, P = .53) or percentage of incomplete donations (5.9% in bradycardic and 5.65% in normocardic, n = 1,514, χ21 = 0.003, P = .96).

CONCLUSIONS

Donors with bradycardia are as safe to donate as normocardic donors. In the absence of comorbidities, blood donor centers should ensure their policies consider donation for volunteers with bradycardia.

Help Is in Your Blood-Incentive to "Double Altruism" Resolves the Plasma Donation Paradox

Blood donation is considered as one of the purest forms of altruism. Plasma donation, in contrast, despite being a similar process, is mostly a paid activity in which donors are compensated for their contribution to the production of therapeutic preparations. This creates a so-called "plasma paradox:" If remuneration is promised for a socially useful effort, volunteers with altruistic motives might be deterred. At the same time, regular plasma donors who pursue the monetary benefits of donation might drop out if remuneration stops. The same controversy can be caught in the messages of most plasma donation companies as well: They promise a monetary reward (MR), and at the same time, highlight the altruistic component of donation. In this study, we tested the assumption that emphasizing the social significance enhances the willingness to donate blood plasma more effectively than either MR or the combination of these two incentives. This had to be rejected since there was no significant difference between the three scenarios. Furthermore, we also hypothesized that individuals might be more motivated to donate plasma if there is a possibility of offering an MR toward other socially beneficial aims. We found an increased willingness to donate in scenarios enabling "double altruism", that is, when donating plasma for therapeutic use and transferring their remuneration to nongovernmental organizations, is an option. We propose relying on double altruism to resolve the plasma paradox, and suggest that it could serve as a starting point for the development of more optimized means for donor recruitment.

Vasovagal syncope after blood donation in active duty military personnel of the Spanish Army

BACKGROUND

All studies of vasovagal syncope (VVS) after blood donation have been performed with civilian donors. We hypothesized that military donors have a lower incidence of VVS and a particular set of predisposing factors.

STUDY DESIGN AND METHODS

Retrospective case-control study matching every case of VVS seen from 2011 to 2019 with two controls without VVS from the same blood drive. We used the odds ratio (OR) and its 95% confidence interval (CI), estimated by multivariate logistic regression, to identify independent predictors of VVS.

RESULTS

There were 105 episodes of VVS among 65.481 whole blood donations (0.15%). VVS was more frequent among donors from military academies than from other military units (0.37% vs. 0.10%, p < .001) and in collections conducted in mobile inside setups than in mobile buses (0.23% vs. 0.06%, p < .001). In the multivariate analysis, the only independent predictors of VVS were the status of first-time donor (OR 2.6, 95% CI 1.5-4.4; p < .001) and pre-donation systolic blood pressure (SBP) < 120 mm Hg (OR 1.9, 95% CI 1.1-3.3; p = .01). Donors with both risk factors had a 5.5-fold increased risk of VVS than donors without any risk factor. Age and female sex were not predictive of VVS.

DISCUSSION

Active duty military blood donors have a lower incidence of VVS than that reported in civilian donors. First-time donors and donors with SBP < 120 mm Hg should be temporarily deferred when immediate reincorporation to hazardous or strenuous duty tasks after donation is inescapable.

Short-term health outcomes following whole blood donation: A nationwide, retrospective cohort study

BACKGROUND

Blood donation is associated with a number of adverse events. Most of these are both uncommon and nonsevere, leading to mild discomfort for the donor at worst. However, adverse events occurring outside of the donation facility have largely not been studied. In this study, we aim to further the understanding by performing the first large-scale analysis of short-term risks following whole blood donation.

METHODS

We set up a nationwide cohort of donors who donated whole blood between 1987 and 2018. Analyses were conducted using conditional logistic regression in a self-comparison design, where each donor was compared only to themselves, considering the 30-day risk of 16 outcomes following whole blood donation. Outcomes included cardiac/vascular diseases such as myocardial infarction, unspecified conditions such as fainting, accidents or external causes of injury, and death.

RESULTS

A total of 963,311 donors were included; of whom, 19,670 experienced at least one of the outcomes within 30 days of a blood donation. For fainting and hypotonia, we observed transient 2- to 5-fold risk increases on the day of donation and the subsequent 2-3 days. Importantly, the risk increase for the most pronounced effect corresponded to less than one additional events of fainting per 200,000 blood donations. Risks of all other outcomes were either unaffected or lower than expected right after blood donation.

DISCUSSION

To conclude, we found no evidence of new or unexpected short-term health effects after blood donation and confirmed that risks of hypotension-related events requiring hospital care are present but small.

Whole blood donors' post-donation symptoms diminish quickly but are discouraging: Results from 6-day symptom diaries

BACKGROUND

Whole blood donors may experience post-donation symptoms such as fatigue, dizziness, or headache after blood donation, which could influence donor retention. We aimed to examine post-donation symptoms during 1 week after whole blood donation, investigate donor characteristics associated with symptoms, and evaluate associations between symptoms and donor return.

METHODS

During 1 week, whole blood donors who donated successfully at one of the collection centers in The Netherlands were invited to participate. Three thousand seventy six donors filled in a diary, assessing post-donation symptoms during days 1 to 6 after donation. We used linear mixed models analyses to determine the change in post-donation symptoms after donation for male and female donors separately. Furthermore, we investigated associations between post-donation symptoms and donors' physical characteristics using multivariable regression and determined associations between symptoms and donor return.

RESULTS

Donors reported fatigue as the most common symptom, with approximately 3% of donors experiencing severe problems at the first day after donation. Multiple symptoms improved significantly up to day 3 after whole blood donation. Age, BMI, blood pressure (male donors), and blood volume (female donors) were significantly associated with post-donation symptoms. Donors with less fatigue after whole blood donation were more likely to return for their next donation within 31 days after receiving an invitation.

CONCLUSION

Post-symptoms improve up to 3 days after whole blood donation. Our results may help blood collection centers to identify donors more prone to post-donation symptoms and provide personalized information about the presence and course of post-donation symptoms, possibly increasing donor return rates.

Ethical Issues and Management of Fetal Hemolytic Anemia Caused by Anti-Rh17 in a Multipara with Rare -D- Phenotype

Background

The development of allo-anti-Rh17 (anti-Hr0) in a -D- phenotype whose red blood cells (RBCs) lack CcEe antigens is most likely triggered by transfusion, transplantation, or pregnancy. Gene conversion is the predominating factor in generating RHD-CE-D and RHCE-D-CE hybrids like -D-.

Methods

We report here immunohematological and obstetrical data from 2 of the 5 pregnancies of a 24-year-old woman presenting with the -D- phenotype with anti-Rh17. Blood group typing, antibody screening, antibody differentiation, direct antiglobulin test (DAT), and antibody titers were performed by routine gel technology and tube testing. Additionally, molecular genetic analysis was performed. Fetal surveillance was done by sonographic evaluation of the fetal middle cerebral artery peak systolic velocity (MCA-PSV).

Results

Blood group typing showed O, C-c-D+E-e- and the DAT was negative. DNA sequencing revealed homozygosity for an RHCE-D(3-9)-CE null allele. Anti-Rh17 titers in the fourth pregnancy remained between 1:8 and 1:128, and no signs for a fetal anemia were observed. However, in the fifth pregnancy, the antibody titers increased up to 1:4,096. Signs of moderate fetal anemia were detected and cesarean section was performed at 34 + 6 weeks of gestation. The newborn presented with hemolytic anemia (cord blood hemoglobin [Hb] = 8.5 mg/dL). She received 2 compatible (small) packed RBC concentrates, phototherapy, and intravenous immunoglobulins.

Conclusion

Our case shows that the risk for hemolytic complications increases with the number of pregnancies of sensitized women. Only people who also lack CcEe antigens are compatible as donors. The role of such rare donors as lifesavers, their freedom, and voluntariness conflict with the urgent need for compatible blood.

The central blood volume as measured by thoracic electrical impedance and plasma proANP is not compromised by donation of 900 mL of blood in men

OBJECTIVES

To evaluate whether the donation of 900 mL of blood reduces the central blood volume (CBV) assessed by thoracic electrical impedance (TI) and plasma pro-atrial natriuretic peptide (proANP).

BACKGROUND

Donation of 450 mL of blood carries a 1% risk of a vasovagal reaction. Withdrawal of 900 mL of blood decreases cardiac output; however, the effect on CBV remains unknown.

METHODS/MATERIALS

A randomised, single-blinded, placebo-controlled, crossover design was used, where 21 healthy semi-recumbent men donated 2 × 450 mL blood or were sham-phlebotomised. Changes in CBV were estimated by proANP and TI at 1.5 (TI_1.5 ) and 100 (TI₁₀₀ ) kHz, reflecting extracellular volume and (regional) total body water, respectively, and the index value (IDX; 1/T_1.5 -1/TI₁₀₀ ) was used to estimate changes in intracellular (red cell) volume. Systolic, diastolic and mean arterial blood pressure; heart rate; stroke volume; cardiac output; and systemic vascular resistance were monitored. After completion of the study, 1000 mL of isotonic saline was infused.

RESULTS

Changes (mean% ± SD) in TI_1.5 , TI₁₀₀ and IDX were similar after 450 mL (-0.2 ± 1.6%, 0.0 ± 1.1%, -0.4 ± 10.1%) and 900 mL (0.1 ± 1.6%, 0.2 ± 1.5% and -2.0 ± 15.8%) of blood donation compared to after a sham donation of 450 mL (-0.9 ± 1.2%, -0.5 ± 1.5% and -0.1 ± 6.1%) and 900 mL (-1.2 ± 1.5%, -0.6 ± 1.3% and 0.5 ± 9.9%). In addition, changes in plasma proANP were similar after 450 and 900 mL of blood donation (-0.8 ± 6.7% and -7.6 ± 7.9%) as after sham donations (1.3 ± 7.3% and -4.5 ± 5.6%). Monitoring haemodynamic variables revealed that stroke volume decreased after the donation of 900 mL of blood (-12 ± 12 mL) compared to sham donations.

CONCLUSION

During a 900-mL blood loss in semi-recumbent men, CBV measured by TI and plasma proANP is not affected.

Offering new and returned donors the option to give plasma: implications for donor retention and donor adverse events

BACKGROUND AND OBJECTIVES

In 2018, Australian Red Cross Lifeblood changed its plasmapheresis eligibility criteria to allow donors to donate plasma without the requirement of a prior successful whole blood donation. This study evaluated the impact of this policy change on donor retention and donor safety.

MATERIALS AND METHODS

All donors who had attempted to give their first plasma or whole blood donation from January to June 2018 were included in this retrospective cohort study. Donor characteristics and adverse events were analysed for this index donation, and the cohort was followed for 18 months to analyse time to return, subsequent donation frequency and predictors of return.

RESULTS

Male and younger donors provided a significantly greater proportion of first donation plasma than females and older donors. New donors who gave plasma had the highest rate of donor adverse events, including vasovagal reactions and phlebotomy injuries. Nevertheless, donor retention was not affected, with more new donors returning and at a greater subsequent donation frequency after a plasma donation compared to new donors donating whole blood. First-time plasma donors who had previously donated whole blood, however, had greater and quicker rates of return, and more subsequent donations.

CONCLUSION

Offering new donors the option to give plasma had a positive effect on donor return and subsequent donation frequency. Removing the requirement of a prior whole blood donation is a viable way to increase plasma collections although the combined effect of new donor status and plasmapheresis procedure on adverse event risk needs to be considered.

Frequency and Causes of Deferral among Blood Donors Presenting to Combined Military Hospital Multan

Background & Aim

It is of great importance to carefully choose appropriate donors according to strict eligibility criteria, so as to guarantee an adequate and safe blood supply. The aim of this study was to determine the rate of deferral in blood donors and evaluate the different causes of deferral in Multan.

Materials & Methods

This prospective study was carried out at the Blood Bank of Combined Military Hospital (CMH) Multan. All donors who came for the donation of blood from 1st February to 30th September 2019 were evaluated after taking their consent. The data was analyzed to determine the frequency and causes of deferral using Statistical Package for the Social Sciences (SPSS) version 20.

Results

Among 3348 individuals presenting for blood donation, 433 (12.9%) were deferred (427 males and only six females). The mean age of deferred individuals was 28.96 + 6.42 years. The youngest individual was 18 years, while the eldest one was 51 years of age. Almost 65% of the individuals were less than 30 years of age. The most frequent cause of deferral was low hemoglobin. Anemia was the leading cause of deferral in more than half of the individuals (n = 221). Hepatitis C virus (HCV) infection was the second most frequent cause of deferral, seen in 83 (19.2%), followed by hepatitis B virus (HBV) infection (n = 49, 11.3%), syphilis (n = 36, 8.3%), thrombocytopenia (n = 18, 4.2%), and active infection (n = 14, 3.2%). Other rarer causes included early donation, thrombocytosis, polycythemia, pancytopenia, malaria, allergies, insulin, and tuberculosis.

Conclusion

Deferral for blood donation is a significant problem in Multan and accounts for almost 13% of all prospective blood donors. Our results stress the importance of addressing the problem of anemia which is the most prevalent cause of temporary deferral for blood donation in this region of the world.

Use of red blood cells in Danish intensive care units: A population-based register study

BACKGROUND

Red blood cell (RBC) transfusion is common in the intensive care unit (ICU). Recent trials have shown that a restrictive transfusion strategy is safe in most patients, and recent guidelines recommend such a strategy in most ICU patients. It is unknown if this has translated into a change in clinical practice.

METHODS

We conducted a population-based register study of RBC transfusions in ICUs in the Danish Capital Region between 1st of January 2011 and 31st of December 2016 by linking data from the regional blood bank and the Danish Intensive Care Database. We used crude data and run- and control-charts to analyse changes in the number of RBC transfusions.

RESULTS

We included 27 835 ICU admissions of which 6936 received 40 889 RBC units. The crude use was 36.2 RBC units per one-hundred patient bed-days in 2011 vs 29.8 in 2016. The run-chart analysis did not confirm a change in the total use of RBC units in all ICUs combined, and we observed no change in the proportion of transfused patients or in the use of RBCs among transfused patients. Sensitivity analyses showed decreased use of RBC units in two general ICUs, and a reduced use of RBC units among medical ICU patients.

CONCLUSIONS

In this population-based register study, we did not with certainty observe changes over time in the use of RBC transfusions in all patients in all ICUs in the Danish Capital Region. A reduction in RBC use may have occurred in some general ICUs and in medical ICU patients.

Beyond Description: The Predictive Role of Affect, Memory, and Context in the Decision to Donate or Not Donate Blood

Background

Research on the recruitment and retention of blood donors has typically drawn on a homogeneous set of descriptive theories, viewing the decision to become and remain a donor as the outcome of affectively cold, planned, and rational decision-making by the individual. While this approach provides insight into how our donors think about blood donation, it is limited and has not translated into a suite of effective interventions. In this review, we set out to explore how a broader consideration of the influences on donor decision-making, in terms of affect, memory, and the context in which donation takes place, may yield benefit in the way we approach donor recruitment and retention.

Summary

Drawing on emerging research, we argue for the importance of considering the implications of both the positive and the negative emotions that donors experience and we argue for the importance of directly targeting affect in interventions to recruit nondonors. Next, we focus on the reconstructed nature of memory and the factors that influence what we remember about an event. We discuss how these processes may impact the retention of donors and the potential to intervene to enhance donors' recollections of their experiences. Finally, we discuss how our focus on the individual has led us to neglect the influence of the context in which donation takes place on donor behavior. We argue that the amassing of comprehensive large data sets detailing both the characteristics of the individuals and the context of their giving will ultimately allow for the more effective deployment of resources to improve recruitment and retention.

Key Messages

In suggesting these directions for future research, our want is to move beyond the ways in which we have traditionally described blood donation behavior with the aim of improving our theorizing about donors while improving the translational value of our research.

Donor InSight: characteristics and representativeness of a Dutch cohort study on blood and plasma donors

Background and Objectives

More insight into donor health and behaviour may contribute to more efficient and focused strategies regarding donor care and management. Donor InSight (DIS) is a Dutch cohort study of blood and plasma donors. We aimed to outline the objectives and methods of DIS, describe the cohort, and compare it to the active Dutch donor population.

Materials and Methods

In 2007‐2009 (DIS‐I, n = 31 338) and 2012‐2013 (DIS‐II, 34 826, of whom 22 132 also participated in DIS‐I) questionnaire data on demographics, donation, lifestyle, family composition, health and disease were collected. A second follow‐up (DIS‐III, n = 3046), including donors with differing haemoglobin trajectories, was completed in 2015‐2016. DIS‐III includes data on genetic determinants, iron and red cell indices. Representativeness of the DIS‐I sample for the entire Dutch donor population was assessed by comparing characteristics of both.

Results

Donor InSight was initially set up because of a need for more detailed information and evidence as a basis for decision‐making in blood banks. DIS‐I sample is comparable to the total Dutch donor population in terms of age, body mass index, haemoglobin level, blood pressure, blood type and donation behaviour.

Conclusion

Donor InSight is a cohort study representative of the Dutch donor population. It provides evidence to support evidence‐based decision making.

Blood Product Administration in the Critical Care and Perioperative Settings

The critical care and perioperative settings are high consumers of blood products, with multiple units and different products often given to an individual patient. The recommendation of this review is always to consider the risks and benefits for a specific blood product for a specific patient in a specific clinical setting. Optimize patient status by treating anemia and preventing the need for red blood cell transfusion. Consider other options for correction of anemia and coagulation disorders and use an imperative non-overtransfusion policy for all blood products.

Associations of health status with subsequent blood donor behavior-An alternative perspective on the Healthy Donor Effect from Donor InSight

INTRODUCTION

In donor health research, the 'Healthy Donor Effect' (HDE) often biases study results and hampers their interpretation. This refers to the fact that donors are a selected 'healthier' subset of a population due to both donor selection procedures and self-selection. Donors with long versus short donor careers, or with high versus low donation intensities are often compared to avoid this HDE, but underlying health differences might also cause these differences in behaviour. Our aim was to estimate to what extent a donor´s perceived health status associates with donation cessation and intensity.

METHODS

All active whole blood donors participating in Donor InSight (2007-2009; 11,107 male; 12,616 female) were included in this prospective cohort study. We performed Cox survival and Poisson regression analyses to assess whether self-reported health status, medication use, disease diagnosed by a physician and recently having consulted a general practitioner (GP) or specialist were associated with (time to) donation cessation and donation intensity.

RESULTS

At the end of 2013, 44% of the donors in this study had stopped donating. Donors in self-rated good health had a 15% lower risk to stop donating compared to donors in perceived poorer health. Medication use, disease diagnoses and consulting a GP were associated with a 20-40% increased risk to stop donating and a lower donation intensity, when adjusting for age, number of donations and new donor status. Both men and women reporting good health made on average 10% more donations.

CONCLUSION

Donors with a "good" health status were less likely to stop donating blood and tended to donate blood more often than donors with perceived poorer health status. This implies that the HDE is an important source of selection bias in studies on donor health and this includes studies where comparisons within donors are made. This HDE should be adjusted for appropriately when assessing health effects of donation and donors' health status may provide estimates of future donation behavior.

Retrospective analysis of capillary hemoglobin recovery in nearly 1 200 000 blood donor returns

Measuring the concentration of capillary hemoglobin (cHb) is a standard procedure before blood donation. To further assess the time period needed for cHb recovery after blood donation and to have a more in-depth understanding of features of recovery, we used data-mining tools in a large, retrospective data pool containing all 1 163 524 donor returns that took place in Finland in 2010 to 2015. The results show that the average recovery times for cHb to return back to the level preceding donation were substantially longer, over 200 days in all age groups, than were the minimum allowed donation intervals. cHb recovery was especially poor in women under the age of 30 who returned to donate soon after the minimum allowed donation interval. It was of interest that frequent donors recovered substantially faster, with the average recovery times of ∼100 days in men and ∼200 days in women, than did infrequent donors, suggesting that there is a subpopulation of donors who can donate frequently without fear of iron deficiency. Return interval in fact explained only 1% of the variation in cHb recovery, which points to unknown, individual features, such as genetic or lifestyle factors, warranting further studies and suggesting that simply extending the allowed donation intervals may not suffice to improve cHb recovery. The study demonstrates that data mining of blood bank records is a powerful tool for depicting features of blood donor population.

No association between frequent apheresis donation and risk of fractures: a retrospective cohort analysis from Sweden

BACKGROUND

Citrate anticoagulation during apheresis induces transient alterations in calcium homeostasis. It is unknown whether the repeated, transient alterations in calcium homeostasis experienced by repeated apheresis donors affects bone turnover to increase fracture risk. Our aim was to investigate the risk of osteoporotic and nonosteoporotic fracture among voluntary, frequent apheresis donors.

STUDY DESIGN AND METHODS

All apheresis donors were identified from the Scandinavian Donations and Transfusions database (SCANDAT2), which includes information on over 1.6 million blood donors from Sweden and Denmark from the years 1968 and 1981, respectively. Only data from Sweden were used for these analyses. Information on fractures was obtained by linking SCANDAT2 to hospital registers. Poisson regression was used to compute incidence rate ratios of fractures in relation to the cumulative number of apheresis donations, both overall and in fixed time windows.

RESULTS

In total, 140,289 apheresis donors (67,970 women and 72,319 men) were identified from the SCANDAT2 database and were followed for up to 23 years. We observed no association between the frequency of apheresis donation and the risk of fracture either in the overall study period or during fixed-length time windows. The incidence rate ratio of fractures in donors who had made 100 or more cumulative apheresis donations was 0.99 (95% confidence interval, 0.92-1.06) compared with donors who had made from 9 to 24 donations. The results were similar in analyses stratified by sex and restricted to postmenopausal women.

CONCLUSIONS

The absence of an association between repeated apheresis donation and fracture risk indicates that apheresis collection is safe with regard to bone health.

One more health benefit of blood donation: reduces acute-phase reactants, oxidants and increases antioxidant capacity

BACKGROUND

One of the most important problems in finding blood donors is the inadequacy of volunteer number. To overcome this problem, one of the solutions we suggest is innovating new health benefits of blood donation. The aim of the present study is to investigate the effects of blood donation on oxidative status markers and acute-phase reactants.

METHODS

A total of 96 healthy volunteers were recruited into the study. Blood samples were withdrawn 5 min before and 24 h after the blood donation. Serum nitric oxide, malondialdehyde levels, and activity of superoxide dismutase and myeloperoxidase were measured spectrophotometrically. Serum levels of high-sensitive C-reactive protein and pentraxin-3 as acute-phase reactants were measured by enzyme-linked immunosorbent assay kits.

RESULTS

We found statistically significant lower pentraxin-3 and high-sensitive C-reactive protein levels and higher superoxide dismutase activity and nitric oxide level 24 h after blood donation in serum of blood donor when compared with before blood donation.

CONCLUSIONS

These findings suggest that blood donation affected oxidative status and acute-phase reactants in donors. Blood donation removes oxidants and decreases oxidative stress by elevating antioxidant enzyme such as superoxide dismutase. This is one more health benefit or reason why we should donate blood. Further large-scale studies should evaluate this mechanism and compare the same effect of wet cupping therapy.

High-dose intravenously administered iron versus orally administered iron in blood donors with iron deficiency: study protocol for a randomised, controlled trial

Background

About 2–3 % of the population participates in blood donation programmes. Each whole blood donation or ten apheresis donations cause a loss of 200–250 mg of iron. As a result, one of the most common risks of regular blood donors is iron deficiency. Although this has been known for decades, in most countries, iron status is currently not assessed or treated in this population. Premenopausal women are particularly affected, as they have lower iron reserves and higher daily requirements. Besides anaemia, iron deficiency may lead to fatigue and impaired cognitive and physical performance. Current iron preparations for intravenous administration are well tolerated and allow for application of large doses up to 1 g in one visit. Our hypothesis is that in blood donors with iron deficiency, intravenously administered iron is more efficient and as safe as oral iron supplementation. Since anaemia is one of the most frequent reasons for permanent or intermittent donor deferral, maintaining an iron-replete donor pool may help to prevent shortages in blood supply and to avoid iron deficiency-related comorbidities.

Methods/design

In this randomised clinical trial we include male and female blood donors aged ≥18 and ≤65 years with a ferritin value of ≤30 ng/ml. Stratified by gender, participants are randomized with a web-based randomisation tool in a 1:1 ratio to either 1 g of intravenously administered ferric carboxymaltose or 10 g of iron fumarate supplements at one to two daily doses of 100 mg each. Eight to 12 weeks after the first visit, iron status, blood count and symptoms are assessed in both groups. The primary endpoint is the difference in transferrin saturation (%) following the intervention between both groups. Secondary endpoints include other parameters of iron metabolism and red blood cell count, the number of patients with drug-related adverse events, and subjective symptoms including those of the restless legs syndrome, quality of life, and fatigue.

Discussion

Iron supplementation administered intravenously in non-anaemic but iron-deficient blood donors could represent an effective strategy to protect blood donors from comorbidities related with iron deficiency and therefore improve blood donor wellbeing. Furthermore, iron supplementation will help to maintain an iron-replete blood donor pool.

Trial registration

EudraCT: 2013-000327-14, Clinical Trials Identifier: NCT01787526. Registered on 6 February 2013.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1648-y) contains supplementary material, which is available to authorized users.

The International Haemovigilance Network Database for the Surveillance of Adverse Reactions and Events in Donors and Recipients of Blood Components: technical issues and results

BACKGROUND AND OBJECTIVES

The International Haemovigilance Network's ISTARE is an online database for surveillance of all adverse reactions (ARs) and adverse events (AEs) associated with donation of blood and transfusion of blood components, irrespective of severity or the harm caused. ISTARE aims to unify the collection and sharing of information with a view to harmonizing best practices for haemovigilance systems around the world.

MATERIALS AND METHODS

Adverse reactionss and adverse events are recorded by blood component, type of reaction, severity and imputability to transfusion, using internationally agreed standard definitions.

RESULTS

From 2006 to 2012, 125 national sets of annual aggregated data were received from 25 countries, covering 132.8 million blood components issued. The incidence of all ARs was 77.5 per 100 000 components issued, of which 25% were severe (19.1 per 100 000). Of 349 deaths (0.26 per 100 000), 58% were due to the three ARs related to the respiratory system: transfusion-associated circulatory overload (TACO, 27%), transfusion-associated acute lung injury (TRALI, 19%) and transfusion-associated dyspnoea (TAD, 12%). Cumulatively, 594 477 donor complications were reported (rate 660 per 100 000), of which 2.9% were severe.

CONCLUSIONS

ISTARE is a well-established surveillance tool offering important contributions to international efforts to maximize transfusion safety.

Blood donors' physical characteristics are associated with pre- and post-donation symptoms - Donor InSight

BACKGROUND

Observational data suggest that some donors might benefit from donating while others may be harmed. The aim of this study was to investigate the prevalence and potential, routinely measured, determinants of pre- and post-donation symptoms.

MATERIALS AND METHODS

In Donor InSight, questionnaire data from 23,064 whole blood donors (53% female) were linked to routinely measured data on donors' physical characteristics (haemoglobin, blood pressure, body mass index and estimated blood volume) from the Dutch donor database. Absolute and relative associations between donors' physical donor and the presence of pre- and post-donation symptoms were studied using multivariable logistic regression.

RESULTS

Pre-donation symptoms (lack of energy, headaches) were reported by 3% of men and 3% of women. Five percent of men and 4% of women reported positive post-donation symptoms (feeling fit, fewer headaches). Negative symptoms (fatigue, dizziness) were more common, occurring in 8% of men and 19% of women. All the studied donors' physical characteristics were positively associated with pre- and positive post-donation symptoms and negatively associated with negative symptoms. Body mass index was most consistently and independently associated with symptoms.

DISCUSSION

Donors' physical characteristics, in particular body mass index, were consistently associated with pre- and post-donation symptoms. This indicates that subgroups of donors more and less tolerant to donation might be identifiable using routinely measured data. Further research is warranted to study underlying mechanisms and potential strategies to predict and prevent donor reactions.