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Lee AHH, Qi SD, Chiang N. Acute Upper Limb Ischemia Due to Delayed Presentation of a Brachial Artery Pseudoaneurysm Post-Venipuncture. Vasc Endovascular Surg 2019; 54:80-84. [PMID: 31533547 DOI: 10.1177/1538574419877620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brachial artery pseudoaneurysms (BAPs) are rare but could lead to complications of high morbidity. We report a case of a BAP presenting with hand ischemia and median nerve neuropathy nearly a decade after the inciting iatrogenic trauma, successfully treated with excision and direct repair. This report highlights that untreated pseudoaneurysms can be indolent and present late with both symptoms of embolization and local compression.
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Affiliation(s)
- Adele H H Lee
- Department of Vascular and Endovascular Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Vascular and Endovascular Surgery, The Austin Hospital, Melbourne, Victoria, Australia
| | - Sara D Qi
- Department of Vascular and Endovascular Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Vascular and Endovascular Surgery, The Austin Hospital, Melbourne, Victoria, Australia
| | - Nathaniel Chiang
- Department of Vascular and Endovascular Surgery, The Austin Hospital, Melbourne, Victoria, Australia
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Abstract
BACKGROUND Reports on unexpected events (UEs) during blood donation (BD) inadequately consider the role of technical UEs. METHODS Defined local and systemic UEs were graded by severity; technical UEs were not graded. On January 1, 2008, E.B.P.S.-Logistics (EBPS) installed the UE module for plasma management software (PMS). Donor room physicians entered UEs daily into PMS. Medical directors reviewed entries quarterly. EBPS compiled data on donors, donations, and UEs from January 1, 2008 to June 30, 2011. RESULTS 6,605 UEs were observed during 166,650 BDs from 57,622 donors for a corrected incidence of 4.30% (0.66% local, 1.59% systemic, 2.04% technical UEs). 2.96% of BDs were accompanied by one UE and 0.45% by >1 UE (2-4). 6.3% of donors donating blood for their first time, 3.5% of those giving blood for their second time, and 1.9% of donors giving their third or more BD experienced UEs. Most common UEs were: discontinued collections due to venous access problems, repeated venipuncture, and small hematomas. Severe circulatory UEs occurred at a rate of 16 per 100,000 BDs. CONCLUSIONS Technical UEs were common during BD. UEs accompanied first and second donations significantly more often than subsequent donations.
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Diekamp U, Gneißl J, Rabe A, Kießig ST. Donor Hemovigilance during Preparatory Plasmapheresis. Transfus Med Hemother 2014; 41:123-33. [PMID: 24847188 PMCID: PMC4025159 DOI: 10.1159/000357991] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Reports on unexpected donor events (UEs) during preparatory plasmapheresis (PPP) are scarce, and rarely consider technical UEs. METHODS Defined local and systemic UEs were graded by severity; technical UEs were not graded. On January 1, 2008, E.B.P.S.-Logistics (EBPS) installed the UE module for plasma management software (PMS). Donor room physicians entered UEs daily into the PMS. Medical directors reviewed entries quarterly. EBPS compiled data on donors, donations and UEs from January 1, 2008 to June 30, 2011. RESULTS 66,822 UEs were observed during 1,107,846 PPPs for a corrected incidence of 6.55% (1.4% local, 0.55% systemic, 4.6% technical UEs). 3.36% of PPPs were accompanied by 1 UE and 1.18% by >1 UE (2-5). 13.7% of donors undergoing PPP for the first time, 9.7% of those having a second PPP and 4.0% of those having a third or more PPPs were associated with UEs. Most common UEs were repeated venipuncture, and broken-off collection due to venous access problems and small hematomas. Severe systemic UEs occurred at a rate of 36 per 100,000 PPPs. CONCLUSIONS Technical UEs were common with PPP. UEs accompanied first and second donations significantly more frequently than for subsequent donations.
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Amrein K, Valentin A, Lanzer G, Drexler C. Adverse events and safety issues in blood donation--a comprehensive review. Blood Rev 2011; 26:33-42. [PMID: 21996651 DOI: 10.1016/j.blre.2011.09.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Although blood donation is generally safe, a variety of risks and complications exist, the most common being iron deficiency, vasovagal reactions and citrate-related events. In the last decades, extensive efforts have significantly improved recipient and product safety, but there is still great potential to optimise donor care. Many therapies in modern medicine depend on the prompt availability of blood products, therefore it is crucial to maintain a motivated and healthy donor pool in view of a limited number of healthy volunteers willing and able to give blood or blood components. We present a comprehensive review on adverse events addressing all types of blood donation including whole blood, plasma, platelet, peripheral blood stem cell, leucocyte and bone marrow donation. In addition, we outline strategies for the prevention and treatment of these events and give a blueprint for future research in this field.
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Affiliation(s)
- Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Auenbruggerplatz 15, 8036 Graz, Austria.
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Abstract
PURPOSE OF REVIEW This review focuses on the common and uncommon adverse events that occur during or after whole-blood donation. The incidence of seeking outside medical care for an adverse event is at least 1 in 3400 blood donations. Physicians may encounter blood donors with adverse events and should be familiar with their prognosis and treatment. RECENT FINDINGS There are 15 million whole-blood donations per year in the United States, and one third of the donors develop one or more adverse events. A recent study defined the common complications based on a postdonation interview as bruise (23%), sore arm (10%), fatigue (80/%), and vasovagal reaction (7%). A 2003 American Red Cross national donor complication database from 7,000,000 whole-blood donations classified reported donor complications and the incidence of outside medical care. Descriptive studies have been published on vasovagal syncopal reactions, antecubital nerve injuries (irritations), and arterial punctures, and the medical outcomes for these entities have been more precisely defined. The effect of blood donor adverse events on donor retention rates is a new area that is just beginning to be studied. SUMMARY The incidence of complications and types of complications is more precisely defined today. Medical outcomes are better defined for vasovagal reactions, nerve injuries (irritations), and arterial puncture. These data should help physicians who encounter these entities.
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Affiliation(s)
- Bruce H Newman
- American Red Cross, Services, Southeastern Michigan Region, Detroit, MI 48201, USA.
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Abstract
BACKGROUND Up to 36 percent of blood donors may experience a donation-related complication. Fatigue, bruises, hematomas, and vasovagal reactions comprise the great majority of donor reactions and injuries. Serious complications are rare. CASE REPORT A 20-year-old female taking the third-generation oral contraceptive desogestrel/ethinyl estradiol and ethinyl estradiol (Mircette) developed bruising and increased pain and swelling of her right arm over a 5-day period after whole-blood donation. She was a first-time donor and the venipuncture was reported as being mildly traumatic. There was no personal or family history of thrombosis. RESULTS Ultrasound examination of her upper extremity revealed the presence of a deep venous thrombosis that required treatment with enoxaparin sodium for 5 days and warfarin for 6 months. Evaluation for thrombophilia was negative. The only risk factor for thrombosis was use of oral contraceptives. CONCLUSION Although serious complications from whole-blood donation are rare, they may occur. Deep venous thrombosis should be considered in a donor presenting with increasing pain and swelling after blood donation.
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Affiliation(s)
- R B Covin
- University of Minnesota Medical School, Department of Laboratory Medicine and Pathology, Minneapolis, USA
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Abstract
BACKGROUND An arterial puncture during whole-blood phlebotomy is a rare event. A series of arterial punctures was evaluated to determine the clinical findings and the incidence of complications. STUDY DESIGN AND METHODS Arterial punctures reported by staff between January 1, 1999, and February 28, 2001, were evaluated. Follow-up interviews were done with the phlebotomy nurses to determine what the clinical findings were and what the incidence of complications was. RESULTS Twelve cases of arterial punctures were identified from 410,000 blood donations (0.0029%; 1/34,000). Eleven cases had a fast blood-flow rate of <4 minutes; 9 units (75%) were bright red; and in 4 cases (33%), the needle was pulsating. One case was diagnosed because the donor developed a brachial artery pseudoaneurysm 3 days after donation. Four hematomas occurred, for an occurence rate of 33 percent (0.35% in the general donor population). There was also an association with newly trained staff. CONCLUSION Fast blood-flow rate is the most common clinical feature after an arterial puncture. Bright red blood is usually, but not always, present, and a pulsating needle is sometimes present. Hematoma is a relatively common complication, and brachial artery pseudoaneurysms are rare, although one case was seen in this study.
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Affiliation(s)
- B H Newman
- American Red Cross Blood Services, Southeastern Michigan Region, Detroit, Michigan 48201, USA.
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Crawford DL, Yuschak JV, McCombs PR. Pseudoaneurysm of the brachial artery from blunt trauma. THE JOURNAL OF TRAUMA 1997; 42:327-9. [PMID: 9042893 DOI: 10.1097/00005373-199702000-00028] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- D L Crawford
- Abington Memorial Hospital, Pennsylvania 19001, USA
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Abstract
In this review of common and uncommon donor reactions and injuries, donation-associated deaths were found to be extremely rare and generally thought to be coincidental; the rate of coincidental deaths was less than what would be expected based on life insurance tables. Vasovagal reactions, hematomas/bruises, and history of irritation or allergic reaction to adhesive tape or skin preparations are observed daily in a busy blood collection center. Syncopal vasovagal reactions sometimes resemble shock, but unlike shock, they reverse themselves and do not cause death. Through good management, a blood donor organization can minimize the incidence of syncope. Accidental arterial venipuncture is very uncommon (1 in 100,000), and donors with arterial punctures do well if pressure is applied for an extended period of time. Rarely, a pseudoaneurysm results, and this requires surgery. AV fistulas and compartment syndromes can also occur, but these are extremely rare; most experienced blood center physicians have never observed a case. Neurologic needle injuries occur approximately once in every 6,300 donations. Although neurologic needle injury complaints are usually received within 10 days of blood donation, 10% of the injured donors may complain weeks to months later. Most donors with needle injuries recover within a month and many within a day or two, but approximately 30% will have a recovery period of greater than 1 month and an occasional case may exceed 6 months. Donors with neurologic needle injuries generally have a full recovery, even when the recovery period may be extended. Thrombophlebitis has a low incidence (1 in 50,000 to 1 in 100,000), and infection at the phlebotomy site is rare. Both are easily treated and have little impact on the donor's health.
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Affiliation(s)
- B H Newman
- American Red Cross Blood Services, Southeastern Michigan Region, Detroit 48201, USA
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