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Williams EL, Khan FM, Claydon VE. Counter pressure maneuvers for syncope prevention: A semi-systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:1016420. [PMID: 36312294 PMCID: PMC9606335 DOI: 10.3389/fcvm.2022.1016420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/20/2022] [Indexed: 11/24/2022] Open
Abstract
Physical counter pressure maneuvers (CPM) are movements that are recommended to delay or prevent syncope (fainting) by recruiting the skeletal muscle pump to augment cardiovascular control. However, these recommendations are largely based on theoretical benefit, with limited data evaluating the efficacy of CPM to prevent syncope in the real-world setting. We conducted a semi-systematic literature review and meta-analysis to assess CPM efficacy, identify literature gaps, and highlight future research needs. Articles were identified through a literature search (PubMed, April 2022) of peer-reviewed publications evaluating the use of counter pressure or other lower body maneuvers to prevent syncope. Two team members independently screened records for inclusion and extracted data. From 476 unique records identified by the search, 45 met inclusion criteria. Articles considered various syncopal conditions (vasovagal = 12, orthostatic hypotension = 8, postural orthostatic tachycardia syndrome = 1, familial dysautonomia = 2, spinal cord injury = 1, blood donation = 10, healthy controls = 11). Maneuvers assessed included hand gripping, leg fidgeting, stepping, tiptoeing, marching, calf raises, postural sway, tensing (upper, lower, whole body), leg crossing, squatting, “crash” position, and bending foreword. CPM were assessed in laboratory-based studies (N = 28), the community setting (N = 4), both laboratory and community settings (N = 3), and during blood donation (N = 10). CPM improved standing systolic blood pressure (+ 14.8 ± 0.6 mmHg, p < 0.001) and heart rate (+ 1.4 ± 0.5 bpm, p = 0.006), however, responses of total peripheral resistance, stroke volume, or cerebral blood flow were not widely documented. Most patients experienced symptom improvement following CPM use (laboratory: 60 ± 4%, community: 72 ± 9%). The most prominent barrier to employing CPM in daily living was the inability to recognize an impending faint. Patterns of postural sway may also recruit the skeletal muscle pump to enhance cardiovascular control, and its potential as a discrete, proactive CPM needs further evaluation. Physical CPM were successful in improving syncopal symptoms and producing cardiovascular responses that may bolster against syncope; however, practical limitations may restrict applicability for use in daily living.
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2
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Wang C, Chen L, Sun C, Zhang Y, Cao C, Ma Y, Shi W. Prevention of Blood Donation-related Vasovagal Response by Applied Muscle Tension: a Meta-analysis. J Int Med Res 2022; 50:3000605221121958. [PMID: 36127814 PMCID: PMC9500294 DOI: 10.1177/03000605221121958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Vasovagal reaction (VVR) is an adverse reaction to blood donation. Applied
muscle tension (AMT) has been reported to reduce the probability of VVR
during blood donation; however, the results have been controversial. We
therefore conducted a meta-analysis to systematically evaluate the effect of
AMT in reducing VVR. Methods We searched six major databases using “applied muscle tension” and “blood
donation-related vasovagal response” as keywords. Relevant articles
published in English or Chinese between 1 January 2000 and 30 June 2021 were
included in the analysis. The quality of the included articles was evaluated
and publication bias was assessed by forest and funnel plots and by Egger's
test. Results Fifty-one articles were identified, of which six were included according to
the pre-defined inclusion and exclusion criteria. A fixed-effects model was
adopted for effect size combination and revealed a relative risk of 0.52
(95% confidence interval 0.40 to 0.67). The AMT group was superior to the
control in terms of VVR prevention. A funnel plot and Egger's test suggested
that the findings were accurate and reliable with low publication bias. Conclusion AMT could effectively reduce VVR during blood donation. Further multicenter
studies with large sample sizes are needed to confirm these results.
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Affiliation(s)
- Cong Wang
- Hebei Province Blood Center, Shijiazhuang 050011, China
| | - Li Chen
- Hebei Province Blood Center, Shijiazhuang 050011, China
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago 60657, IL, USA
| | - Yan Zhang
- Hebei Province Blood Center, Shijiazhuang 050011, China
| | - Can Cao
- Hebei Province Blood Center, Shijiazhuang 050011, China
| | - Yuanyuan Ma
- Hebei Province Blood Center, Shijiazhuang 050011, China
| | - Wenwen Shi
- Hebei Province Blood Center, Shijiazhuang 050011, China
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Kowalsky JM. Predicting COVID-19 and seasonal influenza vaccine uptake: The impact of fear and vasovagal symptoms. Appl Psychol Health Well Being 2022; 15:293-314. [PMID: 35705510 PMCID: PMC9349497 DOI: 10.1111/aphw.12380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Abstract
Vaccines are vital to protecting health. However, fear and experiencing vasovagal symptoms (e.g., dizziness) are deterrents to medical procedures. Thus, study aims were to test (1) if vaccine relevant fears predict vasovagal symptoms during or following seasonal influenza vaccination and (2) if vaccine relevant fears and vasovagal symptoms predict seasonal influenza and COVID-19 vaccine uptake. Using a prospective design, 1077 participants recruited online completed surveys during Oct 2019 assessing vaccine relevant fears, and May-June 2020 assessing 2019-2020 seasonal influenza vaccine uptake, ratings of vasovagal symptoms, and seasonal influenza and COVID-19 vaccination intention. A behavioral follow up assessing 2020-2021 seasonal influenza and COVID-19 vaccine uptake took place June-July 2021. Heightened vaccine relevant fears predicted reduced 2019-2020 seasonal influenza vaccine uptake and greater vasovagal symptoms among those who did receive a seasonal influenza vaccine. Serial mediation analyses identified significant indirect effects with greater vaccine relevant fears reducing 2020-2021 seasonal influenza vaccine uptake through intention and reducing COVID-19 vaccine uptake through vasovagal symptoms and intention. Intervention research to reduce fear and prevent vasovagal symptoms to support vaccine uptake is warranted.
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Cheung CHY, Khaw ML, Leung WS, Tam SY, Chu CY, Lee CK, Lee SWY. Effects of Performing Applied Muscle Tension during Recovery after Phlebotomy in Young, First-Time Donors: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910541. [PMID: 34639841 PMCID: PMC8508044 DOI: 10.3390/ijerph181910541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/26/2021] [Accepted: 09/29/2021] [Indexed: 12/02/2022]
Abstract
Vasovagal reaction (VVR) compromises donor safety and reduces the subsequent return rates. Performing applied muscle tension (AMT) during phlebotomy may reduce the incidence of VVR. However, the effectiveness of performing AMT after phlebotomy to reduce delayed VVR remains unclear. With ethics approval, 12 young, first-time donors (YFTD) were recruited to study the effects on stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR) while performing AMT from needle insertion to end of recovery. Measurements from 12 matched control YFTD were used for comparison. Pre-donation anxiety and VVR severity were assessed. Compared to controls, donors who performed AMT had higher SV (Control: 57 mL vs. AMT: 69 mL, p = 0.045), higher CO (Control: 3.7 L·min−1 vs. AMT: 5.2 L·min−1, p = 0.006) and lower SVR (Control: 1962 dyn·s·cm−5 vs. AMT: 1569 dyn·s·cm−5, p = 0.032) during mid-phlebotomy. During recovery, the AMT group retained higher SV, higher CO and lower SVR than the control, but not reaching statistical significance. Practicing AMT during recovery resulted in sustained haemodynamic improvements beyond the donation period, despite the reduction in delayed VVR was insignificant compared to the control group. A larger sample size is needed to validate the effectiveness of performing AMT after donation to mitigate delayed VVR.
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Affiliation(s)
- Cara H. Y. Cheung
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China; (C.H.Y.C.); (W.S.L.); (S.Y.T.)
| | - May L. Khaw
- Tasmanian School of Medicine, University of Tasmania, Hobart, TAS 7005, Australia;
| | - Wan Shun Leung
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China; (C.H.Y.C.); (W.S.L.); (S.Y.T.)
| | - Shing Yau Tam
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China; (C.H.Y.C.); (W.S.L.); (S.Y.T.)
| | - Chui Yee Chu
- Blood Collection and Donor Recruitment Department, Hong Kong Red Cross Blood Transfusion Service, HA, Hong Kong, China; (C.Y.C.); (C.K.L.)
| | - Cheuk Kwong Lee
- Blood Collection and Donor Recruitment Department, Hong Kong Red Cross Blood Transfusion Service, HA, Hong Kong, China; (C.Y.C.); (C.K.L.)
| | - Shara W. Y. Lee
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China; (C.H.Y.C.); (W.S.L.); (S.Y.T.)
- Correspondence: ; Tel.: +852-3400-8592
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Near Infrared Spectroscopy in Anemia Detection and Management: A Systematic Review. Transfus Med Rev 2020; 35:22-28. [PMID: 32907764 DOI: 10.1016/j.tmrv.2020.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/19/2020] [Accepted: 07/26/2020] [Indexed: 01/28/2023]
Abstract
Red cell transfusions are intended to improve oxygen delivery to tissues. Although studies comparing hemoglobin concentration triggers for transfusion have been done, the hemoglobin threshold for clinical benefit remains uncertain. Direct measurement of tissue oxygenation with non-invasive near infrared spectroscopy has been proposed as a more physiological transfusion trigger, but its clinical role remains unclear. This systematic review examined the role of near infrared spectroscopy for detection of anemia and guiding transfusion decisions. Abstracts were identified up until May 2019 through searches of PubMed, EMBASE and The Web of Science. There were 69 studies meeting the inclusion criteria, most (n = 65) of which were observational studies. Tissue oxygen saturation had been measured in a wide range of clinical settings, with neonatal intensive care (n = 26) and trauma (n = 7) being most common. Correlations with hemoglobin concentration and tissue oxygenation were noted and there were correlations between changes in red cell mass and changes in tissue oxygenation through blood loss or transfusion. The value of tissue oxygenation for predicting transfusion was determined in only four studies, all using muscle oxygen saturation in the adult trauma setting. The overall sensitivity was low at 34% (27%-42%) and while it had better specificity at 78% (74%-82%), differing and retrospective approaches create a high level of uncertainty with respect to these conclusions. There were four prospective randomized studies involving 540 patients, in cardiac and neurological surgery and in neonates that compared near infrared spectroscopy to guide transfusion decisions with standard practice. These showed a reduction in the number of red cells transfused per patient (OR: 0.44 [0.09-0.79]), but not the number of patients who received transfusion (OR: 0.71 [0.46-1.10]), and no change in clinical outcomes. Measuring tissue oxygen saturation has potential to help guide transfusion; however, there is a lack of data upon which to recommend widespread implementation into clinical practice. Standardization of measurements is required and greater research into levels at which tissue oxygenation may lead to adverse clinical outcomes would help in the design of future clinical trials.
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Thijsen A, Gemelli CN, Davison TE, O'Donovan J, Bell B, Masser B. Does using applied muscle tension at strategic time points during donation reduce phlebotomist- and donor-reported vasovagal reaction rates? A three-armed randomized controlled trial. Transfusion 2018; 58:2352-2359. [DOI: 10.1111/trf.14940] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Amanda Thijsen
- Clinical Services and Research; Australian Red Cross Blood Service; Sydney Australia
| | - Carley N. Gemelli
- Clinical Services and Research; Australian Red Cross Blood Service; Melbourne Australia
| | - Tanya E. Davison
- Clinical Services and Research; Australian Red Cross Blood Service; Melbourne Australia
| | - Justine O'Donovan
- Clinical Services and Research; Australian Red Cross Blood Service; Sydney Australia
| | - Barbara Bell
- Clinical Services and Research; Australian Red Cross Blood Service; Sydney Australia
| | - Barbara Masser
- Clinical Services and Research; Australian Red Cross Blood Service; Brisbane Australia
- School of Psychology; The University of Queensland; Brisbane Australia
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7
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Effects of respiratory and applied muscle tensing interventions on responses to a simulated blood draw among individuals with high needle fear. J Behav Med 2018; 41:771-783. [PMID: 29679183 DOI: 10.1007/s10865-018-9925-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
Abstract
Fear of blood and needles increases risk for presyncopal symptoms. Applied muscle tension can prevent or attenuate presyncopal symptoms; however, it is not universally effective. This study examined the effects of applied muscle tension, a respiratory intervention, and a no treatment control condition, on presyncopal symptoms and cerebral oxygenation, during a simulated blood draw with individuals highly fearful of needles. Participants (n = 95) completed questionnaires, physiological monitoring, and two trials of a simulated blood draw with recovery. Presyncopal symptoms decreased across trials; however, no group differences emerged. Applied muscle tension was associated with greater cerebral oxygenation during trial two, and greater end-tidal carbon dioxide during both trials. The respiratory intervention did not differ from the no treatment control. Applied muscle tension is an intervention that can increase cerebral oxygenation and end-tidal carbon dioxide. While the respiratory intervention is promising within therapeutic settings, it was not efficacious after a brief audio training.
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Morand C, Coudurier N, Rolland C, Thoret S, Legrand D, Tiberghien P, Bosson JL. Prevention of syncopal-type reactions after whole blood donation: a cluster-randomized trial assessing hydration and muscle tension exercise. Transfusion 2016; 56:2412-2421. [DOI: 10.1111/trf.13716] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Sophie Thoret
- TIMC-IMAG Université Grenoble Alpes
- INSERM CIC-1406; Grenoble France
| | | | - Pierre Tiberghien
- UMR1098, INSERM, Etablissement Français du Sang, University of Franche-Comté; Besançon France
| | - Jean-Luc Bosson
- TIMC-IMAG Université Grenoble Alpes
- INSERM CIC-1406; Grenoble France
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9
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Fisher SA, Allen D, Dorée C, Naylor J, Di Angelantonio E, Roberts DJ. Interventions to reduce vasovagal reactions in blood donors: a systematic review and meta-analysis. Transfus Med 2016; 26:15-33. [DOI: 10.1111/tme.12275] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/16/2015] [Accepted: 12/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- S. A. Fisher
- Systematic Review Initiative; NHS Blood and Transplant; Oxford UK
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine; University of Oxford; Oxford UK
| | - D. Allen
- Blood Research Group; NHS Blood and Transplant; Oxford UK
| | - C. Dorée
- Systematic Review Initiative; NHS Blood and Transplant; Oxford UK
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine; University of Oxford; Oxford UK
| | - J. Naylor
- Blood Supply; NHS Blood and Transplant; Leeds UK
| | - E. Di Angelantonio
- Department of Public Health and Primary Care; University of Cambridge; Cambridge UK
| | - D. J. Roberts
- Systematic Review Initiative; NHS Blood and Transplant; Oxford UK
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine; University of Oxford; Oxford UK
- Blood Research Group; NHS Blood and Transplant; Oxford UK
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10
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Kowalsky JM, France CR, Wissel ME, Conatser R. Enhancing cerebral oxygenation during blood donation using biofeedback. Clin Auton Res 2013; 23:339-41. [PMID: 23864480 DOI: 10.1007/s10286-013-0210-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
Abstract
Biofeedback of cerebral oxygenation was used to guide application of applied muscle tension during whole blood donation, and resulted in attenuated reductions compared to donors who did not receive feedback.
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Affiliation(s)
- Jennifer M Kowalsky
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH, 45701-2979, USA
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11
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Ditto B, Gilchrist PT, Holly CD, Dubuc S, Delage G, France CR. The effects of leg crossing and applied tension on blood donor return. Vox Sang 2013; 105:299-304. [DOI: 10.1111/vox.12055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/26/2013] [Accepted: 04/30/2013] [Indexed: 11/29/2022]
Affiliation(s)
- B. Ditto
- Department of Psychology; McGill University; Montreal; QC; Canada
| | - P. T. Gilchrist
- Department of Psychology; McGill University; Montreal; QC; Canada
| | - C. D. Holly
- Department of Psychology; McGill University; Montreal; QC; Canada
| | - S. Dubuc
- Héma-Québec; Montreal; QC; Canada
| | | | - C. R. France
- Department of Psychology; Ohio University; Athens; OH; USA
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12
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France CR, France JL, Wissel ME, Ditto B, Dickert T, Himawan LK. Donor anxiety, needle pain, and syncopal reactions combine to determine retention: a path analysis of two-year donor return data. Transfusion 2013; 53:1992-2000. [PMID: 23305267 DOI: 10.1111/trf.12069] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/08/2012] [Accepted: 11/08/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Efforts to expand the donor pool by recruiting younger donors have resulted in higher numbers of initial donations, but retention of young donors continues to be challenging. STUDY DESIGN AND METHODS Path analysis was used to examine the simultaneous relationships among syncopal reactions, donation anxiety, needle pain, donor satisfaction, and donation intention in predicting repeat donation. Participants included 421 first- and second-time donors recruited for a study comparing the effects of predonation water loading with and without the use of applied muscle tension during donation (52% female, 60.8% first-time donor, mean age 20.3 years). For this longitudinal follow-up study, donor database records were accessed 2 years after the index donation to assess repeat donation. RESULTS Results of a series of path analyses demonstrated the influential role of donor anxiety in shaping donor retention (final model χ(2) = 35.75, root mean square error of approximation 0.03, comparative fit index 0.98, weighted root mean square residual 0.74). First, anxiety exerted a direct negative influence on donation intention, the proximal and sole direct predictor of repeat donation. Second, anxiety increased the likelihood of donor-reported needle pain, adversely affecting donation satisfaction and, subsequently, donation intention. Finally, anxiety was associated with donor ratings of syncopal reactions through its impact on needle pain, which also contributed to decreased donation intention. CONCLUSION These results provide novel evidence that donation anxiety plays a central role in shaping future donation behavior. Individual differences in anxiety must be considered when developing and testing strategies to enhance blood donor retention.
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Affiliation(s)
- Christopher R France
- Ohio University, Athens, Ohio; American Red Cross, Blood Services, Central Ohio Region, Columbus, Ohio; McGill University, Montreal, Quebec, Canada
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14
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Wieling W, France CR, van Dijk N, Kamel H, Thijs RD, Tomasulo P. Physiologic strategies to prevent fainting responses during or after whole blood donation. Transfusion 2011; 51:2727-38. [DOI: 10.1111/j.1537-2995.2011.03202.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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