The influence of adverse reactions, subjective distress, and anxiety on retention of first-time blood donors

How anxiety relates to blood donation intention of non-donors: the roles of moral disengagement and mindfulness

Blood donation anxiety is a major psychological obstacle for blood donation. However, it remains unclear what the mechanism underlying the relationship between anxiety and blood donation intention is and what factor(s) will buffer the negative effects of anxiety. Based on social cognitive theory, we theorized a model delineating the mechanism with which blood donation anxiety was related to blood donation intention. Data were collected in a three-wave online survey including 425 individuals and was analyzed using hierarchical multiple regression with SPSS 24.0 software. The results indicated that the negative relationship between blood donation anxiety and blood donation intention was mediated by moral disengagement. Meanwhile, mindfulness was found to play a buffering role in the relationship between blood donation anxiety and moral disengagement as well as the indirect relationship between blood donation anxiety and blood donation intention via moral disengagement. Our findings advanced the understanding of the detrimental consequences of blood donation anxiety and demonstrated that while blood donation anxiety came at a high cost, it can be managed.

Delayed adverse reaction in donors after whole blood donation: Is it a matter of concern?

BACKGROUND

Blood donation has a remarkable safety record and most of the donors have a good experience or only mild symptoms after blood donation were noted. Although even a very low rate of reactions may have gloomy effect diminishing their fondness to donate again. The main aim of our study was to determine the incidence and to analyze how various donor demographic factors tend to be associated with delayed adverse donor reactions (ADR).

MATERIAL AND METHODS

The prospective observational study was conducted in Department of Immuno-hematology and Blood Transfusion of tertiary care hospital. All the whole blood donors, who gave consent to participate in the study were contacted telephonically after 24 hours and day 7 after donation. The donor who couldn't be contacted telephonically, was tried again at an interval of four hours in a day for two consecutive days before declaring the participant to be non-responder.

RESULTS

A total of 2495 (92.4%) blood donors experienced delayed ADRs. The commonest delayed ADRs reported were generalized weakness (24.6%), bruises (24.2%) followed by painful arm (14.5%). Females, first-time blood donors, donors with low BMI and donors engaged in manual labor were more vulnerable to develop any adverse reactions.

CONCLUSION

Blood donors can experience delayed ADRs. It is important to prevent these reactions especially in susceptible donors. Proper awareness and training to the staff was provided to minimize the incidence of ADR.

Adverse Reactions and Complication in Voluntary Blood Donors

Background

Blood transfusion is a process by which blood replacement is performed in the treatment of various diseases with disorders of the number or function of blood cells or after bleeding. Blood helps save human lives and treat various diseases. Blood and blood products for the treatment of patients are prepared from the blood of voluntary donors.

Objective

The aim of this sudy was to examine the frequency of adverse reactions in voluntary blood donors at the Polyclinic for Transfusion at the University Clinical Center Tuzla in the period 01.01.-31.12.2021. and, also, to determining the frequency, is to determine the severity of adverse reactions and the causes that led to them (gender, age, place of donation, whether they are more common during the first or repeated blood donation) as well as the consequences they leave behind.

Methods

Our research includes voluntary blood donors who, in the period from 01.01.2021 until 31.12.2021., donated blood at the Polyclinic for Transfusion at the University Clinical Center Tuzla (UCC Tuzla). All donors have been selected according to earlier set criteria, according to the recommendations of the World Health Organization and the Council of Europe (12,13), involving age (≥18 years), weight (≥55kg), hemoglobin level (≥125g/dl for women, ≥135g/dl for men), hematocrit level (≥38% for women, ≥41g/dl for men), pulse (50-100 /min) and blood pressure (120/80-160/100mmHg). Each donor voluntarily filled out a uniformed questionary that involved data about personal and family history, as well as prior blood donations.

Results

In the Polyclinic for Transfusion UCC Tuzla, a study was conducted about adverse reactions among voluntary blood donors. During 2021 there were 14191 blood donors. From that number of donors, there were 75,4% (107000) fitting donors, while those who have been returned because they haven't satisfied donating criteria were 24,6% (3487). From the number of those who have donated blood (10700), negative reactions appeared in 1,8% (195) blood donors. Figure 1 shows adverse reactions in relation to the number of blood donations and gender. When it comes to gender, adverse reactions were recorded in 75,9% (148) male donors and 24,1% (47) female donors concering the total number of donors with adverse reactions. Our research showed that the prevalence of adverse reactions in voluntary blood donors is relatively low (1.8%). The adverse reactions are the result of vasovagal reactions, and most often occur in younger people (18 to 30 years old) in 55.9% of donors.

Conclusion

Considering the low percentage of adverse reactions in relation to the total number of blood donors, and that they are mostly mild in intensity, it can be concluded that donating blood is safe process, and doesn't leave lasting consequences for the blood donor's health, and every donor returns to daily activities very quickly.

Evaluation of Work Quality Indicators in Medical Biochemical Laboratories

Background

A laboratory professional concerned with the quality of work in medical-biochemical laboratories ensures the accuracy and precision of laboratory analyses through the implementation of international and European guidelines for working with hazardous substances, through the availability and implementation of Standard Operating Procedures (SOPs). Laboratory hazards that affect the concentration and safety of workers arise from laboratory deficiencies such as: lack of preventive measures, knowledge and skills implemented through SOPs and good laboratory practice. Biophysical hazards in medical laboratories are manifested by needles and sharp objects, infectious materials, noise, vibration, radiation, poor air quality, temperature inversions.

Objective

Aim of the research was to raise awareness of the quality of work in medical-biochemical laboratories in order to ensure the safety of workers.

Methods

A cross-sectional questionnaire-based study was conducted among 100 laboratory proffesionals from Bosnia and Herzegovina and Croatia. The research was conducted over a period of three months.

Results

A higher percentage of exposure to infectious agents and needles and sharp objects was found among respondents from BiH compared to CRO (p=0.018 and p=0.001, respectively).We found that respondents employed in accredited laboratories are aware of exposure to hazards in a high percentage related to infectious agents, toxins (p=0.0012 and p=0.0046, respectively). A significant statistical difference was found between respondents with BiH and respondents with CRO in terms of knowledge of accreditation standards of medical-biochemical laboratories (p=0.0155). Respondents who have standard operating procedures available are aware of the hazards of infectious agents (p=0.0001), toxins (p=0.0466), needles and sharp objects (p=0.0052), noise (p=0.0030), vibration (p=0.0007) and extreme temperatures (p=0.0014).

Conclusion

Efficient implementation and continuous compliance with the ISO 15189:2018 standard requires constant commitment and active participation of laboratory staff. Laboratories must have standard operating procedures in place and actively monitor their use.

Self-ignored onsite adverse donor reaction among whole blood donors: A single center experience from India

OBJECTIVES

Adverse donor reactions (ADR) may often go unreported due to donor related or blood center related factors. Possible donor related factors are self-ignorance of the adverse reaction, inertia to notify blood centre and non-compliance to follow-up. A better understanding of the self-ignored adverse donor reaction (SIADR) helps in early detection, avoidance of complications, adoption of mitigation strategies, and retention of donors. In the current study, we aim to identify the incidence and reasons for onsite SIADR among whole blood donors.

MATERIALS AND METHODS

Prospective single-center observational study where 501 participants who completed whole blood donation were recruited. They were interviewed twice by an experienced investigator to identify any onsite SIADR occurred. First interview was conducted just before leaving the premise and second two days after donation using a peer reviewed and validated questionnaire. Cross-tabulation and Chi-square test were used for bivariate analysis.

RESULTS

Twelve participants out of 501 (2.39%) were found to have onsite SIADR which was twice the frequency of reported onsite ADR (1.20%) during the study period in our center. A majority (75%) of them experienced grade I vaso-vagal reactions (VVR). Around 58.3% of the SIADR donors ignored the reaction as they perceived it as mild, while 25% perceived the symptoms but failed to interpret them as a reaction.

CONCLUSION

In our center, incidence of onsite SIADR was double the incidence of ADR and majority were VVR grade I. Commonest reason for SIADR was interpretation of reaction as mild. Blood center team shall be proactive and vigilant to identify and report SIADR.

An intervention study for the prevention of vasovagal reactions and evaluating donors' experience: Analysis of donors' return for subsequent donation

BACKGROUND AND OBJECTIVES

The EPISoDe (Experience Success in Donation) study investigated the effect of interventions on self-reported vasovagal reactions (VVRs) in first-time and novice (second to fourth donation) whole blood donors aged ≤30 years, demonstrating a 23% reduction of VVR from water drinking shortly before donation in the novice donors. Because donation experience and complications affect donor retention, we analysed intervention group donors' return for subsequent donation, a predefined secondary outcome.

MATERIALS AND METHODS

The interventions were as follows: 330 ml water, 500 ml water, ball squeezing before phlebotomy (placebo) and a control group. All donors received an online questionnaire about their experience within a week after donation. In the Netherlands, eligible donors are invited at least yearly depending on hospitals' needs. We analysed attendances within 421 days through return percentages and binomial logistic regression.

RESULTS

Of the 8300 EPISoDe participants, 6538 (78.8%) returned within 421 days. Return did not differ between the two water groups, whereas odds for return were significantly higher in both water and placebo intervention donors compared to the control group (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.00-1.29 and 1.22, 1.05-1.43, respectively) after adjustment for occurrence of VVR, unsuccessful collection, gender and donation history. Staff-recorded or self-reported VVR at index donation was associated with reduced odds for return (OR 0.47, 95% CI 0.37-0.60 and OR 0.53, 95% CI 0.46-0.61, respectively).

CONCLUSION

In this cohort of younger inexperienced blood donors, 78.8% returned for subsequent donation. Donors who received an active study intervention, either water or placebo, were more likely to return than control group donors.

Effects of message framing on recruiting Rh-D-negative blood donors in an emergency situation: Two randomized trials

OBJECTIVES

Prospect theory categorizes message framing according to whether it emphasizes a possible loss or a possible gain. Promotions of blood donation worldwide mainly focus on gain-framed appeal. The objective of the current study is to examine the effects of message framing on recruiting Rh-D-negative blood donors (RDNBDs) in an emergency situation.

DESIGN

Two randomized trials.

METHODS

In Study 1, 813 group O and 500 group B RDNBDs were randomly assigned to three groups receiving three different recruitment text messages: (1) gain-framed, (2) loss-framed, and (3) information messages. In addition, 613 group A and 148 group AB RDNBDs were marked as (4) no message group. In Study 2, 758 RDNBDs were randomly provided one of two versions of materials focusing on either the possible survival (gain-framed) or the death (loss-framed) of a Rh-D-negative patient needed a blood transfusion. These participants then completed a questionnaire to examine the possible mechanisms underlying the observed effects.

RESULTS

Compared to not receiving any message, significantly more RDNBDs re-donated within 14 days after they received a loss-framed message. Study 2 found that RDNBDs who read the loss-framed material expressed more willingness to donate immediately than those who read the gain-framed material. RDNBDs with high-risk perception expressed a greater blood donation intention in the loss-framed group. The loss-framed message made participants perceive others' needs more strongly, which generated more empathy, and thus increased blood donation intention.

CONCLUSIONS

The results suggested that recruiting RDNBDs using a loss-framed message is suitable under an emergency.

The Impact of Temporal Trajectories of Emotional Experience on Blood Donor Return

BACKGROUND

Despite recognition that blood donation is an affectively poignant process, many aspects of donors' emotional experiences and their consequences remain unexamined.

PURPOSE

This study tracked the donor's experience of several positive and negative emotions live as they arose during the donation process and tracked the impact of that experience on donor return.

METHODS

New whole blood donors (N = 414) reported their experience of 10 positive and 10 negative discrete emotions before, during, and after donation. Return behavior of these donors and a business-as-usual control group was tracked over the next 6 months.

RESULTS

In total, 46.4% of participants and 43.2% of the control group returned to donate within 6 months. On the basis of established relevance to blood donation and statistical considerations, group-based latent trajectories of three emotions (joy, calm, and stress) were modeled over time, revealing five classes of emotion trajectories. A trajectory of low/increasing joy and calm and high/decreasing stress was associated with significantly lower probability of return (preturn = .28, 95% confidence interval [CI] = 0.20, 0.38) relative to all but one other trajectory group and the control group. A trajectory of medium-high/increasing joy, high calm, and low/decreasing stress was associated with a significantly greater probability of return (preturn = .59, 95% CI = 0.49, 0.69) relative to two other trajectory classes and the control group.

CONCLUSIONS

By identifying blood donors' emotion trajectories over time and the impact of those trajectories on return behavior, this research paves the way for the development of effective emotion-focused interventions to boost retention.

Iron status and self-reported fatigue in blood donors

Fatigue is a reported symptom of iron depletion, but studies in blood donors show no conclusive link. We conducted an observational analysis of data from the STRIDE randomized trial to evaluate association of iron status with self-reported fatigue.

STUDY DESIGN AND METHODS

Three blood centers randomly assigned 692 frequent donors to education or iron supplementation treatments. Biomarkers for iron status were measured during 20 to 24 months of follow-up. A fatigue score was derived from an 11-item questionnaire at baseline and final visits, and associations between iron status and fatigue were assessed.

RESULTS

Final lab and questionnaire data were evaluable from 337 subjects. At baseline, female sex, older age, and anemia were associated with fatigue, but iron status was not. Mean (±SD) fatigue score change was 0.0 (±0.5). Mean (±SD) increase in iron stores was 1.0 (±3.5) mg/kg, but changes in body iron stores were not associated with fatigue score changes (0.01 per mg/kg; 95% CI, -0.01 to 0.02) or with fatigue (RR, 1.01; 95% CI, 0.99 to 1.04). The only factor associated with fatigue score changes was baseline fatigue (0.36; 95% CI, 0.25 to 0.48).

CONCLUSION

Among high-frequency donors, neither iron status at baseline nor changes in iron status predicted fatigue during follow-up, with improvements limited to those with higher levels of baseline fatigue. Assessment of the association between iron and fatigue in blood donors benefits from careful consideration of study design and the study population.

A descriptive phenomenological analysis of the experience of blood donation as a regular donor

Maintaining adequate blood supplies requires the recruitment of a significant number of regular donors. However, research examining the first-hand experience of blood donation from the perspective of regular donors is very limited. This study sought to describe the essential features of this experience from the accounts of 10 regular donors, analysed using Colaizzi's descriptive phenomenological method. Eight essential themes contributed to the fundamental structure of the experience, emphasising issues of blood donor identity, comfortable routine, feeling good helping others and human connectedness and interaction in the donation process. Implications for future research and practice are discussed.

Psychosocial characteristics of blood donors influence their voluntary nonmedical lapse

BACKGROUND

Approximately 10% of Dutch donors lapse yearly. Common reasons are nonvoluntary medical issues (e.g., low hemoglobin), reaching the upper age limit, and voluntary (e.g., own request, nonresponse). Little is known about predictors of voluntary noncompliance (lapses). Psychosocial characteristics have been linked to various health behaviors, including voluntary noncompliance. Hence, we investigated whether psychosocial characteristics, measured before the first donation, similarly predict subsequent voluntary nonmedical lapse.

STUDY DESIGN AND METHODS

New donors (n = 4861) randomly received a blood donation survey between July 2008 and March 2009, before their first appointment at the blood bank. Voluntary lapses included personal reasons, nonresponse to invitations, donor who could not be reached, and no show. Univariate and multivariate Cox regression models of lapse on psychosocial characteristics and confounders (e.g., demographics) were estimated.

RESULTS

Of 2964 donors who took the questionnaire, more than one-third (36.5%) had voluntarily lapsed due to nonmedical reasons by 2016. Univariate regression showed that lapse negatively associated with norms, attitudes, and intentions toward blood donation; self-efficacy; and more donation experience. Lapse positively associated with anxiety. Multivariate Cox models showed that lapse was primarily driven by anxiety and need for information.

CONCLUSION

Certain psychosocial characteristics increase risks of voluntary lapse. Especially donors with higher donation anxiety had increased lapsing risks. They might benefit from extra attention during donation. Donors with more information need or wish about procedure and patients were less likely to lapse, indicating that binding with the blood bank might prevent lapse. Generally, this study showed that donor lapse and donor return are determined by different psychosocial factors not just the reverse of each other.

The fear of needles: A systematic review and meta-analysis

AIMS

The aim of this study was to evaluate the prevalence of needle fear and summarize the characteristics of individuals who exhibit this fear.

BACKGROUND

Injections are among the most common medical procedures, yet fear of needles can result in avoidance of preventive measures and treatment.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE (1966-2017), Embase (1947-2017), PsycINFO (1967-2017), and CINAHL (1961-2017) were searched, with no restrictions by age, gender, race, language, or country.

REVIEW METHODS

The prevalence of needle fear was calculated and restricted maximum likelihood random effects models were used for meta-analysis and meta-regression.

RESULTS

The search yielded 119 original research articles which are included in this review, of which 35 contained sufficient information for meta-analysis. The majority of children exhibited needle fear, while prevalence estimates for needle fear ranged from 20-50% in adolescents and 20-30% in young adults. In general, needle fear decreased with increasing age. Both needle fear and needle phobia were more prevalent in females than males. Avoidance of influenza vaccination because of needle fear occurred in 16% of adult patients, 27% of hospital employees, 18% of workers at long-term care facilities, and 8% of healthcare workers at hospitals. Needle fear was common when undergoing venipuncture, blood donation, and in those with chronic conditions requiring injection.

CONCLUSIONS

Fear of needles is common in patients requiring preventive care and in those undergoing treatment. Greater attention should be directed to interventions which alleviate fear in high-risk groups.

Blood donor show behaviour after an invitation to donate: The influence of collection site factors

BACKGROUND AND OBJECTIVES

Show behaviour after invitation to donate varies considerably across donors. More insight into this variation is important for blood banks in achieving stable stocks. This study examined individual factors determining intended show behaviour. Most importantly, however, this study is the first study to account for variation in donor behaviour across different collection sites.

MATERIALS AND METHODS

We applied a multilevel approach to data from Donor InSight, including 11 889 donors from 257 fixed and mobile collection sites in the Netherlands. The aim of the multilevel models was to account for variance at two levels, that is donors and collection sites. We estimated the likelihood of showing after invitation based on individual predictors, including demographics, donation history and attitude. At the collection site level, we included satisfaction with the blood bank aggregated from individual responses by donors who donate at this site, opening hours and collection site type, that is fixed/mobile.

RESULTS

Most importantly, show behaviour varied considerably across collection sites and depended on characteristics of these sites. Moreover, women, older and more experienced donors had higher odds of showing after invitation than men, younger and less experienced donors. Donors higher on warm glow, self-efficacy and donor identity more likely showed after an invitation. Higher aggregate satisfaction and donating at fixed collection sites increased the odds of show.

CONCLUSION

In addition to individual factors, collection site characteristics are important in explaining variation in donor show behaviour, thus presenting clues for blood bank policies and interventions to improve donor show.

Incidence, predictors and severity of adverse events among whole blood donors

Background

Adverse events have been reported post blood donation. Donors might refrain from donating again due to such events which lowers the blood supply in collection centers.

Aim

This study measured the incidence, predictors and severity of adverse events among donors of a single whole blood unit at one of the largest donation centers in Saudi Arabia.

Methods

A retrospective cohort was conducted in 2015 to investigate the adverse events immediately post donation. Donor characteristics such as age, blood pressure, hemoglobin level, weight and history of donation were described and tested as potential risk predictors. Eligible blood donors were 18,936/24,634 (76.8%).

Results

Incidence of adverse events found 1.1% (208 donors), of which 0.65% had mild symptoms (chills; nausea; pallor; dizziness; nervousness; headache), while 0.45% had severe symptoms (hypotension; convulsions; syncope; respiratory distress; emesis). Multiple logistic regression showed that, the incidence of adverse events was significantly higher among young age donors <30 years RR[95%CI] = 1.58[1.18–2.12], p < 0.002, higher hemoglobin levels RR[95%CI] = 1.30[1.15–1.46], lower weight donors <75kg RR[95%CI] = 1.71[1.29–2.27], p <0.001 and first time donors RR[95%CI] = 2.21[1.64–2.97], p < 0.001 compared to older age donors ≥30, lower hemoglobin levels, heavier weight donors ≥ 75, and previous donors, respectively. More severe adverse events were observed among older and heavier donors, previous donors, lower hemoglobin levels and hypertensive donors but with no statistical significance.

Conclusion

Young blood donors, donors with lower weight and first time donors are at higher risk of contracting adverse events. Higher hemoglobin level is also a potential risk predictor of adverse events post whole blood donation.

Individual, contextual and network characteristics of blood donors and non-donors: a systematic review of recent literature

BACKGROUND

The ageing population and recent migration flows may negatively affect the blood supply in the long term, increasing the importance of targeted recruitment and retention strategies to address donors. This review sought to identify individual, network and contextual characteristics related to blood donor status and behaviour, to systematically discuss differences between study results, and to identify possible factors to target in recruitment and retention efforts.

METHODS

The systematic review was conducted in accordance with a predefined PROSPERO protocol (CRD42016039591). After quality assessments by multiple independent raters, a final set of 66 peer-reviewed papers, published between October 2009 and January 2017, were included for review.

RESULTS

Individual and contextual characteristics of blood donor status and behaviour were categorised into five main lines of research: donor demographics, motivations and barriers, adverse reactions and deferral, contextual factors, and blood centre factors. Results on donor demographics, motivations and barriers, and contextual factors were inconclusive, differing between studies, countries, and sample characteristics. Adverse reactions and deferral were negatively related to blood donor behaviour. Blood centre factors play an important role in donor management, e.g., providing information, reminders, and (non-)monetary rewards. No studies were found on network characteristics of (non-)donors.

DISCUSSION

Although individual and contextual characteristics strongly relate to blood donor status and behaviour, mechanisms underlying these relations have not been studied sufficiently. We want to stress the importance of longitudinal studies in donor behaviour, exploring the role of life events and network characteristics within blood donor careers. Increased understanding of donor behaviour will assist policy makers of blood collection agencies, with the ultimate goal of safeguarding a sufficient and matching blood supply.

How to reverse first time donors to become regular donors? A questionnaire survey in Estonia

BACKGROUND

Donating blood in Estonia is non-remunerated and voluntary. Estonian Blood Service system has four independent regional blood centres that are responsible for blood collection, processing, screening and distribution of blood components to hospitals for clinical use.

STUDY DESIGN

This research was carried out as a questionnaire survey. A questionnaire was developed to study lapsing first time donors' (FTD) blood donation experience, intention and willingness to donate again.

METHODS

A thousand five hundred and forty-six questionnaires were posted to donors who had one successful donation in 2010 and who had not returned to second donation till the year 2012. For data analysis routine statistical methods were used. To evaluate the most appropriate number of classes, based on previous experience and future expectations, latent class analysis was used.

RESULTS

There were 453 respondents (29.3%). For the majority of aspects of blood donation experience the emotions were positive. Results of the study suggested that blood collection agencies should intervene to bolster donors' attitudes, perceived control, and identity as a donor during this crucial post-first donation period.

CONCLUSION

First blood donation seems to have been a positive experience. Reasons leading to stopping blood donation should be studied further. Establishing a donor registry for Estonia would be essential to keep track of donors.

Negative experiences and pre-donation blood pressure: the role of attitude and anxiety

BACKGROUND/OBJECTIVES

Negative experiences (NEs) have been shown to result in an increased stress response, as indicated by blood pressure, at the subsequent donation. This response might be influenced by how the donor rates the donation in terms of importance and pleasantness [affective attitude (AA)/cognitive attitude (CA)] or by anxiety about donating blood. We investigated the effect of AA/CA/anxiety on the impact of NEs on pre-donation blood pressure (pd-BP) in the subsequent donation.

MATERIALS/METHODS

pd-BP at visit 3 was compared between donors with and without a history of NEs during or after their first two visits (visit 1: medical check, visit 2: first donation). The effect of AA/CA/anxiety (measured 1 month prior to visit 1 on a 7-point scale) on visit 3 pd-BP was explored using linear regression and interaction analyses. Analyses were stratified for gender, age and pd-BP at visit 1, which were taken into account as confounders.

RESULTS

In 1106 first-time blood donors (70% female), 632 donors (57% of total) indicated an NE at their first donation. Mean scores for AA/CA/anxiety were 5·2/6·5/2·2 (men without NE), 4·8/6·3/3·0 (men with NE), 5·2/6·6/2·6 (women without NE) and 4·8/6·6/3·2 (women with NE). No significant associations were found for NE and pd-BP at visit 3 after adjusting for confounding. Of 48 interaction effects, four were significant, but effects were small and inconsistent.

CONCLUSION

In donors who had had negative experiences during their first donation, anxiety and attitude to donation did not influence their pre-donation blood pressure at their subsequent visit.

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.

Adverse events and retention of donors of double red cell units by apheresis

BACKGROUND

Safety of double-erythrocyte (2RBC) collection and reasons for ceasing 2RBC donation were retrospectively analysed in the blood donor population of Basel, Switzerland.

METHODS

Donors with at least 1 2RBC apheresis were included in the study. Minimal requirements were Hb ≥140 g/L and body weight ≥70 kg; serum ferritin (SF) values were measured routinely, but were not part of the selection criteria. 2RBC collections were performed with ALYX devices at 6-month intervals. Adverse events (AEs) were systematically recorded and classified according to the ISBT EHN 2008 criteria. Data of procedures were retrieved from the ALYX software. Demographics, apheresis data and AEs were analysed with descriptive statistics.

RESULTS

Data of 4,377 2RBC aphereses performed in 793 donors (779 males) between 1(st) January 2003 and 31(st) May 2015 were evaluated. Mean donor age at first 2RBC donation was 44 years (standard deviation [SD] 21), median number of donations was 4 (interquartile range [IQR] 8); 32% of the donors underwent a single procedure. There were 161 AEs, mostly local haematomas (55%) and vasovagal reactions (20%); fatigue was reported in 6% of the cases and was more frequent than citrate toxicity. Two severe AEs were observed. The most frequent reasons for abandoning 2RBC donation were low SF levels and donor choice (both 11%), but most donors simply did not reply to invitations (16%). Overall, procedure-related causes (AEs, low SF levels, no time for apheresis, inadequate venous access) were observed in 14% of the cases. At the end of the observation period, 40% of the donors were still active blood donors, but only 20% were donating 2RBC.

DISCUSSION

2RBC donation is overall safe. Donor retention was low over a period of 11 years. An important reason for abandoning 2RBC was the detection of low SF levels. The impact of fatigue on donor retention and the course of iron stores after repeated 6-monthly 2RBC apheresis require further investigation.

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

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

Blood donor selection in European Union directives: room for improvement

BACKGROUND

Transfusion-transmissible infections have made both blood bankers and health authorities overly cautious. The general public expects and hence reinforces this policy. To obtain a high level of blood product safety, blood and plasma donors have to meet increasingly stringent eligibility criteria; however, it is not known whether this policy translates into improved outcomes for patients. There is a risk that the management of donors does not match the ambition of greater safety for patients. European directives related to the collection process and donor selection will probably be reconsidered in the next few years.

MATERIAL AND METHODS

The development of European directives on donor selection and their basis in the literature were reviewed with an emphasis on the background and considerations for eligibility criteria to be included in the directives.

RESULTS

The precautionary principle appears to be the predominant reason behind the set of eligibility criteria. However, the formal eligibility criteria, put into force in 2004, do not balance with the developments of the past decade in laboratory tests and measures that have substantially reduced actual infection risks. In no cases were the effects of eligibility criteria on the donor pool and donor well-being quantified. Regional differences in the epidemiology of transfusion-transmissible infections were not taken into consideration either.

DISCUSSION

First, the Authors promote the collection of epidemiological data on the incidence and prevalence of conditions in the general population and in blood and plasma donors which could pose a risk for transfused patients, in order to use these data as a basis for decision-making in donor-selection policies. Second, the Authors suggest including allowance for differential deferral criteria throughout Europe, based on factual risk levels. There should be an accepted balance between donor and patient welfare, and also between risk to transfusion safety and risk of compromising the blood supply.

Translation into Portuguese and validation of the Blood Donation Reactions Inventory

Background

the Blood Donation Reactions Inventory (BDRI) scale was proposed as part of a study about the predictors of psychological reactions in volunteer blood donors, as uncomfortable reactions are associated with a lower probability to return for further donations.

Objective

to translate the Inventory into Brazilian Portuguese and evaluate its psychometric properties (validity and reliability). The inventory has 11 items, but the literature suggests that shorter inventories, of four or six items, should be used.

Methods

this study was carried out at the blood center of Franca, Brazil. Three people with knowledge of English and familiarity with medical terms translated the Blood. Donation Reactions Inventory into Brazilian Portuguese. Aiming to evaluate the objectivity and relevance of the items of the translated instrument, its content was independently evaluated by a panel of eight assessors. After this, data on 1,001 blood donors was collected. Internal consistency was assessed by Cronbach’s alpha coefficient. An exploratory factor analysis with varimax rotation was used to analyze the measure for construct validity.

Results

the sample consisted of 65.8% men, and 27.3% first time donors. Internal consistency determined by Cronbach’s alpha coefficient was satisfactory for the 11, 6 and 4-item scales. Considering the factor analysis, the 11-item scale seems to measure more than one construct as three factors were identified with eigenvalues greater than 1. These factors correspond to ‘vasovagal adverse reactions’, ‘fear’ ‘anxiety/excitation’.

Conclusion

the Portuguese version of the Blood Donation Reactions Inventory is a valid and reliable instrument for collecting information regarding systemic reactions experienced by blood donors. The 6-item scale seems to be useful when the objective is to measure only vasovagal adverse reactions.

© 2014 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. All rights reserved.

Blood donor iron status: are we bleeding them dry?

PURPOSE OF REVIEW

This review examines the recent research on the prevalence, determinants and importance of low iron in blood donors, and on the efforts to reduce or prevent iron depletion in donor populations.

RECENT FINDINGS

Female donors, especially younger women, are at highest risk for donation-induced low iron, but menopausal women and high-frequency donors of both sexes also face considerable risk for iron depletion. Predonation screening for hemoglobin contributes little information on donor iron status. Consumption of supplemental iron is helpful in preventing or reversing low iron, and waiting longer between donations also facilitates the recovery of the iron lost through donation.

SUMMARY

Although the impact of phlebotomy-related iron depletion on donor health requires better documentation, measures are available now that can be deployed on a targeted or standardized basis. Blood centers, regulators, and donors should continue to evaluate different approaches for addressing this problem, with the likely outcome that no single measure is optimal for maintaining adequate collections while safeguarding donor health.