If I Had a Bad Reaction to Giving Blood Does That Mean I Shouldnt Do It Again

Blood Transfus. 2007 Jul; 5(3): 143–152.

Adverse reactions during voluntary donation of blood and/or claret components. A statistical-epidemiological study

Received 2007 February 13; Accepted 2007 Jun xx.

Abstract

Background

Voluntary donors commonly tolerate blood donation very well, but, occasionally, adverse reactions of variable severity may occur during or at the end of the collection. Aim of this study was to gauge and possibly avoid the crusade of unwanted reactions.

Materials and methods

The study was conducted over a period of 6 months, from 24^thursday October, 2005 to 24^th April 2006. The donor population analysed consisted of 4,906 donors (3,716 male and 1,190 female person). In total, three,983 (81%) voluntaries accept donated whole claret, 851 (17%) plasma from apheresis, 64 (1.three%) experienced multicomponent donation, and viii (0.1%) were donors of plasma-platelet apheresis.

Results

Only 63 donors (ane.2% of all the volunteers) suffered some kind of agin reaction: 59 (1.08% of the subjects) had mild reactions (agitation, sweating, pallor, cold feeling, sense of weakness, nausea), and only 4 (3 males and one female person, 0.2%) had more severe disorders, including vomiting, loss of consciousness, and convulsive syncope.

Conclusions

Although the number of donors who adult disturbances during or at the finish of blood donations was very low, information technology is nevertheless desirable to reduce risks to a minimum. A set of advices is provided for preventing problems.

Keywords: claret donors, claret donations, agin reactions

Introduction

Blood donors normally tolerate the donation very well, but occasionally adverse reactions of variable severity may occur during or at the stop of the collection. The adverse reactions that occur in donors can be divided into local reactions and systemic reactions.

1. Local reactions occur predominantly considering of bug related to venous access. They are usually haematomas due to extravasation from the veins, caused by incorrect placement of the needle during the venipuncture. Pain, hyperaemia and swelling may develop at the site of the extravasation. Other local events include pain due to slight trauma to the subcutaneous nerve endings. In near cases, still, these are banal complications that practise non require any treatment. Local phlebitis and thrombophlebitis are more than serious complications than the foregoing, but are very rare.

2. The systemic reactions, in contrast to the local reactions, can be divided into balmy or astringent. In most cases, they are vasovagal reactions than can be triggered by the hurting of the venipuncture, past the donor seeing his or her own blood, by the donor seeing another donor unwell, by the anxiety and state of tension of undergoing the donation, etc. The systemic reactions are characterised by the appearance of pallor, sweating, dizziness, gastrointestinal disorders, nausea, hypotension, and bradycardia. Therapeutic intervention must be swift, otherwise this clinical picture, typical of a vasovagal reaction, will progress into an episode of syncope, of variable severity, which may or may non be complicated by the onset of tonic-clonic muscle spasms (convulsive syncope), accompanied by vomiting and loss of sphincter control.

Systemic reactions can occur during apheresis procedures, which crave the use of anticoagulants such equally acid-citrate-dextrose (ACD) for the collection of the blood component. This anticoagulant can cause hypocalcaemia, considering of chelation. The lowered concentration of calcium ions leads to episodes of paraesthesia of the lips, oral cavity and limbs. These symptoms resolve after break of the apheresis procedure, although it may sometimes be necessary to utilise a therapeutic intervention, such as the administration of calcium gluconate. Much more rarely, tremor, muscle spasms, hypotension, tachycardia, arrhythmia, convulsions and tetany develop.

There are rare reports of acute intoxication due to overdoses of ACD¹. Another rare complication, that can occur during apheresis procedures, is severe arrhythmias.

The aim of this study was to estimate the frequency and type of adverse events, distinguishing mild disturbances from more severe reactions, and to measure the fourth dimension for the donor to recover a state of well-being. In this way it is possible to monitor and ameliorate the donation clinics and the environmental context. A prepare of rules can exist created to govern the behaviour of the staff and improve the quality of the interventions.

Our survey identified a grouping of donors predisposed to the development of adverse reactions and enabled us to prevent problems in these subjects at subsequent donations.

Materials and methods

The population analysed in this study consisted of iv,906 voluntary claret donors of whom 3,716 (75.74 %) were male person and 1,190 (24.26%) female (male/ female person ratio 3:1). The mean age of the men was 43 years and that of the women 41 years (minimum age eighteen years, maximum historic period 66 years). The donors included were selected for complying with requisites established by current legislation.

The population was farther characterised into three,983 (81%) donors of whole blood, 851 (17%) donors of plasma from apheresis, 64 (i.iii%) multicomponent donors, and viii (0.1%) donors of plasma-platelets from apheresis (Effigy 1). Effigy 2 illustrates the contributions that the 2 sexes gave to the different types of donations. The volunteers were also divided into four,181 periodic donors, 348 occasional donors and 377 new donors (Figure 3).

The percentages of dissimilar types of blood components produced during the period under consideration

The percentages of the different claret components produced, divided co-ordinate to the gender of the donor

The percentages of different types of donor

In order to create the database, a information collection form was designed to tape the parameters analysed in the study. The parameters were recorded in a dichotomous form (present/absent-minded). A statistical-inferential assay was carried out on the data nerveless, to make up one's mind whether there were any significant associations or independent factors.

The statistical analysis of the information, regarding both the descriptive statistics and the inferential analysis, was conducted using the SPSS, Minitab and OpenStat software packages. The various models of statistical analysis used concerned:

1. a contingency analysis of the groups of 'get-go-time donors' and 'periodic donors' against the factors, agitation and sweating;

2. multivariate logistic regression analysis, taking into consideration various factors, to quantify the weight of each of the dissimilar factors such as pallor, sweating, agitation, pain of a difficult venipuncture compared to that of an efficient venipuncture, in the evolution of a vasovagal reaction;

3. multivariate logistic regression analysis, to determine the weight of different factors, such every bit first donation, periodic donation, difficult venipuncture compared to an efficient venipuncture, in the evolution of syncope.

The data collection class had 22 fields, divided into four groups. The first group consisted of: sex activity, age, starting time donation, periodic donation. The 2nd group concerned type of donation: whole blood, plasmapheresis, multicomponent apheresis. The third group consisted of efficient venipuncture and difficult venipuncture. Finally, the fourth group concerned the symptoms felt, past the donor during or after the donation, and consisted of xiii parameters: agitation, pallor, sweating, pins and needles, feeling of weakness, cold sensation, dizziness, nausea, airsickness, loss of consciousness, convulsive syncope, and loss of sphincter control.

In our Transfusion Service, the phlebotomy squad consists of physician who accept the donation (four members of the permanent staff and one temporary doctor) and the nursing staff (six units of staff).

Results

The incidence of vasovagal reactions was very depression, occurring in 0.two % of the total sample. Indeed, amidst the population of 4,906 donors, only 63 suffered some kind of adverse reaction, of a minor or more astringent entity, accounting for 1.2% of all the subjects (Figures iv, ​ five and ​ 6). Among the population of four,906 donors, the statistical probability of some type of adverse reaction was p = one.ii %, a rather low value, considering the large number of subjects forming the statistical sample and the fact that 'adverse reactions' include vasovagal reactions, which are themselves represented by predominantly pocket-size symptoms.

Absolute frequency of mild or severe symptoms, stratified past gender, among the 63 subjects who had some kind of adverse reaction

Absolute frequency of the symptoms occurring in donors during or immediately after the donation

Absolute frequency of symptoms according to the gender of the donors. It can be seen that women develop adverse reactions during donation of blood more rarely than exercise men

The statistical probability of an episode of complete loss of consciousness was equivalent to an incidence of 0.1%, that is, one instance every 1,000 donors. The 63 donors who had some kind of adverse reaction were divided into two groups: the first group consisted of subjects who had mild adverse reactions (agitation, sweating, pallor, dizziness, common cold feeling, sense of weakness, nausea, pins and needles)^{2 , 7 , 9 , 10}; the second grouping consisted of the subjects who had severe adverse reactions (loss of consciousness, convulsive syncope, loss of sphincter control, vomiting)^{2 , 10 – 13}. Only 1.08% of the subjects had mild agin reactions and another 0.2% had more severe disorders, including airsickness, loss of consciousness, loss of sphincter control, and convulsive syncope.

The greatest number of reactions occurred during or afterward donations of whole blood, with there beingness fewer after donations of other claret components. This finding is explained past the greater number of donors, both periodic donors and commencement-time donors, recruited to give whole blood; plasma and other blood components were near always donated by periodic donors. As can be seen from the therapeutic interventions carried out to resolve the clinical film caused past "small symptoms", it was sufficient to put the subject in the Trendelenburg position ('antishock' position) to increase the afterload and thus provide acceptable oxygenation of the brain.

In other circumstances, as well putting the field of study in the antishock position, it was also necessary to administer oral vasopressors (midodrine hydrochloride); fluid supplementation with an infusion of crystalloids was rarely needed (Figure seven). It should exist noted that in no case were colloids necessary to expand the circulatory book and, also, atropine was never necessary to restore the cardiac rhythm or for whatsoever other haemodynamic bug. Indeed, it should be appreciated that information technology is not necessary to use colloids (as clearly demonstrated by the data), since the volume of claret removed during a donation (450 mL ± 10% of claret) represents just well-nigh 10% of the full claret mass of a discipline weighing 70 Kg. This is far from the tabulated values of blood loss that can cause hypovolaemic shock, since more than xv–20% of the total claret mass, that is, 800–ane,500 mL of blood, need to be lost, in order to be in at least class I run a risk of hypovolaemia. Thus, a donation of 450 mL of claret will not put the discipline fifty-fifty in class I chance, co-ordinate to the table of classification of blood loss^{xvi – 19}. Nonetheless, this does not mean that some subjects, particularly those with marked feet, can not accept a slight decrease in blood pressure²¹.

Absolute frequency of the different types of handling used

Amid those subjects who did suffer adverse reactions, the systolic blood pressure never decreased beneath 80–90 mmHg immediately after the vasovagal reaction or syncope; the diastolic claret force per unit area values never fell below 40 mmHg and the centre rate was never slower than 40 beats per minute. For these reasons, it was not necessary to use more than ambitious therapy; in all cases, intravenous infusion of crystalloids and oral assistants of vasopressors was sufficient to control the symptoms^{1 , 4 , five , 9 , 21 – 24}. Subjects with severe symptoms were given not only oral vasopressors, but also intravenous infusion of crystalloids in a ratio of 3:1, every bit suggested past the best accredited guidelines and protocols on claret loss. In no example was information technology necessary to use atropine to restore the heart rate. Simply in a few cases, were corticosteroids administered in saline solution (hydrocortisone 1 thousand, methylprednisolone i g for intravenous employ, Figure vii)^{25 – 31}. All subjects, who had vasovagal reactions, recovered within 10–15 minutes afterwards the donation, whereas the donors who suffered syncope recovered in 15–20 minutes with fluid compensation.

It tin exist said that agitation, pallor and sweating are the harbingers of a vasovagal reaction; indeed, these symptoms can be present already before the donation, being associated with the emotions that the donor accumulates during the reception at the donor site and while waiting to brand the donation.

In this report it was possible to describe the sequential development of the symptoms precisely and, subsequently, they were recorded. It is, therefore, articulate that dizziness and gastric disorders (nausea, dysphagia, epigastric pain and gastric pyrosis) represent the fully adult stage of the vasovagal reaction.

Of the 63/4,906 (1.2%) donors who had adverse reactions to blood donation, merely xl (0.8%) were administered oral vasopressors, while the other 23 (0.4%) recovered from the vasovagal reaction merely from existence placed in the antishock position. Of the 63 donors who had a vasovagal reaction, just 18 (0.36%) were given crystalloid solutions, while less than five (0.1%) required additional therapy with cortisone (Figure seven). In no case was re-blitheness based on oxygen therapy or assistants of adrenaline needed.

Episodes of convulsive syncope occurred in 0.08% (iii/3,716) of males and as well in 0.08 % (1/1,190) of females of the whole population. In these cases, it was necessary to use crystalloids and cortisone, which resolved this clinical complication within 15–20 minutes, without there being any repercussions in the hours post-obit the donation.

Simply one subject (0.02%) developed a vasovagal reaction with vomiting, which resolved very quickly later the infusion of crystalloids and cortisone.

The subjects, who manifested the typical clinical picture of a vasovagal reaction or episodes of syncope or convulsive syncope, were treated co-ordinate to the Basic Life Support (BLS) protocol, in which the medical and nursing staff were trained during the compulsory BLS-D course.

Donors who developed the a vasovagal reaction were immediately placed in the antishock position. Their vital signs (claret force per unit area, heart rate and oxygen saturation) and state of consciousness were measured. The starting time action consisted in ensuring venous access, in case the infusion of fluids or drugs became necessary.

Likewise, the donors affected by episodes of syncope were also immediately placed in an antishock position, with particular care taken to hyperextend the caput, in order to ensure that the tongue did not obstruct the oropharynx and that the respiratory tract remained patent, thus facilitating quick recovery.

It is essential to intervene rapidly in subjects with syncope, because in hypoxic states clonic contractions can develop. These, obviously, are not related in whatsoever way to epilepsy, but can lead to lesions due to the venipuncture needle and even cause the donor to fall off the donation bed/chair. It is, therefore, essential that the staff present restrict the movements of the donor. Donors who have any disorders must be retained at the donation centre until all vital parameters have returned to normal.

The follow-upward of the subjects who had whatever type of complication was connected into the post-donation period, that is, for 20 to 30 minutes. After this flow, the donors left the Transfusion Service, simply were asked to inform the staff of the Service of their state of well-being the following 24-hour interval. None reported psychophysical disturbances in the 2d day post-donation^{20 , 22 , 23}.

Discussion

Contingency assay betwixt groups of beginning-time donors and periodic donors

A contingency analysis of the groups of "first-time donors" and "periodic donors", with regards to the variables agitation and sweating, which together reflect a state of feet, was conducted in social club to study the level of association with these two groups of donors, stratified by gender. The analysis of the first-fourth dimension donors showed that in that location was non a significant degree of association (chi-square = 5.59; 95 % CI and p = 0.06).

The contingency assay of periodic donors (subjects who had, therefore, already given blood) vs. agitation and sweating, showed a strong, very statistically meaning clan (chi-foursquare = 13.47; 95% CI and p = 0.001). This finding demonstrates a greater tendency to develop an feet syndrome, with this being much more than pronounced in periodic donors; this tin can be explained by the not very large number of kickoff donors (377/4,906; 7.seven%) or past an feet cistron that is intensely felt during subsequent donations. In fact, a state of feet tin can be manifested even before the donor reaches the donation bed/chair, with premonitory signs, such as agitation and sweating, which in themselves form a condition predisposing to a land of distress.

There was non a well-divers pathophysiological cause for the vasovagal reactions, merely rather a set of neuropsychological factors that the subjects had developed during their life, starting from the starting time donation. In order to determine which of the prodromic factors was predominant in inducing vasovagal reactions during blood donation, nosotros used a multivariate logistic regression model to identify those factors that could be responsible for causing the above mentioned country of distress.

Multivariate logistic regression analysis for vasovagal reactions

1. This analysis was used to determine whether there was a connection between the development of pallor and a difficult venipuncture. The donors who developed pallor were divided into two groups: those in whom the venipuncture had been traumatic and those in whom the venipuncture had been efficient. The logistic regression analysis showed that the grouping of donors, in whom the venipuncture was difficult, had a statistically college probability of developing pallor (95% CI and p < 0.001). From these information, it can be concluded that a traumatic venipuncture, compared to an easy one, is a strong determinant of a vasovagal reaction. It can, therefore, be stated that a painful stimulus caused past venipuncture can atomic number 82 to a vasovagal reaction.

2. The analysis was also used to make up one's mind whether there was a causal connexion betwixt the symptom of "sweating" and hard venipuncture versus atraumatic venipuncture. The aim was to determine how much these two contained variables were determinant in inducing sweating. The logistic regression analysis showed that traumatic venipuncture was a statistically significant determinant (p <0.001 and 95% CI) compared to easy, non-harmful venipuncture. Information technology can be said that the variable "traumatic venipuncture" plays a predisposing part in causing sweating and, therefore, in triggering vasovagal reactions.

3. Finally, the assay was used to determine whether several factors simultaneously play a role in determining vasovagal reactions. In this case the dependent variable was taken to exist the symptom of pallor, and the number of independent factors was increased to include traumatic venipuncture, easy venipuncture, agitation and sweating. The multivariate logistic regression analysis showed that in that location was a marked statistical significance (p < 0.0002 and 99% CI), in favour of the gene sweating.

All this is in agreement with the literature, in which it is described that an anxiogenic stimulus, represented by the strong emotion of giving claret or the donor'southward sight of his or her own blood, evokes fear and anxiety and the expectation that the phenomenon could be repeated has the same emotional significance.

From a purely psychological point of view, this phenomenon can exist likened to what is technically divers, in psychology, as a "uncomplicated phobia", which is nothing other than a learned behaviour associated with an anxiogenic stimulus^{half dozen , seven , 21}. This type of behaviour, usually not conscious, is maintained by a set of dramatic or catastrophic thoughts and past unpredictable complications or consequences, that can occur during the donation. Vasovagal reactions often occur in these subjects immediately after the needle insertion, or fifty-fifty after, once the donation has been completed.

It can be said that, irrespectively of whether the venipuncture is traumatic or atraumatic, the donor attributes this part of giving blood a particular weight. Indeed, for many people, 1 of the uncertainties about giving blood derives from the psychological impact of the needle insertion.

Multivariate logistic regression analysis for syncope

The aim of the start analysis was to determine the importance of some factors such as first-fourth dimension donor, periodic donor, and effective vs traumatic venipuncture in determining an episode of syncope. The group of donors who lost consciousness was stratified, co-ordinate on the ground of several independent variables: first-fourth dimension donor, periodic donor, constructive venipuncture and traumatic venipuncture.

The multivariate logistic regression model showed very clearly that the greatest statistical significance occurred in the group of periodic donors (p <0.002 and 95% CI). This finding, which might seem to contradict what was stated above for vasovagal reactions, could advise two fundamental concepts: the group of periodic donors who developed syncope was more numerous than that of the first-time donors and that loss of consciousness is not strictly related to the venipuncture, but rather to other factors. While venipuncture is one of the triggers of a vasovagal reaction, syncope represents the normal evolution of a poorly managed clinical situation.

At this bespeak of the study, we used logistic regression assay to determine whether at that place were factors associated with the symptoms of vasovagal reactions in common with factors causing a loss of consciousness. In this cases, loss of consciousness was taken as the dependent variable, with the independent variables existence a common cold feeling, sweating, pallor and dizziness. The factors sweating and dizziness emerged as being statistically significant (p <0.05 and 95% CI).

Sweating, in fact, causes a further decrease in blood force per unit area because of vasodilatation, with sequestration of the blood in splanchnic organs and stasis in the lower limbs, due to gravity. All this is added to the fall in claret pressure acquired by the removal of blood during the donation (450 mL). The outcome is a slight and temporary deficit in blood period to the encephalon. Dizziness follows on from hypoxia and causes a sense of ill-being or a vasovagal reaction, which sometimes evolves into syncope in the absenteeism of a swift therapeutic intervention. Therefore, as shown by the logistic regression analysis, there is a chain reaction, which starts gradually with a bland vasovagal stimulus and then evolves inexorably into syncope, if not fairly treated^{13 – 17 , 20}.

Conclusions

Although the number of donors who adult disturbances in relation to donating blood was very low, it is nevertheless desirable to reduce risks to a minimum, working not just with the maximum environmental safety, simply besides with complete medical assist. Thus, a series of innovations have been introduced to facilitate non only the work of the staff, but besides safe donation by the volunteer blood donors. The remedies and specific areas of care are the post-obit:

• shorten the waiting times,

• do non let the fasted donor to remain standing for long periods,

• allow the donor a calorie-free breakfast, excluding carbohydrate, milk and milk products, in item in subjects predisposed to develop some form of distressⁱⁱⁱ,

• ensure a comfortable room temperature and humidity,

• avoid a semi-sitting position during the donation,

• place those subjects who are particularly broken-hearted and ensure them the greatest comfort and the most bulldogged attention past the staff,

• if necessary, reduce the amount of blood collected, within the limits allowed by law (range 405–495 mL),

• engage especially anxious donors in conversation, in order to distract their attention from what is happening,

• carry out the venipuncture precisely and cleanly,

• avoid traumatic needle insertion with invasive and painful manoeuvres,

• identify the best venous access, past inspecting both forearms,

• if the first venipuncture is unsuccessful, allow the donor to residue and reassure him or her, before attempting a new venipuncture,

• practice not allow the donor exit the donor site too quickly,

• invite donors to wear comfortable clothes, avoiding tight ties and belts,

• exercise not let the donors drink very hot or very cold drinks during the recovery phase,

• monitor very carefully young, bradycardic donors, whose blood pressures tend to exist low,

• exercise not accept blood from donors, who have carried out very intensive sporting activities in the preceding 24 hours,

• give bully care to those donors who take antihypertensive drugs, particularly β-blockers,

• donation of blood components is contraindicated after a night shift,

• do non let donors to eat solid foods during the donation^{16 , 17},

• it is recommended that donor practice not drinkable alcohol the night before a donation,

• react swiftly to the initial symptom of pallor, by putting the subject in the Trendelenburg position,

• reassure the donor,

• loosen any tight habiliment, in order to facilitate normal respiration,

• if necessary, administer vasopressors per os,

• if the donor has low claret pressure, infuse fluids (physiological saline, Ringer's lactate solution, counterbalanced solutions),

• monitor the donor and retain him or her at the donor site until there has been an adequate haemodynamic recovery,

• if recovery is very slow, corticosteroids can be administered as a continuous infusion in a solution,

• if the pulse is very weak and the heart rate slow, atropine can exist administered,

• if the clinical situation evolves into an episode of syncope, ensure that the airways are patent.

​

The order of appearance of the typical symptoms of a vasovagal reaction in a blood donor, which, if non treated promptly, evolves into syncope

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2535889/

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