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To inform the development of interventions to retain donors following a vasovagal reaction (VVR), the aim of this study is to use the Health Action Process Approach (HAPA) to identify predictors of intentions to re-donate and actual return behavior among whole blood (WB) and plasma donors who experienced a VVR.A total of 1136 WB donors (MThe motivational and social support variables accounted for 47.2% of the variance in intentions to return in WB donors and 15.7% in plasma donors. For both groups, task self-efficacy, positive and negative outcome expectancies, and social support were significant predictors of intentions to return. Intentions and action planning were significant predictors of donor return in both groups, and recovery self-efficacy was significant for plasma only.The HAPA model can provide guidance to blood collection agencies to design phase-specific and individually-focused interventions to retain WB and plasma donors following a VVR.

Background: Severe blood donor adverse events are rare, but due to their rarity studying them can be difficult. To get an accurate estimate of their frequency and rate in the donor population it may be necessary to combine donation data across countries. Study Design and Methods: International blood collection organizations (BCOs) provided data on rare/severe donor reactions as well as denominator information for their donor populations from 2015 to 2017. Donor reactions were classified using standardized definitions. Results: BCOs from six countries provided reaction data for more than 22 million donations. A total of 480 rare reactions were reported of which 76.7% were imputed as definite and 11% probable. Rates of rare reactions were higher in females and first-time donors. Systemic rare reactions were the most common reaction type, accounting for over three quarters of reactions reported. Of systemic reactions, vasovagal reactions with loss of consciousness and injury or off-site (n = 350) made up the majority and occurred 1.53 per 100,000 donations. For the 22.3% that were localized reactions, the majority of these were cellulitis (n = 71, 0.31 per 100,000 donations) followed by deep venous thrombosis (n = 21, 0.09 per 100,000 donations). Conclusion: Pulling together data from multiple BCOs across countries allows for a better understanding of rare reactions, such as vasovagal reaction with injury or cellulitis, and for generating a reliable incidence rate for air embolism or compartment syndrome. However, gaps remain due to missing elements such as unknown donor status or location of reaction.

Background: Fear of blood donation is implicated in vasovagal reactions, donor recruitment, and retention. This study examined the extent to which fear among donors is associated with various donor outcomes in an Australian sample, and whether fear can be addressed on-site to reduce adverse reactions and improve the donation experience. Study design and methods: Six hundred and sixty-four donors (age M = 33.4, SD = 12.7; 55% female) participated in a two-center, pragmatic, parallel group, individually randomized controlled trial. Following donor registration and consent, whole-blood (n = 539) and plasma (n = 125) donors were assigned to one of four Conditions: control; fear assessment; fear assessment + brochure; fear assessment + brochure + tailored conversation focused on any self-reported fear and coping strategies. Post-donation questionnaires assessed the donors' experience including positive support, donor self-efficacy, anxiety, fear, venipuncture pain, and vasovagal reactions. Results: Fear among donors predicted higher venipuncture pain, post-donation anxiety, and vasovagal reactions and remained significant after controlling for other established predictors (i.e., total estimated blood volume, age, sex, and donation experience). Mediational analyses showed that exposure to brochures (with or without the tailored conversation) was associated with less pain, with this effect mediated by donor perceptions of more positive support. Venipuncture pain was also associated with vasovagal reactions, reduced likelihood of return within 6 months, and less satisfaction with the donation experience. Conclusion: The current results underline the importance of interventions to address fear among both whole-blood and plasma donors to secure the safety and well-being of donors and the blood supply.

BACKGROUND There are several strategies to reduce donor reactions. We report donor participation and reaction rates before and after implementing multiple measures at Canadian Blood Services. STUDY DESIGN AND METHODS We introduced a structured program of 500 mL of water and a salty snack pre-donation and applied muscle tension (AMT) during donation. Donors were not deferred for out of range blood pressure (BP); however, BP was measured in first time donors. Time on the donation chair post-donation was decreased from 5 to 2 min for repeat donors. We assessed participation rates using our quarterly survey of 10,000 recent donors. We extracted vasovagal reactions with loss of consciousness (LOC) from our operational database and compared pre-implementation (Oct 12,018-March 31,2019) and post-implementation (Oct 12,019-March 31,2020) periods. RESULTS Survey response rates varied from 11% to 16%. The percentage of donors who drank the water and ate the salty snack increased from 58% to 82% and 44% to 70% over 4 quarters; those performing AMT increased from 24% to 41%. Reactions decreased from 19.07 per 10,000 (744 reactions in 390,123 donations) to 14.04 per 10,000 (537 in 382,382 donations) (p

BACKGROUND Prior studies have shown donation-related fear to be associated with decreased donor confidence and an increased risk for vasovagal reactions. This study examined the effects of a predonation intervention that provided fearful donors with suggestions for coping. STUDY DESIGN AND METHODS Using a tablet-based application, high school donors (49.4% female) answered a question regarding their fear of having blood drawn. Those who reported fear were randomly assigned to either a control (n = 930) or an intervention (n = 911) group. Donors in the control group rated their confidence in dealing with their fear and then donated as usual. Donors in the intervention group received a brief audiovisual presentation on coping strategies, rated their confidence, and then donated as usual. RESULTS A higher proportion of fearful versus nonfearful donors experienced a vasovagal reaction, even after controlling for other demographic and health predictors (OR, 2.3; 95% CI, 1.655-3.185, p

Background: A new national donor safety initiative was introduced in Australia in 2018, which aimed to encourage all whole blood donors to water load and to use applied muscle tension. This study evaluated the effect of this initiative on the rate of vasovagal reactions (VVR). Study Design and Methods: Routinely collected data were used to identify whole blood donations and any associated VVRs before (n = 167,056 donations) and after implementation (n = 215,572 donations). Multivariate logistic regression analyses were performed to evaluate the differences in VVR rates. Results: The total rate of VVRs declined from 22.5 per 1000 donations to 20.6 per 1000 donations after implementation, a reduction of 8% (p

Background: This study examined the impact of donor adverse events (DAEs) on plasma donor return and compared these against trends in whole blood (WB) donors. Study Design and Methods: Using a retrospective cohort design, donors who attempted to give plasma or WB in 2014-2015 were categorized by DAE and followed for 2 years. Analyses of return rate, time to return, subsequent donation frequency, and recurrent risk were performed. Donor characteristics associated with return were also assessed. Results: For both plasma and WB donors, vasovagal reactions (VVRs) were the strongest deterrent to return, with a lower proportion returning, taking longer to return, and making fewer subsequent donations than those with uncomplicated donations. Despite a higher likelihood of a recurrent event among those who experienced a DAE, the majority had an uncomplicated subsequent donation. Donor characteristics associated with return varied by phlebotomy and DAE type. For donors experiencing a VVR, differences were observed by donor experience, age, sex, and site type between plasma and WB. For phlebotomy-injured donors, differences were observed by sex, blood type, donor experience, and donation outcome between the two groups. No factors associated with return after a citrate reaction were found. Conclusion: This study highlights the detrimental effects of DAEs on plasma return, in particular VVRs, and the differences in factors associated with return compared to WB donors. Further research is required to understand the mechanisms underlying the decision to return following a DAE.

BACKGROUND Complications of donation reduce donor return. Younger and less experienced donors are more likely to experience vasovagal-type reactions (VVR). A water drink of approximately 500 mL shortly before donation may reduce VVR, but the effect of a smaller volume of water has not been investigated. STUDY DESIGN AND METHODS A placebo-controlled comparative study was conducted among donors < 30 years who attended for a 1st-4th whole blood (WB) donation. Collection centers were assigned to offer one of three interventions: 500 mL water drink, 330 mL water drink, or a placebo intervention consisting of pre-donation arm exercise. Within 7 days after attending, participants received an electronic questionnaire about possible symptoms during and after donation. In additional centers, control donors were recruited, who only received standard care and were also sent the questionnaire. Self-reported VVR and other complications were evaluated in all groups. RESULTS Out of 8,300 participating donors, 6,921 (83%) returned the questionnaire. Overall, 18.5% of responding donors reported moderate or worse VVR symptoms. In 2nd-4th time donors, both water volumes decreased the odds of a VVR compared to standard care controls (OR500ml 0.75, 95% CI 0.59-0.94; OR330ml 0.73, 0.58-0.91; adjusted combined OR 0.77, 0.64-0.94). There was no effect in new donors or the placebo group compared to controls. CONCLUSION In young donors making their 2nd-4th WB donation, drinking water was associated with 23% fewer VVR with no difference between 330 and 500 mL. This decrease was not found in the placebo group. The findings support advocating drinking water for the prevention of VVR.

BACKGROUND Research has documented beneficial effects of water loading (WL) and applied muscle tension (AMT) on reducing self-reported vasovagal reactions (VVRs) in whole blood (WB) donors. However, the optimal approach to reducing VVRs using these strategies in routine blood collection practice is not known. This study evaluated the effectiveness of embedding newly developed web-based and on-site donor education materials to increase the use of these two prevention techniques during blood collection. STUDY DESIGN AND METHODS Two studies were conducted with WB donors. In Study 1, donors (n = 375) were randomly allocated to evaluate one of three forms of educational materials (video, webpage, card) in an online questionnaire. In Study 2, donors (n = 598) were randomly assigned to view either off-site web-based or in-center educational materials and were surveyed after donation to assess compliance to the VVR prevention procedure and to self-report VVR. RESULTS In Study 1, donors rated the video as having the highest message appeal and indicated greater likelihood to use AMT compared to the webpage and card. No differences were found in likelihood to use WL. In contrast, in Study 2, greater adherence to VVR prevention strategies was observed in donors who received the in-center instruction card in comparison to those who received the web-based materials. Examination of viewing data indicated that only a small number of donors had seen the web-based materials. No significant effects of the techniques were found on self-reported VVRs. CONCLUSION Providing on-site instructions is the most effective method to increase donor compliance to VVR prevention techniques.

Some countries impose an upper age limit on whole blood and double RBC donation while others do not. We evaluated the safety of blood donation in older individuals (≥71 years), and their contribution to the blood supply of five countries.Twelve blood center members of the Biomedical Excellence for Safer Transfusion (BEST) Collaborative from four countries with no upper age limit for whole blood and double RBC donation (Canada, New Zealand, England, and the United States) or an upper age limit of 80 (Australia) provided 2016 data on donors and donations, deferral rates, and vasovagal reactions by donor age and sex. Donors under age 24 were included in the number of total donors and donations, but not in deferral and reaction rate comparisons.Older donors accounted for 1.0% (New Zealand) to 4.3% (United States) of donors, and 1.5% (New Zealand) to 5.6% (United States) of donations; most were between ages 71 and 76. The deferral rate was higher in older compared to 24- to 70-year-old males, but very similar between older and younger females. In contrast, vasovagal reaction rates were either lower (male donors) or similar (female donor for reactions with loss of consciousness) in older compared to 24- to 70-year-old donors.Exclusion solely based on older age appears to be unwarranted based on safety concerns such as donor reactions. Healthy older individuals can continue to safely donate and make a significant contribution to the blood supply past arbitrary age limits.

Although the risk of fainting and prefaint reactions (e.g., dizziness, lightheadedness) is low during blood donation, there is evidence that this risk remains a concern for many donors. This study sought to measure perceived risk for such reactions within the general population and to relate perceived risk to individual reports of fear of having blood drawn.A sample of 1019 men and women (52.2% male; mean ± SD age, 37.2 ± 12.3 years; range, 18-80 years) completed an anonymous online survey that included questions that asked about their 1) estimation of the frequency of faint and prefaint symptoms experienced by blood donors and 2) fear of having blood drawn.Survey respondents overestimated the risk of both faint and prefaint reactions to blood donation, with estimates of fainting risk being more than 20 times the actual risk. Further, the perceived risk of both faint reactions (F(4,1008) = 25.88, p0.001) and prefaint reactions (F(4,1008) = 17.37, p0.001) was higher among those who reported greater fear of having blood drawn.The general public has inflated expectations of the risk for faint and prefaint reactions to blood donation, suggesting that efforts to educate prospective donors with accurate information may help to reduce this relatively common concern.

Vasovagal reactions (VVRs) have a negative impact on donor safety and return. Applied muscle tension (AMT) increases blood pressure temporarily and has been suggested as a way to reduce donors' risk of VVRs. This study evaluated whether using AMT at three different time points during the donation procedure reduces the VVR symptoms reported by donors and the VVR reactions recorded by phlebotomists.A three-arm, multicenter, open-label randomized controlled trial was used to compare VVR symptoms and reaction rates between those practicing AMT during the entire donation (n = 244) to practicing AMT at VVR high-risk time points (n = 250) to a standard blood donation control group (n = 240). All participants were asked to drink 500 mL of water in the waiting area, and an even distribution of new and repeat donors was sought across conditions.Across all conditions, donors reported few VVR symptoms and the rate of reporting did not differ significantly across conditions. However, donors who practiced AMT at strategic time points had a significantly lower number of phlebotomist-registered VVRs in comparison to the other two study groups, with these rates not varying by sex or donor status. Greater compliance by donors with AMT instructions was observed in those asked to practice AMT at strategic time points compared to those asked to practice AMT during the entire donation.Practicing AMT at VVR high-risk time points reduces the number of phlebotomist-registered VVRs.

This study aimed to characterize the extent of donation-related fears among donors with different levels of donation experience.A sample of 1054 recent donors (48.3% female; mean ± SD age 33.1 ± 9.8 years) completed an anonymous, online survey of their fear of donation-related stimuli, including blood, needles, pain, and fainting. Respondents also provided information regarding demographics, pain, and vasovagal symptoms associated with their recent donation and confidence and intention with respect to a future donation.The sample was divided into four donation history subgroups, including one, two or three, four or five, or six or more prior donations. A significant negative relationship was observed between donation history and each of the assessed fears, indicating less fear with more experience. However, at least one-third of even the most experienced donors reported some fear for each of the stimuli. Further, greater fear was associated with more pain (r = 0.35-0.56, all p 0.001) and more intense vasovagal symptom reports (r = 0.41-0.61, all p 0.001). Finally, greater fear was associated with less donor confidence (r = -0.24 to -0.33, all p 0.001) and lower intentions of donating again (r = -0.14 to -0.20, all p 0.001).These data provide novel evidence that fear persists for many donors, despite increasing experience, and suggest that a greater appreciation of individual differences in fear is needed to address these concerns and promote long-term donor motivation.

BACKGROUND Separators use 1960s sex-based nomograms to estimate apheresis donor blood volume and to calculate the 15% maximum extracorporeal and collection volumes. As US body habitus changes, proportional overestimation of the maximum safe collection volume may become clinically significant with large-volume collections. We correlated 2 years of vasovagal reaction (VVR) data with 148,416 Trima apheresis procedure parameters to identify trends. STUDY DESIGN AND METHODS Only platelet/plasma with or without red blood cell (RBC) procedures yielded collection volumes of at least 900 mL with no saline replacement. Vasovagal events of any severity were correlated by sex with actual collection volume and donor estimated blood volume (EBV). We performed multivariable analysis incorporating the factors that influence VVR rates to assess the significance of EBV and collection volume. RESULTS VVR rates nearly doubled in male donors who had collection volumes greater than 1050 mL. No reaction threshold could be identified in female donors. This was confirmed in multivariable analysis that included donor sex, age, donation experience, draw time, and reporting location. CONCLUSION Limiting apheresis collections to the lesser of 1050 mL or 15% EBV may reduce VVR rates. Further confirmation of this finding by other collection centers is desirable.

BACKGROUND: One of the serious complications of blood donation is vasovagal reaction (VVR) with syncope. This study was performed to determine if the measurement of hemodynamic responses to standing before blood collection (BC) was useful to identify the high-risk donors for VVR and also examined the effect of 300 mL of water ingestion in the prevention of VVR. STUDY DESIGN AND METHODS: Blood pressure and heart rate (HR) during 5 minutes of standing were examined before and after BC in 93 donors. Because HR increase of 6 of 7 donors who developed syncopal VVR during standing after BC was 15 beats per minute (bpm) or greater, those with HR increase of 15 bpm or greater were determined as high-risk donors (n = 31). In another group (n = 117), 45 donors were identified as high risk based on the HR response before BC (≥15 bpm). The effect of 300 mL of water ingestion 15 minutes before BC on hemodynamic responses to standing and the rate of VVR after BC were analyzed. RESULTS: Water ingestion given to the high-risk donors of the second group reduced HR increase with standing before BC (−6.6 ± 13.6 bpm, p

Fear of blood draws is a predictor of vasovagal reaction risk among whole blood donors, and this relationship is particularly evident among less experienced donors. This study examines the combined effect of donor fear and total blood draw time on vasovagal reactions.After successfully completing the blood donor health screening, 2730 whole blood donors attending high school drives were asked about their fear of having blood drawn. Donor reports of fear versus no fear were combined with total blood draw time to predict phlebotomist ratings of donor vasovagal reactions.Both fear and draw time were significant predictors of vasovagal reactions, with observed reaction rates of 31.2% for fearful donors whose blood draw lasted 10 minutes or more versus 5.0% for nonfearful donors whose draw lasted less than 6 minutes. Binomial regression analyses revealed that fear remained a significant predictor of reaction rates across all blood draw intervals examined (odds ratio, 2.8-4.1; all p 0.001) and that these effects were maintained after controlling for donor sex, weight, estimated blood volume, pulse rate, and donation status.This report shows that both fear and blood draw time increase vasovagal reaction rates, and the two are additive. These findings suggest that fearful donors should be the focus of special attention to reduce their distress before donation as well as careful observation throughout the draw.

BACKGROUND: While vasovagal syncopal reactions have been studied in the past, there are several safety questions that could be further addressed. The purpose of this study was to address these safety questions. STUDY DESIGN AND METHODS: One hundred seventy-eight vasovagal reactions were reported in 1999 from 194,000 blood donations. The reactions were retrospectively reviewed for 38 variables that included donor demographics, symptoms, injury, and final disposition. RESULTS: Sixty-one percent of the syncopal reactions occurred at the refreshment table and 12 percent offsite. Fourteen percent of the donors sustained an injury, usually to the head (10%). Eleven donors (6%) had additional medical care in an emergency room: 4 for injuries, 3 for delayed recovery, and 4 for offsite syncope. None of the donors was admitted to the hospital. One of the injured donors developed postconcussion syndrome and had later sequelae. CONCLUSION: Syncopal reactions most commonly occur at the refreshment table, where preventive safety measures against trauma could be applied. A significant number of syncopal reactions occur offsite, where the environment is less safe. The injuries that occur, particularly to the head, may in rare cases lead to long-term sequelae.

Blood is a valuable resource, but most people do not donate. One deterrent to blood donation is the anticipation of vasovagal symptoms (e.g., dizziness, nausea, and fainting), despite the fact that such symptoms typically affect a small proportion of donors. The current research examined norm perceptions regarding vasovagal symptom experiences and used a message-framing paradigm to communicate accurate norm information and increase future donation intentions.Three studies were conducted using young adult samples. In Study 1, donors and nondonors estimated the percentage of people who experience vasovagal symptoms. In Studies 2 and 3, nondonors and donors (respectively) were provided with accurate, positively framed, or negatively framed norm messages and indicated their intentions to donate.In Study 1 we found that participants vastly overestimated how normative it was to experience vasovagal symptoms and this overestimation was stronger among nondonors. In Studies 2 and 3, we showed that positively framed normative messages ("90% of donors do not experience vasovagal symptoms") were generally more influential than negatively framed messages ("10% of donors do experience vasovagal symptoms"), except among past donors who had unfavorable donation experiences.These findings suggest that targeting and correcting norm perception may be a critical step toward improving blood donation rates.

We previously demonstrated that fear of having blood drawn is one of the strongest known predictors of vasovagal reactions among high school blood donors. This report examines the combined effects of donor fear and experience of vasovagal reactions on repeat donation attempts among high school blood donors.Immediately after completing the blood donor health screening, 1715 high school students were asked about their fear of having blood drawn. The donor record was then used to collect information regarding their experience of vasovagal reactions at the time of donation as well as their subsequent donation attempts within the following year.Fear of having blood drawn and the experience of a vasovagal reaction each contributed to donor attrition, with only 33.2% of fearful donors who experienced a vasovagal reaction returning in the following year compared to 56.7% of nonfearful nonreactors. Path analyses demonstrated that fear has an indirect effect (through vasovagal reactions) on repeat donations among first-time donors and both direct and indirect effects on repeat donation attempts among experienced donors.Among high school blood donors, fear of having blood drawn has both a direct negative effect on donor retention and an indirect negative effect by increasing the risk of vasovagal reactions. Accordingly, targeted efforts to reduce donor fear may be particularly efficient in promoting long-term donor loyalty among our youngest donors.

This study investigated the effects of adverse events (i.e., needle reactions, fatigue, and vasovagal reactions) and feelings of distress and anxiety on retention of first-time blood donors. All effects were explored separately for men and women.First-time blood donors (n = 2438) received a questionnaire, asking them about their experience of adverse events, subjective distress, and anxiety at their first donation. Provision of a second donation was checked approximately 18 months later. After exclusion of nonresponders and donors who did not experience an adverse event, 1278 first-time donors were included in the logistic regression analyses.Nine percent of donors who experienced an adverse event at their first donation did not return for a second donation. Vasovagal reactions decreased retention in both males and females (men-odds ratio [OR], 0.45; 95% CI, 0.23-0.89; women-OR, 0.71; 95% CI, 0.51-0.98). Fatigue decreased retention in males only (OR, 0.62; 95% CI, 0.42-0.91), and subjective distress decreased retention in females only (OR, 0.77; 95% CI, 0.65-0.92).In addition to decreasing vasovagal reactions, retention interventions could productively target coping with fatigue and reducing subjective distress after adverse reactions.

We previously demonstrated in a group of mostly experienced blood donors that fear of blood draws was a significant predictor of vasovagal reactions. Importantly, being asked about one's fear immediately before donation did not increase reaction rates. This study further evaluates the relationship between fear and reactions among high school blood donors, who are known to be at a relatively greater risk for vasovagal reactions.Immediately after completing the blood donor health screening, 17- and 18-year-old high school students were asked about their fear of having blood drawn. Based on a random selection, the fear question was administered in approximately half of the schools, resulting in a final sample of 1715 donors who did and 1692 donors who did not answer the fear question.Fear was a significant predictor of donor reactions and remained a significant independent predictor (along with estimated blood volume and donor sex) in a logistic regression analysis. There was no difference in the proportion of reactions observed between those who did and did not answer the predonation fear question.Consistent with previous evidence in older and more experienced blood donors, these findings indicate that assessing fear of blood draws may help to identify those who are most likely to experience vasovagal reactions among young donors without increasing the frequency of such reactions.

This study investigates the effect of a vasovagal reaction (VVR) or needle reaction (NR) on the risk of stopping as a blood donor, taking into account variables from the Theory of Planned Behavior (TPB). Is stopping risk solely related to the adverse reaction itself, or do the TPB variables play a role as well? Emphasis is placed on possible sex differences.TPB variables were assessed within 12,051 whole blood donors. Also, donors reported the occurrence of adverse reactions during or after their last donation. Blood bank records were used to determine whether donors stopped donating within the next 2 years. Logistic regression analyses were performed to estimate the effect of self-reported adverse reactions on stopping risk, adjusting for the TPB variables. Analyses were performed separately for both sexes.Men have a lower odds of reporting a NR or a VVR than women (odds ratio [OR] 0.34, 95% confidence interval [CI], 0.28-0.43; and OR 0.26, 95% CI 0.19-0.36, for NR and VVR, respectively). For both sexes, only a VVR was associated with stopping risk, which is higher in men (men, OR 3.95, 95% CI 2.19-7.11; women, OR 1.78, 95% CI 1.35-2.35). After adjusting for the TPB variables both ORs declined (men, OR 3.38, 95% CI 1.86-6.15; women, OR 1.58, 95% CI 1.17-2.14). Also, self-efficacy and affective attitude are negatively associated with adverse reactions.Female donors report more VVRs than male donors, but male donors have a higher stopping risk after a VVR than female donors. Coping differences and possible reporting tendencies might play a role. For donor retention purposes, prevention and coping techniques should take sex differences into account.

Vasovagal syncope (VVS) is a consistent, but infrequent (0.1%-0.3%) complication of volunteer, whole blood donation. Given the large number of blood donations, a significant number of donors is involved. Syncope occasionally leads to injury. Recent rigorous data collection and analysis have led to the association of a small number of donor and donation factors with the risk of syncope. An analysis of the time course of syncope reactions among approximately 500,000 whole blood donors suggests that there are three distinct periods of risk for vasovagal reactions before, during, and after phlebotomy. This review examines the physiologic mechanisms that contribute to these periods of increased risk including the direct effects of removal of approximately 500 mL of whole blood, the psychological stress of instrumentation and giving blood (i.e., fear of needles, pain, and the sight of blood), and the orthostatic effects superimposed on a hypovolemic state after the donation. Specifically, we describe interventions that have been useful in controlling VVS in patients with fainting syndromes and we examine the potential of these interventions in the blood donation context, based on the physiologic principles involved. Finally, we propose an intervention (dietary replacement of salt lost with blood donation) that has not been applied in transfusion medicine previously but which has the potential to reduce risk.

There have been multiple reports concerning the predictors of fainting reactions in blood donors, but few attempts to reduce the rates of fainting reactions with concomitant rigorous attempts to monitor the success of the interventions.We used a retrospective observational cohort study design, comparing the likelihood of reaction from 213,031 allogeneic whole blood donations made by 17- to 22-year-old donors in two separate 12-month periods before and after the implementation of interventions to reduce reactions. The interventions were 1) a limit on the maximum percentage of estimated blood volume young donors could donate, 2) encouraging applied muscle tension during donation, and 3) providing approximately 500 mL of water before donation. Reactions were defined by severity and time in relation to the end of phlebotomy and documented according to standard procedures. Data analysis included comparison of stratified reaction rates and multivariable logistic regression analysis.The interventions decreased the aggregate reaction rates in male and female donors by 24% (p0.0001). There was a 25% decrease in delayed reactions (p = 0.0006) and a 38% decrease in off-site reactions (p = 0.001) in female donors. The impact of the three interventions together on reaction rate was greater than the combined impact of exercises and water provision. Multivariable modeling showed that the interventions reduced reactions but did not prevent their occurrence in identified higher risk groups.The interventions to reduce vasovagal reactions in whole blood donors were effective. Future efforts to reduce reactions in blood donors can build on the strengths and avoid the weaknesses identified while conducting and analyzing the data from this study.

Whole blood donation in the United States is restricted in volume to 10.5 mL/kg or less in an effort to prevent hypovolemic reactions, but still may exceed more than 15% of a donor's estimated blood volume (EBV). We analyzed the association of EBV with prefaint and systemic vasovagal reactions (SVRs) among whole blood donors and the potential impact of an EBV-based deferral policy.Independent predictors for prefaint reactions and SVRs were assessed by multivariate logistic regression analysis on 591,177 unique donors participating in the Retrovirus Epidemiology Donor Study-II study.Young age (16 years old odds ratio [OR], 3.70; 95% confidence interval [CI], 2.78-4.94), low EBV (3.5 L OR, 3.30; 95% CI, 2.57-4.23), and first-time donation status (OR, 2.33; 95% CI, 2.03-2.67) were the strongest predictors for SVRs, with similar trends seen for prefaint reactions. Sex, height, race, blood center, and donation site were weakly associated predictors. A total of 5.6% of all donors had an EBV of less than 3.5 L and experienced 12.5% of all prefaint reactions and 14.5% of SVRs. The highest reaction rates were seen in donors less than 23 years old with an EBV of less than 3.5 L who comprised 2.7% of all donors, who were mostly female (99.9%), and who experienced 8.8% of prefaint reactions and 11.0% of SVRs.Young age, low EBV, and first-time donation status are the major correlates of prefaint reactions and SVRs, suggesting that high school and college donors are at particular risk. Deferral of donors with low EBV who are less than 23 years old may offer a rational approach to protecting donors at greater risk of reactions without jeopardizing the adequacy of the blood supply.

BACKGROUND: Although not universal, a certain amount of predonation anxiety is common and not surprising among inexperienced blood donors. Variations in predonation anxiety, however, may influence the donor’s experience in several respects and might be related to the likelihood of subsequent donation even among those who do not report particularly high levels of anxiety. STUDY DESIGN AND METHODS: A total of 671 inexperienced blood donors (zero or one prior donation) enrolled in a treatment study and completed questionnaires assessing anxiety before and after giving blood. Ratings of pain and blood donation–related symptoms were obtained after giving blood, as well as information from the nurses about the blood donation procedure. Follow-up information on number of additional visits to a blood collection clinic during the subsequent year was also obtained for most participants. RESULTS: Predonation anxiety was positively related to ratings of blood donation–related symptoms and chair reclining by the nurses and negatively related to the donor’s rating, obtained at the end of the procedure, of the likelihood that he or she would give blood again. Women, but not men, with higher predonation anxiety were significantly less likely to return to a blood clinic in the following year. The results of mediation analyses suggest that this was due to the association between anxiety and donation-related symptoms. CONCLUSION: The results do not indicate whether or not it is feasible or useful to modify predonation anxiety, but highlight the relationships between the emotional state of inexperienced donors and several aspects of the donation experience, including subsequent donor return. Further study of the psychosocial aspects of blood donation and examination of related research (e.g., treatment of dental anxieties) may be worthwhile.

Intermittent-flow plasmapheresis often involves a large extracorporeal blood volume of the donor during the procedure with the concomitant risk of circulatory reactions. Guidelines governing donor recruitment often apply an arbitrary threshold of 15 percent of the donors' blood volume not to be exceeded during hemapheresis procedures. No data demonstrating the suitability of this approach exist.The blood volumes of 1204 plasmapheresis donors were calculated with different formulae that utilized either body weight or body surface area. Extracorporeal blood volumes of these donors were determined for a commonly used intermittent-flow plasmapheresis machine known to result in a large extracorporeal blood volume. A validated model was employed that calculated the fluid volume shifts occurring during the procedure. The records of all plasmapheresis procedures of these donors were retrospectively reviewed for circulatory reactions.The median extracorporeal volumes ranged from 14 to 17 percent of the blood volume at a donor Hct level of 0.40 to 0.48 L per L for men and from 17 to 20 percent at a Hct level of 0.36 to 0.44 L per L for women. In more than 60 percent of male and more than 90 percent of female donors, extracorporeal volumes exceeded 15 percent of the blood volume during plasmapheresis. In this subgroup, 65 percent of male and 75 percent of female donors never presented with any signs of circulatory reactions.Application of an arbitrary threshold of 15 percent of the donors' blood volume not to be exceeded during hemapheresis procedures is expected to lead to an unjustified deferral rate in plasmapheresis donors.

The effect of weight on vasovagal reaction rates has not been evaluated in high- and low-risk populations or in first-time versus repeat blood donors. In addition, vasovagal reaction rates and weight have not been evaluated based on solicited information.A total of 1073 Caucasian high school students from randomly selected whole-blood drives in 2001 and 949 randomly selected Caucasian donors from the general donor population in 2001 and 2002 were subdivided into weight groups and evaluated for vasovagal reaction rates.The high school population had a much higher vasovagal reaction rate than the general donor population (8.0 vs. 2.6%). The vasovagal reaction rate was inversely proportional to body weight in first-time blood donors in both populations, but the trend was not as well defined in repeat blood donors. Solicitation of information from the general donor population increased the vasovagal reaction detection rate by 2.5 times (from 2.6% to 6.5%), and it is suggested that the vasovagal reaction rate might be as high as 27 percent in first-time general donors who weighed between 110 and 139 pounds.Body weight is a very important determinant of vasovagal reaction rates in first-time donors, but previous successful blood donation appears to mitigate the effect of body weight on vasovagal reaction rates. Solicitation of information from blood donors increases the number of vasovagal reactions detected and enhances the data.

BACKGROUND : High school (HS) students have a high incidence of vasovagal reactions and are a good population for the study of vasovagal reactions. STUDY DESIGN AND METHODS : Data from 1076 Caucasian students, 226 African-American students, and 157 nonstudents from HS blood drives in 2001 were entered into a database. Race, high-risk-factor synergism, the phenomenon of “survivorship,” and female sex were evaluated. In addition, non-HS student participants were described. RESULTS : Vasovagal reactions were 84 percent lower in African-American HS students than in Caucasian HS students (3 of 226 vs. 88 of 1076; 1.3 vs. 8.2 percent; p = 0.0001; relative risk, 6.2). In Caucasian HS students, first-time donor status increased the vasovagal reaction rate to 9.4 percent (vs. 3.6% in repeat donors, p 81.2 kg, p < 0.001). Together they increased the reaction rate to 16.0 percent (vs. 3.2%, p < 0.0001). Females had more reactions than males (11.3 vs. 4.8%, p < 0.001), but the reaction rates equalized when donors under 150 lb were excluded (5.7 vs. 4.6%, p = 0.66). CONCLUSION : African-American HS students had a significantly lower vasovagal reaction rate than Caucasian HS students. There was synergy among high-risk factors in Caucasian HS students. Female and male vasovagal reaction rates were similar when low-weight donors were excluded.

Therapeutic apheresis was found to be reasonably safe in prior studies using instruments that are now largely obsolete. The incidence of adverse effects with current instruments and techniques has not been assessed in a large multicenter study.A survey was conducted in 1995 using a uniform questionnaire that asked about 32 specific events but excluded transient paresthesia and mild vasovagal events. Eighteen centers returned 3429 responses concerning 125 to 500 therapeutic apheresis procedures per center.Two hundred forty-two adverse events were reported in 163 procedures (4.75% of all procedures; 6.87% of first-time procedures and 4.28% of repeat procedures). The numbers (incidence) of selected specific events were transfusion reaction, 56 (51 in plasma exchange [PE] with plasma replacement) (1.6%); citrate-related nausea and/or vomiting, 41 (1.2%); systolic blood pressure80 mmHg, 34 (1.0%); vasovagal nausea and/or vomiting, 17 (0.5%); pallor and/or diaphoresis, 16 (0.5%); pulse120, 14 (0.4%); respiratory distress, 9 (0.3%); tetany or seizure, 9 (0.2%); and chills or rigors, 6 (0.2%). Rates for other specific events wereor =0.1 percent. Vasovagal phenomena were more frequent in procedures done in neurologic patients than in those done in hematology or oncology patients (p = 0.011) or renal or rheumatic patients (p = 0.038). Procedure-specific rates were red cell exchange, 8 (10.26%) of 78; PE (plasma), 89 (7.81 %) of 1140; PE (no plasma), 42 (3.35%) of 1255; leukapheresis, 4 (5.71%) of 70; plateletpheresis, 0 of 18; and autologous peripheral blood progenitor cell collection, 11 (1.66%) of 664. Three deaths were reported; all were attributed to primary disease.Therapeutic apheresis procedures are relatively safe, with a 4.75-percent overall incidence of mostly reversible adverse effects. Among the most commonly performed procedures, the risk is higher for blood component exchanges, especially if allogeneic red cell or plasma transfusion occurs, and lower for peripheral blood progenitor cell collection.