Status:
Ready to upload
Record number:
1657
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
10-40/10,000 with an average of about 30/10,000 depending upon the age and population.
Time to detection:
Immediate to within hours of donation; most occur within 15 minutes of donation completion.
Alerting signals, symptoms, evidence of occurrence:
Loss of consciousness (LOC) usually preceded by signs and symptoms including: discomfort, weakness, anxiety, light-headedness/dizziness, nausea, chills, sweating, vomiting, pallor, hyperventilation, rapid or slow pulse; LOC may be accompanied by loss of bladder or bowel control or convulsive movements.
Demonstration of imputability or root cause:
Reactions occur during or immediately after donation as a consequence of direct removal of up to 500 ml whole blood, psychological stress and orthostatic effects superimposed on the hypovolemic state brought on by donation.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
syncope
young donors
salt loading
applied muscle tension
Reference attachment:
Suggest references:
- Wieling, W., France, C. R., van Dijk, N., Kamel, H. Thijs, R. D. and Tomasulo, P. (2011). Physiologic strategies to prevent fainting responses during or after whole blood donation. Transfusion 51(12):2727-2738;
- Tomasulo, P., Kamel, H., Bravo, M., James, R. C. and Custer, B. (2011). Interventions to reduce the vasovagal reaction rate in young whole blood donors. Transfusion 51(7):1511-1521;
- Bravo, M., Kamel, H., Custer, B. and Tomasulo, P. (2011). Factors associated with fainting: before, during and after whole blood donation. Vox Sang 101(4):303-312;
- Eder, A. F., Hillyer, C. D., Dy, B. A., Notari, E. P. and Benjamin, R. J. (2008). Adverse reactions to allogeneic whole blood donation by 16- and 17-year-olds. JAMA299(19):2279-2286;
- Sorensen, B. S.. Johnsen, S. P. and Jorgensen, J. (2008). Complications related to blood donation: a population-based study. Vox Sang 94(2):132-137.
Note:
There some differences between these papers and there may need to be a separate entry for one or more, e.g. teen reactions. It's up to the editors.
Expert comments for publication:
Rates for vasovagal and vasovagal syncope vary depending upon the donor population with rates of syncope roughly between 2-40/10,000 donation with an average around 30/10,000. Syncope reactions are typically tracked because they are easily identified by the loss of consciousness (LOC) and because they are more likely to cause injury than mild reactions. In general, syncope occurs statistically more frequently in young donors (<20 years old) (Eder): rates among young donors occur at 10.7/10,000, 8.310,000 and 2.8/10,000 in, respectively, 16-17 year olds, 18-19 year olds and donors 20 years old or older.
Other factors putting donors at risk for syncope include gender, history of donation and total blood volume. Even among at risk donors, syncope occurs at different times during the donation, depending upon the physiologic or psychologic factor in play (Wieling, Bravo). During registration risk is highest in those who are young and donating for the first time, likely due to fear. During the actual phlebotomy and up until 4 minutes after the needle is removed, young, first time and low blood volume donors have more frequent reactions, due to fear and loss of blood volume. After the donor moves from a reclining to a sitting or standing position, about 500 ml of blood pool in the lower extremities; during this time donors at the highest risk are those with love blood volume but also those who are young and donating for the first time. Finally, after leaving the donation site, donors at risk for syncope include young, first-time, female and low volume donors.
Because multiple factors influence the rate and timing of syncopal reactions, interventions to prevent, abort or treat such reactions must address these psychological and physiological factors. Education and information to address fear and anxiety are effective in young and first time donors. Interventions targeting orthostatic triggers include provision of water, salt and sports drinks to increase and/or replace the lost blood volume. Finally maneuvers that empty large capacitance veins in the lower extremities increase the central blood volume, cardiac filling pressures, stroke volume, cardiac output and cerebral circulation. Such maneuvers include applied muscle tension in which large lower extremity muscles are tensed rhythmically; further these interventions work instantaneously and are able to abort or prevent a reaction in donors who are taught to effectively use them at the appropriate time.