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Adverse Occurrence type:
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
A 20 year old female first-time (non-smoker) blood donor with no family history of venous thrombosis, only risk factor third-generation oral contraceptive (desogestrel/ethinyl estradiol and ethinyl estradiol). She had a slightly traumatic venipuncture with slight difficulty accessing the vein, but collection took only 6 minutes for completion. She contacted the donor center 5 days after donation with arm swelling and pain, 2 inch hematoma. Normal neurological exam of hand and arm. Labs showed normal coagulation panel; testing to exclude a hypercoagulable state performed 4 months after diagnosis were normal. She was treated successfully with 6 months warfarin therapy and discontinuation of oral contraceptives.
Demonstration of imputability or root cause:
Thrombus in distal brachial vein and basilic vein by real-time scanning with color flow compressive ultrasonograpy.
Suggest new keywords:
deep venous thrombosis
whole blood donation
Covin RB, Rich N, Aysola A. (2004). Upper-extremity deep venous thrombosis complicating whole-blood donation. Transfusion 44, 586-590
Expert comments for publication:
Venous thrombosis is usually associated with more invasive venous procedures and is rarely associated with blood donation. Such cases can be associated with hypercoagulable states (Factor V Leiden, FII variant, Protein C or S deficiency, Antithrombin III deficiency), all of which were excluded in this case. This donor's only risk factor was the use of oral contraceptives, though third generation OCP have a lower dose of estrogen and are less likely to be prothrombotic.