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Adverse Occurrence type:
Very rare; only 5 cases reported in the literature, including current report. no estimated rates are given.
Time to detection:
About 2 weeks after suspected arterial puncture; ecchymoses over antecubital fossa.
Alerting signals, symptoms, evidence of occurrence:
Following a known arterial puncture, donor developed a thrill in his left antecubital fossa. Physical exam revealed a bruit, diminished radial pulses in left compared with right arm. No suggestion of pseudoaneurysm or residual hematoma. Vascular surgery repair of left brachial artery to median antecubital vein AV fistula.
Demonstration of imputability or root cause:
Evidence of arterial puncture followed in 2 weeks by symptomatic AV fistula with no other known source of injury. Likely cause of needle penetrating through left antecubital vein into brachial artery. Unclear if donor's continued physical exercise compromised clot formation, aiding fistula formation.
Suggest new keywords:
arterial puncture, blood donation, pseudoaneurism, AV fistula
Omura MC, et al. Arteriovenous fistula following needle puncture for blood donation. Omura MC, et al.Transfusion. 2005 Feb;45(2):270-3 Arm complications after manual whole blood donation and their impact. Newman B. Transfus Med Rev. 2013 Jan; 27(1):44-9. Epub 2012 Jun 6 Repair of a Left Brachial Artery PseudoaneurysmAfter Blood Donation in a 17-Year-Old Male. Weber, C.; Craig, R.; Milner, R. Vascular Disease Management 2012; 9 (1) :1 Adverse effects in blood donors after whole-blood donation: a study of 1000 blood donors interviewed 3 weeks after whole-blood donation. Newman BH1, Pichette S, Pichette D, Dzaka E. Transfusion. 2003 May;43(5):598-603
Expert comments for publication:
Case study of AV fistula formation within 2 weeks of arterial puncture. Article also provides estimated rates of arterial puncture (1/34,000 to 1/11,000 venepunctures for blood donation) and of pseudoaneurism (1.5% of arterial punctures). Because of the difficulty in preventing AV fistulas and pseudoaneurism after arterial puncture, donors with known arterial punctures should be advised to seeks professional care immediately if they have dilated veins, a thrill or a mass appear in the venipuncture site.