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Record number:
2235
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Estimated frequency:
This study examines the combined effect of blood donor fear and total blood draw time on vasovagal reactions. 2730 whole blood donors attending high school drives who successfully completed their health screen were asked to grade their fear of having blood drawn using a likehert scale (1 = "not afraid at all" to 5 = "extremely afraid"). 31.2% of fearful donors whose blood draw lasted 10 minutes or more versus 5% of non-fearful donors whose draw lasted < 6 minutes had vasovagal reactions. Eleven phlebotomies that were 3 minutes or less were excluded from analyses as they were considered potential arterial punctures. Donors who reported some fear of having blood drawn (responses of 2 to 5 on the likehert scale) were more likely than non-fearful donors to have a vasovagal reaction (21.7% vs 7.2%, p<0.001). The overall proportion of reactions increased as a function of draw time, from 7.7% of those with a draw times of < 6 minutes to 16.9% of those with draw times 10 minutes or longer.
Time to detection:
In this study, the "harm" to donors (vasovagal reactions) occurred at the time of or soon after donation. Prior to donating, donors were asked to grade their fear of having their blood drawn on a likehert scale; their responses were kept confidential from the phlebotomists. The phlebotomists were asked to rate the severity of the vasovagal reactions (88.3% of donors had no vasovagal reaction, 10.4% had a mild reaction, 0.5% had a moderate reaction, and 0.8% were severe) and the location where the reaction occurred (88.4% occurred in donation chair, 8.7% after leaving the chair but still on-site, and 2.9% off-site (ie, school classroom, hallway, or bathroom)). The length of time for blood draw was also determined and divided into the following intervals: < 6 minutes (30% of donors), 6 to < 8 minutes (28.4% of donors), 8 to < 10 minutes (13.2% of donors), and 10 minutes or longer (28.5% of donors).
Alerting signals, symptoms, evidence of occurrence:
The phlebotomists rated the severity of the vasovagal reactions (ie, mild, moderate, severe) and entered the location where the reactions occurred (ie, in donation chair, on-site but not in chair, off-site). The authors provided a table with the signs and symptoms used to classify mild, moderate, and severe vasovagal reactions. Mild reactions include pallor; feeling faint, lightheaded, dizzy, sweating; hyperventilation, possibly tingling of fingers; or pale, nauseated, stomach cramps. Moderate reactions include all or some mild signs and symptoms along with loss of consciousness for 45 seconds or less; or vomiting and/or incontinence. Severe reactions include all or some symptoms and signs of mild/moderate reactions along with tetany; convulsions; confusion; loss of consciousness > 45 seconds; or recovery from mild/moderate symptoms lasting > 30 minutes.
Demonstration of imputability or root cause:
Larger studies are needed to examine the relationship more carefully between fear, draw time, and risk of vasovagal reactions. The results of this study indicate that vasovagal reactions increase as a function of blood draw time, approximately doubling in frequency when comparing draw times >10 minutes versus drawn times < 6 minutes. What is novel about the current findings is that these draw time effects combine with the known effects of blood donor fear to further enhance the prediction of reaction risk. Specifically, the fear of blood draws predicts an approximately 3-fold increase in the odds of experiencing a vasovagal reaction at each draw duration level examined, and these effects persist after controlling for donor sex, weight, estimated blood volume, pulse rate, and first-time donation status.
Imputability grade:
1 Possible
Groups audience:
References:
Suggest new keywords:
blood donor, vasovagal reaction, fear, blood draw time
Reference attachment:
Suggest references:
https://pubmed.ncbi.nlm.nih.gov/26264764/
Expert comments for publication:
This study shows that both fear and blood draw time increase vasovagal reaction rates, however larger studies are needed to examine these relationships more carefully. However, these findings suggest that fearful donors should be the focus of special attention to help decrease their distress before and during donation.