PLT contamination with bacteria that evade detection by QC culture remains a significant residual transfusion risk, in particular for older PLTs and skin-commensal bacteria in components collected by two-arm apheresis procedures during the study period.

Context Donations by minors (16-and 17-year-olds) now account for approximately 8% of the whole blood collected by the American Red Cross, but young age and first-time donation status are known to be independent risk factors for donationrelated complications. Objective To evaluate adverse reactions to allogeneic whole blood donation by 16and 17-year-olds compared with older donors in American Red Cross blood centers. Design, Setting, and Participants Prospective documentation of adverse events among 16-and 17-year-old donors using standardized collection protocols, definitions, and reporting methods in 2006. Data were from 9 American Red Cross blood centers that routinely collect from 16-and 17-year-olds, a population that provides 80% of its donations at high school blood drives. Main Outcome Measures Rate of systemic (syncopal-type) and phlebotomyrelated donor complications per 10 000 collections. Results In 2006, 9 American Red Cross regions collected 145 678 whole blood donations from 16-and 17-year-olds, 113 307 from 18-and 19-year-olds, and 1 517 460 from donors aged 20 years or older. Complications were recorded in 15 632 (10.7%), 9359 (8.3%), and 42 987 (2.8%) donations in each corresponding age group. In a multivariate logistic regression model, young age had the strongest association with complications (odds ratio [OR], 3.05; 95% confidence interval [CI], 2.52-3.69; PϽ.001), followed by first-time donation status (OR, 2.63; 95% CI, 2.24-3.09; PϽ.001) and female sex (OR, 1.87; 95% CI, 1.62-2.16; P Ͻ .001). Infrequent but medically relevant complications, in particular physical injury from syncope-related falls, were significantly more likely in 16-and 17-year-old donors (86 events; 5.9/10 000 collections) compared with 18-and 19-year-old donors (27 events; 2.4/10 000 collections; OR, 2.48; 95% CI, 1.61-3.82) or adults aged 20 years or older (62 events; 0.4/ 10 000 collections; OR, 14.46; 95% CI, 10.43-20.04). Sixteen-year-old donors who experienced even a minor complication were less likely to return to donate within 12 months than 16-year-olds who experienced uncomplicated donations (52% vs 73% return rate; OR, 0.40; 95% CI, 0.36-0.44). Conclusions A higher incidence of donation-related complications and injury occurs among 16-and 17-year-old blood donors compared with older donors. The increasing dependence on recruiting and retaining young blood donors requires a committed approach to donor safety, especially at high school blood drives.

Inlet-line diversion decreased bacterial contamination during two-arm collections by more than 46%. Concurrently, doubling the sample volume was associated with a 54% relative increase in culture sensitivity. These interventions act cooperatively to decrease bacterial risk.

Plasma components linked to female donors with WBC antibodies were responsible for the majority of probable TRALI fatalities. Prudent measures to limit transfusion of WBC antibody-containing plasma components may prevent as many as six fatalities per year in the Red Cross system.

The ARC data describe the current risks of blood donation in a model multicenter hemovigilance system using standardized definitions and reporting protocols. Reported reaction rates varied by regional center independently of donor demographics, limiting direct comparison of different regional blood centers.

Reported TRALI cases from plasma transfusion decreased in 2008 compared to the prior 2 years simultaneously with the conversion to male-predominant plasma for transfusion.

Transfusion-transmitted B. microti can be a significant cause of transfusion-related morbidity and mortality, especially in infant, elderly, and asplenic blood recipients. These data demonstrate the need for interventions, in both endemic and nonendemic areas of the United States, to reduce patient risk.

Greater than 99·5% of collections contain no viable, aerobic bacteria in solution at the time of early culture testing. For every confirmed positive contaminated collection detected, there are at most 19 collections with low concentrations of dormant bacteria that are not readily detected by early BacT/ALERT™ culture.