Drinking 500mL of water or isotonic drink close to phlebotomy is useful in preventing presyncopal or syncopal reactions in blood donors. Isotonic drinks have the advantage of preventing delayed reactions and tiredness after whole blood donation.

Identifying risk factors as well implementing preventive strategies with regard to fainting or prefainting reactions associated with whole blood donation are important issues for donor safety and retention. To assess fainting risk factors, two retrospective case-control studies of severe immediate and delayed fainting reactions were performed based on the French hemovigilance data collected from 2011 to 2013 and involving close to 9 000 000 donors. In a multivariate analysis, immediate fainting was strongly associated with first-time donation and young donor age, while delayed fainting was associated with a female gender. Apheresis was a risk factor for occurrence of both immediate and delayed fainting when compared to whole blood donation. To identify and quantify means to reduce immediate and/or delayed fainting risk, we performed a randomized prospective trial in 4576 whole blood donors assessing three different hydration strategies immediately before donation: 500 ml of an isotonic drink versus 500 ml of water and an advice to drink (control arm) immediately before donation, with or without applied muscle tension during donation. Overall, faintness occurred in 5Á5% of donations. Compared to the control arm, drinking plain water or an isotonic drink significantly reduced overall faintness occurrence, independently of muscle tension. Furthermore, muscle tension reduced faintness during the donation while an isotonic drink reduced delayed off-site faintness as well as tiredness. Such findings are in line with suggested mechanisms regarding fainting occurrence. Implementing these preventive approaches should reduce the frequency of overall unacceptable side-effects of blood donation: faintness and tiredness.

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