Adverse Reactions to Whole Blood Donation and Plasmapheresis

Abstract

Whole blood donation is recognized to be extremely safe, yet there have been reports of serious problems stemming from whole blood donation, and so-called "donor reactions" are regularly seen. While the physiologic causes of the common donor reactions are not completely understood, some effects of whole blood donation (such as transient iron deficiency) are understood but probably not significant. In order to avoid accepting any volunteer donor who might be at risk of a serious reaction, we may have been overly cautious in exclusion of potential donors. The pheresis donor is subjected to potential depletion of the protein or cellular elements being removed, problems caused by the device used for automated pheresis, or problems related to the infusion of potentially toxic substances. Documented benefit to the patient must balance these additional risks.

Donor Hemovigilance during Preparatory Plasmapheresis

“…For systemic UEs, signs and symptoms of citrate toxicity were rare with PPP, and at times difficult to distinguish from brief hyperventilation that may accompany vasovagal reactions [9.] Therefore, a separate hyperventilation category was not established.…”

“…tinnitus, visual disturbances, or cerebrovascular accidents. Today, hemolysis and air embolism are rarely seen with modern blood collection equipment [9]. Severe outcomes [30,43], arterial puncture [44], citrate toxicity, severe injuries to subcutaneous nerves [45,46,47,48,49,50], thrombosis of upper extremity veins [51,52], formation of an arteriovenous fistula [53,54], pseudoaneurysm [55,56,57], or compartment syndrome [58] are all extremely rare, as are some other rare events [59].…”

“…The European Guide to preparation, use and quality assurance of blood components listed adverse reactions related to BDs and included donor safety standards [5]. Several investigators have discussed safety issues relating to collection of cellular component by cytapheresis [6,7,8,9]. Apart from unexpected donor events (UEs) during obsolete manual plasmapheresis [10,11,12], only few reports have focused on the safety concerns of preparatory plasmapheresis (PPP) [13,14,15,16], and these have often been abstracts [17,18,19] or case reports [20]; only 1 older report considered PPP-related UEs [21].…”

Donor Hemovigilance with Blood Donation

“…tinnitus, visual disturbances, or cerebrovascular accidents. Today, hemolysis and air embolism are rarely seen with modern blood collection equipment [29]. Severe outcomes [15,30], arterial puncture [31], severe injuries to subcutaneous nerves [32,33,34,35,36,37], thrombosis of upper extremity veins [38,39], formation of an arteriovenous fistula [40,41], pseudoaneurysm [42,43,44], or compartment syndrome [45] are all extremely rare, as are some other rare events [46].…”

Donor Research in Australia: Challenges and Promise

“…Finally, challenges arise with regard to the ‘duty of care' of donor behavior researchers. This is best illustrated with regard to reporting of adverse events (AEs) [37]. BCAs have a strong and appropriate desire to track and record donor AEs, not only for protective care reasons but also because AEs predict donor return [38,39].…”