Implementation of measures to reduce vasovagal reactions: Donor participation and results

Abstract

Background There are several strategies to reduce donor reactions. We report donor participation and reaction rates before and after implementing multiple measures at Canadian Blood Services. Study design and methods We introduced a structured program of 500 mL of water and a salty snack pre‐donation and applied muscle tension (AMT) during donation. Donors were not deferred for out of range blood pressure (BP); however, BP was measured in first time donors. Time on the donation chair post‐donation was decreased from 5 to 2 min for repeat donors. We assessed participation rates using our quarterly survey of 10,000 recent donors. We extracted vasovagal reactions with loss of consciousness (LOC) from our operational database and compared pre‐implementation (Oct 12,018‐March 31,2019) and post‐implementation (Oct 12,019‐March 31,2020) periods. Results Survey response rates varied from 11% to 16%. The percentage of donors who drank the water and ate the salty snack increased from 58% to 82% and 44% to 70% over 4 quarters; those performing AMT increased from 24% to 41%. Reactions decreased from 19.07 per 10,000 (744 reactions in 390,123 donations) to 14.04 per 10,000 (537 in 382,382 donations) (p < .0001). No first‐time donors with high BP (n = 684) but 5 with low BP (n = 718) had reactions, CI were very large. Conclusions Achieving optimal participation was challenging. After implementation of a donor wellness initiative based on best practice, rates of vasovagal reactions with LOC decreased by 25%. A larger dataset is necessary to assess the safety contribution of BP deferrals when other mitigation measures are in place.

Counter pressure maneuvers for syncope prevention: A semi-systematic review and meta-analysis

“…CPM have also been evaluated for use during syncope associated with blood-injection-injury stimuli, especially during blood donation and intravenous catheter insertion. Multiple studies report that CPM are effective at reducing vasovagal reactions and presyncopal symptoms in this setting (104)(105)(106)(107)(108)(109)(110). Responses were more favorable when tensing was applied specifically when the needle was inserted, when the needle was removed, and when getting up from the chair after the procedure (106).…”

“…Responses were more favorable when tensing was applied specifically when the needle was inserted, when the needle was removed, and when getting up from the chair after the procedure (106). Thus far, muscle tensing of the calf, thigh, abdomen, buttock, arm, and chest have been considered (104)(105)(106)(107)(108)(109)(110)(111)(112)(113). Applying CPM during or immediately preceding blood donation significantly increases HR (105,111) and CBFv (111), although responses may vary in patients with heightened anxiety, or those that experience blood-injectioninjury phobia (105).…”

How do I think about blood donor eligibility criteria for medical conditions?

“…4 Working in a large organization, we have a large denominator for adverse donor or recipient events, and our own data are helpful to both support change and provide post-implementation monitoring of donor safety and donor deferral impacts. 24,25 T A B L E 3 Sources of information to support decision-making Donor hemovigilance frequency of donor reactions, injuries underlying medical conditions associated with reactions Operational data on donor deferrals deferral rates for various conditions frequency and reasons for donor medical enquiries errors related to donor screening Donor feedback and surveys sources of donor dissatisfaction related to criteria evaluation of frequency of a condition in donor population Safety in donors screened using different criteria autologous donors international experience Epidemiology and database linkage is the condition more frequent in transfusion recipients is risk of condition higher in recipients with higher risk donors…”

“…If possible, publishing results of criteria changes will assist other blood centers grappling with similar decisions about eligibility criteria. 24,25,32,33 8 | BROADER POLICY ISSUES Donor risk factors for both faint and pre-faint reactions and iron deficiency have been identified in many studies. First time donation status, younger age (particularly teenage donors), estimated blood volume (EBV) below 3.5 L, and female sex are major risk factors for faint and prefaint reactions.…”

Prevention of Blood Donation-related Vasovagal Response by Applied Muscle Tension: a Meta-analysis

“…One study also noted that although most adults showed a decrease in cardiac output, only younger individuals showed a gradual decrease in vascular tone. 17 Stopping donors from entering the second phase may thus minimize the probability of VVR during blood donation.…”