Moderate and Severe Reactions during Autologous Blood Donations Are No More Frequent than during Homologous Blood Donations

Background: 6-year analysis of adverse events (AE) in a preoperative autologous deposit (PAD) program. Patients and Methods: This analysis was performed in 28,244 patients who underwent major bone and joint surgery from 1989 to 1994 and who took part in our PAD program. Patients were included into the PAD program if eligible for elective surgery with supposed blood loss requiring blood transfusion. Patient’s physical status was rated according to the ASA score. Blood or plasma volume donated was replaced routinely, mostly with polygeline. Monitoring during donation included ECG (lead II) and noninvasive blood pressure recording. Oxygen (2 l/min) was applied via nasal sponges. AE were rated as mild (grade I), moderate (grade II), severe (grade III), and fatal (grade IV). All AE happening in the blood bank were taken into account; additionally, all grade III and grade IV AE occurring within 24 h after PAD were considered, independent of a relationship between PAD and AE. AE were analyzed in relation to age and ASA status of the patients. Data were evaluated using descriptive statistics, chi-square test, and Spearman rank correlation; statistical significance was considered for p < 0.05. Results: 28,244 patients underwent 50,542 PAD sessions and donated a total of 132,093 autologous units. A total of 588 AE happened; i.e. in 2.08% of all participating patients and in 1.17% of all donations (not units obtained!). With increasing ASA score, i.e. with worsening of the patient’s physical status, the frequencies of mild and moderate AE decreased. 65.9% (n = 388) of all AE were considered as mild, 33.2% (n = 195) were rated as moderate, 0.51% (n = 3) were graded as severe, and 0.34% (n = 2) were fatal. No overall relation between patients’ age and frequency of AE could be demonstrated. However, patients over 70 years (21.1%) accounted for 30.7% of AE (p < 0.05). The rate of AE associated with autologous plasmapheresis was 3.4-times higher than that associated with autologous blood donation. With one exception, all severe and fatal AE were found in patients over 70 years with ASA score III and a history of cardio- or cerebrovascular diseases. All these patients had undergone autologous plasmapheresis. Conclusion: The overall frequency of AE in our PAD program was not higher than that reported for homologous programs. However, severe and fatal AE exclusively happened in patients who underwent autologous plasmapheresis. Therefore, in elderly patients and in those with concomitant cardio- or cerebrovascular diseases the indication for participation in a PAD/autologous plasmapheresis program has to be made very cautiously and by weighing pros and cons.

Section: Resultssupporting

confidence: 83%

Section: Discussionmentioning

confidence: 94%

Adverse Events in Autologous Blood Donation and Plasmapheresis – a 6-Year Analysis in 28,244 Patients with 50,542 Donations

Singbartl¹,

Schleinzer²

1999

“…As long as these conditions are respected, the rate of mild and moderate reactions is not higher for autologous blood collection than for allogeneic blood donation. This has previously been shown in different settings [13,14], but the variability in reporting problems at different blood centers was very high [15], resulting in reaction rates between 1 and 8% for comparable patient groups. Severe reactions, defined as those requiring hospitalization, were found in 1 of 16,783 autologous blood donations and hence 12 times more frequently than in allogeneic donors [16].…”

Section: Resultssupporting

confidence: 61%

Donor Reactions and Traffic Risks in Autologous Blood Predeposits

Felleiter¹,

Freudenberg²,

Wiesneth³

et al. 1999

Data of 956 patients referred to a regional blood center for participation in an autologous blood program were reviewed. Mild and moderate reactions appeared in 3.8% of phlebotomies, no severe reactions were observed. The specific risks of patients participating in an autologous blood program cover also traffic accidents while travelling to a blood center. For the studied sample the risk of injury is 1:9,523 for a single visit, increasing to 1:4,519 for 2.1 blood units deposited by each patient on average. The risk to die in a traffic accident is about 1:490,000 for one visit and 1:230,000 for 2.1 units. This risk is in the same order of magnitude as the risk of dying from a viral infection acquired by an allogeneic blood transfusion. Therefore the decision for or against an autologous blood predeposit has to be made individually for each patient.

“…Comparison between donors who experienced adverse events and normal donors erogeneity [1,2,[4][5][6][7][8][9][10][11]. Furthermore, most reports come from multicenter studies with a marked center-to-center variation in adverse events rates [1,2,14,15,19]. Our single-center study should overcome this limitation and allow a homogeneous collection of data.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Adverse Events during Blood and Apheresis Donations: A Single-Center Study

Franchini¹,

Gandini²,

Gandini³

et al. 2002

Background: Blood and apheresis donations are widely considered safe, with a low incidence of adverse reactions and injuries. However, data reported in the medical literature on the prevalence of adverse events in donors and studies on the predictive risk factors for donor reactions are limited and contradictory. Material and Methods: From January 1998 to June 2001, we recorded at our transfusion center all adverse events occurring during 116,952 consecutive blood and apheresis donations (homologous and autologous whole blood donation, plasmapheresis and plateletpheresis). Results: 1,960 adverse events were reported (1.7% of all donations). With a frequency of 1.2%, vasovagal reactions, mostly of mild intensity, were the most commonly observed adverse event. The frequency of vasovagal reactions was significantly lower in autologous blood and apheresis donations than in homologous blood donations. Hematoma at the venipuncture site was the second most frequent adverse effect with a rate of 0.4%. A mild to moderate citraterelated toxicity was observed in 0.3% of apheresis donations. With an overall rate of 0.02%, severe adverse reactions (vasovagal, citrate-related and cardiopulmonary events) were very rare. No life-threatening adverse effect was reported, and no severe adverse event required hospitalization. Finally, we found that those donors who experienced adverse reactions were primarily first-time donors, were younger, and had a lower weight and predonation blood pressure than donors without reactions. Conclusions: Blood and apheresis donations are safe procedures with a low incidence of adverse reactions. Young age, first-time donation status, low weight and predonation blood pressure are predictive factors of donor reactions.