Report on 50 Cases of Severe Acute Hypotension at Donor Plasmaphereses: Treatment and Course

Abstract

Treatment by placing the donor in the Trendelenburg position and rapid infusion of 1,000 mL saline appears to be an effective procedure for resolving severe acute hypotension associated with donor plasmaphereses.

Impact of saline infusion as replacement fluid at donor plasmapheresis

“…The data that support the findings of this letter to the editor are openly available in references (2,3,4).…”

“…It was based on three studies: an observation of saline infusion in donors with severe drops in blood pressure at DP, 2 and two crossover trials of 32 repeat plasma donors each on saline infusion 500 ml in divided doses after each cycle during DP. 3,4 DP was performed with the automated plasma collecting system (PCS2, Haemonetics) via a single needle technique.…”

“…We observed 50 cases who developed a severe drop in systolic blood pressure (SBP) to ≤90 mm HG systolic or by more than one-third of the initial systolic blood pressure with clinical signs such as pallor, sweating or loss of consciousness at DP during 1 year (average drop in SBP of 45 mm HG, incidence 0.15%), predominantly in young, female first-time donors. 2 After treatment with placing the donor in the Trendelenburg position, stopping the procedure and rapid infusion of 1000 mL saline 49 ± 18 min after the event all plasma donors could safely leave the center, without any sequelae. F I G U R E 1 Course of average hemoglobin values (%) in 32 plasma donors in a crossover trial "with a steep increase" without saline (red line) and "a flatter curve" with saline (blue line).…”

“…4 Our research has led to significant improvements in the practice of DP: (a) Based on an observational study and the crossover design of the two trials with saline confirmed by a triple crossover study from Australia the efficacy or level of evidence (estimated 1b) and safety of saline infusion at DP is high. [2][3][4][5] (b) Saline should be infused at DP as clinically indicated in agreement with the donor. [2][3][4][5] (c) Young, female first-time donors require special care.…”

“…[2][3][4][5] (b) Saline should be infused at DP as clinically indicated in agreement with the donor. [2][3][4][5] (c) Young, female first-time donors require special care. 2…”