The potential impact of selective donor deferrals based on estimated blood volume on vasovagal reactions and donor deferral rates

Abstract

BACKGROUND Whole blood donation in the United States is restricted in volume to 10.5 mL/kg or less in an effort to prevent hypovolemic reactions, but still may exceed more than 15% of a donor’s estimated blood volume (EBV). We analyzed the association of EBV with prefaint and systemic vasovagal reactions (SVRs) among whole blood donors and the potential impact of an EBV-based deferral policy. STUDY DESIGN AND METHODS Independent predictors for prefaint reactions and SVRs were assessed by multivariate logistic regression analysis on 591,177 unique donors participating in the Retrovirus Epidemiology Donor Study-II study. RESULTS Young age (16 years old odds ratio [OR], 3.70; 95% confidence interval [CI], 2.78-4.94), low EBV (<3.5 L OR, 3.30; 95% CI, 2.57-4.23), and first-time donation status (OR, 2.33; 95% CI, 2.03-2.67) were the strongest predictors for SVRs, with similar trends seen for prefaint reactions. Sex, height, race, blood center, and donation site were weakly associated predictors. A total of 5.6% of all donors had an EBV of less than 3.5 L and experienced 12.5% of all prefaint reactions and 14.5% of SVRs. The highest reaction rates were seen in donors less than 23 years old with an EBV of less than 3.5 L who comprised 2.7% of all donors, who were mostly female (99.9%), and who experienced 8.8% of prefaint reactions and 11.0% of SVRs. CONCLUSION Young age, low EBV, and first-time donation status are the major correlates of prefaint reactions and SVRs, suggesting that high school and college donors are at particular risk. Deferral of donors with low EBV who are less than 23 years old may offer a rational approach to protecting donors at greater risk of reactions without jeopardizing the adequacy of the blood supply.

Body Mass Index as Predictor of Vasovagal Reactions in First Time Male Blood Donors

“…It's suggested that Nadler's formula overestimates blood volume by as much as 12%. 7 BMI was explicitly cited by Ancel Keys as being appropriate for population studies. Due to its simplicity, it came to be widely used for individual diagnosis, despite its inappropriateness.…”

“…So identifying this group and giving extra attention during and after donation may reduce the chances of reaction. Rios et al 7 in a huge study comprising 5, 91 and 177 donors concluded that deferral of donors with low Estimated Blood Volume (EBV) may offer a rational approach in protecting donors at greatest risk from vasovagal reactions without jeopardizing the blood supply to a greater extent. Our study shows a gradual decrease in VVR rates as the BMI increases linearly as been shown by Narbey et al 9 in their study that higher BMI is protective for both men and women against vasovagal reactions.…”

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“…The formula given by Nadler SB, et al [6] is cumbersome to use and needs either software or a designated person for its calculation and time consuming to be used at donor registry. It's suggested that Nadler's formula overestimates blood volume by as much as 12% [7]. BMI was explicitly cited by Ancel Keys as being appropriate for population studies.…”

“…So identifying this group and giving extra attention during and after donation may reduce the chances of reaction. Rios JA, et al [7] in a huge study comprising 5, 91 and 177 donors concluded that deferral of donors with low Estimated Blood Volume (EBV) may offer a rational approach in protecting donors at greatest risk from vasovagal reactions without jeopardizing the blood supply to a greater extent. Our study shows a gradual decrease in VVR rates as the BMI increases linearly as been shown by Narbey D, et al [9] in their study that higher BMI is protective for both men and women against vasovagal reactions [9].…”

Complications Developed Due to Blood Donation: Review

“…11,13,18,28,29 Y Ya aş ş: : Kan bağışına bağlı komplikasyonlar genç vericiler arasında daha sık gelişmekte-dir. 6,9,11,14,16,18,30,31 16-17 yaşındaki vericilerde yaşça daha büyük vericilere oranla vazovagal reaksiyon oranının daha yüksek olduğu bildirilmektedir. 6 Otuz yaş altı 12 173 verici ile yapılan çalışmada, reaksiyon gelişme oranı (%0,87) diğer çalışmalara göre daha düşük bulunmuştur.…”