Although blood donation is a safe and well established procedure, certain blood donors face an adverse reaction either during or post donation. The severity of such reactions varies from person to person. However, a general pattern of the nature can be drawn. Such reactions may discourage these donors from donating again.
Different studies across the world have been taken up on the topic of post blood donation reactions. Studies have shown the rate of adverse events/reactions to vary from 0.59% to 33% [1] [2], [3]. However, the huge variation is also because of the lack of common standard to define the adverse event and the difference in the donor selection criteria. A previous single centre study done in North India showed overall reaction rate was 2.5% [4]. Results of other single centre studies in India concluded upon rate of reactions varying between 0.6%-2.33% [5] [6]. In India the complications associated with blood donation which happen once the donor leaves the donation site are yet to be studied.
Need for emphasis on reducing complications
Neuman BH, in his study showed the dramatic drop (85% reduction in blood donor return rate) in the return rates of blood donors who experience any kind of complication [7]. Repeat blood donors are safer than the first time donors both in terms of complications for the donor as well as those which impact the patient. [7] [8]. The importance of retaining blood donors cannot be over-stressed.
Since the blood banking system of today relies upon the selfless and philanthropic act of the voluntary non-remunerative blood donors, it is the moral and social responsibility of the blood banks to strive to reduce any kind of discomfort that the donor may be subjected to.
Blood centres around the world are exploring techniques to reduce the rate of complications in blood donation. There is an urgent need to learn from the experience of the other centres across the world and enhance the protocols that are being used locally so as to expedite the process of identification of best strategies to minimize discomfort.
In-spite of the fact that the intent of the global as well as national regulators and policy making agencies is clear, there is very little clarity on the specific steps to be taken. While several nations like UK have clear indications for the strategies to be used for prevention, identification and documentation of complications associated with blood donation [9] the same is not well defined in our country.
The need for greater awareness and preparedness in treating adverse reactions is more than ever. A voluntary Blood Donation Drive is a place where a donor walks in with his/her free will to donate a unit of blood without the expectation anything in return. When people come in with such a noble thought, there must be considerable effort put in by all of us as part of the blood banking community to give them the best experience. Steps to prevent chances of adverse blood donor reactions must be put in place. In case there is a reaction, a well established procedure to handle that must be known to all volunteers and blood bank staff.
Sankalp India Foundation's Perspective
Sankalp India Foundation is committed to delivering the best quality and safety standards in all its blood donation drives. As of July 2013, the organization has enabled a collection of close to 40,000 units of blood across Karnataka. The organization is attempting to increase the availability of voluntarily donated blood by encouraging individuals to donate blood repeatedly and regularly. Donor retention and satisfaction is of utmost importance for the success of the voluntary blood donation program of the organization. A less studied aspect which is known to have a dramatic impact on the supply of blood is the impact of complications on the possibility of the organization to conduct regular blood donation drives. The need to contain donor reactions gathers still greater importance because of the massive damaging impact a poorly managed situation can have (because of the organization opting not to involve in organizing blood donation drives).
Sankalp India Foundation formulated the Policy for Blood Donation Drives in 2008. The aim of the policy was to lay out the standards to be followed in the blood donation drive. The identification of standard norms to be followed across institutions turned out to a big step in the direction of enhanced quality and safety in blood donation camps. The success of this collective attempt of all the involved blood banks to emerge with better working protocols is indicative of the fact that similar effort could further enhance quality, especially in areas which have not be explored yet.
While working on identification and documentation of the complications associated with blood donation over last few years, the organization has come to realise that there are no established 'Standard Operating Procedures' to refer and adhere to for prevention as well as management of adverse events and reactions. Hence the need was felt for the preparation of standardized protocols which could be used by all blood banks participating in the blood donation drives conducted by the organization.
Not much difference has been observed in the rate of complications associated with blood donation between in-house and outdoor blood donation [4]. However, this document focuses on the identification, prevention, management and documentation in the context of outdoor blood donation drives and restricted to whole blood donation. This protocol document shall be available in all Sankalp blood donation drives.
In the next few editions of the Patrika, the details of the protocols shall be published in full. The intent of this document is to enlist and outline the steps to be taken in order to minimize complications associated with blood donation. It will provide for the common definitions, sharing of the best practices, clear identification of responsibilities and action items. It will also serve the need to identify the training areas for the staff involved in blood donation. The protocols have been reviewed, corrected and finally approved by many transfusion experts.
The protocols will cover the following major aspects in the months mentioned.
A. Identification of Adverse Events
February 2014 edition shall focus on identification techniques. Identifying the complication is the first step in management and drawing subsequent actions for prevention. The identification section looks into the following important aspects:
I) Definition of Standard Terms
II) Grading of severity of Complication
III) Categories of complications related to blood donation
IV) Grading of imputability
B. Prevention of Adverse Events
The March 2014 edition shall lay emphasis on prevention techniques. Generally it is believed that many reactions can be controlled by putting simple methods and tools in place during the blood donation drive. Described in this section are such scientific methods and practices.
C. Management of Adverse Events
Management of adverse events shall be looked in detail in the April 2014 edition. Poor handling of an adverse reaction could lead to further complications. The ambience of the entire blood donation drive can easily get reckless even if one such event is not dealt with in the right manner. This section delves into some effective strategies for management.
D. Documentation
The edition in May 2014 shall focus on documentation. In most cases, people and teams working in health care systems fail to document events that need analysis. Lack of proper documentation means continuing to deliver poor quality service. There are some very important parameters to be captured and analysed for adverse events in blood donation drives. This section of the protocol goes into the tools and technology behind them.
The protocol will also in relevant sections address the training needs for staff and volunteers, highlight proper and effective materials required and also look into methods in improving the ambience of the drive. A separate article in the June 2014 edition shall add light to this topic. Finally, a consolidated reference card shall also be shared in the July 2014 edition.
Through the Patrika an appeal is made to all Blood Bankers to put in practice the methods and tools as mentioned in the protocol.
This protocol is a sincere effort from Sankalp India Foundation to make blood donation drives a pleasurable and awesome experience for blood donors. Readers are encouraged to bring forth queries, suggestions and ambiguities by writing to sankalp.admin@gmail.com
Lets walk together to make voluntary blood donation in India safer.
Why prepare? Here are some complications from recent blood donation camps
Here are 3 incidents from recent blood donation drives that have highlighted the gaps in preparedness in handling adverse donor reactions
A) One lady donor had an immediate vasovagal reaction after the phlebotomy was completed. There was a temporary loss of consciousness Necessary actions were taken to handle the syncope. The following were done
i) Donor was made to lie down with feet in an elevated position
ii) Fluids were administered orally. iii) Donor was rested at a place with good ventilation.
However, that did not seem to be enough. She went through spells of gaining consciousness and falling unconscious several times. She was administered Intravenous fluids. There was a sense of panic in the blood bank team and other volunteers. Another medical team, that of the company where the drive was being organized was also pressed into action. An injection was given to the donor. After about 1.5 hours, just when hospitalization was being considered she seemed getting better. After a few more minutes, she was feeling fine and walked out of the donation room. The lack of complete preparedness to handle such a situation on the part of the blood bank stood well exposed.
B) In another incident, barely a month after the first one, another donor collapsed about 2 hours after donation. The blood donation drive was in progress in the ground floor and this happened in the 4th floor. After basic medical care was administered there (oral fluids and rest), it was felt that more rest was required. On the way there was another syncope. There was no spinal board/stretcher to carry the donor. 4 others had to literally carry the person. Here again only after an IV line was setup and fluids administered was the donor back to normal. The lack of proper equipment to handle this scenario unfolded itself here.
C) A third incident happened last month at a blood donation drive in Bidar. A student had an adverse reaction on the bed during the phlebotomy. The vasovagal syncope included nausea, sweating and a deep sense of discomfort. Here too, just oral fluids and rest did not help. Further medical actions including fluids through the veins, injections were put in place. After 1-1.5 hours the donor seemed fine and was released from the donation room.
The need for greater awareness and preparedness in treating adverse reactions is more than ever. A voluntary Blood Donation Drive is a place where a donor walks in with his/her free will to donate a unit of blood without the expectation anything in return. When people come in with such a noble thought, there must be considerable effort put in by all of us as a part of the blood banking community to give them the best experience. Steps to prevent chances of adverse blood donor reactions must be put in place. In case there is a reaction, a well established procedure to handle that must be known to all volunteers and blood bank staff.
References:
- [1] S. E. S. K. W. D. L. S. S. D. T. P. P. A. M. E. B. M. C. B. Gonçalez TT, “Transfusion,” May 2012. [Online]. Available: http://www.ncbi.nlm.nih.gov/pubmed/22073941.
- [2] S. P. J. J. J. B. S. Sorensen, “Vox Sanguinis,” 2008. [Online]. Available: http://www.haemovigilance.dk/pdf/vox_1000.pdf.
- [3] B. Newman, “Current Opinion in hematology,” 11 September 2004. [Online]. Available: http://www.ncbi.nlm.nih.gov/pubmed/15666658.
- [4] N. M. R. R. S. Naveen Agnihotri, “Analysis of adverse events and predisposing factors in voluntary and replacement whole blood donors: A study from north India,” Asian Journal of Transfusion Medicine, pp. 155-160, 2012.
- [5] P. M. P. S. J. M. Pathak C, “Blood Transfusion,” 9 January 2011. [Online]. Available: http://www.ncbi.nlm.nih.gov/pubmed/21084010.
- [6] A. M. R. D. D. B. Seema Gupta, “Journal of Evolution of Medical and Dental Sciences,” March 2013. [Online]. Available: http://www.jemds.com/data_pdf/seema%20gupta.pdf.
- [7] N. D. A. R. R. A. Newman BH, “The effect of whole-blood donor adverse events on blood donor return rates.,” Transfusion, vol. 46, no. 8, pp. 1374-9, 2006.
- [8] G. S. B. M. S. U. W. D. K. S. Schreiber GB and R. E. D. Study., “Incidence rates of viral infections among repeat donors:are frequent donors safer?,” 2001. [Online]. Available: http://www.ncbi.nlm.nih.gov/pubmed/11399811.