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Blood Bank

Adverse Reactions

While blood donation is incredibly safe for most people, sometimes donors can experience side effects or reactions during or shortly after donation. It’s crucial for us to recognize these reactions, know how to respond appropriately, and understand how to minimize their occurrence. Adverse reactions can range from very mild and common to, very rarely, more serious events

Common Reactions (Mostly Mild & Manageable)

Vasovagal Reactions (Fainting/Near Fainting)

  • What it is: This is the most common type of reaction! It’s not directly caused by blood loss volume itself, but rather the body’s reaction to the stress of the donation (needle insertion, sight of blood, anxiety). The vagus nerve gets stimulated, causing a sudden drop in heart rate and blood pressure, reducing blood flow to the brain
  • Symptoms
    • Mild/Moderate: Feeling lightheaded, dizzy, nauseous, sweaty (diaphoretic), pale (pallor), weak, blurred vision, hyperventilation
    • Severe (Syncope): Actual loss of consciousness (fainting). May be brief, sometimes accompanied by brief seizure-like muscle contractions (convulsive syncope - usually benign and due to lack of oxygen to the brain, not a true seizure disorder)
  • Management
    • Recognize early signs! Ask the donor how they’re feeling
    • If symptoms start: Stop or pause the donation immediately
    • Have the donor lie flat and elevate their legs above heart level (Trendelenburg position, or modified). This helps blood flow back to the brain
    • Apply cool compresses to the forehead or back of the neck
    • Offer sips of water once they feel better
    • Reassure the donor calmly
    • Monitor vital signs (pulse, blood pressure)
    • If syncope occurs, protect the donor from injury during the faint. Ensure airway is clear
  • Prevention: Ensure donor is well-hydrated and has eaten beforehand, create a calm environment, use distraction techniques (conversation, music), identify and support anxious donors, instruct donors to tense muscles (like crossing legs and tensing thighs) if they feel faint

Needle Site Complications

  • Hematoma (Bruise)
    • What it is: Blood leaks from the punctured vein into the surrounding tissues
    • Cause: Needle going through the vein, inadequate pressure after needle removal, fragile veins
    • Symptoms: Swelling, tenderness, pain, and discoloration (bruising) at the venipuncture site
    • Management: If forming during donation, stop immediately. Remove needle, apply firm, direct pressure for at least 5-10 minutes. Apply a cold compress later to reduce swelling and pain
    • Prevention: Skilled venipuncture technique, selecting a good vein, ensuring adequate pressure post-donation, instructing donor on proper arm care
  • Infiltration (Apheresis Return)
    • What it is: The return needle (in apheresis) slips out of the vein, and fluids (blood components, saline, citrate) infuse into the tissue instead of the bloodstream
    • Symptoms: Swelling, pain, coolness at the site
    • Management: Stop the return immediately, remove the needle, elevate the arm, apply compresses (often cold initially)
    • Prevention: Secure needle placement, careful monitoring of the return site during apheresis

Less Common, Potentially More Serious Reactions

Nerve Irritation/Injury

  • What it is: The needle comes close to or touches a nerve during insertion or manipulation
  • Symptoms: Sharp, tingling, shooting, or radiating pain down the arm or into the hand/fingers; numbness
  • Management: Stop the donation immediately. Carefully reposition or remove the needle. Document the event thoroughly. Most symptoms resolve quickly, but persistent symptoms require medical evaluation
  • Prevention: Careful vein selection (avoiding areas where major nerves are close to the surface), smooth venipuncture technique, avoiding excessive needle probing. Listen to the donor! If they report sharp, radiating pain, act immediately

Arterial Puncture

  • What it is: The needle accidentally punctures an artery instead of a vein
  • Symptoms: Bright red blood, rapid filling of the bag (may be pulsatile), pain at the site
  • Management: Stop the donation immediately. Remove the needle and apply firm, direct pressure for a longer duration (at least 10-15 minutes, sometimes more) because arterial pressure is higher. Check for hematoma formation. Notify a supervisor/medical director
  • Prevention: Careful palpation to distinguish between veins (bouncier) and arteries (firmer pulse). Avoid venipuncture near known arterial locations

Citrate Toxicity (Apheresis Specific)

  • What it is: Occurs only during apheresis because the citrate anticoagulant (which binds calcium) is returned to the donor’s circulation. This temporarily lowers the amount of ionized calcium in their blood
  • Symptoms: Tingling or numbness, especially around the lips (circumoral paresthesia) or in the fingers/toes; chills; shivering; muscle cramps; feeling of vibration; rarely, severe muscle spasms (tetany) or cardiac rhythm changes (very rare)
  • Management: Slow down the rate of blood return. Give oral calcium supplements (like Tums or other calcium carbonate tablets) for the donor to chew. Reassure the donor. Symptoms usually resolve quickly
  • Prevention: Prophylactic oral calcium before or during the procedure for susceptible donors, careful monitoring of infusion rates, adjusting citrate concentration based on donor tolerance

Allergic Reactions

  • What it is: Reaction to substances used during donation
  • Cause: Most commonly, sensitivity to skin disinfectants (iodine, chlorhexidine), latex (in gloves or wraps), or tape adhesive. Extremely rarely, a reaction to something being returned during apheresis
  • Symptoms: Itching (pruritus), rash, hives (urticaria) at the site or more widespread. Rarely, respiratory symptoms (wheezing) or anaphylaxis (severe, life-threatening reaction)
  • Management: Stop donation/return. Assess severity. For mild skin reactions, remove the offending agent, apply cool compress, consider oral antihistamine. For severe reactions (anaphylaxis), immediate emergency medical intervention (epinephrine, airway support) is needed
  • Prevention: Screen donors for known allergies (iodine, latex, chlorhexidine). Use alternative supplies when available (e.g., non-latex wraps, chlorhexidine scrub for iodine allergy)

Severe Systemic Reactions (Very Rare)

  • Bacterial Contamination/Sepsis: Extremely rare for the donor to become septic from the donation process itself, but theoretically possible with grossly inadequate site disinfection, especially in an immunocompromised donor. Much greater risk for the recipient
  • Hemolytic Reaction: Essentially impossible in standard allogeneic donation. Only a theoretical risk in specific apheresis or autologous scenarios if there’s a catastrophic misidentification error during return/reinfusion

Delayed Reactions

  • Delayed Fainting/Syncope: Fainting after leaving the donation center (usually within 24 hours)
  • Hematoma: Bruising may appear or worsen hours after donation
  • Iron Deficiency: Not an acute reaction, but a potential long-term consequence, especially for frequent whole blood or double red cell donors. Managed with education and iron supplementation advice

General Management & Prevention Principles

  • Observe: Keep a close eye on donors during and immediately after donation
  • Listen: Pay attention to what the donor tells you about how they feel
  • Act Quickly: Respond promptly to any signs or symptoms of a reaction
  • Follow Protocol: Know your institution’s procedures for managing adverse events
  • Document: Record all reactions, interventions, and outcomes accurately
  • Educate: Provide clear post-donation instructions, including warning signs of delayed reactions and who to contact
  • Prevent: Focus on good technique, donor comfort, pre-donation screening, and hydration/nutrition advice

Key Takeaway

While we need to be prepared for adverse reactions, the vast majority of donations go smoothly. By being knowledgeable, vigilant, and responsive, we ensure the donation process remains safe and positive for our volunteer donors!

Key Terms

  • Vasovagal Reaction: A common reaction triggered by stress/anxiety leading to a drop in blood pressure and heart rate, potentially causing dizziness or fainting (syncope)
  • Syncope: Fainting or temporary loss of consciousness
  • Hematoma: A collection of blood outside of blood vessels, commonly called a bruise, often occurring at the venipuncture site
  • Citrate Toxicity: Symptoms caused by temporary low ionized calcium levels due to citrate anticoagulant infusion during apheresis (e.g., tingling, muscle cramps)
  • Paresthesia: An abnormal sensation, typically tingling, numbness, or “pins and needles,” often experienced around the mouth or in extremities during citrate reactions
  • Diaphoresis: Excessive sweating, often a symptom accompanying vasovagal reactions
  • Pallor: Paleness of the skin, another common sign in vasovagal reactions
  • Trendelenburg Position: Placing the patient flat on their back with their feet elevated higher than their head, used to manage vasovagal reactions
  • Infiltration: Leakage of intravenous fluids (like saline or blood components being returned during apheresis) into the tissue surrounding the vein
  • Urticaria: Hives; raised, itchy welts on the skin, often indicating an allergic reaction