Donor vigilance: a global update

Background Without blood donations and the availability of blood transfusion, many important therapeutic advances could not have been achieved. Donor haemovigilance is the systematic monitoring of adverse reactions and incidents in the whole chain of blood donor care, with a view to improving quality and safety for blood donors. Method This ‘global update’ draws on work by the International Haemovigilance Network and International Society for Blood Transfusion haemovigilance working party, experience in the Netherlands, as well as a PubMed search using terms blood donor and adverse reaction. Results are discussed for vasovagal reactions, needle-related complications, long-term morbidity, donor iron status and frequent apheresis. Results and Discussion The occurrence of vasovagal reactions is associated with young, female donors, smaller estimated blood volume, first-time donor status. A reduction in vasovagal reactions has been documented with use of a water drink before donation, muscle tensing, social distraction and lower collection volume for donors with small estimated blood volume. Needle injury is relatively frequent as a cause in cases of long-term morbidity; needle injury is associated with traumatic phlebotomy, and in some cases, nerve damage is documented. Repeated whole blood donations lead to reduction in body iron stores and in some cases anaemia. Some blood services adjust donation intervals to avoid or reduce this, while others have or are considering a policy of iron replacement therapy. Fewer studies on acute complications in plasma and other types of apheresis have been published. Preliminary studies of bone density and protein levels in non-commercial frequent plasma donors have not substantiated any specific hazard despite theoretical concerns of calcium or protein depletion. International collaboration in strengthening donor vigilance definitions and data analysis may in future increase potential for study of risk factors and measures to improve donor care worldwide. Conclusion Donor vigilance is gaining international interest and has increased knowledge of risk factors for vasovagal reactions associated with blood donation. There remains a need of research and of developing preventive measures, including prevention and treatment of needle injury as well as possible long-term effects of frequent donation.