Donor vigilance: progress and challenges

Background  Internationally, there is increased interest in reporting, treating and attempting to reduce complications of blood donation. 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. International Developments  Several studies have described the risk factors for vasovagal reactions – female donors, young age, first-time status, low body weight, etc. A water drink before donation, use of applied muscle tension and social support during donation have been found effective in reducing minor vasovagal reactions and/or increasing the likelihood of donors returning for subsequent donations. Haematomas and other venepuncture-related complications are frequent and are the predominant cause of long-term morbidity from complications of blood donation. International surveillance data on donor complications are captured in ‘ISTARE’ International Surveillance database for Transfusion-associated Adverse Reactions and Events, which is being developed by the International Hemovigilance Network. Experience in The Netherlands: Better Monitoring of Donor Complications, Where Next?  All donor complications and procedural problems are routinely recorded in the computer system eProgesa. Since 2009, the results have been monitored. An improved coding list was introduced in 2010 in order to record more details and cover new procedures such as Rhesus immunizations. The overall rate of donor complications increased from 0·64 in 2009 to 0·80 per 1000 whole blood collections (second half of 2010) and from 1·34 to 1·40 per 1000 plasmaphereses; there were no changes in donor demographics or procedures to explain this, so better recording is presumed. The recorded complications and procedural problems are regularly presented in team leaders’ and regional directors’ meetings. The data have been used to analyse the effect of a procedural modification: increasing the concentration of citrate solution used in plasmapheresis. The rate of terminating procedures because of citrate reactions was 0·14 per 1000 collections [95% confidence interval (CI) 0·018–0·27] before and 0·09 (95% CI 0·018–0·17) after the modification, signifying no relevant change. It is hoped that in 2012 a revised donor information brochure with instructions on avoiding vasovagal reactions will be piloted and subsequently tested. Nevertheless, only immediate and short-term complications can be effectively addressed by the recording and analysis of complications. Longer term issues such as whole blood donor iron status are the subject of research in our country and abroad. Conclusion  In our country as well as elsewhere, recording and monitoring the incidence of complications of blood donation has become the norm. Knowledge of risk factors and evidence-based interventions will enable blood establishments worldwide to reduce donor complications. As yet, longer term complications are not well addressed.