Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 10  |  Issue : 1  |  Page : 36-40  

Adverse reactions to blood donation: A descriptive study of 3520 blood donors in a Nigerian tertiary hospital


Department of Haematology and Blood Transfusion, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

Date of Web Publication9-Jan-2017

Correspondence Address:
Dr. C Aneke John
Department of Haematology and Blood Transfusion, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.197894

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  Abstract 

Background: The occurrence of adverse reactions to blood donation significantly hampers donor retention and negatively impacts on the universal availability of adequate numbers of blood donor units. Objective: To analyze the spectrum and prevalence of adverse reactions in blood donors in a tertiary hospital-based blood bank in Nigeria. Subjects and Methods: The details of 3520 blood donors who presented for donation over a 12 months period were retrieved from the departmental archives for analysis. These included sociodemographic information, type of donor, type and frequency of adverse reactions to blood donation. Data were analyzed using the Statistical Package for Social Sciences version 20.0 (SPSS Inc., Chicago, IL, USA) computer software. Descriptive and inferential statistics were employed to represent the distribution of donor characteristics (as percentages) and compare reaction rates by gender and severity, respectively. Results: The prevalence of adverse reactions to blood donation was (56/3520) 1.60%; this occurred more frequently in male and family replacement donors (55.35% and 100.0%, respectively). The spectrum of donor adverse reactions included anxiety 25 (44.64%), generalized body weakness 11 (19.64%), hematoma 10 (17.86%), fainting 5 (8.93%), and vomiting 5 (8.93%). Vasovagal reactions were the most frequent adverse reaction encountered among the donors (46/56; 82.14%). Conclusion: Vasovagal reactions are common adverse phenomena in our blood donor set; this has implications on transfusion safety and blood donor retention.

Keywords: Adverse blood donor reactions, blood donor retention, blood transfusion safety, vasovagal reactions


How to cite this article:
John C A, Theodora U E, Gloria A N, Chika E A. Adverse reactions to blood donation: A descriptive study of 3520 blood donors in a Nigerian tertiary hospital. Med J DY Patil Univ 2017;10:36-40

How to cite this URL:
John C A, Theodora U E, Gloria A N, Chika E A. Adverse reactions to blood donation: A descriptive study of 3520 blood donors in a Nigerian tertiary hospital. Med J DY Patil Univ [serial online] 2017 [cited 2019 Jun 16];10:36-40. Available from: http://www.mjdrdypu.org/text.asp?2017/10/1/36/197894


  Introduction Top


Donor recruitment is very challenging in parts of Sub-Saharan Africa; this is worsened by inadequate numbers of voluntary blood donors, infrastructural deficits, and often poor organization of transfusion services. Prospective blood donor recruitment in Nigeria has been reported to be suboptimal, even among well-informed groups such as health care workers.[1] The factors responsible for this were well captured in earlier studies in Lagos and Calabar (South-West and South-South Nigeria, respectively), which showed that fear of contacting transfusion transmissible infections (52.4%), fear of side effects such as weight loss (23.8%), sudden death (3.3%), sexual failure (5.9%), high blood pressure (5.2%), convulsions (1.5%), and diverse religious beliefs constituted huge impediments to blood donor recruitment.[2],[3] These combine to significantly hamper efforts toward achieving universal availability of safe and affordable blood units in the country.

Over the years some strategies have been evolved to increase the pool of appropriate units of blood and blood products in blood banks; these included the establishment of well-organized National blood transfusion services, which embark on the robust recruitment of new donors as well as retention of already recruited ones.[4] It is vital that blood donors (particularly voluntary donors) are retained and encouraged to become regular donors as a way of increasing the availability of donor units in blood banks. This laudable innovation has however been observed to be significantly hampered by the occurrence of adverse reactions in blood donors following donation.[5]

Donor adverse reaction has been defined as symptom or sign of donor discomfort that is severe enough to either warrant the donor calling for attention of the blood bank staff or was noticed by the staff.[4] These have been observed in up to 2–6% of donors; however, serious adverse reactions leading to loss of consciousness are rarely encountered (reported in only 0.08–0.3% of the donor population).[6],[7] Among the plethora of potential adverse reactions that could arise from blood donation, vasovagal reactions have been most frequently reported in a number of series and have been equally recognized to be a significant deterrent to repeat blood donation.[4],[8],[9],[10] Some donor characteristics including young age, low weight, first-time donation status, female gender, and Caucasian race have been variously reported to reliably predict for the development of adverse reactions in potential blood donors.[11],[12]

In view of the negative influence of adverse blood donor reactions on donor retention and attainment of self-sufficiency in blood availability, we set out to evaluate the prevalence and spectrum of adverse reactions to blood donation in the set of blood donors seen in our hospital blood bank.


  Subjects and Methods Top


The study was conducted on allogeneic whole blood donors who presented to the blood bank of our hospital over a period of 12 months (from January 2015 to December 2015). Donor information was retrieved from the blood bank register as well as through oral interview of the donor Bay staff. The criteria for the selection of eligible blood donors used by the unit were adapted from the World Health Organization blood donor selection criteria.[13] Blood collection was performed in the donor Bay by trained phlebotomists. Each donor was observed before, during, and after donation for the occurrence of any adverse reactions.

Donor adverse reaction was defined as any donor discomfort that was of sufficient severity to be noticed by the donor or the blood bank staff.[4] All donor reactions were observed immediately after donation (within 30 min following blood donation) and included vasovagal reactions, development of hematoma at the site of venesection, vomiting, and generalized body weakness. Donors who had vasovagal reactions were further stratified into those whose symptoms were severe or mild, using the classification of Kumari.[14] The unit has a protocol for managing adverse reactions which include the involvement of medical staff of the department (hematologists and hematologists-in-training) in cases with severe reactions. Ethical approval for this study was sought from the Ethics and Research Committee of our Institution.

Statistical analysis

Data were analyzed using the Statistical Package for Social Sciences version 20.0 (SPSS Inc., Chicago, IL, USA) computer software. Descriptive statistics were employed to represent the frequency of adverse reactions in donors (as percentages). Rates of adverse reactions across gender groups and by reaction severity were compared using the Chi-square test; P was statistically significant at <0.05.


  Results Top


A total of 3520 donors were seen within the study period, comprising of 3089 (87.76%) males and 431 (12.24%) females, the mean age of the donors was 30.64 ± 7.23 years (range of 18–50 years). There were 3497 (99.34%) family replacement and 23 (0.65%) voluntary donors in this study.

Adverse reactions to blood donation were observed in 56 donors; consisting of 31 (55.35%) males, 25 (44.64%) females and 100.0% family replacement donors, with an overall prevalence rate of 1.60% (56/3520).

The spectrum of adverse reactions observed in male donors included anxiety (10/31; 32.26%), generalized body weakness (8/31; 25.81%), fainting spells (5/31; 16.13%), hematomas (5/31; 16.13%), and vomiting (3/31; 9.68%), [Table 1].
Table 1: Spectrum of adverse reactions in male and female blood donors

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Correspondingly, the adverse reactions reported in females donors were, anxiety (15/25; 60.00%), generalized body weakness (3/25; 12.00%), hematomas (5/25; 20.00%), and vomiting (2/25; 8.00%), [Table 1]. Fainting attacks were not observed in any of the female donors.

There were no significant differences in the frequency of rates of adverse reactions to blood donation when compared between male and female donors (P = 0.24).

Mild vasovagal reactions were encountered more often in this study compared with severe reactions [78.26% vs. 21.74%, respectively, [Table 2], this difference was however not statistically significant (P = 0.16). The spectrum of mild vasovagal reactions in all donors was generalized body weakness (23.91%) and anxiety (54.35%) while that for the severe reactions included 10.87% for vomiting and fainting spells, respectively [Table 2].
Table 2: Severity of vasovagal reactions in donors

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The adverse reactions occurred in 56 (100.0%) and 0 (0.0%) of family replacement and voluntary donors, respectively. None of the donors experienced convulsions or any other adverse reactions that warranted hospital admission or involvement of the medical team (for further management) during the study.


  Discussion Top


There was a male dominated donor pool (87.76%) in this study who consisted mainly of young adults (mean age of 30.64 ± 7.23 years). These demographic patterns have equally been replicated in an earlier study in our center and studies from other parts of Nigeria.[15],[16],[17]

Some authors had reported a paucity of voluntary blood donors in parts of Africa and attributed this to the fact that the culture of altruism is not as popular in Africa as it is in more developed countries.[15],[17],[18] Family replacement blood donation has been shown to be popular and even predominant in parts of Africa because it is well supported by the extended family structure which characterizes the typical African setting.[19],[20] The findings from this study agree with these earlier reports as our donor population consisted mainly of family replacement donors (99.34%).

Adverse reactions to blood donation were observed in 56 donors in this study, giving a prevalence rate of 1.60% [Table 1]. Earlier reports from America and India noted higher prevalence rates of adverse reactions (8.9% and 2.5%, respectively) among blood donors.[4],[21] The report of Newman, in African American and Caucasian blood donors equally, showed a higher prevalence rate of adverse reactions than was observed in this study (11–21% vs. 1.60%).[6] Our result is, however, higher than reported by Kumari among 27,664 blood donors in North India (0.7%).[14] A number of variables have been identified to significantly influence the prevalence rates of adverse donor reactions among different donor sets. These include differences in donor demographics, behavior of collection staff, use of donor chairs versus flatbed, and methodology used to obtain information regarding adverse reactions from donors.[4]

The frequency of adverse reactions to blood donation in male and female donors appear conflicting. While some reports suggested predominance of adverse reactions in female donors, others were contradictory and concluded that reactions occurred more in males.[4], 7, [22],[23],[24] Our finding is in agreement with the latter reports; adverse reactions occurred more in male donors compared with their female counterparts [55.35% vs. 44.64%, respectively, [Table 2].

Adverse donor reactions were predominantly seen in family replacement donors (100.0%). Even though the higher number of family replacement donors compared with voluntary donors in this study could have skewed the prevalence of adverse reactions towards the former, earlier studies had emphasized that nonvoluntary donors are prone to more adverse reactions.[4],[25] This is thought to occur as a result of the “opponent-affective theory” which states that repeated exposure to adverse stimuli gradually decreases the intensity of response to such stimuli.[25] It is, therefore, likely that the repeated blood donations enabled the voluntary donors to become well acclimatized to the routines of donation, as against family replacement donors who may only donate at irregular intervals.

Vasovagal reactions were the most frequent adverse reaction observed in this study (46/56; 82.14%), while anxiety was the most frequent vasovagal reaction encountered [25/46; 54.35%, [Table 2]. This finding is equally reiterated by earlier studies conducted among American and Indian donors.[4],[14] Vasovagal reactions are distressing symptoms (such as dizziness, vomiting, weakness, fainting, and anxiety) which are thought to represent physiologic response that occur due to changes in blood volume and typically happens toward the end or after blood donation.[26] A number of predisposing factors to vasovagal reactions among blood donors have been highlighted and include first-time donation, low body weight, young donor age, and blood pressure indices.[6],[7],[27] It has been earlier reported that women tended to experience higher rates of vasovagal reaction compared with men, mainly because of their smaller body build.[26] This observation was however not replicated in this study; though the reason for this discrepancy was not entirely apparent from our data, we suspect that the smaller sample size of this study (compared to earlier similar studies) might have been contributory. Importantly, the occurrence of vasovagal reactions has been observed to negatively impact on blood donor retention.[8],[9],[28],[29] In recognition of the significant influence of vasovagal reactions on donor safety, retention, and attainment of self-sufficiency in the availability of appropriate blood donor units, a number of interventions have been explored as ways of preventing vasovagal reactions in blood donors. These include addressing fear in potential donors, improving donor attitude, water fluid preloading, and application of muscle tension and decreasing blood donation duration.[30],[31],[32],[33] The extent to which these interventions will reduce the frequency of vasovagal reactions in Nigerian donors has not been determined; this could be an interesting subject of future research.


  Conclusion Top


Donor safety is an integral and very important component of blood transfusion safety which needs to be strengthened through regular appraisal of adverse reactions that occur following blood donation. The spectrum of adverse reactions among our donor set is comparable to reports from other parts of the world, with a preponderance of mild vasovagal reactions. This underscores the importance of adequate donor counseling and observation before and after blood donation, as well as the application of other measures that have been reported to reduce the frequency of donor adverse reactions (particularly vasovagal reactions). A follow-up study which will evaluate the effect(s) of adverse reactions and application of these preventive measures on donor retention in Nigeria is advocated.

Limitations of the study

  • There was no proper protocol in place to monitor for delayed adverse reactions which could occur after the donor had left the donor bay
  • The small number of voluntary donors probably skewed the observed adverse reactions in this study toward family replacement donors
  • The documentation of repeat donation was not complete; this would have enabled the evaluation of the influence of donor adverse reactions on donor retention.


Acknowledgment

The authors would like to acknowledge Onyiye Emodi and Stella Ezema, both of the Blood Group Serology unit for assisting in data retrieval for this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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