Wiltbank Thomas B, Giordano Gerald F, Kamel Hany, Tomasulo Peter, Custer Brian
United Blood Services, and Blood Systems, Scottsdale, Arizona; and Blood Systems Research Institute, San Francisco, California, USA.
Transfusion. 2008 Sep;48(9):1799-808. doi: 10.1111/j.1537-2995.2008.01745.x. Epub 2008 May 14.
A small proportion of blood donors have adverse reactions. The purpose of this study was to determine predictors of faint and significant hypotensive reactions that could serve as targets for interventions to reduce reactions, thus improving the blood donation experience for those at higher risk of reactions and reducing the risk of serious adverse events.
The records of 422,231 allogeneic whole-blood donations from a 9-month period were assessed for adverse reactions. Incidents related to needle insertion, such as hematoma, were excluded. Demographic, biometric, and clinical measurements were collected. Reactions were analyzed by multivariate logistic regression analysis comparing donors with any adverse reaction to donors without reactions and by stratified rates according to reaction severity.
The overall reaction prevalence was 1.43 percent. Of the reactions, 63, 29, and 8 percent were classified as mild, moderate, and severe, respectively. Markers of reactions were age, sex, race, blood volume, blood pressure, pulse, and body mass index. Compared to donors without reactions, the strongest predictor of a reaction was a donor's blood volume of less than 3500 mL (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.57-3.23). Age and first-time status were also associated with a significantly higher risk of reaction with 17- to 18-year-olds (OR, 2.8; 95% CI, 2.59-2.98) and 19- to 24-year-olds (OR, 2.39; 95% CI, 2.23-2.56) at higher risk compared to 25- to 65-year-olds and first-time donors at higher risk compared to repeat donors (OR, 2.2; 95% CI, 2.07-2.33).
The results of this study are helpful in identifying donors at risk for adverse reactions and in understanding the contributors to reactions. Donor blood volume was an unexpectedly strong predictor of reaction. Potential interventions to reduce the frequency of reaction are discussed.
一小部分献血者会出现不良反应。本研究的目的是确定晕厥和显著低血压反应的预测因素，这些因素可作为干预目标以减少反应，从而改善高反应风险人群的献血体验，并降低严重不良事件的风险。
评估了9个月内422,231例异体全血捐献的记录以确定不良反应情况。排除了与针头插入相关的事件，如血肿。收集了人口统计学、生物特征和临床测量数据。通过多因素逻辑回归分析比较有任何不良反应的献血者与无反应的献血者，并根据反应严重程度进行分层率分析。
总体反应发生率为1.43%。在这些反应中，分别有63%、29%和8%被分类为轻度、中度和重度。反应的标志物包括年龄、性别、种族、血容量、血压、脉搏和体重指数。与无反应的献血者相比，反应的最强预测因素是献血者血容量小于3500 mL（比值比[OR]，2.9；95%置信区间[CI]，2.57 - 3.23）。年龄和首次献血状态也与显著更高的反应风险相关，17至18岁的献血者（OR，2.8；95% CI，2.59 - 2.98）和19至24岁的献血者（OR，2.39；95% CI，2.23 - 2.56）相比25至65岁的献血者风险更高，首次献血者相比重复献血者风险更高（OR，2.2；95% CI，2.07 - 2.33）。
本研究结果有助于识别有不良反应风险的献血者，并了解反应的影响因素。献血者血容量是一个出人意料的强反应预测因素。讨论了降低反应频率的潜在干预措施。
