Blood Systems, Inc., Scottsdale, Arizona 85257, USA.
Transfusion. 2011 Jul;51(7):1511-21. doi: 10.1111/j.1537-2995.2011.03074.x. Epub 2011 Mar 7.
There have been multiple reports concerning the predictors of fainting reactions in blood donors, but few attempts to reduce the rates of fainting reactions with concomitant rigorous attempts to monitor the success of the interventions.
We used a retrospective observational cohort study design, comparing the likelihood of reaction from 213,031 allogeneic whole blood donations made by 17- to 22-year-old donors in two separate 12-month periods before and after the implementation of interventions to reduce reactions. The interventions were 1) a limit on the maximum percentage of estimated blood volume young donors could donate, 2) encouraging applied muscle tension during donation, and 3) providing approximately 500 mL of water before donation. Reactions were defined by severity and time in relation to the end of phlebotomy and documented according to standard procedures. Data analysis included comparison of stratified reaction rates and multivariable logistic regression analysis.
The interventions decreased the aggregate reaction rates in male and female donors by 24% (p < 0.0001). There was a 25% decrease in delayed reactions (p = 0.0006) and a 38% decrease in off-site reactions (p = 0.001) in female donors. The impact of the three interventions together on reaction rate was greater than the combined impact of exercises and water provision. Multivariable modeling showed that the interventions reduced reactions but did not prevent their occurrence in identified higher risk groups.
The interventions to reduce vasovagal reactions in whole blood donors were effective. Future efforts to reduce reactions in blood donors can build on the strengths and avoid the weaknesses identified while conducting and analyzing the data from this study.
已有多项关于献血者晕厥反应预测因素的报告，但很少有尝试通过同时严格监测干预措施的效果来降低晕厥反应发生率。
我们采用回顾性观察队列研究设计，比较了在实施减少反应干预措施前后两个 12 个月期间，17-22 岁的异基因全血献血者 213031 次献血中反应的可能性。干预措施包括 1）限制年轻献血者可捐献的估计血容量的最大百分比，2）鼓励在献血过程中应用肌肉紧张，3）在献血前提供约 500 毫升水。反应根据严重程度和与采血结束的时间来定义，并按照标准程序进行记录。数据分析包括分层反应率的比较和多变量逻辑回归分析。
干预措施使男性和女性献血者的总反应率降低了 24%（p<0.0001）。女性献血者的迟发性反应（p=0.0006）和场外反应（p=0.001）分别降低了 25%和 38%。三种干预措施对反应率的综合影响大于运动和供水的综合影响。多变量建模表明，干预措施降低了反应发生率，但未能预防在确定的高风险人群中发生反应。
减少全血献血者血管迷走性反应的干预措施是有效的。未来减少献血者反应的努力可以借鉴本研究实施和分析数据时发现的优势，并避免其弱点。
