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1.  Adverse reactions in blood and apheresis donors: experience from two Italian transfusion centres 
Blood Transfusion  2009;7(1):35-38.
Blood and apheresis donations are widely considered to be safe with a low incidence of adverse reactions and injuries; however, data reported in the medical literature on the prevalence of adverse events in donors and studies on the predictive risk factors for donor reactions are limited and contradictory.
From January 2002 to December 2006 we recorded every adverse reaction verified during 240,596 consecutive blood and apheresis donations (183,855 homologous whole blood donations, 6,669 autologous whole blood donations, 38,647 plasmapheresis, 2,641 plateletpheresis and 8,784 multicomponent donations) at the Italian Transfusion Centres of Verona and Ragusa,.
Using a special, pre-arranged form within the quality system, a total of 686 adverse reactions (related to 0.28% of all donations) were recorded. Vasovagal reactions, mostly of mild intensity, were the most commonly observed adverse reactions, with a frequency of 0.20% (487/ 240,596). The frequency of the vasovagal reactions varied according to the different types of donation, being 0.19% (346/183,855) for homologous whole blood donations, 0.24% (16/6,669) for autologous whole blood donations, 0.16% (63/38,647) for plasmapheresis, 0.68% (18/2,641) for plateletpheresis and 0.49 (43/8,784) for multicomponent donations. Citrate toxicity was reported in 0.38% (189/50,072) of apheresis donations. Severe adverse reactions were very rare, as they occurred in 0.004% of the donations (10/240,596).
In conclusion, the results of our 5-year survey document that apheresis and blood donation are safe procedures for the donor with a low incidence of adverse reactions; the adverse reactions that did occur were mostly mild and resolved rapidly.
PMCID: PMC2652234  PMID: 19290078
blood donation; apheresis; adverse events
2.  Vasovagal reactions in whole blood donors at 3 REDS-II blood centers in Brazil 
Transfusion  2011;52(5):1070-1078.
In Brazil little is known about adverse reactions during donation and the donor characteristics that may be associated with such events. Donors are offered snacks and fluids prior to donating and are required to consume a light meal after donation. For these reasons the frequency of reactions may be different than those observed in other countries.
A cross-sectional study was conducted of eligible whole blood donors at three large blood centers located in Brazil between July 2007 and December 2009. Vasovagal reactions (VVRs) along with donor demographic and biometric data were collected. Reactions were defined as any presyncopal or syncopal event during the donation process. Multivariable logistic regression was performed to identify predictors of VVRs.
Of 724,861 donor presentations, 16,129 (2.2%) VVRs were recorded. Rates varied substantially between the three centers: 53, 290 and 381 per 10,000 donations in Recife, São Paulo and Belo Horizonte, respectively. Although the reaction rates varied, the donor characteristics associated with VVRs were similar [younger age (18–29), replacement donors, first time donors, low estimated blood volume (EBV)]. In multivariable analysis controlling for differences between the donor populations in each city younger age, first-time donor status and lower EBV were the factors most associated with reactions.
Factors associated with VVRs in other locations are also evident in Brazil. The difference in VVR rates between the three centers might be due to different procedures for identifying and reporting the reactions. Potential interventions to reduce the risk of reactions in Brazil should be considered.
PMCID: PMC3687805  PMID: 22073941
3.  Risk factors for complications in donors at first and repeat whole blood donation: a cohort study with assessment of the impact on donor return 
Blood Transfusion  2014;12(Suppl 1):s28-s36.
First-time donation is among recognised risk factors for vasovagal reactions to blood donation and reactions are known to reduce donor return. We assessed associations between potential risk factors and vasovagal reactions and needle-related complications in first-time whole blood donation in comparison to repeat donation and analysed the impact of complications on donor return.
Materials and methods
We performed a cohort study on whole blood donations in The Netherlands from 1/1/2010 to 31/12/2010 using data extracted from the blood service information system. Donation data up to 31/12/2011 were used to ascertain donor return.
In 2010 28,786 donors made first whole blood donations and there were 522,958 repeat donations. Vasovagal reactions occurred in 3.9% of first donations by males and 3.5% of first donations by females compared to in 0.2% and 0.6%, respectively, of repeat donations. Associations of vasovagal reactions with other factors including age, body weight, systolic and diastolic blood pressure were similar in first-time and repeat donors. Needle-related complications occurred in 0.2% of male and 0.5% of female first-time donations and in 0.1% and 0.3%, respectively, of repeat donations. Among first-time donors, the return rate within 1 year was 82% following an uncomplicated first donation, but 55% and 61% following vasovagal reactions and needle-related complications, respectively; the corresponding percentages among repeat donors were 86%, 58% and 82%.
Among first-time donors, females suffered less than males from vasovagal reactions. Other risk factors had similar associations among first-time and repeat donors. Vasovagal reactions and needle-related complications in both first-time and repeat donors are followed by reduced donor return.
PMCID: PMC3934284  PMID: 23867173
blood donation; vasovagal reaction; needle-related complication; donor retention; first-time donor
4.  Complications Associated with Blood Donations in a Blood Bank at an Indian Tertiary Care Hospital 
Background: Blood donation, though safe, has a few potentially avoidable complications associated with it. They are important reasons for the failure of the donors to return for repeat donations. The aim of this study was to assess the frequency and identify the possible factors associated with increased risk of blood donation related complications so that they can be minimized.
Materials and Methods: A prospective study was done over a period of four months in the blood bank of an Indian tertiary care hospital to record the donation related complications.
Results: Out of 7450 blood donations, total donation associated complications were 74, of which majority were vasovagal reactions (VVRs) (n=48), followed by venous hematomas (n=24) and arterial punctures (n=2). The incidence of VVRs was more, though not statistically significant, in females, replacement/repeat donors, donors between 21-30 y of age and who had a body-mass-index (BMI) of 18.5-24.9. VVRs were more common in April (p=0.002) and in those who donated 450ml of blood (p<0.001). Though hematomas were more frequent in females, voluntary donors, donors in age-group of 41-50, those with BMI<18.5 and in those who donated 350ml of blood, statistically significant association was seen only in repeat donors (p<0.001).
Conclusion: Our study emphasizes that blood donation in our country has a complication rate of nearly 1%.
PMCID: PMC4225916  PMID: 25386464
Arterial punctures; Blood donation; Blood donors; Complications; Vasovagal reactions; Venous hematomas
5.  Women as whole blood donors: offers, donations and deferrals in the province of Huelva, south-western Spain 
Blood Transfusion  2014;12(Suppl 1):s11-s20.
Women seem more willing to donate blood than men despite the limitations that affect their donation rate. The aim of our study was to determine the role of women in altruistic donation of blood in Huelva, a province in south-western Spain.
Materials and methods
We registered 87,601 offers to donate whole blood between January 1st, 2005 and December 31st, 2009. We statistically analysed variables such as sex, age, offers, deferrals and donations, problems in venous access, vasovagal reactions, weight and blood pressure to establish their significance according to donor gender.
With regards to gender, 52.3% of donors were women and 47.7% men. Of the 87,601 offers to donate blood, 46.5% were from females and 53.5% from males. More females than males made their first donation during the study period. However, 43.9 % of donations were from women, whereas 56.1% were from men. Overall 8.7% of offers were deferred, 62.7% of which due to a low haemoglobin concentration, which was the most frequent cause of deferral in women. Difficulties in venous access and vasovagal reactions were also more frequent in female donors than in male donors. By the end of the study period, donor fidelity was 58.6% for men and 48.6% for women.
In the province of Huelva, women are more altruistically inclined than men to give blood, with the percentages of donors and first-time donors being higher among females. However, there are restrictions to women giving blood, especially low haemoglobin concentration, which reduce the number of female blood donations. Women also have more difficulty when blood is withdrawn and are more susceptible to vasovagal reactions, which negatively affect their experience as donors. Measures should be taken to reduce these barriers to encourage women to continue to offer to donate blood, thereby ensuring that they become regular donors, which is a key factor in guaranteeing an adequate supply of blood within the region of Andalusia.
PMCID: PMC3934236  PMID: 23245721
female; blood donor; deferral; adverse reactions; fidelity
6.  The Knowledge, Attitude and Practice Towards Blood Donation Among Voluntary Blood Donors in Chennai, India 
Introduction: An integrated strategy for blood safety is required for the provision of safe and adequate blood. Recruiting a sufficient number of safe blood donors is an emerging challenge. The shortage of blood in India is due to an increase in the demand, with fewer voluntary blood donors. A study on the knowledge, attitude and the practice of donors may prove to be useful in the successful implementation of the blood donation programme. Our aim was to find the level of the knowledge, attitude and practice of blood donation among voluntary blood donors.
Material and Methods: A structured questionnaire was given to 530 voluntary blood donors to assess their knowledge, attitude and practice with respect to blood donations. The statistical analyses were done by using the SPSS software. The associations between the demographic factors were analysed by using the Chi square test.
Results: Among the 530 donors, 436 (93%) were males and 36 (7%) were female donors. 273 (51.2%) donors knew about the interval of the donation and 421 (79.4%) donors knew about the age limit for the donation. 305 (57%) donors felt that creating an opportunity for the donation was an important factor for motivating the blood donation and 292 (55%) donors felt that the fear of pain was the main reason for the hesitation of the donors in coming forward to donate blood.
Conclusion: A majority of the donors were willing to be regular donors. The donors showed positive effects like a sense of satisfaction after the donation. Creating an opportunity for blood donation by conducting many blood donation camps may increase the voluntary blood donations.
PMCID: PMC3708194  PMID: 23905099
Blood donation; Knowledge; Motivation; Voluntary donors
7.  Blood Donation by Elderly Repeat Blood Donors 
Upper age limits for blood donors are intended to protect elderly blood donors from donor reactions. However, due to a lack of data about adverse reactions in elderly blood donors, upper age limits are arbitrary and vary considerably between different countries.
Here we present data from 171,231 voluntary repeat whole blood donors beyond the age of 68 years.
Blood donations from repeat blood donors beyond the age of 68 years increased from 2,114 in 2005 to 38,432 in 2012 (from 0,2% to 4.2% of all whole blood donations). Adverse donor reactions in repeat donors decreased with age and were lower than in the whole group (0.26%), even in donors older than 71 years (0.16%). However, from the age of 68 years, the time to complete recovery after donor reactions increased. Donor deferrals were highest in young blood donors (21.4%), but increased again in elderly blood donors beyond 71 years (12.6%).
Blood donation by regular repeat blood donors older than 71 years may be safely continued. However, due to a lack of data for donors older than 75 years, blood donation in these donors should be handled with great caution.
PMCID: PMC4164071  PMID: 25254019
Blood donation; Elderly blood donors; Donor safety; Blood donors; Donor deferral; Adverse donation reactions
8.  Knowledge, attitude and beliefs of people in North India regarding blood donation 
Blood Transfusion  2014;12(Suppl 1):s21-s27.
To develop targeted interventions in the field of donor recruitment, an understanding of existing knowledge, attitudes and beliefs regarding blood donation is required. Recruiters should be aware of variability in different demographic strata when implementing interventions.
Material and methods
A self-administered questionnaire along with a face-to-face interview was conducted in 400 each of voluntary donors, replacement donors and non-donors to assess their knowledge, attitude and beliefs regarding blood donation and their motivations for giving blood. Data were analysed using ANOVA and the c2 test.
The most common reason given by non-donors (40.75%) for not donating blood was “no one asked them to give blood”. Voluntary donors had a more pleasant blood donation experience compared to replacement donors and, therefore, more of them were willing to donate again (89.5%). The knowledge scores of non-donors were lower than those of donors and, among the latter, voluntary donors had better scores compared to replacement donors. Expectedly, the frequency of false beliefs was highest among non-donors (22.75%), with the most prevalent misbelief being that blood donation is associated with infertility. Television was found to be the most effective medium of communication for raising awareness about blood donation.
It is recommended that extensive blood donation campaigning should be initiated, targeting the campaigns to eliminate specific misbeliefs and reinforce motivational perceptions. Blood centres should implement strategies to improve donor retention and should aim to provide a pleasant donation experience, regardless of the donor type. The idea of voluntary blood donation needs to be intensively promoted.
PMCID: PMC3934261  PMID: 23245709
voluntary donors; replacement donors; knowledge; attitude; beliefs
9.  A single-centre study of vasovagal reaction in blood donors: Influence of age, sex, donation status, weight, total blood volume and volume of blood collected 
Vasovagal reactions (VVRs) in blood donors.
To find an association of age, sex, donation status, weight, total blood volume and volume of blood collected with occurrence of immediate VVR.
Settings and Design:
Retrospective single-centre study.
Materials and Methods:
The study was conducted from March 2000 to November 2010 at a tertiary care blood transfusion centre. All VVRs with or without syncope occurring during or at the end of donation were noted.
Statistical Analysis Used:
For qualitative association, c2-test was used. Unpaired ‘t’ test was used for assessing difference between two groups with respect to VVR status. Simultaneous impact of all risk factors was assessed using multivariate logistic regression analysis. The data entry software SPSS (version 17.0) was used for statistical analysis. A P-value <0.05 was considered statistically significant.
Overall 1085 VVRs were reported in relation to 88,201 donations, resulting in an overall VVR rate of 1.23%, that is, an incidence of 1 in every 81 donations. Donors with low blood volume, first-time donors, with low weight and female donors had higher absolute donation VVR rates than other donors.
Donation-related vasovagal syncopal reactions are a multifactorial process determined largely by weight, age, first-time donor status and total blood volume. Our study reinforces the fact that blood donation is a very safe procedure, which could be made even more event-free by following certain friendly, reassuring practices and by ensuring strict pre-donation screening procedures.
PMCID: PMC3943146  PMID: 24678174
Blood donor; first-time donors; total blood volume; vasovagal reaction; volume of blood collected
10.  The potential impact of selective donor deferrals based on estimated blood volume on vasovagal reactions and donor deferral rates 
Transfusion  2010;50(6):1265-1275.
Whole blood donation in the United States is restricted in volume to 10.5 mL/kg or less in an effort to prevent hypovolemic reactions, but still may exceed more than 15% of a donor’s estimated blood volume (EBV). We analyzed the association of EBV with prefaint and systemic vasovagal reactions (SVRs) among whole blood donors and the potential impact of an EBV-based deferral policy.
Independent predictors for prefaint reactions and SVRs were assessed by multivariate logistic regression analysis on 591,177 unique donors participating in the Retrovirus Epidemiology Donor Study-II study.
Young age (16 years old odds ratio [OR], 3.70; 95% confidence interval [CI], 2.78-4.94), low EBV (<3.5 L OR, 3.30; 95% CI, 2.57-4.23), and first-time donation status (OR, 2.33; 95% CI, 2.03-2.67) were the strongest predictors for SVRs, with similar trends seen for prefaint reactions. Sex, height, race, blood center, and donation site were weakly associated predictors. A total of 5.6% of all donors had an EBV of less than 3.5 L and experienced 12.5% of all prefaint reactions and 14.5% of SVRs. The highest reaction rates were seen in donors less than 23 years old with an EBV of less than 3.5 L who comprised 2.7% of all donors, who were mostly female (99.9%), and who experienced 8.8% of prefaint reactions and 11.0% of SVRs.
Young age, low EBV, and first-time donation status are the major correlates of prefaint reactions and SVRs, suggesting that high school and college donors are at particular risk. Deferral of donors with low EBV who are less than 23 years old may offer a rational approach to protecting donors at greater risk of reactions without jeopardizing the adequacy of the blood supply.
PMCID: PMC4167765  PMID: 20113451
11.  The effect of repeated blood donations on the iron status of male Saudi blood donors 
Blood Transfusion  2011;9(2):167-171.
Regular blood donation can lead to iron deficiency. Screening donors’ serum ferritin levels at the time of first donation and subsequently once every year is a very rational way to pick up iron deficiency in a voluntary blood donor population. The aim of this study was to determine the effect of blood donation and the prevalence of erythropoiesis with iron deficiency (sideropenia) in Saudi male blood donors.
Materials and methods.
The study was prospectively conducted, between December 2008 and March 2009, on 182 male native Saudi blood donors at King Fahd Central Hospital in Jazan region, Saudi Arabia. Each donor gave 450±50 mL of whole blood. Following the donation, samples were removed into 2.5 mL EDTA tubes for measurement of mean cell volume (MCV) and mean corpuscular haemoglobin (MCH) and into 7.5 mL plain tubes for estimation of iron and serum ferritin concentrations. The blood donors were divided into five groups, according to the number of donations they had given in the preceding 3 years. The blood donors in group I were first-time donors, with no previous history of blood donation. Group II donors had donated once in the last 3 years. Subjects in groups III, IV and V had donated more than once in the preceding 3 years and were considered regular donors.
The mean serum iron was significantly higher among subjects with no previous history of blood donation (group I) than among regular donors who had donated twice or more. The difference in serum ferritin concentration was statistically significant (p<0.05) when comparing regular donors in group III (72.4 μg/L), group IV (67.4 μg/L) and group V (26.2 μg/L) with first-time blood donors (131.4 μg/L). In contrast, the difference in the concentration of serum ferritin between subjects in group II (98.9 μg/L), who had donated once in the last 3 years, and in first-time blood donors (131.4 μg/L) was not statistically significant (p<0.131). None of the group I donors suffered from iron deficiency, whereas 2.8% of the donors who had donated between two to five times had iron deficiency. The prevalence of erythropoiesis with iron deficiency in regular blood donors was 4.3%.
The results of this study show that an increase in the number of donations results in an increase in the frequency of depleted iron stores and subsequently in erythropoiesis with iron deficiency, although the level of haemoglobin remained acceptable for blood donation. This result may indicate the need to review the guidelines on acceptance of donors.
PMCID: PMC3096860  PMID: 21084007
iron deficiency; erythropoiesis with iron deficiency; sideropenia; regular blood donors; serum iron; serum ferritin
12.  Motivators and Barriers to Blood Donation in African American College Students 
An adequate blood supply depends on volunteer non-remunerated blood donors. African Americans have lower blood donation rates than whites. To improve African American blood donation rates, the motivators and barriers to African Americans must be explored. To study the differences in motivators and barriers to blood donation between donor and non-donor African American college students.
African Americans college students at two Historically Black Colleges and Universities completed a 41-item, self-administered questionnaire, which assessed participant’s donation frequency, motivators and barriers toward donation, and knowledge and beliefs towards blood donation.
364 primarily female college students (96% African Americans, 93% female) completed the questionnaire. 49% reported prior blood donation experience (donors) and 51% were non-donors. The primary motivator for donors and non-donors was convenience (89% donor, 82% non-donor). Donors were more likely than non-donors to disagree with statements regarding blood donation as being too painful (82% donor, 44% non-donor), resulting in feeling faint, dizzy, or nauseated (61% donor, 29% non-donor). Donors more often agreed that the blood supply is safe (77% donor, 58% non-donor), less often concerned about receiving a transfusion (61% donor, 73% non-donor), and more often aware of local blood shortages (50% donor, 35% non-donor).
African Americans female college students are willing to donate blood given convenience and support from their university. Educational campaigns to increase knowledge regarding the safety of the blood donation process and the ongoing needs of an adequate blood supply might be effective methods to increase blood donation.
PMCID: PMC2784155  PMID: 19782000
13.  Adverse reactions to blood donations: the READ project 
Blood Transfusion  2010;8(1):49-62.
In 2006 in Italy 2,404,267 donations of blood components were made by 1,539,454 donors; approximately 55% of the donations were collected directly by Transfusion Structures (TS), while about 45% were collected in Donation Centres managed by Associations and Federations of Donors. The aim of the READ (Rilevamento Eventi Avversi alla Donazione) project is to create a network of TS to test a standardised system for monitoring adverse events (AE) related to blood donations.
Materials and methods
Shared, standardised data collection forms, compatible with the forms produced by the ISBT-EHN, were prepared. Two types of form were used: (i) a form to collect data on single events (READ 1), to be used at the individual collection sites; (ii) a form for processing the data collected by each TS (READ 2).
Between February and August 2008 six TS collected data related to the donation of 89,332 units of blood. Overall, 523 AE were recorded. The AE occurred in 0.59% of the donations. The mean duration of the symptoms was 17 minutes. Fifteen percent of the symptoms were related to the venipuncture (mainly haematomas) and 77% to vasovagal AE. The AE were defined severe (grade C) in 47 cases. The donations in which AE were recorded were completed in 81% of the cases; 59% of the AE did not require treatment. Three donors were monitored briefly (for less than 4 hours) in hospital.
The use of standardised forms enabled the collection of data that could be analysed. Some problems related to the performance of the haemovigilance programme did, however, emerge: (i) organisational problems, (ii) limited sensitivity, (iii) inadequate training, and (iv) poorly defined responsibilities. These problems must be resolved at various levels: local, regional and national.
PMCID: PMC2809512  PMID: 20104279
blood donation; adverse events to donation; Italian multicentre study
14.  Blood donors' motivation and attitude to non-remunerated blood donation in Lithuania 
BMC Public Health  2006;6:166.
In the Soviet period, the blood donation system operated in Lithuania exclusively on a remunerative basis. After joining the EU, Lithuania committed itself to meeting the EU requirements to provide all consumers within its boundaries with safe blood products made from voluntary unpaid blood donations. However, the introduction of a non-remunerated donation system may considerably affect donors' motivation and retention. Thus the aim of the current research was to determine blood donation motives among the present donors and investigate their attitude towards non-remunerated donation.
A questionnaire survey of 400 blood donors. Survey data processed using SPSS statistical analysis package. Statistical data reliability checked using Fisher's exact test (p < 0.05).
Paid donors comprised 89.9%, while non-paid ones made 10.1% of the respondents. Research findings show that 93 per cent of the paid donors give blood on a regular basis; while among the non-remunerated donors the same figure amounted merely to 20.6 per cent. The idea of the remuneration necessity is supported by 78.3 per cent of the paid donors, while 64.7 per cent of the non-remunerated respondents believe that remuneration is not necessary. The absolute majority of the paid donors (92%) think they should be offered a monetary compensation for blood donation, while more than half of the non-remunerated donors (55.9) claim they would be content with a mere appreciation of the act. Provided no remuneration were offered, 28.44 per cent of the respondents would carry on doing it, 29.6 per cent would do it only in emergency, 29.6 per cent would donate blood merely for their family or friends, and 12.3 per cent would quit it completely.
Most respondents admitted having donated blood for the following reasons: willingness to help the ill or monetary compensation. Majority would consent to free blood donation only in case of emergency or as a family replacement, which leads to a conclusion that provided monetary remuneration is completely terminated part of the currently active paid donors would withdraw from this activity, which might seriously affect the national supply of blood and its products.
PMCID: PMC1524746  PMID: 16792814
15.  An Adapted Post-Donation Motivational Interview Enhances Blood Donor Retention 
Transfusion  2010;50(8):1778-1786.
Blood donors may hold conflicting thoughts about future donation. While they may perceive the direct benefit to themselves and others, they often report compelling reasons not to give again. As a result the standard encouragements to return may not be sufficient to motivate some donors. The present study examined the effects of a post-donation adapted motivational interview on blood donor attitudes and repeat donation behavior.
Study Design and Methods
Donors (n=215) were randomly assigned to either an adapted motivational interview (AMI) or a no-interview control group. Approximately one month after their index donation, donors in the AMI group completed a brief telephone interview to clarify individual-specific motivations and values concerning blood donation and address potential barriers. They were then asked to complete questionnaires regarding donation attitudes, anxiety, self-efficacy and intention to donate. Donors in the control group were also contacted one month post-donation and asked to complete the same series of questionnaires.
Donors in the AMI group reported greater intention to provide a future donation, F = 8.13, p < 0.05, more positive donation attitudes, F = 4.59, p < 0.05, and greater confidence in their ability to avoid adverse reactions, F = 10.26, p < 0.01. Further, AMI was associated with higher rates of attempted donation at 12 months (OR, 2.48; 95% CI, 1.27–4.87).
Application of an adapted motivational interview may be an effective strategy to increase the donor pool by enhancing retention of existing donors.
PMCID: PMC2948616  PMID: 20456674
Blood donation; Motivational interviewing; Donor Retention
16.  Translation into Portuguese and validation of the Blood Donation Reactions Inventory 
the Blood Donation Reactions Inventory (BDRI) scale was proposed as part of a study about the predictors of psychological reactions in volunteer blood donors, as uncomfortable reactions are associated with a lower probability to return for further donations.
to translate the Inventory into Brazilian Portuguese and evaluate its psychometric properties (validity and reliability). The inventory has 11 items, but the literature suggests that shorter inventories, of four or six items, should be used.
this study was carried out at the blood center of Franca, Brazil. Three people with knowledge of English and familiarity with medical terms translated the Blood Donation Reactions Inventory into Brazilian Portuguese. Aiming to evaluate the objectivity and relevance of the items of the translated instrument, its content was independently evaluated by a panel of eight assessors. After this, data on 1,001 blood donors was collected. Internal consistency was assessed by Cronbach's alpha coefficient. An exploratory factor analysis with varimax rotation was used to analyze the measure for construct validity.
the sample consisted of 65.8% men, and 27.3% first time donors. Internal consistency determined by Cronbach's alpha coefficient was satisfactory for the 11, 6 and 4-item scales. Considering the factor analysis, the 11-item scale seems to measure more than one construct as three factors were identified with eigenvalues greater than 1. These factors correspond to 'vasovagal adverse reactions', 'fear' and 'anxiety/excitation'.
the Portuguese version of the Blood Donation Reactions Inventory is a valid and reliable instrument for collecting information regarding systemic reactions experienced by blood donors. The 6-item scale seems to be useful when the objective is to measure only vasovagal adverse reactions.
PMCID: PMC4005513  PMID: 24790540
Blood donors; Validation studies; Translations; Hemotherapy service; Factor analysis, statistical
17.  Adverse reactions during voluntary donation of blood and/or blood components. A statistical-epidemiological study 
Blood Transfusion  2007;5(3):143-152.
Voluntary donors normally tolerate blood donation very well, but, occasionally, adverse reactions of variable severity may occur during or at the end of the collection. Aim of this study was to estimate and possibly avoid the cause of unwanted reactions.
Materials and methods
The study was conducted over a period of 6 months, from 24th October, 2005 to 24th April 2006. The donor population analysed consisted of 4,906 donors (3,716 male and 1,190 female). In total, 3,983 (81%) voluntaries have donated whole blood, 851 (17%) plasma from apheresis, 64 (1.3%) experienced multicomponent donation, and 8 (0.1%) were donors of plasma-platelet apheresis.
Only 63 donors (1.2% of all the volunteers) suffered some kind of adverse reaction: 59 (1.08% of the subjects) had mild reactions (agitation, sweating, pallor, cold feeling, sense of weakness, nausea), and only 4 (3 males and 1 female, 0.2%) had more severe disorders, including vomiting, loss of consciousness, and convulsive syncope.
Although the number of donors who developed disturbances during or at the end of blood donations was very low, it is nevertheless desirable to reduce risks to a minimum. A set of advices is provided for preventing problems.
PMCID: PMC2535889  PMID: 19204767
blood donors; blood donations; adverse reactions
18.  Analysis of Chinese Donors’ Return Behavior 
Transfusion  2010;51(3):523-530.
It is important to understand donor return behavior. Converting first time donors to become repeat donors is essential for maintaining an adequate blood supply.
Characteristics of 241,552 whole blood (WB) donations from first time (FT) and repeat (RPT) donors who donated in 2008 at the 5 blood centers in China were compared. A subset of 54,394 WB donors who donated between January 1 and March 31, 2008 were analyzed for their return behavior in 2008 following the index donation using logistic regression.
Of all donations, 64% was from FT donors. Donors with self-reported previous donations tended to be male, older, married, donated larger volume (≥300mL), and were heavier in weight. Among donors who donated from January to March, 2008, 14% returned for subsequent WB donations by the end of 2008. The number of previous donations and blood collection location were the two strongest predictors for making subsequent donations. Donors with 1, 2–3 and more than 3 previous donations were 3.7, 5.7, and 11.0 times more likely to return than FT donors. Those who donated in a blood collection vehicle were 4 times more likely to return than those who donated at a blood center. Being female, younger and of a lower education level (≤ middle school) were positively associated with subsequent return blood donation during the follow-up period observed in this study.
Most of the Chinese blood supply is from first time donors. Strategies aimed at encouraging current donors to become repeat donors are needed.
PMCID: PMC3025301  PMID: 20849408
first time donor; repeat donor; donor return
19.  Adverse reactions in whole blood donors: an Indian scenario 
Blood Transfusion  2011;9(1):46-49.
Whole blood donation is generally considered to be a safe procedure, but occasionally adverse reactions of varying severity may occur during or at the end of the collection. The aim of the study was to estimate the frequency and type of adverse events occurring during blood donation and to assess the practices which would help to minimise them.
Materials and methods
This retrospective single-centre study was conducted from June 2007 to November 2009 at a regional blood transfusion centre. All whole blood donations made at the centre were analysed. All adverse events occurring during or at the end of donation were noted using a standardised format.
Overall 113 adverse events were reported in relation to 19,045 donations, resulting in an overall adverse event rate of 0.6%, that is, an incidence of 1 in every 166 donations. Presyncopal symptoms, in other words vasovagal reactions of mild intensity, were the most commonly observed adverse reactions and accounted for approximately 70% of all adverse reactions noted.
Only 0.6% of blood donations were complicated by adverse events and most of these events were presyncopal symptoms. Our study reinforces the fact that blood donation is a very safe procedure which could be made even more event-free by following certain friendly, reassuring and tactful practices.
PMCID: PMC3021397  PMID: 21084010
blood donation; adverse events; vasovagal reaction
20.  Donor anxiety, needle pain, and syncopal reactions combine to determine retention: A path analysis of two-year donor return data 
Transfusion  2013;53(9):1992-2000.
Efforts to expand the donor pool by recruiting younger donors have resulted in higher numbers of initial donations, but retention of young donors continues to be a problem.
Path analysis was used to examine the simultaneous relationships among syncopal reactions, donation anxiety, needle pain, donor satisfaction, and donation intention in the prediction of repeat donation. Participants included 421 first- and second-time donors recruited for a study comparing the effects of pre-donation water loading with and without the use of applied muscle tension during donation (52% female, 60.8% first-time donor, mean age 20.3 years). For this longitudinal follow-up study, donor database records were accessed two years after the index donation to determine whether a repeat donation had been attempted.
Results of a series of path analyses demonstrated the influential role of donor anxiety in shaping donor retention (final model Χ2=35.75, RMSEA=0.03, CFI=0.98, WRMR=0.74). First, anxiety exerted a direct negative influence on donation intention, the proximal and sole direct predictor of repeat donation. Second, anxiety increased the likelihood of donor-reported needle pain, adversely affecting donation satisfaction and, subsequently, donation intention. Finally, anxiety was associated with donor ratings of syncopal reactions through its impact on needle pain, which also contributed to decreased donation intention.
These results provide novel evidence that donation anxiety plays a central role in shaping future donation behavior; hence, individual differences in anxiety must be considered when developing and testing strategies to enhance blood donor retention.
PMCID: PMC3626759  PMID: 23305267
Blood donor; syncopal reactions; anxiety; pain; donor satisfaction
21.  Gender differences in giving blood: a review of the literature 
Blood Transfusion  2010;8(4):278-287.
An overview of European blood donors shows that the distribution of men and women donors is similar in many countries, with Italy being an exception in that women account for only 30% of donors. Gender medicine is a key issue in this context, even though gender studies are very limited in the transfusion field, whether considered broadly or with specific regards to the selection, management and retention of donors. It, therefore, seemed important to compare the presence of women among blood donors in different European countries and examine the roles that gender is reported to play in the donation of blood in order to identify possible implications for communication with and management of the donor.
To determine the proportion of women among donors in European countries, data were collected from annual reports or documents available on the websites of national associations; furthermore, all papers related to giving blood published in the five main journals in the sector (Transfusion, Vox Sanguinis, Transfusion and Apheresis Science, Transfusion Medicine, Blood Transfusion) were considered; about 80 publications were selected and the gender variable was examined.
The published studies showed that gender plays key roles in the motivation to give blood (women being more altruistic, men being more individualistic) and in adverse reactions, which was a particularly critical problem leading to fewer women become regular donors. A few aspects specific to the management of donors in Italy also emerged.
Gender seems to play an important role in the aspects studied and does, therefore, merit further consideration in relation to strategies to recruit donors and the management of critical events during donation.
PMCID: PMC2957494  PMID: 20967170
donation; blood; gender differences
22.  Management of Young Blood Donors 
The emphasis on high-school blood drives and acceptance of 16-year-old blood donors led to more research on physiologic and psychological ways to decrease vasovagal reaction rates in young blood donors and to increase donor retention. Research on how to accomplish this has been advantageous for the blood collection industry and blood donors. This review discussed the current situation and what can be done psychologically, physiologically, and via process improvements to decrease vasovagal reaction rates and increase donor retention. The donation process can be significantly improved. Future interventions may include more dietary salt, a shorter muscle tension program to make it more feasible, recommendations for post-donation muscle tension / squatting / laying down for lightheadedness, more donor education by the staff at the collection site, more staff attention to donors with fear or higher risk for a vasovagal reaction (e.g. estimated blood volume near 3.5 l, first-time donor), and a more focused donation process to ensure a pleasant and safer procedure.
PMCID: PMC4164065  PMID: 25254024
Blood donation; Vasovagal syncope; Donor safety
23.  Pre-donation Hydration and Applied Muscle Tension Combine to Reduce Presyncopal Reactions to Blood Donation 
Transfusion  2010;50(6):1257-1264.
A randomized controlled trial was conducted to test the effects of hydration and applied muscle tensing on presyncopal reactions to blood donation. Both interventions are designed to prevent the decreases in blood pressure that can contribute to such reactions, but due to the distinct physiological mechanisms underlying their pressor responses it was hypothesized that a combined intervention would yield the greatest benefit.
Prior to blood donation, first- and second-time blood donors (Mean Age = 20.2 years, SD = 4.9) were randomly assigned to: 1) standard donation, 2) placebo (leg exercise prior to venipuncture), 3) pre-donation water, or 4) pre-donation water and leg exercise during donation.
Main effects of group were observed for phlebotomist classification of vasovagal reactions, X2 (3) = 8.38, p<0.05, and donor reports of presyncopal reactions, X2 (3) = 13.16, p < 0.01. Follow-up analyses of phlebotomist classifications revealed fewer reactions in the pre-donation water and pre-donation water and leg exercise groups relative to placebo but not standard donation. Follow-up analyses of self-reported reactions revealed that women, but not men, had lower scores in both the pre-donation water and pre-donation water and leg exercise groups relative to both placebo and standard donation.
Pre-donation hydration and a combination of hydration and leg exercise may help attenuate presyncopal reactions in relatively novice donors, although future studies with larger samples are required to confirm this effect.
PMCID: PMC2935324  PMID: 20113455
Blood donation; water; muscle exercise; presyncopal reactions
24.  Mass Counseling: Effective Tool to Improve Knowledge, Attitude and Behavior Regarding Blood Donation 
Annually, India meets only half of its blood requirement and half of it from unsafe blood donors. There is a need to increase blood donations from safe and voluntary blood donors. Recruitment and retainment of voluntary blood donors are key challenges for blood agencies.
The aim of this study is to assess the impact of mass counseling in the creation of voluntary blood donor.
Subjects and Methods:
Interventional study with intervention of mass counseling of relatives of patients admitted in the wards of Tertiary Care Hospital attached to medical college in Pune. It was carried out during 1st May 2010 to 31st May 2010. 110 relatives were randomly selected for the study. Mass counseling of cases regarding voluntary blood donation was carried out by trained persons. Pre-counseling and post-counseling knowledge, attitude, and behavior (KAB) scores regarding blood donation were assessed using a pre-tested semi-structured questionnaire.
Counseling improved knowledge, attitude and behavior score (KAB) regarding blood donation significantly. Pre-counseling and post-counseling KAB scores difference was statistically significant (P < 0.001) and was not merely by chance. Counseling helped to improve behavior of cases regarding blood donation, too.
Continuous counseling sessions for blood donation may serve the purpose for institutes dealing with a large number of people every-day. Establishment of mobile counseling units by blood banks may help to create a voluntary blood donor. Changes in motivation and the development of self-identity as a blood donor are needed to retain voluntary blood donors. Incentive's offered for voluntary blood donation card should be strengthened.
PMCID: PMC3952305  PMID: 24669338
Africa; Blood donation; Counseling; Voluntary blood donor
25.  Blood Donor Management in China 
Despite a steady increase in total blood collections and voluntary non-remunerated blood donors, China continues to have many challenges with its blood donation system. The country's donation rate remains low at 9%o, with over 60% of donors being first-time donors. Generally there is a lack of adequate public awareness about blood donation. The conservative donor selection criteria, the relatively long donation interval, and the small donation volume have further limited blood supply. To ensure a sufficient and safe blood supply that meets the increasing clinical need for blood products, there is an urgent need to strengthen the country's blood donor management. This comprehensive effort should include educating and motivating more individuals especially from the rural areas to be involved in blood donation, developing rational and evidence-based selection criteria for donor eligibility, designing a donor follow-up mechanism to encourage more future donations, assessing the current donor testing strategy, improving donor service and care, building regional and national shared donor deferral database, and enhancing the transparency of the blood donation system to gain more trust from the general public. The purpose of the review is to provide an overview of the key process of and challenges with the blood donor management system in China.
PMCID: PMC4164075  PMID: 25254023
Blood donors; Blood supply; China

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