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Promoting awareness of donation-related iron depletion among high risk blood donors
France JL, France CR, Rebosa M, Shaz BH, Kessler DA
Transfusion. 2021
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Editor's Choice
Abstract
BACKGROUND The potential for iron deficiency is a known blood donor health concern and suggests the need to inform donors about the potential risks of low iron levels as well as strategies to address these risks. STUDY DESIGN AND METHODS Frequent (n = 904) and young (n = 629) donors were randomly assigned within risk group to either a control (n = 548) or an intervention (n = 985) group. The control group answered questions at baseline and 6-month follow-up regarding their awareness of the risk of donation-related iron depletion and whether they were taking actions to address their iron status. The intervention group answered the same questions at baseline and follow-up, but after completing the baseline survey, they received information regarding their risk of iron depletion and behaviors they could adopt to mitigate this risk. Intervention group participants were also offered the opportunity to develop an action plan to help them supplement their iron intake. RESULTS The intervention enhanced overall awareness of donation-related iron loss (OR = 1.5, 95% CI 1.171-1.864, p = .001), with no negative impact on retention. Reported iron health behaviors (iron supplementation, speaking with a doctor) showed significant increases when action planning was paired with the educational information. CONCLUSION These findings suggest that it is possible to increase awareness of donation-related risk for iron depletion without negatively influencing retention, and combining education with encouragement to develop an action plan may increase the likelihood of both retention and behavioral changes to promote healthy iron levels.
PICO Summary
Population
Frequent or young blood donors (n= 1,533).
Intervention
Educational information on their risk of iron depletion, advice on how to mitigate against iron loss, encouragement and reminder messages in addition to a baseline and follow-up survey on iron awareness (n= 985).
Comparison
Baseline and follow-up survey on iron awareness (n= 548).
Outcome
The intervention enhanced overall awareness of donation-related iron loss (OR = 1.5), with no negative impact on retention. Reported iron health behaviours (iron supplementation, speaking with a doctor) showed significant increases when action planning was paired with the educational information.
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Effect of tourniquet time on whole blood point-of-care lactate concentration: A healthy human volunteer study
Chiew AL, Tran CT, Mackenzie J
Emergency medicine Australasia : EMA. 2021
Abstract
OBJECTIVE Lactate is frequently utilised in clinical practice. Some have concerns that tourniquet application for venous blood collection may falsely elevate venous lactate. The objective of the present study was to determine the effect of tourniquet time on varying venous lactate concentrations. METHODS This is a healthy volunteer study, in which subjects were their own controls. A cannula was inserted into each arm, with a tourniquet remaining on one. Subjects were allocated to one of three groups; rest (no activity), exercise (maximal exertion to elevate lactate concentrations) with immediate tourniquet application or exercise with delayed (5-min post-exercise) tourniquet application. In all blood was drawn simultaneously from both cannulas at 0, 2.5, 5, 10 and 15-min post-tourniquet application and analysed for lactate on a point-of-care device. The primary outcome was a clinically significant difference (>1 mmol/L) in tourniquet versus non-tourniquet arm lactate concentration. RESULTS There were 10 subjects per group; the exercise groups achieved a mean maximum lactate concentration of 10.4 mmol/L (standard deviation [SD] 3.6) (exercise with immediate tourniquet application group) and 8.9 mmol/L (SD 2.5) (exercise with delayed tourniquet application group). There was no clinically significant increase in lactate concentration in the tourniquet compared to non-tourniquet arm in all groups, across all tourniquet application times, and over a range of lactate concentrations. In the rest group after 15-min of tourniquet application the mean lactate concentration of the tourniquet versus non-tourniquet arm was 0.91 mmol/L (SD 0.55) versus 0.89 mmol/L (SD 0.46) (P = 0.99), respectively. CONCLUSION In the present study tourniquet application for blood collection did not significantly increase lactate concentration. Hence, clinically a raised venous lactate concentration should not be attributed to prolonged tourniquet application.
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Repeat donation and deferral rates in US source plasma donors: Exploratory analysis from the IMPACT trial
Hartmann J, Ragusa MJ, Burchardt ER, Manukyan Z, Popovsky MA, Leitman SF
Transfusion. 2021
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Editor's Choice
Abstract
BACKGROUND The IMPACT trial demonstrated the safety of a new personalized nomogram for plasma donation and provided an opportunity to explore short- to mid-term impact on repeat donation and deferral rates, and factors affecting these. STUDY DESIGN AND METHODS In the IMPACT trial, participants were randomized to donate plasma using an established weight-based nomogram (control) versus a new personalized nomogram incorporating height, weight, and hematocrit (experimental). In this exploratory analysis, repeat donations (per donor, by study arm) were analyzed using negative binomial generalized linear regression models and descriptive statistics. The mean number of donor deferral events was compared between the two arms using logistic regression and count data modeling approaches and were analyzed by lead cause. RESULTS The predicted mean number of repeat donations was similar between the control and experimental arms (6.82 vs. 6.62, respectively; p = .22). Overall, the predicted mean number of repeat donations was significantly higher in males compared with females (p < .0001). Naïve donors had on average 2.8/2.7 (control/experimental) fewer repeat donations compared with experienced donors. In 23, 137 donations from 3443 donors, 798 donors (376 control, 422 experimental, p = .80) had at least one deferral (for any cause). The predicted mean number of deferrals in all categories of interest was not statistically different between the study arms. CONCLUSION Similar repeat donation and deferral rates between arms suggest that the new nomogram did not result in disruptions to subsequent donation. Further longitudinal research on mid- to long-term effects is warranted.
PICO Summary
Population
Plasma donors enrolled in the IMPACT trial (n= 3,443).
Intervention
Personalised nomogram incorporating height, weight, and haematocrit (experimental, n= 1,717).
Comparison
Established weight-based nomogram (control, n= 1,726).
Outcome
The predicted mean number of repeat donations was similar between the control and experimental arms (6.82 vs. 6.62). Overall, the predicted mean number of repeat donations was significantly higher in males compared with females. Naïve donors had on average 2.8/2.7 (control/experimental) fewer repeat donations compared with experienced donors. In 23,137 donations from 3,443 donors, 798 donors (376 control, 422 experimental) had at least one deferral. The predicted mean number of deferrals in all categories of interest was not statistically different between the study arms.
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Social Contagion of Vasovagal Symptoms in Blood Donors: Interactions With Empathy
Mennitto S, Vachon DD, Ritz T, Robillard P, France CR, Ditto B
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2021
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Editor's Choice
Abstract
BACKGROUND Vasovagal reactions (VVRs) are commonly experienced in medical situations such as blood donation. Many believe that psychosocial contagion can contribute to the development of VVRs, but this is largely clinical lore. PURPOSE The goal of the present investigation was to examine the physiological effects of observing another experience a reaction, focusing on the potential moderating effects of empathy. METHODS This study was part of a randomized controlled trial of behavioral techniques on the prevention of VVRs in blood donors. The sample was composed of 530 healthy university students. Measures of symptoms were obtained with the Blood Donation Reactions Inventory (BDRI) and through observation. Physiological variables were measured using respiratory capnometry and a digital blood pressure monitor. The Affective and Cognitive Measure of Empathy was administered to 230 participants. RESULTS Donors who witnessed another experiencing a reaction were more likely to spontaneously report symptoms during the blood draw, to be treated for a reaction, to score higher on the BDRI, and to exhibit smaller compensatory heart rate increases. Donors with higher affective empathy reported more symptoms, exhibited hyperventilation, and were more likely to be treated. Donors with higher cognitive empathy were less likely to require treatment if they witnessed a reaction. CONCLUSION These results suggest that psychosocial contagion of physical symptoms can occur. The moderating effects of empathy differed depending on the subtype of empathy. Perhaps a better cognitive understanding of how other people are feeling functions as a coping response, whereas feeling sympathetic about others' distress increases one's own.
PICO Summary
Population
Blood donors (n= 530).
Intervention
Various comparators of behavioural techniques on the prevention of vasovagal reactions.
Comparison
Outcome
Donors who witnessed another experiencing a reaction were more likely to spontaneously report symptoms during the blood draw, to be treated for a reaction, to score higher on the Blood Donation Reactions Inventory, and to exhibit smaller compensatory heart rate increases. Donors with higher affective empathy reported more symptoms, exhibited hyperventilation, and were more likely to be treated. Donors with higher cognitive empathy were less likely to require treatment if they witnessed a reaction.
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Evaluation of efficacy of Valsalva for attenuating needle puncture pain in first time nonremunerated voluntary plateletpheresis donors: A prospective, randomized controlled trial
Srivastava A, Kumar S, Agarwal A, Khetan D, Katharia R, Mishra P, Khati S, Gautam S, Sandeep K
Asian journal of transfusion science. 2021;15(1):68-74
Abstract
BACKGROUND Plateletpheresis is generally safe but may have adverse reactions. Adverse reactions can negatively influence donor recruitment and retention. Valsalva is a proven method of attenuating pain caused by venipuncture. AIMS The aim was to evaluate the efficacy of the Valsalva maneuver on the attenuation of needle pain and donor anxiety. SETTINGS AND DESIGN This prospective randomized controlled trial was conducted between November 2015 and April 2016 at the Department of Transfusion Medicine. SUBJECTS AND METHODS One-hundred and sixty consecutive donors were grouped into control group (C) and Valsalva group (V) each of sample size 80. The Valsalva group performed a Valsalva maneuver and control did nothing before the venipuncture. Anxiety and pain were scored using a 10 cm visual analog scale (VAS). Severity was graded as VAS = 0 defines no pain and anxiety, VAS = 1-3 as mild pain and anxiety, VAS = 4-6 as moderate pain and anxiety, VAS = 7-9 as severe pain and anxiety, whereas VAS = 10 denotes extreme pain and anxiety. STATISTICAL ANALYSIS Statistical Package for Social Sciences, version 23 was used for analysis. Independent samples t-test/Mann-Whitney U-test was used to compare between treatment and control group, whereas the Wilcoxon signed-rank test was used to test the difference between pre- and postobservations. RESULTS In the Valsalva group, post-Valsalva anxiety levels were significantly reduced to (1 [0-2]) from their pre-Valsalva values of (2 [0-3]); (P < 0.001). Pain was significantly lower (2[1-2]) in Valsalva group compared to control (4[2-5]); (P < 0.001). CONCLUSIONS Valsalva reduced both severity of venipuncture pain and anxiety. Valsalva can be performed by donors as it is an easy, painless, and nonpharmacological method of pain and anxiety attenuation.
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The effects of intravenous iron supplementation on fatigue and general health in non-anemic blood donors with iron deficiency: a randomized placebo-controlled superiority trial
Keller P, von Känel R, Hincapié CA, da Costa BR, Jüni P, Erlanger TE, Andina N, Niederhauser C, Lämmle B, Fontana S
Scientific reports. 2020;10(1):14219
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Free full text
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Editor's Choice
Abstract
We investigated whether intravenous iron supplementation improves fatigue and general health in non-anemic repeat adult blood donors with iron deficiency (ferritin ≤ 50 µg/L). Of 1,487 potentially eligible participants, 203 were randomly assigned to a single intravenous dose of 800 mg iron-carboxymaltose and 202 to placebo; 393 participants completed the trial. At 6 to 8 weeks after intervention, self-rated mean fatigue scores (numeric rating scale from 1-10, primary outcome) were 3.9 ± 1.8 in the iron supplementation group and 4.0 ± 2.2 in the placebo group, showing no group difference (p = 0.819). Pre-specified subgroup analyses of gender, ferritin < 25 µg/L and fatigue ≥ 4 points, as well as exploratory analyses of lower ferritin cut-offs did not reveal any between-group differences. In terms of secondary outcomes, the mean differences were 114.2 µg/L for ferritin (95% CI 103.1-125.3) and 5.7 g/L for hemoglobin (95% CI 4.3-7.2) with significantly higher values in the iron supplementation group. No group differences were observed for different measures of general well-being and other clinical and safety outcomes. Intravenous iron supplementation compared with placebo resulted in increase of ferritin and hemoglobin levels in repeat blood donors with low iron stores, yet had no effect on fatigue and general well-being.
PICO Summary
Population
Non-anaemic blood donors with iron deficiency (n= 405).
Intervention
Single intravenous dose of 800 mg iron-carboxymaltose (n= 203).
Comparison
Placebo (n= 202).
Outcome
At 6 to 8 weeks after intervention, self-rated mean fatigue showed no group difference. Pre-specified subgroup analyses of gender, ferritin < 25 µg/L and fatigue ≥ 4 points, as well as exploratory analyses of lower ferritin cut-offs did not reveal any between-group differences. No group differences were observed for different measures of general well-being and other clinical and safety outcomes. Intravenous iron supplementation compared with placebo resulted in increase of ferritin and hemoglobin levels in repeat blood donors with low iron stores, yet had no effect on fatigue and general well-being.
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Evaluation and improvement of blood donor educational materials: results from a multicenter randomized controlled trial
Wehrli G, Rossmann SN, Waxman DA, Katz LM
Transfusion. 2020
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Abstract
BACKGROUND Blood collection centers are charged with creating donor educational materials (DnEM) that are easily understood across all prospective donor populations, while addressing mandates and recommendations from regulatory agencies and professional standard setting organizations. Donors must have sufficient information to understand the donation process with its risks and benefits, time to consider options before deciding, and opportunity to choose whether to proceed with or decline donating. The goal of this multisite randomized controlled trial was to evaluate knowledge acquired using standardized DnEM. America's Blood Centers' Working Group (WG) for Donor Education and Communication was formed to evaluate and suggest modifications of these documents. Based on pilot work, a randomized clinical trial was designed to test donor knowledge across a variety of populations. The WG identified several shortcomings in the current DnEM and proposed new DnEM. The new DnEM were tested against the same, current DnEM being used at all three sites (Blood Donor Educational Material, 2016 version 2.0, published in conjunction with the AABB uniform donor history questionnaire). METHODS AND MATERIALS One-hundred sixty-five first time and returning donors were randomized in a 2x2 model to review either new DnEM or current DnEM. Every participant completed a pre- and post-quiz that tested their understanding of the DnEM. RESULTS Returning donors had greater baseline knowledge compared to new donors, but new donors improved more versus returning donors. Donors using the new DnEM showed greater improvement in knowledge than those using current DnEM. CONCLUSION Comprehension of DnEM can be improved. With this sample size the results suggest that the findings are independent of demographic characteristics, but a larger study would be necessary to confirm this.
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Iron status and self-reported fatigue in blood donors
Spencer BR, Fox MP, Wise LA, Cable RG, Mast AE
Transfusion. 2020
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Editor's Choice
Abstract
Fatigue is a reported symptom of iron depletion, but studies in blood donors show no conclusive link. We conducted an observational analysis of data from the STRIDE randomized trial to evaluate association of iron status with self-reported fatigue. STUDY DESIGN AND METHODS Three blood centers randomly assigned 692 frequent donors to education or iron supplementation treatments. Biomarkers for iron status were measured during 20 to 24 months of follow-up. A fatigue score was derived from an 11-item questionnaire at baseline and final visits, and associations between iron status and fatigue were assessed. RESULTS Final lab and questionnaire data were evaluable from 337 subjects. At baseline, female sex, older age, and anemia were associated with fatigue, but iron status was not. Mean (±SD) fatigue score change was 0.0 (±0.5). Mean (±SD) increase in iron stores was 1.0 (±3.5) mg/kg, but changes in body iron stores were not associated with fatigue score changes (0.01 per mg/kg; 95% CI, -0.01 to 0.02) or with fatigue (RR, 1.01; 95% CI, 0.99 to 1.04). The only factor associated with fatigue score changes was baseline fatigue (0.36; 95% CI, 0.25 to 0.48). CONCLUSION Among high-frequency donors, neither iron status at baseline nor changes in iron status predicted fatigue during follow-up, with improvements limited to those with higher levels of baseline fatigue. Assessment of the association between iron and fatigue in blood donors benefits from careful consideration of study design and the study population.
PICO Summary
Population
Frequent donors from the STRIDE trial (n= 692).
Intervention
Iron supplementation treatment after each donation: 38-mg iron pill (n= 76); 19-mg iron pill (n= 63); placebo pill (n= 53).
Comparison
Education treatment after each donation: Letter informing on iron status and recommendation about supplemental iron (n=96); thank you letter (n= 105).
Outcome
At baseline, female sex, older age, and anemia were associated with fatigue, but iron status was not. Mean fatigue score change was 0.0. Mean increase in iron stores was 1.0 mg/kg, but changes in body iron stores were not associated with fatigue score changes 0.01 per mg/kg; or with fatigue. The only factor associated with fatigue score changes was baseline fatigue. 299 participants did not complete the study.
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The central blood volume as measured by thoracic electrical impedance and plasma proANP is not compromised by donation of 900 mL of blood in men
Gybel-Brask M, Nordsborg NB, Goetze JP, Johansson PI, Secher NH, Bejder J
Transfusion medicine (Oxford, England). 2020
Abstract
OBJECTIVES To evaluate whether the donation of 900 mL of blood reduces the central blood volume (CBV) assessed by thoracic electrical impedance (TI) and plasma pro-atrial natriuretic peptide (proANP). BACKGROUND Donation of 450 mL of blood carries a 1% risk of a vasovagal reaction. Withdrawal of 900 mL of blood decreases cardiac output; however, the effect on CBV remains unknown. METHODS/MATERIALS A randomised, single-blinded, placebo-controlled, crossover design was used, where 21 healthy semi-recumbent men donated 2 × 450 mL blood or were sham-phlebotomised. Changes in CBV were estimated by proANP and TI at 1.5 (TI(1.5) ) and 100 (TI(100) ) kHz, reflecting extracellular volume and (regional) total body water, respectively, and the index value (IDX; 1/T(1.5) -1/TI(100) ) was used to estimate changes in intracellular (red cell) volume. Systolic, diastolic and mean arterial blood pressure; heart rate; stroke volume; cardiac output; and systemic vascular resistance were monitored. After completion of the study, 1000 mL of isotonic saline was infused. RESULTS Changes (mean% ± SD) in TI(1.5) , TI(100) and IDX were similar after 450 mL (-0.2 ± 1.6%, 0.0 ± 1.1%, -0.4 ± 10.1%) and 900 mL (0.1 ± 1.6%, 0.2 ± 1.5% and -2.0 ± 15.8%) of blood donation compared to after a sham donation of 450 mL (-0.9 ± 1.2%, -0.5 ± 1.5% and -0.1 ± 6.1%) and 900 mL (-1.2 ± 1.5%, -0.6 ± 1.3% and 0.5 ± 9.9%). In addition, changes in plasma proANP were similar after 450 and 900 mL of blood donation (-0.8 ± 6.7% and -7.6 ± 7.9%) as after sham donations (1.3 ± 7.3% and -4.5 ± 5.6%). Monitoring haemodynamic variables revealed that stroke volume decreased after the donation of 900 mL of blood (-12 ± 12 mL) compared to sham donations. CONCLUSION During a 900-mL blood loss in semi-recumbent men, CBV measured by TI and plasma proANP is not affected.
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A randomised wait-list controlled pilot trial of one-session virtual reality exposure therapy for blood-injection-injury phobias
Jiang MYW, Upton E, Newby JM
Journal of affective disorders. 2020;276:636-645
Abstract
Virtual reality exposure therapy (VRET) has been recognized as an effective treatment for specific phobias and has the potential to overcome the limitations of traditional in vivo exposure therapy (e.g., acceptability). No past research has evaluated the efficacy of VRET for the treatment of blood-injection-injury (BII) phobia. Therefore, we conducted a randomized controlled trial to examine the acceptability and efficacy of a single-session VRET intervention for BII phobias. Participants who met DSM-5 criteria for BII phobia (N = 43) were randomized to VRET or a waiting list control group, and completed self-report measures of BII severity (Medical Fear Survey [MFS] and Multidimensional Blood Phobia Inventory [MBPI]) and dental anxiety (Modified Dental Anxiety Scale), as well as clinician ratings of BII phobia severity and catastrophic cognitions at baseline, one-week post-treatment, and 3-month follow-up. We found medium to large differences in catastrophic cognitions (probability [g = 0.88] and cost [g = 0.66] ratings), favouring VRET. We found moderate to large differences favouring VRET on the MBPI Injection and Injury fears subscales (g's=0.64-1.14) at one-week post-treatment and 3-month follow-up, and on the MBPI Fainting subscale (g = 0.84) and Injections subscale of the Medical Fear Survey (g = 0.63) at follow-up. There were no other significant group differences. These findings provided some initial evidence to suggest that a single-session VRET may provide some improvements in fears of injections, injury, and fainting. While it may be a useful adjunct or interim step before in vivo exposure therapy, it is not sufficient as a standalone treatment for BII phobia.
