Severe Complications in Blood Donors Long term morbidity after phlebotomy of blood donors

1. Severe Complications in Blood DonorsLong term morbidity after phlebotomy of blood donors Betina Samuelsen Sorensen, M.D. Jan Jorgensen, M.D. Department of Clinical Immunology and Transfusion Medicine

2. Danish Database for Complications in Blood Donors Collect data on complications related to blood donation Required medical attention Symptoms for more than a week Definitions According to IHN-ISBT approved standard

3. Complications investigated Severe: Medical attention Hospitalization Symptoms for more than a year (long term morbidity, LTM) Death Imputability Certain or likely Year 2000-2007

4. Complications investigated Data given as: Rates: per 100,000 donations Denominator: Number of bleedings: 2,942,734 (whole-blood, single unit) All severe complications: Number: 443 Rate: 15 LTM only: Number: 137 Rate 4.6 (31 %) Conclusion: One third of all the severe complications had LTM

5. Complications investigated

6. Complications investigated Conclusion: Pain occurred with the highest rate of all complications 67 % of all severe complications 96 % of all LTM

7. Category pain Caused by injury of tissue needle or hematoma pressure Tissue can be nerves, vessels, tendons, muscles Injury of nerves can result in peripheral neurophatic pain (PNP) Symptoms: Allodynia (nonpainful stimulus provoke pain) Hyperalgesia (increased response to painful stimulus) Dysesthesia (unpleasant abnormal sensation)

8. Category pain: Needle insertion technique Conclusion: In the category pain 20 % of all severe complications and all LTM, the needle insertion was complicated and did not follow the national recommendation introduced to secure safe needle insertion without extensive injury of the tissue

9. Category pain: Kind of symptoms Conclusion: PNP is the dominant symptom in about � of all severe or LTM complications

10. Category pain: Treatment Conclusion: An established therapy is not available About ? of donors with LTM did not receive any treatment at all

11. Category pain:Treatment Most of the severe or LTM cases are dominated by PNP Neural tissue mobilization technique is a specialized kind of physiotherapy which has proven efficient in treatment of PNP Our experience with a few donors is promising

12. Summary of conclusions Showing that: 67 % of all severe complications and 96 % of all LTM cases belong to the category pain 20 % of these were associated with a complicated needle insertion not following recommendations 75 % of the cases have symptoms of PNP

13. Summary of conclusions Efforts to minimize occurrence and outcome of complications related to blood donation should concentrate on: Use of a validated and recommended technique for needle insertion Establishing of education and relevant education material Quality control of practical and theoretical knowledge in phlebotomists Routinely audit of used technique Investigation of the effect of the neural tissue mobilization technique on LTM cases with PNP