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Difficult Donors

Difficult Donors. FABB Annual Meeting Richard R. Gammon, MD Medical Director. Too Many Platelets. Case Study. 79 year-old female presented for plateletpheresis donation Qualified by questionnaire and miniphysical Donation history

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Difficult Donors

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  1. Difficult Donors FABB Annual Meeting Richard R. Gammon, MD Medical Director

  2. Too Many Platelets

  3. Case Study • 79 year-old female presented for plateletpheresis donation • Qualified by questionnaire and miniphysical • Donation history • Four previous whole blood donations during a two-year period without incident

  4. Case Study • Current plateletpheresis donation – successful • Testing of the precount specimen (obtained at beginning of donation) and plateletpheresis collected • Platelet count – 1,889,000/uL (normal 150,000-400,000/uL) • Hemoglobin/Hematocrit and white blood cells –within normal limits

  5. Case Study www.healthsystem.virginia.edu06/13

  6. Additional Information Donor aware of diagnosis- did not disclose Treated with hydroxyurea –could not tolerate her prescribed course Currently taking no medications Impression-blood center could remove platelets for community use Per current procedures – permanently deferred

  7. Thrombocytosis J Clin Apheresis 2007; 22:158. • Platelet count >500,000/uL • Causes • Acute bleeding • Hemolysis • Inflammation or infection • Asplenia • Cancer • Iron deficiency

  8. Essential Thrombocytosis (ET)Overview • Myeloproliferative disorder • Thrombosis and functionally abnormal platelets • Arterial and venous thromboembolic events (11-25%) • Pregnant, surgery, over age 60 • Microvascular ischemia of digits • >600,000/uL • Bleeding in mucocutaneous sites (4-37%) • >1,500,000/uL or 12%

  9. Treatments • Medical • Hydroxyurea, anagrelide, interferon alpha • Thrombotic complications • Heparin Warfarin • Thrombocytapheresis • >1,500,000/uL • One procedure 30-60%platelet lowering agents

  10. Conclusions Patients with ET have dysfunctional platelets Experience medical complications Generally not eligible for blood donation Safety of donor and recipient

  11. The Hot Seat

  12. Case Report 62 year-old male Multigallon donor Presented for plateletpheresis donation – heating pad used Discharged without incident

  13. Case Report • Contacted blood center three days post-donation • Burns and bleeding blisters on back and buttocks • Questioned about heating pad • Donor stated “was not hot” • Staff confirmed – low setting, covered by blanket

  14. Follow-Up Donor was evaluated at urgent-care center Lesions were not burns - abscess of buttock and folliculitis – treated with antibiotics Donor stated would return to donate when condition resolved – but no more heating pads!

  15. Incidents of burns from donation J Emerg Med 1994; 12: 819-824 No papers directly related to blood donors One paper discussed risk to patients with sensory defects – partial and full thickness burns Emphasize to donors to voice any concerns to donor service staff promptly

  16. Donor Adverse Event Treatment Transfusion 2010; 50 (supplement): 95-96A • Nurses on-call triage donor concerns • Supportive→ Urgent Care → ED • Blood center has contracts with urgent care centers – billed directly • Donor insurance or lack would not deter visit

  17. Donor Advocacy Triage Results - 2009

  18. Donation During The Golden Years

  19. Case Report 79 year-old male 14 time Whole Blood Donor

  20. Case Report • Donor sent email • Every time I give blood my girlfriend gets very upset because she claims that it takes too long to recover • Weakens me and the indices of my blood. • In native Germany people can’t donate after the age of 40 and I am 79 and in good health. • Your comment please

  21. Upper Age Limits Selected Countries Vox Sanguinis 2012; 102:134–139

  22. German ARC Study Donation extended to 70 with physician evaluation Proportion of total donations in 2010 were determined Analyzed adverse reaction rates in donors with respect to sex and age Calculated mean annual donation frequencies

  23. ResultsDonations

  24. ResultsAdverse Donor Events

  25. ResultsDonation Frequency

  26. Conclusion Elderly donors have very low adverse event frequencies Highly committed to donate blood Consider donations from repeat donors aged 69–70 safe Suggest a powerful short- to midterm strategy to, at least partially, overcome the challenges of the demographic change

  27. Outcome Donor and wife appreciative of article (both German) Argument resolved He continues to donate

  28. The Donor that Needed A Transfusion

  29. Case Report • 19 year-old 6x whole blood donor • Donated whole blood at noon without incident and was discharged to home • Hemoglobin 11.9 g/dL and 12.6 g/dL • At approximately 3:00 pm she experienced a syncopal episode and was transported by ambulance to a local hospital

  30. Outcome • At hospital hemoglobin was noted to be 6.2 g/dL • Transfused 2 units RBCs and discharged • Primary Care Evaluation • CBC, Fe, TIBC, ferritin, B12, folic acid

  31. I Can’t Believe I Ate the Whole Thing

  32. History • 53 year-old female plateletpheresis donor • Successfully completed her donation at branch and was discharged to home • Plateletpheresis donors may be offered sandwiches as incentive- donor ordered roast-beef sub

  33. HistoryDay of Donation Contacted on-call nurse 30 minutes post-ingestion donor experienced nausea/vomiting and stomach pain Decided not to go to ED due to lack of insurance Blood center offered to arrange for urgent care visit Donor declined

  34. HistoryNext Day Nursing staff spoke to donor who was feeling better and had increased fluid intake Donor declined further medical evaluation

  35. Food Poisoning www.emedicine.medscape.com 06/13 • Illness caused by consumption of food or water contaminated with bacteria and/or toxins, or with parasites, viruses or chemicals • Symptoms • Most- abdominal pain, vomiting, headache and diarrhea • Severe-neurologic, hepatic or renal symptoms that can be life-threatening

  36. Treatment • Most cases self-limited • Supportive • Adequate rehydration and electrolyte supplementation • IV fluids if severe • Symptoms persist beyond 3-4 days • Stool cultures to determine etiology

  37. A Donor Center: Attracting Donors Who Do NotWish To See Blood Transfusion 2013; 53: 13

  38. The End…Questions Richard.Gammon@oneblood.org 407-248-5097 direct line

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