Difficult Donors

June 6, 2013

Difficult DonorsFABB Annual MeetingRichard R. Gammon, MDMedical Director

SECTION ONE

Too Many Platelets

2

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

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

Case Study

www.healthsystem.virginia.edu 06/13

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

Thrombocytosis

• Platelet count >500,000/uL• Causes

– Acute bleeding– Hemolysis– Inflammation or infection– Asplenia– Cancer– Iron deficiency

J Clin Apheresis 2007; 22:158.

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%

Treatments

• Medical – Hydroxyurea, anagrelide, interferon alpha

• Thrombotic complications– Heparin Warfarin

• Thrombocytapheresis– >1,500,000/uL– One procedure 30-60%platelet lowering agents

Conclusions

• Patients with ET have dysfunctional platelets

• Experience medical complications

• Generally not eligible for blood donation

• Safety of donor and recipient

SECTION TWO

The Hot Seat

Case Report

• 62 year-old male

• Multigallon donor

• Presented for plateletpheresis donation – heating pad used

• Discharged without incident

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

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!

Incidents of burns from donation

• 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

J Emerg Med 1994; 12: 819-824

Donor Adverse Event Treatment

• 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

Transfusion 2010; 50 (supplement): 95-96A

Donor Advocacy Triage Results - 2009

Type of Visit Number of Donors

Total Cost (USD) Mean Cost Per Visit (USD)

Urgent Care Center

22 3,557.00 161.68

Emergency Department

182 48,431.26 266.10

SECTION THREE

Donation During The Golden Years

Case Report

• 79 year-old male

• 14 time Whole Blood Donor

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

Upper Age Limits Selected Countries

UK Netherlands Australia Canada US Germany

65 70 70 71 None 68

Vox Sanguinis 2012; 102:134–139

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

ResultsDonations

Males Females

<69 429,674 293,932

69-70 4371 (1.02%)

1790(0.61%)

ResultsAdverse Donor Events

ResultsDonation Frequency

Male Female

69-70 2.53 2.15

<69 1.79 1.52

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

Outcome

• Donor and wife appreciative of article (both German)

• Argument resolved

• He continues to donate

SECTION FOURThe Donor that Needed A Transfusion

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

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

SECTION FIVEI Can’t Believe I Ate the Whole Thing

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

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

HistoryNext Day

• Nursing staff spoke to donor who was feeling better and had increased fluid intake

• Donor declined further medical evaluation

Food Poisoning

• 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-threateningwww.emedicine.medscape.com 06/13

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

A Donor Center: Attracting Donors Who Do Not Wish To See Blood

Transfusion 2013; 53: 13

June 6, 2013

The End…QuestionsRichard.Gammon@oneblood.org407-248-5097 direct line