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��ADVERSE DONOR REACTION DURING AND AFTER PLATELETPHERESIS IN A TERTIARY CARE CENTRE

SN NORLIDA BINTI OTHMAN

International journal of research in medical sciences, April 2017, 5(4)

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Definition of apheresis

Refers to method of collecting either only plasma or platelet or both through a device. However during the process all red cell will be return to donor.

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INTRODUCTION

Apheresis procedures are usually well tolerated and reduces the risk of immediate transfusion reaction and disease transmission.
Adverse events of variable severity may occur during or after the procedure.
Adverse events that occur in donors can be divided into local reaction and system reaction.

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Local reaction are usually hematomas due to incorrect placement of needle during venipuncture. This causes pain, hyperemia and swelling.
Systemic reaction are mainly vasovagal reaction that can be triggered by the pain of venipuncture or by the anxiety of undergoing the donation. The symptoms pallor, sweating, dizziness, nausea, hypotension and syncope.
Citrate toxicity may also occur because of the use of acid citrate dextrose in apheresis.

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OBJECTIVE

Author’s goal was to analyse the adverse reactions occurred during and immediately after plateletpheresis donations.

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METHOD

Retrospective, cross-sectional study of adverse reaction related to apheresis donation at Kashmir, India.
A total of 66 procedures were performed between Jan 2015 to Oct 2016.
Fresinius Kabi cell separator with 16 gauze needle was used.

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Criteria preparation directorate general of health guidelines:

Weight 60 kg or more
Age between 18 to 50 years
Hemoglobin 12.5g/dL
Platelet count >150
Absence of any illness
Negative test for HIV, HEP B, HCV, syphilis, malaria
Donor taken medication containing aspirin within 36 hours are usually deferred.
Interval between procedures should be at least 48 hours .Donor shall not undergo the procedure more than 2 times in a month or 24 times in a year.

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RESULT

66 platelet apheresis procedures were performed, 4 adverse reactions were reported.

Type of adverse events occur during time procedure

Vasovagal reactions
Vascular injuries
Citrate toxicity

-mild type

-severe type

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vasovagal reactions

-Nausea, vomiting, syncope, pallor, dizziness, weakness,

Vascular injuries

-hematoma

-bruising at venepuncture site

Citrate toxicity

-mild type→tingling sensation starting from perioral area

-severe type→loss of consciousness, convulsion, tetany

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4 adverse events were reported

Two (3.03%)of them had tingling sensation in perioral sensation.
One (1.51%) of them suffered vomiting and nausea.
One (1.51%) had hematoma formation.

3 (75%) of the 4 donors were the first time donate and while one donor (25%) is the third time repeat donating.

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Table 1: age distribution in donors

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DISCUSSION

Evidence suggests that frequency of reactions to apheresis donation is less than whole blood donation and have been broadly divided into

Venipuncture related
Syncope/sweating/faintness
Citrate reactions

Pain at venipuncture site is more common due to the same vein is used for inflow and return, resulting in trauma and hematoma.
citrate is used as primary anticoagulant in the procedures. This produces sign and symptoms of citrate toxicity including perioral paresthesia, shivering, twitching and tremors.

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It is important to elicit the presence of early symptoms from donor.
In this study, Calcium supplement was given to donors when they complained about tingling or numbness sensation.
Vasovagal reaction occurred in the form of sweating , syncope and faintness.
Hypovolemia and vasovagal reactions are treated similarly.

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CONCLUSION

Overall apheresis donations performed on cell separator are safe and have acute reaction rates less than that seen in whole blood donation.
The adverse events of apheresis donations are relatively mild and easily treated.

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STATISTIC IN PDN

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Total donation plateletpheresis in 2018

3479 platelet apheresis procedures were performed, 12 adverse reactions were reported.

Type of adverse events occur during time procedure

-local reaction

(hematoma/arm swelling/arm pain)

-vasovagal reaction

(mild reaction→Nausea, pallor, dizziness, weakness)

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STATISTIC ADR 2018 IN PDN

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MANAGEMENT ADR AT PDN

MILD VASOVAGAL REACTION	MODERATE VASOVAGAL REACTION	SEVERE WITH CONVULSION
discontinue procedure is still in dizziness, nausea, vomiting, pallor Raise both the donor’s legs and lower the head to improve the blood supply to the brain. Check donor BP, PR, and RR. Keep the donor cool by opening window or switching on a fan. Encourage donor to cough which will help to increase blood pressure. Offer a cool drink if donor has no nausea or vomiting. Record the reaction on the donor registration form, incident reporting form for adverse donor event(BTS/DV/2/2016) and enter into BBIS incident report.	Discontinue procedure if still in vomiting, nausea, dizziness. Check BP, PR and RR regularly every 5 minutes until donor is stable. Administer IV normal saline or dextrose saline infusion if hypotension is prolonged. Assess and talk to the donor throughout all this stages. It may be necessary to advise the donor not to donate in future. Record the donor reaction on the registration form, incident reporting form the adverse donor event(BTS/DV/2/2016) and enter into BBIS.	Discontinue the donation. Turn the donor to a lateral position to maintain a clear airway. Loosen tight clothing. Check the BP, PR and RR frequently. Once the donor has recovered, reassure the donor and explain what had happened. Take blood from the donor. Tactfully advice the donor not to donate blood again(permanent defer). Record the reaction on the donor registration form, incident reporting form for adverse donor event(BTS/DV/2/2016) and enter into BBIS incident.