difficult donors
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
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June 6, 2013
Difficult DonorsFABB Annual MeetingRichard R. Gammon, MDMedical Director
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SECTION ONE
Too Many Platelets
2
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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
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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
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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
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Thrombocytosis
• Platelet count >500,000/uL• Causes
– Acute bleeding– Hemolysis– Inflammation or infection– Asplenia– Cancer– Iron deficiency
J Clin Apheresis 2007; 22:158.
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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%
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Treatments
• Medical – Hydroxyurea, anagrelide, interferon alpha
• Thrombotic complications– Heparin Warfarin
• Thrombocytapheresis– >1,500,000/uL– One procedure 30-60%platelet lowering agents
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Conclusions
• Patients with ET have dysfunctional platelets
• Experience medical complications
• Generally not eligible for blood donation
• Safety of donor and recipient
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SECTION TWO
The Hot Seat
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Case Report
• 62 year-old male
• Multigallon donor
• Presented for plateletpheresis donation – heating pad used
• Discharged without incident
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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
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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!
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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
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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
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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
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SECTION THREE
Donation During The Golden Years
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Case Report
• 79 year-old male
• 14 time Whole Blood Donor
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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
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Upper Age Limits Selected Countries
UK Netherlands Australia Canada US Germany
65 70 70 71 None 68
Vox Sanguinis 2012; 102:134–139
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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
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ResultsDonations
Males Females
<69 429,674 293,932
69-70 4371 (1.02%)
1790(0.61%)
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ResultsAdverse Donor Events
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ResultsDonation Frequency
Male Female
69-70 2.53 2.15
<69 1.79 1.52
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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
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Outcome
• Donor and wife appreciative of article (both German)
• Argument resolved
• He continues to donate
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SECTION FOURThe Donor that Needed A Transfusion
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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
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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
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SECTION FIVEI Can’t Believe I Ate the Whole Thing
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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
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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
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HistoryNext Day
• Nursing staff spoke to donor who was feeling better and had increased fluid intake
• Donor declined further medical evaluation
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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
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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
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A Donor Center: Attracting Donors Who Do Not Wish To See Blood
Transfusion 2013; 53: 13