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June 6, 2013 Difficult Donors FABB Annual Meeting Richard R. Gammon, MD Medical Director.

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Presentation on theme: "June 6, 2013 Difficult Donors FABB Annual Meeting Richard R. Gammon, MD Medical Director."— Presentation transcript:

1 June 6, 2013 Difficult Donors FABB Annual Meeting Richard R. Gammon, MD Medical Director

2 SECTION ONE Too Many Platelets 2

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 06/13

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

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 SECTION TWO 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 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

16 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

17 Donor Advocacy Triage Results - 2009 Type of VisitNumber of Donors Total Cost (USD) Mean Cost Per Visit (USD) Urgent Care Center 223,557.00161.68 Emergency Department 18248,431.26266.10

18 SECTION THREE 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 UK Netherlands AustraliaCanadaUSGermany 6570 71None68 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 Results Donations MalesFemales <69429,674293,932 69-704371 (1.02%) 1790(0.61%)

24 Results Adverse Donor Events

25 Results Donation Frequency MaleFemale 69-702.532.15 <691.791.52

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 SECTION FOUR 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 SECTION FIVE 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 History Day 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 History Next Day Nursing staff spoke to donor who was feeling better and had increased fluid intake Donor declined further medical evaluation

35 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-threatening 06/13

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 Not Wish To See Blood Transfusion 2013; 53: 13

38 June 6, 2013 The End…Questions 407-248-5097 direct line

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