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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 5  |  Issue : 2  |  Page : 146-149

Predonation drink: A simple and cost-effective strategy to mitigate vasovagal reactions among whole blood donors, a study from North India


1 Department of Transfusion Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
2 Department of Transfusion Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
3 Department of Radiodiagnosis, Dr. RML Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission27-Jun-2020
Date of Decision17-Jul-2020
Date of Acceptance18-Jul-2020
Date of Web Publication13-Nov-2020

Correspondence Address:
Prashant Agarwal
Department of Transfusion Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GJTM.GJTM_60_20

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  Abstract 


Background and Objectives: In various clinical studies, water drinking is used to counteract orthostatic hypotension in healthy individuals. Thus, predonation water drinking was used as a strategy to attenuate vasovagal donor reactions in whole blood donors. The objective was to assess the effectiveness of predonation water-drinking strategy on vasovagal reactions (VVRs) in whole blood donors. Methods: A total of 6478 healthy blood donors were assessed during the study period. These donors were randomly assigned in groups receiving or not receiving 300–500 ml of water 20–30 min before whole blood donation. Results: The rate of VVR was 1.2% in blood donors given predonation water versus 2.8% in donors not given a predonation water, P < 0.05. Ingestion of 300–500 ml of water before whole blood donation had significantly decreased VVRs 1.2% versus 2.8% (OR 0.48; 95% CI – 0.33–0.69 vs. OR 2.10; 95% CI – 1.44–3.04). Thus, predonation water drinking was associated with less VVRs. Conclusion: About 300–500 ml of water drinking significantly reduced the vasovagal donor reaction rate in otherwise healthy blood donors. The ingestion of water by blood donors did not interfere with the donor management process such as donor questioning, mini physical examination, blood collection, and sampling, and was judged by blood collection staff as donor friendly and an easy protocol to implement.

Keywords: Bradycardia, hypotension, predonation water drinking, syncope, vasovagal reactions, whole blood donor


How to cite this article:
Solanki A, Katharia R, Chauhan A, Singh A, Chandra T, Sonker A, Agarwal P. Predonation drink: A simple and cost-effective strategy to mitigate vasovagal reactions among whole blood donors, a study from North India. Glob J Transfus Med 2020;5:146-9

How to cite this URL:
Solanki A, Katharia R, Chauhan A, Singh A, Chandra T, Sonker A, Agarwal P. Predonation drink: A simple and cost-effective strategy to mitigate vasovagal reactions among whole blood donors, a study from North India. Glob J Transfus Med [serial online] 2020 [cited 2020 Nov 26];5:146-9. Available from: https://www.gjtmonline.com/text.asp?2020/5/2/146/300631




  Introduction Top


At present, blood donation is considered to be a safe procedure. For most of the healthy donors, the process of donating blood is safe and without complications, but sometimes adverse reactions may occur. The adverse blood donation reactions are defined as “any physical or psychological abnormality which a normal healthy donor experiences before, at the time of, or after phlebotomy.”[1]

The ever-increasing blood transfusion requirement, decreased blood availability due to reducing donor pool, and misuse of blood can justify not only the urgent attention for improving blood transfusion practice but also can be addressed as justifying reasons to promote and invest in a high-quality blood donation process.[2] Thus, unpleasant blood donation-related signs and symptoms may discourage otherwise healthy altruistic individuals from becoming regular, repeat voluntary blood donors. The loss of even a few people who are otherwise healthy enough to give their blood, interested enough to do so on at least one occasion, and who might turn into the long-term regular, repeat, and voluntary blood donors is a problem worth serious consideration.[3]

Certain parameters of blood donors such as younger age (<20 years), novice donors, female gender, less body weight, increased heart rate, or lesser blood volume have been related to higher vasovagal reactions (VVRs) and very well reported in the literature.[4],[5],[6],[7],[8],[9],[10],[11] Among these factors, tachycardia and low diastolic blood pressure before blood donations have been documented as hemodynamic risk factors to develop VVRs.[5],[12],[13] Several measures or interventions have been applied to counteract or attenuate the hemodynamic response in the donors such as caffeine intake,[14] audiovisual distraction,[15] water ingestion,[16],[17] and application of muscular tension during blood collection.[18],[19] Recent laboratory studies suggest that 300–500 ml of water drinking at least 20–30 min before donation has been shown to ameliorate orthostatic hypotension.[17] It produces hemodynamic effects that cause significant cardiovascular changes such as increased activation of sympathetic nervous system, peripheral vascular resistance, and blood pressure that reach at peak approximately 20–30 min after drinking of 300–500 ml water and may be sufficient to counteract or reduce risk of syncopal vasovagal attacks and related reactions during blood donation.[20],[21],[22],[23] Thus, water ingestion is very simple and cost-effective strategy to enhance donation experience by reducing unpleasant side effects and possibly increase donor retention and return, thus enhancing voluntary blood donor pool.[17] The aim of this study was to assess the effectiveness of predonation water-drinking strategy on VVR in whole blood donors.


  Materials and Methods Top


It was a prospective study of 3 months which included a total of 6480 whole blood donors who were (both males, females, voluntary, and replacement) coming to the blood center of our institute and were fit to donate. The age of blood donors was ranging from 18 to 65 years, and for the first time donors, the age range was 18–60 years. They were randomly (every alternate donor chosen as test or control) assigned to the two groups one having 300–500 ml of water intake before 20–30 min of donation and the other group served as control. Both groups had both first time and repeat blood donors.

Inclusion criteria: All healthy blood donors without any precipitating factors

Exclusion criteria: those donors were excluded who had previous history of VVR or had other confounding factors for VVR such as anxiety, lack of sleep, or lack of food.

Control group without predonation drink

This group comprised of 3239 healthy blood donors. After taking routine medical history, donors' weight, hemoglobin, pulse rate, and BP were measured. The study protocol was explained in detail to all the eligible blood donors. After taking informed consent from study participants, 350 ml or 450 ml of whole blood was collected as per the institutional standard operating procedure under close supervision. Any adverse reaction before, during, or after blood donation was monitored and recorded. The American Red Cross blood center classifies donor reactions into three categories (i) mild reactions, (ii) moderate reactions, and (iii) severe reactions.[24]

  1. Mild reaction – donor exhibits signs and symptoms of pain, light-headedness, anxiety, perspiration, hyperventilation, irregular breathing, weakness, nausea, vomiting, hypotension, and bradycardia
  2. Moderate reaction – symptoms are a progression of the kind found in mild reaction with loss of consciousness or recovery period is >15 min, decreased pulse rate, rapid shallow respiration, and hyperventilation
  3. Severe reactions – development of tetany, convulsions, incontinence, or cyanosis with or without syncope.


Test group with predonation drink

This group comprised of 3241 healthy blood donors. The purpose and process of the study were explained, and they give informed consent for participation. In waiting area, they were offered 500 ml of commercially available packaged water bottles (Calcium [Ca] – 25 mg/dl, potassium [K] – 2 mg/dl, sodium [Na] – 20 mg/dl, magnesium [Mg] – 10 mg/dl, bicarbonate [HCO3] – 180 mg/dl, and 285 mOsmol). After predonation water drink, they waited for 20–30 min. A 350 ml or 450 ml of whole blood was withdrawn from the donors under supervision. Any adverse reaction before, during, or after blood donation was monitored and recorded.

Statistical analysis

Statistical analysis was done using the SPSS statistical computer software version 20 (IBM Corporation, Armonk, NY, USA). The frequency of syncopal VVRs without ( first group) and with (second group) predonation water ingestion was determined using Chi-square test. P < 0.05 was considered as statistically significant. The data of study are represented as range, mean ± standard deviation. Odds ratio and confidence intervals were also calculated to identify increased likelihood of donor reactions in no water intake group as compared to water intake group. The study was conducted after taking approval from the research and ethics committee of the institute.


  Results Top


The demographic and hemodynamic variables are shown in [Table 1]. The frequency of syncopal VVRs without and with predonation water intake was compared. The result of study was analyzed on 3239 blood donors of the first group and 3239 blood donors of the second group as two donors left from the second group and did not want to follow the complete study protocol. In the first arm (no water intake), a total of 3239 donors were enrolled and comprised of 2592 male and 647 female blood donors. There were 138 first time blood donors. In other arm with water intake, there were 2801 male and 438 female donors. About 142 donors donated whole blood for the first time. About 87 (53 males/34 females) donors from the first group and 42 (24 males/18 females) donors from the second group had adverse VVRs. In the first group reactions, 72 (82.7%) donors had mild VVR, whereas 12 (13.8%) and 3 (3.5%) blood donors had moderate and severe VVR, respectively. On the other hand, 34 (81%) donors had mild VVR, 8 (19%) had moderate VVR, and none of the donor suffered from severe grade of VVR in the water drinking group. The rate of VVR was 2.8% and 1.2% in control and test groups, respectively, P < 0.05. The other parameters including demographic and hemodynamic variables of VVR donors in both groups are shown in [Table 2]. Furthermore, the vasovagal signs and symptoms such as apprehension, diaphoresis, light-headedness, breathlessness, bradycardia, and hypotension were significantly more pronounced in no water intake group. Thus, ingestion of 300–500 ml of water before 20–30 min of whole blood donation had significantly decreased VVRs 1.2% versus 2.8% (OR 0.48; 95% CI – 0.33–0.69 vs. OR 2.10; 95% CI – 1.44–3.04). Thus, predonation water drinking was associated with less vasovagal donor reactions [Flowchart 1].
Table 1: Demographic and hemodynamic characteristics of first group (no water intake) with second group (with water intake)

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Table 2: Demographic and hemodynamic characteristics of vasovagal reaction donors in the first group (no water intake) with the second group (with water intake)

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  Discussion Top


Water ingestion before blood donation causes acute hemodynamic response that can reduce the risk for VVR. Predonation water drinking cause pronounced cardiovascular changes in the body, including increase in sympathetic nervous system, peripheral vascular resistance, and blood pressure to counteract the hypotensive effect of VVR.[17] Hanson and France found that predonation 500 ml of water ingestion causes 47% reduction of VVR in the high school or first time donors.[17] Newman et al. observed that 473 ml of water drink before blood donation in students of high school drops the rate of VVR from 12.5% to 9.9%. They concluded that 473 ml water drink reduced VVR in high school donors by 21%, but to varying degrees in different subpopulations.[16] Ando et al. also analyzed the effect of 300 ml of water intake before blood donation in the prevention of VVR. They found that VVR rate was 4.4% in water drinking group and 19.4% in no water drinking group.[25] In the present study, we found that VVR rate was 1.2% in water drinking group after ingestion of 300–500 ml of water before blood donation and 2.8% in no water drinking group. Furthermore, most of the blood donors in the second group had mild grade of VVR and none had suffered from severe grade of VVR that leads to the permanent deferral of the donor from future blood donation.

Thus, for blood donors, 300–500 ml of water drinking before blood donation is a simple, easy, and effective strategy to mitigate syncopal VVRs.

Limitation of the study

We wish to point out important limitation of our study. This 3-month study on whole blood donors only focused on to assess the effectiveness of predonation water-drinking strategy on vasovagal donor reactions. Other confounding factors such as fatigue, lack of food, or lack of sleep were not considered and excluded those donors from study.


  Conclusion Top


Ingestion of approximately 300–500 ml of water 20–30 min before the donating blood is effective in attenuating negative and unpleasant physiological and hemodynamic reactions in blood donors. Thus, predonation water drinking is a simple and cost-effective strategy to enhance blood donation and possibly increase donor retention by attenuating the blood donation associated negative symptoms. Although the results of this study are encouraging, further research is emphasized to implement and extend the findings on the safety of whole blood donors. In future, other studies may be conducted to assess predonation water drinking along with other confounding factors such as fatigue or lack of sleep.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Rutman RC, Dpasuale-Barrios S. Donor reactions. In: Green TS, Steckler D, editors. Donor Room Policies and Procedures. Arlington: American Association of Blood Banks; 1985. p. 81-90.  Back to cited text no. 1
    
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Ditto B, France CR, Lavoie P, Roussos M, Adler PS. Reducing reactions to blood donation with applied muscle tension: A randomized controlled trial. Transfusion 2003;43:1269-75.  Back to cited text no. 3
    
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Newman B, Siegfried B, Buchanan L. Are vasovagal reaction rates in blood donors related to the duration of the phlebotomy? Transfusion 2008;48:568-9.  Back to cited text no. 4
    
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Wiltbank TB, Giordano GF, Kamel H, Tomasulo P, Custer B. Faint and prefaint reactions in whole-blood donors: An analysis of predonation measurements and their predictive value. Transfusion 2008;48:1799-808.  Back to cited text no. 5
    
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Meade MA, France CR, Peterson LM. Predicting vasovagal reactions in volunteer blood donors. J Psychosom Res 1996;40:495-501.  Back to cited text no. 6
    
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Newman BH. Vasovagal reactions in high school students: Findings relative to race, risk factor synergism, female sex, and non-high school participants. Transfusion 2002;42:1557-60.  Back to cited text no. 7
    
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Newman BH. Vasovagal reaction rates and body weight: Findings in high- and low-risk populations. Transfusion 2003;43:1084-8.  Back to cited text no. 8
    
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Newman BH, Roth AJ. Estimating the probability of a blood donation adverse event based on 1000 interviewed whole-blood donors. Transfusion 2005;45:1715-21.  Back to cited text no. 9
    
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Ditto B, France CR. Vasovagal symptoms mediate the relationship between predonation anxiety and subsequent blood donation in female volunteers. Transfusion 2006;46:1006-10.  Back to cited text no. 10
    
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Newman BH, Siegfried B, Haley NR, Feller I, Sledge L, Roth A. Quantitative study of contributing factors to vasovagal donor reaction rates in 8 blood centers. Transfusion 2008;48:70A, SP53.  Back to cited text no. 11
    
12.
Graham DT. Prediction of fainting in blood donors. Circulation 1961;23:901-6.  Back to cited text no. 12
    
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Sauer LA, France CR. Caffeine attenuates vasovagal reactions in female first-time blood donors. Health Psychol 1999;18:403-9.  Back to cited text no. 14
    
15.
Bonk VA, France CR, Taylor BK. Distraction reduces self-reported physiological reactions to blood donation in novice donors with a blunting coping style. Psychosom Med 2001;63:447-52.  Back to cited text no. 15
    
16.
Newman B, Tommolino E, Andreozzi C, Joychan S, Pocedic J, Heringhausen J. The effect of a 473-mL (16-oz) water drink on vasovagal donor reaction rates in high-school students. Transfusion 2007;47:1524-33.  Back to cited text no. 16
    
17.
Hanson SA, France CR. Predonation water ingestion attenuates negative reactions to blood donation. Transfusion 2004;44:924-8.  Back to cited text no. 17
    
18.
Ditto B, Wilkins JA, France CR, Lavoie P, Adler PS. On-site training in applied muscle tension to reduce vasovagal reactions to blood donation. J Behav Med 2003;26:53-65.  Back to cited text no. 18
    
19.
Ditto B, France CR. The effect of applied muscle tension on symptoms in French speaking blood donors: A randomized trial. Health Psychol 2006;25:433-7.  Back to cited text no. 19
    
20.
Routledge HC, Chowdhary S, Coote JH, Townend JN. Cardiac vagal response to water ingestion in normal human subjects. Clin Sci (Lond) 2002;103:157-62.  Back to cited text no. 20
    
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Jordan J, Shannon JR, Black BK, Ali Y, Farley M, Costa F, et al. The pressor response to water drinking in humans: A sympathetic reflex? Circulation 2000;101:504-9.  Back to cited text no. 21
    
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Scott EM, Greenwood JP, Gilbey SG, Stoker JB, Mary DA. Water ingestion increases sympathetic vasoconstrictor discharge in normal human subjects. Clin Sci (Lond) 2001;100:335-42.  Back to cited text no. 22
    
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Schroeder C, Bush VE, Norcliffe LJ, Luft FC, Tank J, Jordan J, et al. Water drinking acutely improves orthostatic tolerance in healthy subjects. Circulation 2002;106:2806-11.  Back to cited text no. 23
    
24.
Blood Service Directive. Washington: American Red Cross; 1992.  Back to cited text no. 24
    
25.
Ando S, Kawamura N, Matsumoto M, Dan E, Takeshita A, Murakami K, et al. Simple standing test predicts and water ingestion prevents vasovagal reaction in the high-risk blood donors. Transfusion 2009;49:1630-6.  Back to cited text no. 25
    



 
 
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