Can we prevent vasovagal reactions in young inexperienced whole blood donors? A placebo controlled study comparing effects of a 330 vs 500 mL water drink prior to donation

Abstract

BACKGROUND Complications of donation reduce donor return. Younger and less experienced donors are more likely to experience vasovagal‐type reactions (VVR). A water drink of approximately 500 mL shortly before donation may reduce VVR, but the effect of a smaller volume of water has not been investigated. STUDY DESIGN AND METHODS A placebo‐controlled comparative study was conducted among donors < 30 years who attended for a 1st‐4th whole blood (WB) donation. Collection centers were assigned to offer one of three interventions: 500 mL water drink, 330 mL water drink, or a placebo intervention consisting of pre‐donation arm exercise. Within 7 days after attending, participants received an electronic questionnaire about possible symptoms during and after donation. In additional centers, control donors were recruited, who only received standard care and were also sent the questionnaire. Self‐reported VVR and other complications were evaluated in all groups. RESULTS Out of 8,300 participating donors, 6,921 (83%) returned the questionnaire. Overall, 18.5% of responding donors reported moderate or worse VVR symptoms. In 2nd‐4th time donors, both water volumes decreased the odds of a VVR compared to standard care controls (OR500ml 0.75, 95% CI 0.59–0.94; OR330ml 0.73, 0.58–0.91; adjusted combined OR 0.77, 0.64–0.94). There was no effect in new donors or the placebo group compared to controls. CONCLUSION In young donors making their 2nd‐4th WB donation, drinking water was associated with 23% fewer VVR with no difference between 330 and 500 mL. This decrease was not found in the placebo group. The findings support advocating drinking water for the prevention of VVR.

Donation related fears predict vasovagal reactions and donor attrition among high school donors

“…At a minimum this would allow collection staff to identify those who should be monitored most closely. In the ideal, it would encourage further development, implementation, and testing of strategies to allay donor fear and risk for vasovagal reactions, such as pre‐donation education, 10–15 or on‐site strategies such as distraction, 16,17 water loading, 18–23 and applied muscle tension 21,24–27 . From a practical perspective, this could be achieved by including fear questions as part of the pre‐donation health screening.…”

Predonation fears identify young donors at risk for vasovagal reactions

“…Those who are concerned about pain might benefit most from distraction strategies, such as listening to music, conversing with the phlebotomist, or using their smartphone to watch videos or play games . Finally, those who are most concerned about feeling faint or lightheaded could benefit from instruction in water loading or applied muscle tensing . Hence, delivery of the most appropriate coping strategy relies on assessment of each donor's specific fears.…”

Reduced risk of vasovagal reactions in Australian whole blood donors after national implementation of applied muscle tension and water loading

“…Research has identified two effective behavioral strategies to reduce donor risk of VVRs. The first, onsite water loading, where the donor is instructed to drink 500 mL of water within 30 minutes before the needle is inserted, has been found to decrease the incidence of VVRs between 21%–26% . The second technique, applied muscle tension, where the donor is asked to tense their leg and abdominal muscles during their donation, has been shown to significantly reduce donor‐reported vasovagal symptoms .…”