Addenda: June 11 & 19, 2006
Addenda: June 11 & 19, 2006
A nine gallon whole blood donor and repeat platelet pheresis donor reports that he recently experienced a rather severe reaction while undergoing an automated donation of platelets and RBCs which he attributes to the anticoagulation used during the collection. He acknowledges having had mild to moderate 'anticoagulation' related donor reactions in the past and he generally asks the donor staff to adjust downwards the amount of anticoagulation used during an automated collection, as a prophylactic strategy to prevent a reaction. He generally spaces his donations 8-9 weeks apart.
On the day leading up to his most recent combined RBC+Platelet donation he reports in his own words the following: "Breakfast was a 12 ounce smoothie made from frozen berries, whole milk, yogurt, and banana. I had lunch with me at work, but unfortunately had to leave to go purchase a used car. Spent 5 hours test driving, inspecting, getting a second opinion, negotiating, feeling typical "should I buy or not" nervousness, figuring out what to do with my old (and dead) car, etc. Also stress from time constraints and need to get my wife's car back to her at work in time for her to drop me off for the apheresis appointment. Around 3:40 I managed to swing by McDonald's (the need for food overcame the guilt of going to McD) to pick up a 20 piece Chicken McNugget and a large orange juice. Ingested majority of the chicken nuggets (my wife had a few) and the OJ. Made it to the Blood Bank by 4:05 PM."
At the time of his most recent donation he reports the following, also in his own words: "I would guess that the procedure started around 4:55 PM. Standard single-needle procedure, combined platelet and RBC, estimated procedure time of 51 minutes. I made sure to eat some Tums (12-14), that there was a hot blanket for the needle site to help keep the draw pressure up, that I had a pillow in the lumbar region, etc. I forgot, however, to remind the technician to lower my anticoagulation level. I noticed milder than normal anticoagulation symptoms during the majority of the donation, but towards the end when the machine shifted from platelet to RBC, I started to notice an increase in symptoms to more normal levels for me. Normal symptoms for me are moderate tingling in the hands, jaw cramping if I try to chew on something (I have to be careful if I wait too late to start eating the Tums since the cramping can be rather uncomfortable and chewing on the Tums is a sure trigger), and sometimes mild tingling in the feet. As the rinseback started, the symptoms started to skyrocket. By the time rinseback had completed, the technicians indicated that I appeared very pale and had already started placing ice packs on my chest, ankles, and behind my neck. I did not pass out or lose visual or auditory contact with the world. I did, however, experience extreme tingling in the entire body from the neck down. My hands cramped in a position I have seen in people with cerebral palsy. My arms, hands, legs, and feet all experienced rigidity. An attempt was made to get me some juice, but I decided against it after the first sip as it was too hard from a reclining position to defend against it going down the wrong pipe. I would estimate that I was in this state for roughly 10 minutes before the symptoms started to ease. I aggressively maintained verbal and visual contact with the technicians, discussing things like previous experiences and my vague recollections of the role of Ca+ channels in nerve impulse transmission, in an attempt to distract myself, maintain a positive attitude, and ensure that I didn't lose conciousness. Part way through, I discovered that, although I didn't think I could move my fingers and I couldn't feel them through the tingling, I could actually make limited range movement with them and could verify this by watching them. Once the symptoms started to lift sufficiently that I had motor control and proprioception, I ate a Viactiv Calcium Chew and drank a chocolate milk, and then started eating some crackers. When I felt strong enough to stand, I moved to a sofa, where I sat reading and munching while waiting for my wife to pick me up."
Given the foregoing experience, he wonders what blood bankers suggest he should do. He has expressed that he is highly motivated to continue being a blood donor, and he would like to remain an automated collection donor. However, since he has had repeated reactions during automated collections, he wonders if he should limit his donations to being a regular whole blood donor. Were he to continue automated donation, what steps would you recommend he and the blood bank take to increase the margin of safety?
The following comments have been received.
ADDENDA June 11, 2006
ADDENDA June 19, 2006
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