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vigilance systems. There may be other confounding factors for which we have not collected data and which we have not included in the models. Further research is needed. Limitations to our analysis include the likelihood that while changes in position play a role in creating risk of fainting reactions, no record was made of donor position at the time of reaction or the time the donor stood up. Conclusions about position were based on timing and on operational procedures. In addition, there were missing data elements and specifically there were a small number of records with no time for the onset of the reaction. However, for all these reactions we were able to determine the location. We also are unable to confirm with precision, the recording of the reaction onset times. All the reactions recorded for Period 3B were not observed by staff and were voluntarily reported. Under-reporting of off-site reactions is possible [10,11]. While we focused on fainting which should be consistently reported because it is clinically apparent, we cannot be sure that all LOC events were reported. The decision to utilize OMC was not consistent. Blood centre staff participated in the decision to call for help or to refer a donor to the emergency room when reactions occurred on-site, but when reactions occurred off-site, the use of OMC was likely to be inconsistent. For Periods 1 and 3B, due to the small number of events in these two groups, multivariable analysis was limited to a selected group of variables known to have an impact on VVS, it was not possible to replicate the same multivariable model building procedures as we did in Periods 2 and 3A. Summary This study shows that the rates of fainting reactions are not consistent and that the risk factors associated with such reactions are not the same across the time course of blood donation. A key finding of this study is that while donor age and experience are constant risk factors in all periods, higher per cent blood volume donated (based on a fixed donation volume and lower corporeal EBV) and gender are not risk factors before phlebotomy. High per cent EBV donated increases in significance as time passes after the end of phlebotomy. This suggests that low EBV donors, who give a greater per cent of their blood volumes, are at greater risk of reactions which occur when they are upright and which could lead to injury. Reducing the risk of injury from fainting reactions which occur after blood donation may be accomplished by preventing the impact of relative hypovolemia which results from donation. References 1 Tomasulo P, Anderson AJ, Paluso MB, et al.: A study of criteria for blood donor deferral. Transfusion 1980; 20:511–518 2 Wiltbank TB, Giordano GF, Kamel H, et al.: Faint and prefaint reactions in whole blood donors: an analysis of predonation measurements and their predictive value. Transfusion 2008; 48:1799–1808 3 Eder AF, Dy BA, Kennedy JM, et al.: The American Red Cross donor hemovigilance program: complications of blood donation reported in 2006. Transfusion 2008; 48:1809–1819 4 Kamel H, Tomasulo P, Bravo M, et al.: Delayed adverse reactions to blood donation. Transfusion 2010; 50:556–565 5 Tomasulo P, Bravo M, Kamel H: Time course of vasovagal syncope with whole blood donation. ISBT Science Series 2010; 5:52–58 6 Tomasulo P, Kamel H, Bravo M, et al.: Interventions to reduce the vasovagal reaction rate in young whole blood donor. Transfusion. DOI:10.1111/ j.1537-2995.2011.03074.x Fainting risks during stages of donation 9 2011 The Author(s) Vox Sanguinis 2011 International Society of Blood Transfusion, Vox Sanguinis (2011) 7 Eder AF, Dy BA, Kennedy JM, et al.: Improved safety for young whole blood donors with new selection criteria for total blood volume. Transfusion 2010; 50(2S):3A 8 Centers for Disease Control and Prevention. Healthy weight: assessing your weight: BMI: about adult BMI. Vasovagal reactions in blood donors: risks, prevention, and management Amanda Thijsen1 & Barbara Masser2, 3 Author Affiliations: 1 Clinical Services and Research, Australian Red Cross Blood Service, Sydney, New South Wales, Australia 2 Clinical Services and Research, Australian Red Cross Blood Service, Brisbane, Queensland, Australia 3 School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland, Australia Author responsible for correspondence and reprint requests: Amanda Thijsen, 17 O’Riordan Street, Alexandria NSW 2015, Australia Phone: +61 29234 2493, Email: athijsen@redcrossblood.org.au Sources of support: Australian governments fully fund the Australian Red Cross Blood Service for the provision of blood, blood products and services to the Australian community. Conflict of interest: The authors declare that they have no conflicts of interest relevant to the manuscript submitted to Transfusion Medicine. Word count:
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