Improved donor safety in high-volume apheresis collections.

Abstract

Separators use 1960s sex-based nomograms to estimate apheresis donor blood volume and to calculate the 15% maximum extracorporeal and collection volumes. As US body habitus changes, proportional overestimation of the maximum safe collection volume may become clinically significant with large-volume collections. We correlated 2 years of vasovagal reaction (VVR) data with 148,416 Trima apheresis procedure parameters to identify trends. Only platelet/plasma with or without red blood cell (RBC) procedures yielded collection volumes of at least 900 mL with no saline replacement. Vasovagal events of any severity were correlated by sex with actual collection volume and donor estimated blood volume (EBV). We performed multivariable analysis incorporating the factors that influence VVR rates to assess the significance of EBV and collection volume. VVR rates nearly doubled in male donors who had collection volumes greater than 1050 mL. No reaction threshold could be identified in female donors. This was confirmed in multivariable analysis that included donor sex, age, donation experience, draw time, and reporting location. Limiting apheresis collections to the lesser of 1050 mL or 15% EBV may reduce VVR rates. Further confirmation of this finding by other collection centers is desirable.