Donor Arm Research Articles

A novel rapid and effective donor arm disinfection method

The aim of the study was to derive a donor arm disinfection technique that was rapid, but with a disinfection efficacy equivalent to a previous "best-practice" technique. This method consisted of a two-stage procedure with an initial application of 70% isopropyl alcohol and then 2% tincture of iodine (IATI). The total time for the IATI method was 2 minutes in duration. A rapid technique (1 min in duration) was needed to obviate potential problems due to increased donor waiting time, had the IATI method been implemented at blood donation sessions. A direct swabbing and plating technique was used to enumerate bacteria present before and after disinfection. In total, seven methods were evaluated. The chlorhexidine/alcohol applicator (CAA) disinfection device containing 1.5 mL of 2% chlorhexidine gluconate and 70% isopropyl alcohol (99.91% reduction; confidence limits, 99.55%, 99.98%) was shown to have equivalent disinfection efficacy as the IATI method (99.89% reduction; confidence limits, 99.36%, 99.98%; p = 0.86). Procedural time for the 1.5-mL CAA method was 1 minute thereby avoiding potential problems of increased donor waiting time, inherent in the IATI 2-minute procedure at blood donation sessions. The 1.5-mL CAA disinfection method offers blood services a rapid and effective donor arm disinfection procedure. In 2006, the 1.5-mL CAA procedure was implemented throughout the entire English blood service for all donations.

Outcome of Reduced Intensity Allografts in Patients Aged Over 45 Years with Acute Myeloid Leukaemia: Initial Results of the MRC AML15 Trial.

Abstract 523 Introduction:The advent of reduced intensity conditioning (RIC) regimens permits the delivery of allogeneic stem cell transplant (alloSCT) with a potentially curative graft-versus-leukaemia effect in patients with acute myeloid leukaemia (AML) whose outcome with conventional chemotherapy or conventional myeloablative SCT would be poor. Although widely utilised in the management of older patients with AML in 1st complete remission (CR) there are no randomised trials or “donor v. no donor” analyses supporting a role for RIC alloSCT in this setting. Methods:We have examined the impact of RIC allograft in 1st CR on the outcome of patients over the age of 45 treated within the UK MRC AML15 trial. Patients with favourable cytogenetics (t8;21, inv16, t15;17) were not eligible for transplant and were thus excluded from the analysis, which was restricted to patients with intermediate and adverse cytogenetics (defined as: -5, -7, 5q-, abn3q, or 5 or more abnormalities). Patients who were not considered suitable for transplant at the tissue typing stage were excluded. The data was initially analysed by treatment actually received, using the method of Mantel-Byar to allow for time to transplant. The analysis was stratified by presence of a sibling donor, and by cytogenetic risk group. End points were death in 1st CR (DCR), relapse risk (RR), relapse free survival (RFS) and overall survival (OS). A hazard ratio (HR) less than 1 indicates benefit for alloSCT/donor. Results:A total of 700 patients were eligible, of whom 185 received RIC alloSCT in 1st CR (120 sibling, 65 MUD), 109 patients had adverse cytogenetics, and 247 patients had a matched sibling donor. Median follow up from 1st CR was 2.5 years. Mantel-Byar analysis showed increased DCR for RIC alloSCT (HR 6.73; CI 3.49-12.97; p<0.001), but better RR (HR 0.40; CI 0.29-0.55; p<0.001) and RFS (HR 0.68; CI 0.51-0.90; p=0.007). There was some evidence of a benefit on OS (HR 0.76; CI 0.56, 1.03; p=0.08) but the difference was not significant. Whilst the observed treatment effect was greatest in patients with intermediate cytogenetics and a matched sibling donor, there was no significant heterogeneity of effect between groups (figure). To partially allow for selection biases, Cox proportional hazards modelling was performed. Results were in line with the Mantel-Byar analyses, but with a significant benefit for RIC alloSCT on OS (p=0.03). Finally, a sibling donor vs no sibling donor analysis was carried out. 50% of patients in the sibling donor arm received RIC SCT, compared with 13% in the no sibling donor arm. This analysis showed no significant benefit or detriment for any outcome measure (OS: HR 0.94; CI 0.74, 1.19; p=0.6). [Display omitted] Discussion:In the absence of randomised trials, evaluation of the benefit of SCT is difficult. Mantel-Byar analyses may well be subject to selection biases; sibling donor versus no sibling donor analyses are difficult to interpret in this context, since non-receipt of SCT in the donor group and use of MUD SCT (in the no donor group) both tend to reduce any effect. Hence, these results need to be interpreted cautiously. While our data are consistent with the possibility that RIC alloSCT in 1st CR may be effective in some patients aged 45+ (those with both a sibling donor and intermediate cytogenetics being the most likely candidates based on the current evidence), further data are clearly required, ideally from large scale prospective randomised controlled trials. Disclosures:No relevant conflicts of interest to declare.

Haemodynamic changes in the fingers after free radial forearm flap transfer: a prospective study using SPP

Harvesting the radial forearm flap may cause circulatory problems in the donor arm. To investigate the influence on donor hands after radial forearm flap harvesting, we assessed the process of circulatory changes prospectively by measuring skin perfusion pressure (SPP) that is clinically useful in detecting vascular lesions. The records of 17 patients (14 men and 3 women aged 59.7+/-11.8 years) who had undergone free radial forearm flap transfer for head and neck reconstruction, between December 2005 and April 2007, were analysed. SPP in the thumb (finger I), the middle finger (III) and the little finger (V) was measured in the 17 patients preoperatively and 1 month and 3, 6, 9 and 12 months postoperatively. All statistical tests were two sided, with a significance level defined as p<0.05. Preoperatively, baseline SPP was more dominant in finger I than in finger V. Postoperatively, SPP changed significantly in both fingers, while it showed no change in finger III and tended to be higher in finger I than in the other two. Harvesting the free radial forearm flap reduces skin perfusion in the fingers of the donor arm and, we assume, leads to a re-distribution of blood flow to the fingers, with the residual ulnar artery still supplying more blood flow to finger I than to finger V. This suggests the presence of an autoregulating mechanism whereby blood perfusion to the fingers is controlled by the physiological demands of individual fingers.

What Has SHOT Told Us and What Are We Doing About It?

The UK haemovigilance scheme Serious Hazards of Transfusion (SHOT) has just issued its 7th report. Particpiation remains high, and is now actively encouraged by the Dept of Health. The main areas of concern over this period have been hospital errors, bacterial contamination, and more recently transfusion-related acute lung injury (TRALI). Post-transfusion purpura and transfusion-associated graft-versus-host disease, which were already uncommon, have virtually disappeared since universal leucocyte depletion in 1999. To minimise hospital errors, new guidelines for blood administration have been issued, and hospitals are trialling bar code equipment from patient wrists bands and blood fridges, which presents implementation challenges. SHOT is working with the new National Patient Safety Agency on further measures to reduce errors. Bacterial reduction is being approached in a stepwise manner, with new 2-stage donor arm cleansing being rolled out, and blood bag divert pouches now universal. Bacterial screening and pathogen reduction remain under consideration. Review of donors and components associated with TRALI cases showed a strong association between HLA- or HNA- positive female donors and ‘high plasma’ components (FFP and platelets). Therefore we are moving towards ‘male only’ FFP, and approach which requires neither donor testing or deferral. We have achieved 90% success so far, and some centres also use male plasma for suspension of buffy coat pools. Additional options for platelets including additive solution are being considered. Future haemovigilance data will assess the impact of these initiatives.

Neurologic sequelae of the donor arm after endoscopic versus conventional radial artery harvesting

Endoscopic radial artery harvesting remarkably improves cosmetic results after coronary artery bypass surgery. The aim of this study was to investigate neurologic sequelae of the donor arm compared with those occurring after the conventional harvesting technique. Fifty-three patients who had undergone endoscopic radial artery harvesting were followed up 1 year after the coronary artery bypass operation by means of questionnaire analysis and clinical neurologic investigation (ENDO group). Fifty-three patients who had conventional radial artery harvesting during the same time frame served as control subjects (OPEN group). Postoperative wound revision was required in 4 patients of the OPEN group (P = .045 vs the ENDO group). Neurologic symptoms of the donor arm were present in 22 (OPEN group) versus 34 (ENDO group) patients (P = .020): a lesion of the superficial radial nerve was shown in 12 (OPEN group) versus 24 (ENDO) patients (P = .014), and a lesion of the lateral antebrachial cutaneous nerve occurred only in the control group in 12 patients (P < .001). Paraesthesia without impaired sensibility was present in 3 (OPEN group) versus 10 (ENDO group) patients (P = .038). Clinical investigation revealed that temperature, pain, and touch sensation, as well as spatial discrimination, were equally impaired in symptomatic patients, whereas vibration sensation was not affected. After endoscopic radial artery harvesting, impaired sensibility in the region of the superficial radial nerve and paresthesia are more frequent than after the open procedure. However, in contrast to the sequelae of the open procedure, wound revision and injury of the lateral antebrachial cutaneous nerve did not occur. Because of the excellent cosmetic results and avoidance of wound complications, we have opted to use endoscopic radial artery harvesting as the technique of choice, despite the higher incidence of sensory disturbances.

Blood processing

Blood processing

Endoscopic radial artery harvesting for coronary artery bypass grafting leads to an increased incidence of sensation alterations in the donor arm

Endoscopic radial artery harvesting for coronary artery bypass grafting leads to an increased incidence of sensation alterations in the donor arm

From the donor's arm to blood product: a study on bacterial contamination of apheresis platelet concentrates.

Transfusion-associated bacterial infections are a quite frequent collateral effect of administration of platelet concentrates (PC). We carried out a microbiological surveillance of bacterial contamination of apheresis platelet concentrates by studying microbial flora on donors' arms before and after skin disinfection, through blood cultures with the diversion volume and with the PC. Platelet aphereses were carried out using two Haemonetics MCS+ instruments. Cutaneous swabs were examined by the direct plate technique and blood cultures were performed using Bact/ALERT aerobic bottles. In the 5 years from January 2001 to December 2005 we tested 481 PC. Cutaneous swabs showed significant bacterial growth in 89% of cases before skin disinfection and in 44% after. None of the blood cultures performed on diversion blood was positive, one (0.2%) PC was positive on the fifth day after collection and the presence of a Staphylococcus epidermidis strain was demonstrated. Our results suggest that the skin disinfection protocol adopted in our structure is not fully satisfactory. The cultures performed on the PC showed a low prevalence of contamination, and the only positive sample was contaminated by a common skin contaminant (S. epidermidis). The culture became positive on the fifth day after collection, but on the second day the PC had been transfused to a patient, without any adverse reaction. In our experience a culture method using Bact/ALERT aerobic bottles was not able to prevent transfusion of the only contaminated PC identified in this study.

Selective, Concurrent Bilateral Nephrectomies at Renal Transplantation for Autosomal Dominant Polycystic Kidney Disease

An algorithm was developed for performing bilateral nephrectomies for specific indications before or at renal transplantation in patients with autosomal dominant polycystic kidney disease. Outcomes for the living donor arm of the algorithm are reported. Patients with autosomal dominant polycystic kidney disease and end stage renal disease were evaluated for transplantation. Patients with recurrent pyelonephritis, hemorrhage, pain, early satiety or kidneys that extended into the true pelvis underwent bilateral nephrectomies. Bilateral nephrectomies with concurrent renal transplantation were performed if a living renal donor was identified. If no living donor was identified, pre-transplantation bilateral nephrectomies were done and the patients were listed for cadaveric donor renal transplantation. The living renal donor arm of the algorithm was evaluated by comparing certain parameters for 15 and 17 patients with autosomal dominant polycystic kidney disease who underwent pre-transplantation and concurrent bilateral nephrectomies, respectively, including patient and graft survival, delayed graft function, graft function, length of stay for each surgery, transfusions and complications. No deaths, graft failures or delayed graft function occurred. In the delayed renal transplant group median time from nephrectomy to living donor transplantation was 124 days. Serum creatinine at discharge home and 1 year after transplantation for the pre-transplantation nephrectomy cohort was 2.0 and 1.3 mg/dl, respectively. Seven of the 17 patients with concurrent nephrectomy underwent transplantation before starting renal replacement therapy. A longer mean total hospital stay in the pre-transplantation nephrectomy cohort was the only statistically significance outcome variable. Selective bilateral nephrectomies at living donor renal transplantation results in decreased total length of stay without compromising patient or graft outcomes and it allows preemptive renal transplantation. Concurrent nephrectomy is safe and it further validates the algorithm for selective, concurrent bilateral nephrectomies for patients with autosomal dominant polycystic kidney disease who undergo living donor renal transplantation.

Donor site morbidity of the fasciocutaneous radial forearm flap: what does the patient really bother?

The objective of this study was the evaluation of donor site morbidity in head and neck cancer patients after reconstruction using a free vascularized radial forearm flap with emphasis on subjective complaints. Fifty patients who underwent at least 6 months before a reconstruction using a free vascularized radial forearm flap were asked to fill out two questionnaires regarding cosmetics and sensibility and forearm disabilities. Furthermore, a function test including movement extensions (flexion–extension, ulnar–radial deviation and pronation–supination), strength (pinch and grip) and temperature (digiti I and V) of the donor and non-donor site were measured and compared. Thirty-five percent of the patients reported no complaints regarding cosmetics and sensibility and 75% mentioned no forearm disabilities. There was no difference in movement extensions, temperature and grip strength between donor and non-donor sites. The difference in pinch strength appeared to be significant (p < 0.001). The total score of the questionnaire on forearm disabilities correlated significantly with extension, pronation and grip strength of the donor arm. Donor site morbidity of the radial forearm flap measured by objective functional tests was limited but subjective self-ratings revealed complaints regarding cosmestics and sensibility and to a lesser extent regarding forearm disability. The present data may be used for solid patient counselling.

Bacterial risk reduction by improved donor arm disinfection, diversion and bacterial screening

The Interventions of improved donor arm disinfection, diversion and bacterial screening have been implemented by blood services and shown to have substantial benefit. The major source of bacterial contamination is donor arm derived. Blood services are now introducing best practice donor arm disinfection techniques. Diversion has been shown to substantially reduce bacterial contamination in the order of 40-88%. Diversion, together with improved donor arm disinfection, has shown to improve the percentage of reduction in contamination from 47% to 77%. Residual contamination levels after the Introduction of diversion and improved donor arm disinfection may be in the order of 30-40%. Numerous countries have now implemented screen testing programmes for platelet concentrates, which are the major source of bacterial transfusion transmission. Pathogen reduction systems have been developed and are under development. At present, concerns remain with these systems regarding cost, process control, ability to inactivate high titres of viruses, killing of bacterial spores, product damage, genotoxicity and mutagenicity. The interventions of diversion, improved donor arm disinfection and bacterial screen testing are currently available, As such they can be implemented now to increase blood safety with no associated patient risk.

Extrafascially Harvested Radial Artery in CABG: Technique of Harvest, Complications, and Mid-Term Angiographic Patency

The initial use of radial artery (RA) for myocardial revascularization was abandoned due to high incidence of early occlusion. The revival of radial artery graft use was attributable to the improved harvesting techniques as well as the introduction of antispasm prophylaxis by calcium channel blockers. Various techniques of harvesting RA have been described and extrafascial harvest is one of the techniques to minimize trauma during harvest. The immediate arm complications and mid-term angiographic patency of the radial artery grafts harvested using extrafascial no-touch technique and used as a conduit for myocardial revascularization were not documented well in the literature. Between January 1997 and February 2003, 385 patients were operated for coronary artery bypass grafting using radial artery graft as one of the conduits. We used extrafascial no-touch technique and a coagulation current cautery at a strength of 10 to 15 W to control the bleeding during the blunt dissection of the radial artery. The complications related to the radial artery harvest were prospectively recorded and analyzed. This conduit was used as a free graft in 272 patients, left internal mammary artery and radial artery Y graft in 61 patients, Right internal mammary artery, and radial artery composite in situ graft in 52 patients. The radial artery donor arm in these patients was evaluated for complications. Angiographic evaluation of the radial artery graft was carried out randomly in 51 patients and angiography was done after an interval of 6 to 72 months (mean 29.55 +/- 21.77 months). In two patients, although the preoperative Allen test was negative, the radial artery was not harvested after completion of the dissection and was left in situ because the pulse could not be felt in the radial artery distal to the clamp after trial occlusion of the mid part of RA. The arm complications noticed were cutaneous parasthesias in 9 patients (2.33%), which subsided in 4 weeks, stitch abscess and superficial wound infection in 4 patients (1.03%), hematoma/seroma treated with drainage in outpatient department in 3 patients (0.78%), and wound infection requiring open drainage in an operating room in one patient (0.76%). Angiographically radial artery was patent in 48 of 51 patients (94.11%). The extrafascial technique of radial artery harvest is safe and an easily reproducible method with minimal arm complications and good mid-term clinical and angiographic results. The mid-term angiographic patency rates of RA harvested using this technique are comparable to that of the published results of intrafascially harvested radial artery grafts and left internal mammary artery grafts.

Transfusion‐transmitted bacterial infection: risks, sources and interventions

Records of the transmission of bacterial infections by transfusion date back to the beginning of organized blood banking. Despite tremendous strides in preventing viral infection through careful donor screening and viral testing, there has been little improvement in reducing the risk of bacterial sepsis since the introduction of closed collection systems. Based on the French Haemovigilance study, the British Serious Hazards of Transmission (SHOT) study and fatality reports to the United States Food and Drug Administration, the risk of clinically apparent sepsis exceeds the risk of HIV, HBV, and HCV transmission. Sources of contamination include the skin, blood, disposables, and the environment. Potential interventions to reduce transfusion-associated bacterial sepsis include improvements to donor arm preparation, diversion of the first aliquot of whole blood, introduction of bacterial testing and/or implementation of pathogen reduction methods.

The Pneumatic Tourniquet Technique for Endoscopic Radial Artery Harvest

Endoscopic vessel harvest is viewed as a safe, reliable, and cost-effective method for greater saphenous vein removal. As the radial artery has more recently become a popular conduit choice in coronary artery revascularization, we describe herein an endoscopic technique for radial artery harvest in our first 50 patients as an alternative to the more traditional open technique. From November 2001 to July 2002, 54 radial arteries were harvested endoscopically in 50 patients utilizing the VasoView Endoscopic Vessel Harvesting System, an Esmark bandage, and a pneumatic cuff tourniquet. No patients experienced symptoms of vascular compromise, or signs of infection in the donor arm. No adjunctive procedures were required during the vessel harvest, i.e., conversion to open technique. All radial arteries were successfully removed with endoscopic technique and 53 of the 54 radial arteries were successfully used as bypass conduits. Although the quality of the radial artery harvested remains subjective, we found less vasospasm than in our experience with the open technique. Thirty-day follow-up revealed no readmissions, no cardiac ischemic complications, no significant complications with the donor arm, and an excellent cosmetic result. Endoscopic harvest of the radial artery with the tourniquet technique may offer advantages over the more traditional open technique.

A novel method for the detection of bacteria in platelet concentrates utilizing oxygen consumption as a marker for bacterial growth

Bacterial transfusion-transmission remains a significant problem in transfusion medicine. Diversion and improved donor arm disinfection has been introduced by blood services to reduce bacterial transmissions. These interventions are not 100% effective and, therefore, there is still a requirement to screen blood donations, particularly platelet concentrates which are responsible for the majority of transmissions. Pall BDS, a novel bacterial testing system, detects the presence of bacteria in platelet concentrates by measuring the reduction in oxygen content associated with bacterial growth. Buffy coat-derived pooled platelet concentrates were spiked with 12 aerobic and two anaerobic organisms (one species per bag, n = 10) at 100-700 cfu mL(-1). Samples were taken into Pall BDS sample pouches and incubated for 0, 24, 30 and 48 h. An initial incubation was undertaken at 35 degrees C for 24 h and subsequent incubation was at 22 degrees C. At the end of the incubation period the oxygen content in the Pall BDS pouches was measured using a gas analyser. An oxygen content less than or equal to 19.5% was deemed to be positive. Pall BDS pouches tested positive in 80, 94 and 98% units spiked with aerobic bacteria at 24, 30 and 48 h, respectively. Anaerobic bacteria were not detected by the system. Positive BDS pouches contained 10(6) cfu mL(-1) or greater. The system was simple and easy to perform. Pall BDS has a closed sampling system which prevents exogenous contamination. This initial study indicates that the Pall BDS offers a practicable system for detecting bacteria present in leucodepleted platelet concentrates.

Single-Molecule Three-Color FRET

Fluorescence resonance energy transfer (FRET) measured at the single-molecule level can reveal conformational changes of biomolecules and intermolecular interactions in physiologically relevant conditions. Thus far single-molecule FRET has been measured only between two fluorophores. However, for many complex systems, the ability to observe changes in more than one distance is desired and FRET measured between three spectrally distinct fluorophores can provide a more complete picture. We have extended the single-molecule FRET technique to three colors, using the DNA four-way (Holliday) junction as a model system that undergoes two-state conformational fluctuations. By labeling three arms of the junction with Cy3 (donor), Cy5 (acceptor 1), and Cy5.5 (acceptor 2), distance changes between the donor and acceptor 1, and between the donor and acceptor 2, can be measured simultaneously. Thus we are able to show that the acceptor 1 arm moves away from the donor arm at the same time as the acceptor 2 arm approaches the donor arm, and vice versa, marking the first example of observing correlated movements of two different segments of a single molecule. Our data further suggest that Holliday junction does not spend measurable time with any of the helices unstacked, and that the parallel conformations are not populated to a detectable degree.

Validation and assessment of a blood-donor arm disinfectant containing chlorhexidine and alcohol.

To minimize the bacterial contamination rate in blood collected from donors, a study was designed to evaluate the suitability of a single-use chlorhexidine-alcohol antiseptic for donor arm preparation at all blood collection venues in Australia. A prospective study of bacterial load on the skin was performed on 616 blood donors' arms before and after disinfection using a direct swabbing and plating technique. Disinfection was achieved with a swab containing 1 percent chlorhexidine gluconate with 75 percent alcohol, which was applied to the skin in a prescribed method. Feedback from blood donors and staff was obtained using questionnaires. After disinfection, 99 percent of donor arms had bacterial counts of 5 cfu per plate or less, and 99.5 percent had counts of 10 cfu per plate or less, respectively. The mean colony count for all donors after disinfection was 0.39, and the percentage reduction was 99 compared to predisinfection. Sixteen donors (3%) noted transient skin irritation. The majority of staff (64%) preferred not to use the new disinfectant due to the difficulty opening the packaging and an excessive amount of antiseptic solution per pack. The bacteriologic study showed that the disinfectant satisfied the requirements of the Australian Red Cross Blood Service for use to prepare blood-donor arms before venesection. An improvement to the packaging was required before it could be acceptable to all staff.

Transfusion-transmitted bacterial infection: risks, sources and interventions.

Records of the transmission of bacterial infections by transfusion date back to the beginning of organized blood banking. Despite tremendous strides in preventing viral infection through careful donor screening and viral testing, there has been little improvement in reducing the risk of bacterial sepsis since the introduction of closed collection systems. Based on the French Haemovigilance study, the British Serious Hazards of Transmission (SHOT) study and fatality reports to the United States Food and Drug Administration, the risk of clinically apparent sepsis exceeds the risk of HIV, HBV, and HCV transmission. Sources of contamination include the skin, blood, disposables, and the environment. Potential interventions to reduce transfusion-associated bacterial sepsis include improvements to donor arm preparation, diversion of the first aliquot of whole blood, introduction of bacterial testing and/or implementation of pathogen reduction methods.

Iron and cobalt ethylene polymerization catalysts: variations on the central donor.

Three classes of ligands, designed to explore the effect of variations on the central pyridine donor core in bis(imino)pyridine iron and cobalt ethylene polymerization catalysts of the general formula [LMCl(2)] (M = Fe or Co), have been prepared. The first class comprises six-membered N-heterocycles (pyrimidine and triazine) and the second class five-membered heterocycles (furan and thiophene) as the central donor core. In the third class of ligands, the imine donor arm has been extended by one carbon to give anionic tridentate ligands based on carbazole and neutral analogues based on dibenzofuran and dibenzothiophene. The coordination behavior of these ligands upon reaction with FeCl(2) or CoCl(2) has been investigated, whereby only in the case of the neutral pyrimidine or the anionic carbazolide unit as the central donor core have stable complexes been obtained. Ethylene polymerization results are compared with the parent bis(imino)pyridine iron and cobalt catalyst systems.

Adverse effects in blood donors after whole-blood donation: a study of 1000 blood donors interviewed 3 weeks after whole-blood donation.

There are no reports in the transfusion medicine literature that describe adverse reactions and donor arm injuries after whole-blood donation based on solicited information. The present study solicited adverse reaction and donor arm injury information from 1000 randomly selected whole-blood donors approximately 3 weeks after the whole-blood donation. Two 16-gauge phlebotomy needles in use were also compared. Thirty-six percent of the donors had one or more adverse effects (AEs). The most common systemic AEs were fatigue (7.8%), vasovagal symptoms (5.3%), and nausea and vomiting (1.1%). The most common arm findings were bruise (22.7%), arm soreness (10.0%), and hematoma (1.7%). Men were half as likely as women to have an AE (23% AE vs. 48% AE, p < 0.0001). Repeat blood donors had fewer AEs than first-time blood donors (36% AE vs. 47% AE, p < 0.007), and African-American donors had numbers of AEs similar to those of Caucasian donors (31% AE vs. 38% AE, p = 0.30). The two phlebotomy needles did not differ in causing blood donor AEs. AEs after donation and complaints may be more common than previously thought. The postdonation interview is a good tool for defining the blood donor's experience. It can also be used to evaluate and potentially improve blood donor safety and comfort.