What Are Some Potential Adverse Effects of Blood Donation?

Patient Presentation
A 17-year-old female came to clinic for her health maintenance examination. She was doing well and was participating in cross-country and track. She had no concerns. The pertinent physical exam revealed a healthy female with normal vital signs. Her height and weight were 50%. The diagnosis of a healthy female was made.

“I noticed that you said you had fainted on your sports physical questionnaire. What happened?” inquired the pediatrician. “Well I gave blood in the spring for the first time and passed out when I first stood up. It was really embarrassing. I was okay after that though,” she replied. “It’s never happened before or after?,” he asked. “No, never before or since. I was okay. I just sort of slumped over and fell back on the bed but never really lost consciousness. I just sat there for a bit longer and had some juice. It was really embargassing,” she stated. “And you’ve never had any other problems like your heart racing or beating funny or any other problems when exercising?” he asked. “No, no other problems. They also told me that I can give blood again which I’m going to do. I’m just going to drink more and make sure I stand up more slowly next time,” she commented.

Just under 40% of people are eligible to be a blood donor. Up to 6.5% of a population are actual donors. “Blood donors are healthy volunteers who give either whole blood or blood components by apheresis including platelets, plasma, red blood cells, peripheral blood stem cells and leucocytes or a combination of blood components. They represent a large, healthy population exposing themselves voluntarily for altruistic, sometimes financial motives to potential complications and risks.” Blood banking systems world-wide are responsible for caring for individual donors health as well as maintaining a robust blood supply for the general population. The safest blood donors are voluntary, non-remunerated blood donors from low-risk populations,” per the World Health Organization. Young donors < 18 year old make up more than 10% of the donations in the U.S, and therefore are a very important resource for blood.

The common blood types are O+ (39%), A+ (30%), O- and B+ (9%), A- (6%), AB+ (4%) and AB- (2%). “In an emergency, anyone can receive type O red blood cells. Therefore, people with type O blood are known as “universal donors.” In addition, individuals of all types can receive type AB plasma because it does not contain anti-A or anti-B.”

Eligibility criteria for blood donation by the American Red Cross can be found here. Topics related to blood safety by the World Health Organization can be found here.

Learning Point
Adverse events directly related to blood donation is ~1%. Adverse events are more likely in first time donors, younger donors and women. Young age group is at higher risk for adverse events, up to 12% and there is a higher rate in 16-17 year olds compared to 18-19 year olds.

Common and uncommon adverse effects include:

  • Vasovagal reactions – 1.4 – 7% for moderate reaction, 0.1 – 0.5% for severe reaction,
    • Vasovagal effects include apprehension, diaphoresis, dizziness, weakness, pallor, hypotension and bradycardia
    • Hospitalizations are rare and usually due to fall-related injuries
    • Vasovagal events are more likely to occur in first time donors, younger donors, low weight, non-black race, pre-donation rapid pulse or lower blood pressure
  • Venipuncture problems
    • Hematoma – 9 – 23%
    • Nerve injury – 0.016 – 0.9%
    • Arterial puncture – 0.003% – 0.011%
  • Iron deficiency anemia
    • Common in regular frequency donors – 48 – 66%
    • Restless legs syndrome (RLS) due to iron deficiency – 14 – 25%
  • Other
    • Allergic reaction to tape, disinfecting agent, nickle, etc.
    • False positive screening tests – a list of screening tests can be found here
    • Fatalities – a few case reports with underlying problems such as myocardial infarction

Adverse event prevention includes pre-donation education about what to expect, increasing fluid intake before phlebotomy, exercising large muscle groups during phlebotomy and afterwards to increase circulation, support during phlebotomy (e.g. verbal distraction or engagement), and calm environment to provide and maintain psychological support for the donor. For iron deficiency anemia, iron supplementation and/or restriction of donation frequency is usually used.

Questions for Further Discussion
1. How is blood volume estimated for a healthy person?
2. What blood products are made from whole blood?
3. What are the problems with blood that cannot make it easily synthesized?
4. What are indications for bone marrow donation, and what are the eligibility criteria?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: Blood Transfusion and Donation

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Amrein K, Valentin A, Lanzer G, Drexler C. Adverse events and safety issues in blood donation–a comprehensive review. Blood Rev. 2012;26(1):33-42. doi:10.1016/j.blre.2011.09.003

Eder AF. Improving safety for young blood donors. Transfus Med Rev. 2012;26(1):14-26. doi:10.1016/j.tmrv.2011.07.008

Wiersum-Osselton J, Romeijn B, van den Brekel E, et al. 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. Transfusion (Paris). 2019;59(2):555-565. doi:10.1111/trf.15065

World Health Organzation. Voluntary non-remunerated blood donation. WHO. http://www.who.int/bloodsafety/voluntary_donation/en/. Accessed October 3, 2019.

Blood FAQ. AABB.org. http://www.aabb.org/tm/Pages/bloodfaq.aspx. Accessed October 4, 2019.

Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa