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Adverse Reactions to Allogeneic Whole Blood Donation by 16- and 17-Year-Olds
Anne F. Eder, MD, PhD;
Christopher D. Hillyer, MD;
Beth A. Dy, BS;
Edward P. Notari IV, MPH;
Richard J. Benjamin, MD, PhD
JAMA. 2008;299(19):2279-2286.
Context Donations by minors (16- and 17-year-olds) now account for approximately 8% of the whole blood collected by the American Red Cross, but young age and first-time donation status are known to be independent risk factors for donation-related complications.
Objective To evaluate adverse reactions to allogeneic whole blood donation by 16- and 17-year-olds compared with older donors in American Red Cross blood centers.
Design, Setting, and Participants Prospective documentation of adverse events among 16- and 17-year-old donors using standardized collection protocols, definitions, and reporting methods in 2006. Data were from 9 American Red Cross blood centers that routinely collect from 16- and 17-year-olds, a population that provides 80% of its donations at high school blood drives.
Main Outcome Measures Rate of systemic (syncopal-type) and phlebotomy-related donor complications per 10 000 collections.
Results In 2006, 9 American Red Cross regions collected 145 678 whole blood donations from 16- and 17-year-olds, 113 307 from 18- and 19-year-olds, and 1 517 460 from donors aged 20 years or older. Complications were recorded in 15 632 (10.7%), 9359 (8.3%), and 42 987 (2.8%) donations in each corresponding age group. In a multivariate logistic regression model, young age had the strongest association with complications (odds ratio [OR], 3.05; 95% confidence interval [CI], 2.52-3.69; P < .001), followed by first-time donation status (OR, 2.63; 95% CI, 2.24-3.09; P < .001) and female sex (OR, 1.87; 95% CI, 1.62-2.16; P < .001). Infrequent but medically relevant complications, in particular physical injury from syncope-related falls, were significantly more likely in 16- and 17-year-old donors (86 events; 5.9/10 000 collections) compared with 18- and 19-year-old donors (27 events; 2.4/10 000 collections; OR, 2.48; 95% CI, 1.61-3.82) or adults aged 20 years or older (62 events; 0.4/10 000 collections; OR, 14.46; 95% CI, 10.43 -20.04). Sixteen-year-old donors who experienced even a minor complication were less likely to return to donate within 12 months than 16-year-olds who experienced uncomplicated donations (52% vs 73% return rate; OR, 0.40; 95% CI, 0.36-0.44).
Conclusions A higher incidence of donation-related complications and injury occurs among 16- and 17-year-old blood donors compared with older donors. The increasing dependence on recruiting and retaining young blood donors requires a committed approach to donor safety, especially at high school blood drives.
Author Affiliations: Biomedical Services, Medical Office, National Headquarters, American Red Cross, Washington, DC (Drs Eder and Benjamin and Ms Dy); Emory University, School of Medicine, Atlanta, Georgia, and Southern Region, American Red Cross, Douglasville, Georgia (Dr Hillyer); and Jerome H. Holland Laboratory, American Red Cross, Rockville, Maryland (Mr Notari).
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