The value of pre-donation pulse assessment for apheresis donors

During apheresis, donors have up to 6 · 5 L of blood processed and receive citrated plasma during the return cycle. It is of concern that a donor with an unrecognised significant cardiac abnormality might therefore be put at further risk during apheresis.

Apheresis donors with cardiac abnormalities may be at increased risk of severe adverse reactions as a result of repeated volume loss or the adverse effect of citrate anticoagulant on cardiac contractility as the result of reduction in ionised calcium. An abnormal rate or rhythm may indicate a cardiac abnormality.

At two donation centres between May 2001 and April 2009, the pulse rate and rhythm of every donor was measured before each apheresis procedure they underwent. Donors with a pulse rate outside the range 50-100 beats per minute and/or pulse irregularity were deferred from donation and referred to their general practitioner (GP).

Data from 3945 apheresis donors (3874 platelet donors, 71 plasma donors, 3595 males, 350 females) were reviewed. Two hundred thirty-eight donors (6%) were identified as having abnormal pulses and were referred to their GP. Eighty-one donors had bradycardia, 16 had tachycardia and 141 had an irregular pulse. Fifteen of the 3945 donors (0 · 4%) were found to have significant cardiac disease and withdrawn from the donor panel.

By simple monitoring, donors who may be at increased risk from the apheresis procedure can be identified. By performing pre-donation pulse assessment of all apheresis donors, we fulfil our medicolegal duty by not putting donors at avoidable risk.