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Adverse reactions to allogeneic whole blood donation by 16- and 17-year-olds.

Eder AF, Hillyer CD, Dy BA, Notari EP, Benjamin RJ

Biomedical Services, Medical Office, National Headquarters, American Red Cross, 2025 E St NW, Washington, DC 20006, USA. edera@usa.redcross.org

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.

Published 21 May 2008 in JAMA, 299(19): 2279-86.
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