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Transfusion Bulletin

Suspected Acute Myocardial Infarction-An Unusual Reaction in a Blood Donor

Author(s): Dr Sulochana P V; Mrs Mettinamma R; Dr Jaisy Mathai; Dr Sathyabhama, S.

Vol. 12, No. 2 (2004-08 - 2004-08)

Introduction :

Blood donors are the mainstay in any transfusion center. Regular flow of donors is very essential and any untoward reaction could endanger donor return and frighten away first time donors. Vasovagal reactions occur in 2-5% blood donations (1)(2). Vasovagal syncope is largely dependent on the donor’s peripheral baroreceptor sensitivity, which is influenced by age, emotional stress and hypertension(3)(4) . It is thought to occur in a biphasic process. In the presyncopal phase there is an increase in both cardiac output and peripheral resistance and during the syncopal phase there is sudden reduction in peripheral vascular sympathetic activity that causes peripheral vascular dilatation resulting blood pooling and hypotension(5)(6). We report a case of severe donor reaction with symptoms of acute myocardial infarction:

Case Report :

A 42 yr old well built male donor having body weight of 72 kg\'s doing sedentary type of work came for blood donation on a hot summer afternoon. Approximately 1hr before the donation he had moderately heavy lunch. Pre-donation questionnaire and physical examination certified him fit for blood donation. He had donated blood once 2yrs back and did not have any donor reaction. He had no symptoms suggestive of coronary artery disease. He used to do heavy exercises but stopped since past two yrs. Phlebotomy was done and started collecting in a 450 ml double blood bag. There was good flow and within 4minutes 400ml blood was collected. He started complaining of uneasiness but there were no other signs of vasovagal reaction. Since he was restless blood collection was stopped and recovery measures like lowering the head end and raising foot end were done. Immediately donor complained of chest pain and started sweating profusely. Pulse was hardly palpable and BP could not be recorded. There was no cough or cyanosis. Immediately O2 was administered through an O2 mask,. While preparing for an IV infusion, symptoms reduced and he showed signs of relief. Pain reduced and he was free of symptoms with in 15min of O2 administration. In view of the discomfort and sweating we planned to shift him to the coronary care unit (CCU). He was shifted in a wheel chair, though he insisted on walking. While shifting he became unconscious so rushed to CCU. He regained consciousness with in few minutes. ECG and blood sample for enzyme study were taken immediately and was given IV fluids. ECG was repeated after 3 hrs. Since results did not show any abnormality,he was discharged on the same day itself.

Discussion:

The exact reason for this type of donor reaction is not understood. Literature survey did not give much information of similar cases but one report of acute myocardial infarction requiring emergency ICU admission was reported and donor had‘myocardial bridging’ that resulted in infarction (7). Chest discomfort is a warning sign of myocardial infarction and stroke. Considering the age, sedentary life style, and obesity of the present donor the chance of coronary insufficiency cannot be excluded. Even though he is not giving any of the symptoms suggestive of CAD, cardiac status needs evaluation.In the adult blood loss of 430ml in 4minusually produce only trivial effects on the circulation.

As a rule there is no change in BP and pulse, although the venous pressure falls slightly and take more than 30 min to regain its initial level(8). Howarth et al,(9) had reported the loss of 1500-2000ml blood leads to a fall in right atrial pressure and diminished cardiac output, the subject become cold clammy and may display air hunger. The present donor had heavy meal about 1hr before blood donation. Blood pooled in the gastrointestinal tract and peripheral vasodilatation might have resulted in redistribution of blood volume and relative hypotension. Effect of moderate hypovolemia on microcirculation in healthy older blood donors showed that a blood loss of 450ml was immediately accompanied by a median rapid water shift of 208ml (range 134-298ml) and hemodilution, leading to a decrease in hematocrit, protein and plasma (10). Collection of 400ml might have exaggerated the condition and resulted in insufficient coronary perfusion. Timely administration of O2 might have averted an acute MI. We had two other cases of transient chest discomfort in the past; both of them had donated in the afternoon but did not require additional help, so no further investigations were carried out. Even though such incidences are very rare it should be viewed seriously and included in the blood donor selection criteria. Such incidences can cause panic among the personnel in blood center and produce a negative effect on the donor population especially the first time donors. Donor can be deferred for a few hrs if they had a heavy meal especially in outdoor blood collection camps where the temperature may be high.

References:

  1. Greenbury CL. An analysis of the incidence of “fainting” in 5897 unselected blood donors. Br Med J 1942; 1:253-5
  2. Callahan R, Edelman E B, Smith MS, Smith JJ. Study of the incidence and characteristics of blood donor “reactors”. Transfusion1963 ; 3:76-82.
  3. Gribbin B,Pricking TG, Sleight P, Peto R. Effect of age and high blood pressure on baroreflex sensitivity in man.Circ Res 1971;29:424-31.
  4. Adler PS, France C,Ditto B. Baroreflex sensitivity at rest and during stress in individuals with history of vasovagal syncope. J Psychosom Res 1991;35:591-7
  5. Green MA, Boltax AJ, Ulberg R.Cardiovascular dynamics of vasovagal reactions in man. Circulation 1961; 9: 12-17
  6. Engel GL. Physiological stress, vasodepressor (vasovagal) syncope and sudden death. Ann Intern Med1978;89:403-12
  7. Akdemir R, Gunduz H, Emiroglu Y, Uyan C.Myocardial bridging as a cause of acute myocardial infarction: a case report. BMC Cardiovasc Disord2002; 2(1):15
  8. Loutit JF, Mollison MD, vander Walt ED.Venous pressure during venesection and blood transfusion. Brit Med J 1942;ii:658.
  9. Howarth S, Sharpey-Schafer EP. Low blood pressure phases following hemorrage. Lancet1947;I:19
  10. JanetzkoK, Kluter H, Krichner H, Klotz K F. The effect of moderate hypovolemia on microcirculation in healthy older blood donors: Anaesthesia 2001;56:103-7
* Division of Blood Transfusion Services,
Sree Chitra Tirunal Instt for Medical Sciences &
Technology, Thiruvananthapuram, Kerala


 

A TRIBUTE TO KARL LANDSTEINER

To celebrate the occasion on 14th of June We all have gathered enthusiastically this noon. With high spirits let us all celebrate the World Blood Donors Day And motivate people to come forward for this cause in their own simple way Years back this day marks the birth of a great human being Who gave the world an important system of ABO blood grouping. This is an important aspect one has to be cautious and careful about. It has helped in saving innumerable lives about which there is no doubt. Let us all step forward in this Voluntary Blood Donation Movement. So that everyone is benefited from those living in palaces to those living in the pavement. Let us make an effort so that No Professional Blood Donors exist on this earth. Then only our contributions and work will be counted worth.

Dr. Megha Gupta Moulana, Azad Medical College, New Delhi.

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