(P-BC-67) Vasovagal Events in Whole Blood Donors with Self-Reported Lung Conditions

Background/Case Studies: More than 34 million Americans live with lung disease (LD). Blood donors (BD) are considered healthy, but statistically many donors may have LD, current or past. Policies for accepting donors with LD are based on concerns for donor safety, specifically the impact of reduced oxygen-carrying capacity that may result in vasovagal reactions (VVR) and associated complications. Our organization accepts donors with a history of LD if on the day of donation, they have no: shortness of breath, activity restrictions, oxygen use, or pending diagnostic tests. This study sought to identify specific LD diagnoses associated with higher rates of VVR and loss of consciousness (LOC).

Study

Design/Methods: We reviewed allogeneic whole blood (WB) presentations in 2021-2022 for self-reported current/past LD, and observed/reported VVR, LOC, severity and outside medical care (OMC). LD was grouped into categories: asthma + complications, chronic obstructive pulmonary disease (COPD) (including emphysema/bronchitis), pneumonia, pulmonary embolism, pneumothorax/pleurisy, sarcoidosis, other LD's (sleep apnea, pulmonary hypertension, interstitial LD, bronchiectasis, mycoses, others) and non-specific signs/symptoms (cough/dyspnea/PPD). We performed multivariate logistic regression analysis (MVA) on factors associated with all VVRs and LOC, with LD and variables previously reported to be associated with VVR/LOC.

Results/Findings: In 1,660,229 allogeneic WB presentations, 40,039 (2.2%) reported LD of which 99.8% met donation criteria resulting in 39,948 needle-in donation attempts. Of LD's asthma was the most reported (77.4%), with other conditions' frequency listed in Table. The proportion of pre-faint events, all VVRs, LOC, and OMC was higher among those with LD (p< 0.05). Of 3,505 LOC events reported, 113 had LD:[92.9% (n=105) AABB severity grade 1, 7%(n=7) grade 2 and 0.9% (n=1) grade 3]. Proportions of LOC reaction severity grades 1,2 and 3 were similar between donors with/without LD.
The MVA showed significantly increased risk-adjusted odds ratio (OR) for VVR OR (95%CI)+1.22 (1.12-1.32) (but not LOC) in asthma + complications (vs. no LD). None of the other LD's were associated with increased risk of VVR or LOC's. Other factors with increased OR for both VVR and LOC were ages< 25 (vs. 25-64), first-time/reengaged donors (vs. repeat), estimated blood volume < 5L (vs. >5L), and pulse >90 bpm (vs. 65-90 bpm) (data not shown).

Conclusions: BD reporting LD during medical screening represent a small proportion of individuals presenting for WB donation with most qualifying for donation. Among BD reporting various types of LD, those with asthma + complications have a slight but significantly higher risk-adjusted odds for VVR (but not for LCO). Anxiety, a known trigger for VVT, is strongly associated with asthma and may be partially responsible for this effect. Is is reassuring that LD is not associated with higher rates of VVR or LOC.