STANDARD OPERATING PROCEDURE (SOP): MANAGEMENT OF ADVERSE REACTIONS IN A DONOR

BLOOD CENTRE NAME

SOP Number	Effective date	Pages	Author	Authorised by
Version	Review Period	No. of copies	Reviewed by	Date

LOCATION     Donor room	SUBJECT         Blood Collection
FUNCTION           Management of adverse reactions in a donor	DISTRIBUTION 1. Medical-officer-in-charge of Donor area 2. Master File

1.SCOPE AND APPLICATION

Any adverse reaction in the immediate post-donation period requires to be attended to.The source of the adverse reaction is identified and corrective and preventive measures considered.

2. RESPONSIBILITY

The medical officer in attendance is responsible for managing the adverse reaction in the donor.

3. REFERENCE

 •Model Standard Operating Procedures for Blood Transfusion Service,WHO,New Delhi 2002

•Technical Manual of American Association of Blood Banks,18th edition Pg 142-145.

4. MATERIALS REQUIRED

Following materials are required to attend to any emergency arising in the post donation period.

 Oral medication

• Analgesic Tablets
• Calcium and Vitamin C Tablets
• Electrolyte replacement fluid

Injection

• Epinephrine (Adrenaline)
•  Atropine sulphate
• Pheniramine maleate
•  Diazepam
•  Glucocorticosteroid
•  Glucose (Dextrose 25%)
• Furosemide
• Metoclopromide
• Prochlorperazine maleate
• Sodium bicarbonate
• Glucose saline (Sodium chloride and Dextrose 500 ml)

 Antiseptics

• Savlon solution

 Miscellaneous

• Bandages/Dressings
• Band-aids
• Heparin and Benzyl Nicotinate ointment.
• Smelling salt-Spirit of Ammonia
• Analgesic balm
• Tongue depressor
• Disposable syringes and needles 22 G
• Clinical Thermometer
• Oxygen cylinder
• Infusion set
• Paper bag

5. MANAGEMENT OF ADVERSE REACTIONS

1. Giddiness/Syncope (vasovagal syndrome):

• Raise feet and lower head end.
• Loosen tight clothing (belt, tie etc.)
• Ensure adequate airway.
• Check pulse and blood pressure.
• Apply cold compresses to forehead and back.
• Administer inhalation of spirit of ammonia if needed. The donor should respond by coughing which will elevate the blood pressure.
• If there is bradycardia and hypotension-

          – Administer inj. Atropine 1 ml IM, if bradycardia continues for more than 20 minutes.

          – Administer IV normal saline or dextrose saline infusions if hypotension is prolonged.

2. Convulsions: 

• Keep the head tilted to the side
• Prevent the tongue bite
• Keep the airway patent by inserting a tongue blade or gauze between the teeth.

3. Vomiting:

• Usually this provides relief. If the donor feels nauseous or if vomiting is severe, inject Stemetil. Usually subsides on its own.

4. Tetany/muscularspasm/twitching:

• These are usually due to hyperventilation in an apprehensive donor. Ask the donor to breath in a paper bag, which provides prompt relief. Do not give oxygen.

5. Haematoma: 

• Release the tourniquet/pressure cuff immediately.
• Apply pressure on the venepuncture site and withdraw the needle from the vein. 
• Raise the arm above the head for a few minutes.
• Apply Thrombophob ointment gently around the phlebotomy site after about 5 minutes.
• Advise the donor to apply ice if there is pain and inform about the expected change in skin colour.

6. Eczematous reactions of the skin around venepuncture site: 

• Apply steroid ointment.

7. Delayed syncope: 

• These may occur as late as 30 minutes to 1 hour after donation, usually after the donor has left the blood bank. Permanently defer any donor who gives history of such attacks more than twice.

6. DOCUMENTATION

• Enter details of adverse reactions and the management in the donor register
• Keep a record of stocks of materials required, especially the expiry date of medicines.

7. END OF DOCUMENT