捐血後不適就醫之探討

Serious Adverse Events after Blood Donation and Their Related Factors

在捐血過程中或捐血後發生嚴重的不適症狀甚或需就醫治療，對捐血活動將造成負面衝擊。本研究將捐血後不適就醫定義為當捐血人於捐血後有不適症狀發生時無法立即獲得減輕而必需外送至醫院尋求治療。研究之目的在企圖找出造成不適就醫的相關因子，以供制定各項預防措施之參考。此研究乃溯及台灣血液基金會6 個捐血中心2003-2007 年總計發生8,595 人次之捐血人不適（0.10％），其中有176 例捐血後嚴重不適就醫案件（約占捐血後不適的2％ ，[176／8595]）與捐血人基本資料比對，探討不同的因子與捐血後不適，及嚴重不適就醫的關聯性，應用Chi-square test 或Fisher’s exact test （當某些細格的發展數小時）分析法，計算其p value，藉以分析其是否有顯著的關聯性。捐血後不適與嚴重不適就醫之發生率，女性高於男性（p＜0.001），首次捐血發生比率高於重覆捐血人（p＜0.001），年齡層於20 歲以下者發生比率高於其它年齡層（p＜0.001），迷走神經反應的發生率高於手臂反應（p＜0.001），上述差異顯示皆具有統計學意義。捐血後不適依體重而言，體重＜50kg 較體重＞50kg 者為高（p＜0.001），但與不適就醫發生率（p=0.971），顯示捐血人體重與不適就醫並無相關性。本研究發現捐血人發生不適就醫以年輕（20 歲以下）、女性且首次捐血者發生比率較高，捐血機構在面對這些族群時應給予較多的心理支持、加強服務禮儀等令其身心放鬆狀況下愉快的捐血，也可在扎針技巧上加強訓練以減輕捐血者疼痛與不適感，另外當不適症狀出現時也應教育捐血人如何避免更嚴重傷害產生，期有效降低捐血不適就醫比率，以達「捐血快樂」之目標。

A serious adverse event (SAE) is defined as the occurrence of symptoms signs that are not immediately alleviated and necessitating medical care outside the blood center. It is the purpose of this study to understand the factors contributing to the adverse event and to recognize the signs and symptoms associated with those adverse reactions especially delayed adverse reactions, which is essential for the prevention of secondary harm to the donor. Retrospective analysis of adverse reactions and serious adverse events from 6 blood donation centers in Taiwan during a 5-year period (2003-2007) was done. Both Chi-square and Fisher exact test (for small sample) analysis was applied to measure the p value of the different related factors to determine if the differences between the observed data and expected data reflect a significant difference or not. A p-value of <0.05 is considered significant. Recorded data showed that serious adverse reactions in Taiwan Blood Donation Centers occur at the rate of about 0.02%. Vasovagal reactions accounts to about 72% of the adverse reactions and venepuncture related injury about 28%. Serious adverse reactions occur more often in female, donors below 20 years of age, and first time donors. Serious adverse events occur more often in bloodmobiles than in permanent donation sites. Blood donor education is of utmost importance in the prevention of serious adverse reactions especially those of first time, young and female blood donors. The phlebotomy skill and attitude of the staff are factors highly affecting donors’ reaction during blood donation, and proper training of staff is extremely necessary, to attain a happy blood donation activity.