Postdonation Information and Blood Component Retrievals: Realigning Blood Center and Hospital Actions Based on Risk Assessment

Blood centers often receive information from individuals after blood donation that should have resulted in their deferral and may attempt to retrieve distributed blood components that did not meet all quality standards and regulations. Typically, the information is discovered or reported only after the components from the donation have been transfused. Blood centers may notify the transfusion service and provide a statement of the potential risk, if any, associated with the blood components, but the transfusion service must decide if further investigation, notification of the transfusing physician, or counseling of the patient is warranted. Currently, postdonation information (PDI) affects an estimated 1 in 600 donations in the United States. Despite the regularity with which PDI occurs, there has been little analysis of the main sources of PDI, associated transfusion risk, or the actual benefit of various actions taken as a result of PDI. However, blood centers attempt to retrieve thousands of components each year for PDI: actions that can cause confusion, concern, and complaints from hospitals and transfusion services. Postdonation information is largely a reflection of the inherent limitations of the current donor screening process, which is error-prone and uses broad, precautionary questions to guard against theoretical or extremely remote risks. This article reviews the most commonly reported PDI and available information on the possible risk associated with the transfused components from the involved donations, to formulate a framework for blood center retrieval actions and hospital notification that is consistent with current regulations and commensurate with the likelihood of adverse outcomes associated with the most commonly reported PDI.