Abstract
OBJECTIVE:
The objective of this study was to assess the physiological and hormonal stress response during blood donation in healthy voluntary donors.
BACKGROUND:
Blood donation is a stressful event which can cause adverse reactions in this altruistic attempt. This can lead to a reduction in the precious donor population, and there are very less studies on levels of physiological (heart rate and blood pressure [BP]) and hormonal stress in the blood donation. Our attempt is to understand whether there is really a quantifiable physiological and/or hormonal stress during the process of blood donation and whether responses differed in terms of between age, gender, and experience of donors in the blood donation.
MATERIALS AND METHODS:
Randomly selected eligible seventy whole blood donors were selected for the study after obtaining written informed consent. They were medically assessed before selecting and saliva samples were collected just before needle insertion for assessment of salivary cortisol levels. A 2 ml blood sample for serum cortisol assessment from the blood bag tubing at the end of the donation was also collected.
RESULTS:
Stress indicators during donation are compared between different age groups as well as experience of blood donation, and no association is found between them. BP is found to have an association to gender, and salivary cortisol levels were found to be higher in 69 out of 70 blood donors.
CONCLUSION:
Salivary cortisol can be used as a tool for acute stress assessment in blood donation. The response patterns differ between age, women and men, and first-time versus experienced donors.
Keywords: Hormonal stress, physiological stress, salivary cortisol, voluntary blood donation
Introduction
Whenever there comes a stress, our body will try to overcome it by the law of nature by release of stress hormones. This is achieved through the sympathetic nervous system and the hypothalamic–pituitary–adrenal (HPA) axis. This activation leads to an increased secretion of the stress hormones called glucocorticoids (cortisol and cortisone) from the adrenal cortex. Some individuals show persistent, large cortisol increases in response to stress, whereas others show little or no such response.[1] This response to stress, which increases HPA-axis activity, is found to be associated with a subsequent rise in salivary cortisol level as well.[2] Salivary cortisol measurement has been considered a valuable and convenient alternative to plasma cortisol measurement for the assessment of stress.
Blood donation is also considered an episode of hypovolemic stress. During a blood donation, some people experience feelings of satisfaction, being more alert and better in general, but some experience adverse donor reactions, too. For a smooth functioning of a blood center, there should have sufficient donor population, which is achieved through constant donor recruitment, donor motivation, and donor retention. Indeed, several studies indicate that a routine whole-blood donation is associated with psychological and hormonal stress.[3] The commonly seen stress reactions include multiple psychological stress reactions,[4] such as increased levels of arousal, anxiety, fear, or tension[5,6] as well as physiological or hormonal stress reactions, such as increased cortisol excretion, a decrease in heart rate variability.[7,8] The relation between blood donation on the one hand, and anxiety and stress reactions on the other remains largely unclear.[4] This study is done for a mere attempt to understand the physiological stress reaction (changes in pulse rate and blood pressure [BP]) and hormonal stress (changes in salivary and serum cortisol) happening during the event of blood donation. The Hypothesis of this study would be there is an increase in pulse rate and BP before blood donation and the corresponding change in salivary and serum cortisol levels due to the acute stress response mechanism. Since cortisol levels rise during a stress response and needle insertion/phlebotomy falls under this criteria, the average cortisol levels among the first-time as well as the experienced group will be assessed from this study, and this average value will be compared with blood donors who had developed a donor reaction following the phlebotomy.
Aims and objectives
To assess the physiological and hormonal stress response during blood donation in healthy voluntary donors. To evaluate physiological stress response, pulse rate and BP were recorded, and psychological stress response was assessed by measuring predonation salivary cortisol level and postdonation serum cortisol level.
Materials and Methods
Participants and informed consent
This was a pilot study done to assess the physiological and hormonal stress in voluntary blood donors for which the sample size of seventy was selected based on the availability of resource. A random selection of 70 whole blood donors who were found eligible for whole blood donation following screening consisting of first-time and experienced male and female donors were selected from in-house and blood donation campsite for the study after discussing with them regarding the same and informed consent was taken from the participant who showed interest in participation in this study. The inclusion criteria were no use of nonsteroidal anti-inflammatory drugs such as aspirin in the 3 days prior to donation, as they affect platelet functioning, and no use of beta-blockers such as atenolol, as they affect BP and heart rate.
Study in detail
After donor selection, the willing participants were given informed consent after a briefing about the study. The age group and gender distribution and previous blood donation experience were considered for comparison of stress response pattern. The pulse rate and BP were recorded just prior to needle insertion. They were instructed to give a salivary sample in a 2 ml cryovial allotted for them just before needle insertion. At the end of the donation, a 2 ml ethylenediaminetetraacetic acid blood sample was collected from the tubing of the blood bag (to avoid multiple pricks), which is required for assessing serum cortisol levels.
Study variables
Physiological stress
For physiological stress assessment, pulse rate and BP of the participants prior to needle insertion were recorded. The parameters were recorded by the same person using a single equipment. The adverse donor reactions among the participants were noted and included in the physiological stress criteria.
Hormonal stress
The salivary cortisol and serum cortisol levels were used for hormonal stress assessment. The saliva from the participant is collected just before needle insertion after recording the vitals, and a blood sample at the end of blood donation was collected for the salivary and serum cortisol level assessment, respectively. The samples were processed on the same day of collection within 6 h (saliva samples stored in 4°C before performing testing) of sample collection, and quantification of cortisol levels was done using the quantitative ELISA method.
Statistical analysis
Data analysis was done using R studio version 4.0.2., (Posit, PBC, University of Auckland, New Zealand). In addition to descriptive data analysis, statistical tests were performed to find the association between the variables according to the study objectives. Statistical significance for the tests was ascertained by considering a P ≤ 0.05 (Chi-square test). For checking normality, Shapiro–Wilk test was performed. In bivariate analysis, comparisons of categorical variables were conducted using Pearson Chi-square tests and Fisher’s exact tests.
Results
This section describes data analysis results formulated based on the study objectives. Figure 1 depicts the general description of the study population’s sociodemographic information. The study population included seventy participants. Sixty-five percent of the study population were males, and 34.3% were females. Many of the participants (60%) were in the age group 18–30, and the mean age was 30.4 with a standard deviation of 8.7. The proportion of first-time donors was 57%, and 42.9% were experienced in blood donation.
Figure 1.
Participant information
The total distribution of stress indicators like BP, pulse rate, serum cortisol and salivary cortisol were mentioned in Figure 2. 54.3% had high BP and 98.6% had high salivary cortisol. Only 21.4% and 28.6% had tachycardia and high serum cortisol, respectively.
Figure 2.
Distribution of stress indicators
Stress indicators during donation were compared between different age groups [Table 1] and no association was found between them. In the age group 18–30, equal distribution was found in the stress indicator BP. Seventy-six percent had normal heart rate and 69% had normal serum cortisol but everyone had high salivary cortisol. Among participants in the age group 31–40, they showed equal prevalence in terms of BP and 87.5% of them had normal heart rates. Seventy-five percent of them had normal serum cortisol and 100% of them had high salivary cortisol. In the age group 41–50, 72.7% had elevated BP, normal heart rate, and normal serum cortisol, and 91% had high salivary cortisol. Only one participant was there in the age group 51–60, and the person had elevated BP but normal heart rate, normal serum cortisol, and high salivary cortisol.
Table 1.
Distribution of stress indicators across different age groups
| BP | High BP (SBP ≥140 or DBP ≥90), n (%) | Normal BP (SBP <140 or DBP <90), n (%) | P |
|---|---|---|---|
| 18–30 | 21 (50.0) | 21 (50.0) | 0.5 |
| 31–40 | 8 (50.0) | 8 (50.0) | |
| 41–50 | 8 (72.7) | 3 (27.3) | |
| 51–60 | 1 (100.0) | 0 | |
| Total | 38 | 32 | |
|
| |||
| PR | Tachycardia (PR ≥90), n (%) | Normal heart rate (PR <90), n (%) | P |
|
| |||
| 18–30 | 10 (24.0) | 32 (76.0) | 0.7 |
| 31–40 | 2 (12.5) | 14 (87.5) | |
| 41–50 | 3 (27.3) | 8 (72.7) | |
| 51–60 | 0 | 1 (100.0) | |
| Total | 15 | 55 | |
|
| |||
| Serum cortisol | High serum cortisol (>20 µg/dL), n (%) | Normal serum cortisol (10–20 µg/dL), n (%) | P |
|
| |||
| 18–30 | 13 (31.0) | 29 (69.0) | 0.9 |
| 31–40 | 4 (25.0) | 12 (75.0) | |
| 41–50 | 3 (27.3) | 8 (72.7) | |
| 51–60 | 0 | 1 (100.0) | |
| Total | 20 | 50 | |
|
| |||
| Salivary cortisol | High salivary cortisol (>27 ng/mL), n (%) | Normal salivary cortisol (10.2–27 ng/mL), n (%) | P |
|
| |||
| 18–30 | 42 (100.0) | 0 | 0.17 |
| 31–40 | 16 (100.0) | 0 | |
| 41–50 | 10 (91.0) | 1 (9.0) | |
| 51–60 | 1 (100.0) | 0 | |
| Total | 69 | 1 | |
BP=Blood pressure, SBP=Systolic BP, DBP=Diastolic BP, PR=Pulse rate
When stress indicators during donation were compared to males and females [Table 2], BP was found to be associated. Among females, 66.6% had normal BP, 79.2% had normal heart rate, 71% had normal serum cortisol, and all of them had high salivary cortisol. When it comes to male participants, 65.2% had high BP, 78.3% had normal heart rate, 72% had normal serum cortisol, and 45 of all the 46 male participants had high serum cortisol.
Table 2.
Distribution of stress indicators among females and males
| BP | High BP, n (%) | Normal BP, n (%) | P |
|---|---|---|---|
| Female | 8 (33.3) | 16 (66.6) | 0.02 |
| Male | 30 (65.2) | 16 (34.8) | |
| Total | 38 | 32 | |
|
| |||
| PR | Tachycardia, n (%) | Normal heart rate, n (%) | |
|
| |||
| Female | 5 (20.8) | 19 (79.2) | 1.0 |
| Male | 10 (21.7) | 36 (78.3) | |
| Total | 15 | 55 | |
|
| |||
| Serum cortisol | High serum cortisol, n (%) | Normal serum cortisol, n (%) | |
|
| |||
| Female | 7 (29.0) | 17 (71.0) | 1.0 |
| Male | 13 (28.0) | 33 (72.0) | |
| Total | 20 | 50 | |
|
| |||
| Salivary cortisol | High salivary cortisol, n (%) | Normal salivary cortisol, n (%) | |
|
| |||
| Female | 24 (100.0) | 0 | 1.0 |
| Male | 45 (97.9) | 1 (2.1) | |
| Total | 69 | 1 | |
BP=Blood pressure, PR=Pulse rate
Stress indicators were compared with experience of blood donation, but no statistical association was found [Table 3 and Figure 3]. Among the first-time donors, 55% had high BP, 75% had normal heart rate, 65% had normal serum cortisol, and all the first-time participants had high salivary cortisol. Of the experienced donors, 53.3% of them experienced high BP, 83.3% had normal heart rate, 80% had normal serum cortisol, and 29 of the 30 participants had high salivary cortisol.
Table 3.
Distribution of stress indicators among first-time and experienced donors
| BP | High BP, n (%) | Normal BP, n (%) | P |
|---|---|---|---|
| First time | 22 (55.0) | 18 (45.0) | 1 |
| Experienced | 16 (53.3) | 14 (46.7) | |
| Total | 38 | 32 | |
|
| |||
| PR | Tachycardia, n (%) | Normal heart rate, n (%) | |
|
| |||
| First time | 10 (25.0) | 30 (75.0) | 0.6 |
| Experienced | 5 (16.7) | 25 (83.3) | |
| Total | 15 | 55 | |
|
| |||
| Serum cortisol | High serum cortisol, n (%) | Normal serum cortisol, n (%) | |
|
| |||
| First time | 14 (35.0) | 26 (65.0) | 0.3 |
| Experienced | 6 (20.0) | 24 (80.0) | |
| Total | 20 | 50 | |
|
| |||
| Salivary cortisol | High salivary cortisol, n (%) | Normal salivary cortisol, n (%) | |
|
| |||
| First time | 40 (100.0) | 0 | 0.4 |
| Experienced | 29 (96.7) | 1 (3.3) | |
| Total | 69 | 1 | |
BP=Blood pressure, PR=Pulse rate
Figure 3.
Distribution of stress indicators among first-time and experienced donors
Among the 70 participants, only 6 participants had adverse donor reactions in the form of vasovagal reaction (VVR; n = 4) and oozing from the puncture site (n = 2). Three were first-time donors, out of which two were females. Among the experienced donors, there were two males. The mean age group of these 6 participants is 26.33 years. All six donors with adverse donor reactions had high serum and salivary cortisol levels. The three affected female donors had normal BP and heart rate, whereas two male donors had elevated BP, and one had a higher heart rate. There was no difference noted between vitals and cortisol levels in in-house and outdoor blood donation camp donors.
Discussion
Donor recruitment and retention is the major challenge faced by all blood centres across the world. The psychology of repeat blood donation is to consider the myriads of influences that act on some people to make them “life’s best gift givers.”[9] Acute psychosocial stress[10] and stress-induced increases in the glucocorticoid hormone cortisol[11,12] have been linked to reduced altruistic decisions. Since voluntary blood donation is an altruistic act, the importance of reduction of acute stress plays an important role in recruitment as well as retention of blood donors for a safe supply of blood and blood products. In this study attempt was put on “visible” stress responses, mainly BP and pulse rate, which can be assessed at “couch” side over variables such as age distribution, gender, and experience in blood donation.
Among stress indicators, salivary cortisol and BP were found to be elevated in the majority of participants than pulse rate. These findings are consistent with one of the recent studies by Ernst et al., stating there is a considerable change in peripheral vasoconstriction during stress response than heart rate variability and pronounced activation of the HPA axis, causing elevated salivary cortisol values.[13] The salivary cortisol absolutely served as an acute stress indicator irrespective of age, sex, or experience in blood donation.
Our study gives a finding of equal distribution of BP response and normal heart rate response in the age group of 18–30 years and 31–40 years whereas elevated BP and normal heart rate in 41–50 year and 51–60-year age groups. In a Swiss study on adult age differences in the psychophysiological response to acute stress by Mikneviciute et al., compared to younger adults, older adults not only showed overall lower cortisol levels but also a lower stress-induced cortisol increase and concerning heart rate, the results indicated that older (vs. younger) adults showed lower heart rate in the stress condition.[14] A meta-analysis by Brindle et al. found an association between aging and a decrease in sympathetic activation under stress, especially in the heart rate response, as older people tend to show a lower heart rate response to stress.[15]
Our study population constituted 24 female participants out of 70, and the males in our study population had significant high BP (no significance noted in hormonal stress response and heart rate) prior to blood donation (P = 0.02) when compared to females. In a Spanish meta-analysis by Pulopulos et al. states that sex plays an important role in the BP response to stress but not in other autonomic nervous system activity indicators such as heart rate, heart rate variation, or salivary Alpha Amylase response that males are observed to have a higher prevalence of coronary heart disease.[16] Hoogerwerf et al. found a clear donation-induced response in females compared to males.[4] Another study by France et al. states that the odds of experiencing a reaction were higher for female donors (vs. male donors), first-time donors (vs. experienced donors), donors with pulse rates 90 (vs. those 75 to <82), and donors who reported any level of fear (vs. no fear).[17]
As per our study, experience in blood donation has no significant effect on heart rate, BP, or hormonal response. This is found to be the same as the findings by Bellitti et al.[18] who conducted a pioneer study in hormonal changes in young blood donor, that experience in blood donation also had no effect on pulse rate (P = 0.6) and heart rate during the first donation showed a significant difference (P < 0.001) between the values obtained before (78 ± 2 beats/min) and after (68 ± 1 beats/min) the phlebotomy, whereas there was no difference during the fourth donation (71 ± 1 vs. 70 ± 1 beats/min). The results of a study by France and France[19] reveal a significant relationship between level of fear and donation history for each of the five types of fears assessed (fear of blood drawn, needles, etc.), with a pattern of less fear among more experienced donors.
The present study indicates most of the participants had elevated BP and salivary cortisol levels just before needle insertion. Kaur et al.[20] found that the systolic BP and pulse rate before blood donation were found to be increased significantly before needle insertion. Similarly, Hoogerwerf et al.[4] also found that donation stress peaked during needle insertion, and cortisol decreased in all our donors towards the end of the donation procedure. In the current study, 71.4% of the population had normal serum cortisol level in blood samples taken at the end of blood donation.
Among the seventy participants in our study, only 6 participants had adverse donor reactions in the form of (VVR; n = 4) and oozing from the puncture site (n = 2). Three were first-time donors, out of which two were females. Among the experienced donors, there were two males. The mean age group of these 6 participants is 26.33 years. Younger whole blood donors are more likely to experience a VVR than older donors,[21,22,23,24,25] as is first-time donor status versus more experienced donors[21,22,23,25] and gender, with women being more likely to experience a VVR than men.[21,22,23,24] In our study, only one male donor among the adversely affected donors had elevated heart rate and two males had increased BP. As per Hoogerwerf et al.[26] the most prominent negative experiences associated with increased BP were fainting and dizziness, which were associated with systolic BP increases of up to 3.0 mm Hg in both male and female whole blood donors. The most significant observation in the study is that all 6 participants had adverse donor reactions had elevated serum and salivary cortisol levels. Lorenz[27] states heart rate variability response to fingerstick significantly predicted that individual’s vasovagal-like responses to venipuncture, suggesting that measuring heart rate variability during predonation hemoglobin testing may identify donors at risk for adverse events during venipuncture. Hinrichs et al. state that negative effects were described by 23.5% of all (n = 110) blood donors and constituted the younger age group. The actual predonation strain scores in the above study were higher in first-time donors than in repeat donors, which became equivalent after donation, and the higher cortisol levels were noted in these first-time donors 15 min before and 30 min after blood donation.[28]
Hence, from the current study, BP is found to have an association in relation to gender, and salivary cortisol can be used as a tool for determining acute stress in blood donation.
Study limitations
The salivary cortisol was used only in predonation assessment, and serum cortisol was found not much effective in the assessment of acute stress. An elaborate cohort study with more distribution of participants in each category along with psychological stress assessment would have given more scope of stress assessment arena. Physiological stress assessment could have included more parameters apart from heart rate and BP such as skin temperature and heart rate variability.
Conclusion
Blood donation is a stressful event eliciting physiological and hormonal stress response patterns. The response patterns differ in terms of age, gender, and blood donation experience. Salivary cortisol levels are the best indicator for acute hormonal stress response in blood donation when compared to heart rate and BP fluctuations.
Author Contributions
Gayathri A M: Constructed Methodology for this study, performed Investigation required for this study, Interpretation of results, Validation of results and Writing of the original article. Debasish Gupta: Conceptualization and supervision of the studyGeorge Paul Thaliath: Counselling, Sample collection and data curationAbhilash R: Performed Data analysis.
Conflicts of interest
No conflict of interest among the authors.
Data availability statement
The authors confirm that that the data supporting the findings are available within the article. Raw data that support the findings of this study are available from the corresponding author, upon reasonable request.
Acknowledgments
I would like to express my sincere gratitude to my colleagues in Department of Biochemistry, SCTIMST for their invaluable guidance throughout this study. Their insightful feedback and expertise were instrumental in shaping this research. Additionally, I acknowledge the sponsorship from the administration team of Kerala AIDS Control Society, who provided us with the ELISA kits, made this study possible. Finally, I appreciate the encouragement from my colleagues in the department and family, whose support kept me motivated throughout the research process.
Funding Statement
The ELISA kits (salivary and serum cortisol ELISA kits) for the study were sponsored by Kerala AIDS Control Society (KSACS), Government of Kerala.
References
- 1.Kirschbaum C, Hellhammer DH. Salivary cortisol in psychoneuroendocrine research: Recent developments and applications. Psychoneuroendocrinology. 1994;19:313–33. doi: 10.1016/0306-4530(94)90013-2. [DOI] [PubMed] [Google Scholar]
- 2.Singh R, Goyal M, Tiwari S, Ghildiyal A, Nattu SM, Das S. Effect of examination stress on mood, performance and cortisol levels in medical students. Indian J Physiol Pharmacol. 2012;56:48–55. [PubMed] [Google Scholar]
- 3.Hoogerwerf MD, Veldhuizen IJ, De Kort WL, Frings-Dresen MH, Sluiter JK. Factors associated with psychological and physiological stress reactions to blood donation: A systematic review of the literature. Blood Transfus. 2015;13:354–62. doi: 10.2450/2015.0139-14. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Hoogerwerf MD, Veldhuizen IJ, Merz EM, de Kort WL, Frings-Dresen MH, Sluiter JK. Psychological and hormonal stress response patterns during a blood donation. Vox Sang. 2017;112:733–43. doi: 10.1111/vox.12556. [DOI] [PubMed] [Google Scholar]
- 5.Terluin B, van Marwijk HW, Adèr HJ, de Vet HC, Penninx BW, Hermens ML, et al. The four-Dimensional Symptom Questionnaire (4DSQ): A validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization. BMC Psychiatry. 2006;6:34. doi: 10.1186/1471-244X-6-34. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Ferguson E, Singh AP, Cunningham-Snell N. Stress and blood donation: Effects of music and previous donation experience. Br J Psychol. 1997;88:277–94. doi: 10.1111/j.2044-8295.1997.tb02635.x. [DOI] [PubMed] [Google Scholar]
- 7.Levine A, Zagoory-Sharon O, Feldman R, Lewis JG, Weller A. Measuring cortisol in human psychobiological studies. Physiol Behav. 2007;90:43–53. doi: 10.1016/j.physbeh.2006.08.025. [DOI] [PubMed] [Google Scholar]
- 8.Joosen M, Sluiter J, Joling C, Frings-Dresen M. Evaluation of the effects of a training programme for patients with prolonged fatigue on physiological parameters and fatigue complaints. Int J Occup Med Environ Health. 2008;21:237–46. doi: 10.2478/v10001-008-0025-9. [DOI] [PubMed] [Google Scholar]
- 9.Masser BM, White KM, Hyde MK, Terry DJ. The psychology of blood donation: Current research and future directions. Transfus Med Rev. 2008;22:215–33. doi: 10.1016/j.tmrv.2008.02.005. [DOI] [PubMed] [Google Scholar]
- 10.Vinkers CH, Zorn JV, Cornelisse S, Koot S, Houtepen LC, Olivier B, et al. Time-dependent changes in altruistic punishment following stress. Psychoneuroendocrinology. 2013;38:1467–75. doi: 10.1016/j.psyneuen.2012.12.012. [DOI] [PubMed] [Google Scholar]
- 11.Starcke K, Polzer C, Wolf OT, Brand M. Does stress alter everyday moral decision-making? Psychoneuroendocrinology. 2011;36:210–9. doi: 10.1016/j.psyneuen.2010.07.010. [DOI] [PubMed] [Google Scholar]
- 12.Singer N, Sommer M, Döhnel K, Zänkert S, Wüst S, Kudielka BM. Acute psychosocial stress and everyday moral decision-making in young healthy men: The impact of cortisol. Horm Behav. 2017;93:72–81. doi: 10.1016/j.yhbeh.2017.05.002. [DOI] [PubMed] [Google Scholar]
- 13.Ernst H, Scherpf M, Pannasch S, Helmert JR, Malberg H, Schmidt M. Assessment of the human response to acute mental stress-An overview and a multimodal study. PLoS One. 2023;18:e0294069. doi: 10.1371/journal.pone.0294069. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Mikneviciute G, Pulopulos MM, Allaert J, Armellini A, Rimmele U, Kliegel M, et al. Adult age differences in the psychophysiological response to acute stress. Psychoneuroendocrinology. 2023;153:106111. doi: 10.1016/j.psyneuen.2023.106111. [DOI] [PubMed] [Google Scholar]
- 15.Brindle RC, Ginty AT, Phillips AC, Carroll D. A tale of two mechanisms: A meta-analytic approach toward understanding the autonomic basis of cardiovascular reactivity to acute psychological stress. Psychophysiology. 2014;51:964–76. doi: 10.1111/psyp.12248. [DOI] [PubMed] [Google Scholar]
- 16.Pulopulos MM, Hidalgo V, Puig-Pérez S, Salvador A. Psychophysiological response to social stressors: Relevance of sex and age. Psicothema. 2018;30:171–6. doi: 10.7334/psicothema2017.200. [DOI] [PubMed] [Google Scholar]
- 17.France CR, France JL, Himawan LK, Stephens KY, Frame-Brown TA, Venable GA, et al. How afraid are you of having blood drawn from your arm?A simple fear question predicts vasovagal reactions without causing them among high school donors. Transfusion. 2013;53:315–21. doi: 10.1111/j.1537-2995.2012.03726.x. [DOI] [PubMed] [Google Scholar]
- 18.Bellitti P, Valeriano R, Gasperi M, Sodini L, Barletta D. Cortisol and heart rate changes in first- and fourth-time donors. Vox Sang. 1994;67:42–5. doi: 10.1111/j.1423-0410.1994.tb05036.x. [DOI] [PubMed] [Google Scholar]
- 19.France CR, France JL. Fear of donation-related stimuli is reported across different levels of donation experience. Transfusion. 2018;58:113–20. doi: 10.1111/trf.14382. [DOI] [PubMed] [Google Scholar]
- 20.Kaur A, Kaur R, Sood T, Malhotra A, Arun P, Mittal K, et al. Physiological and psychological stress response of blood donors during the blood donation process. Vox Sang. 2023;118:1061–8. doi: 10.1111/vox.13541. [DOI] [PubMed] [Google Scholar]
- 21.Thijsen A, Masser B. Vasovagal reactions in blood donors: Risks, prevention and management. Transfus Med. 2019;29(Suppl 1):13–22. doi: 10.1111/tme.12488. [DOI] [PubMed] [Google Scholar]
- 22.Ogata H, Iinuma N, Nagashima K, Akabane T. Vasovagal reactions in blood donors. Transfusion. 1980;20:679–83. doi: 10.1046/j.1537-2995.1980.20681057157.x. [DOI] [PubMed] [Google Scholar]
- 23.France CR, Rader A, Carlson B. Donors who react may not come back: Analysis of repeat donation as a function of phlebotomist ratings of vasovagal reactions. Transfus Apher Sci. 2005;33:99–106. doi: 10.1016/j.transci.2005.02.005. [DOI] [PubMed] [Google Scholar]
- 24.Ditto B, Gilchrist PT, Holly CD. Fear-related predictors of vasovagal symptoms during blood donation: It's in the blood. J Behav Med. 2012;35:393–9. doi: 10.1007/s10865-011-9366-0. [DOI] [PubMed] [Google Scholar]
- 25.Zervou EK, Ziciadis K, Karabini F, Xanthi E, Chrisostomou E, Tzolou A. Vasovagal reactions in blood donors during or immediately after blood donation. Transfus Med. 2005;15:389–94. doi: 10.1111/j.1365-3148.2005.00600.x. [DOI] [PubMed] [Google Scholar]
- 26.Hoogerwerf MD, Veldhuizen IJ, van den Hurk K, de Kort WL, Sluiter JK, Frings-Dresen MH. Negative experiences and predonation blood pressure at the subsequent donation in blood donors. Vox Sang. 2016;110:107–15. doi: 10.1111/vox.12319. [DOI] [PubMed] [Google Scholar]
- 27.Lorenz TK. Autonomic, endocrine, and psychological stress responses to different forms of blood draw. PLoS One. 2021;16:e0257110. doi: 10.1371/journal.pone.0257110. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Hinrichs A, Picker SM, Schneider A, Lefering R, Neugebauer EA, Gathof BS. Effect of blood donation on well-being of blood donors. Transfus Med. 2008;18:40–8. doi: 10.1111/j.1365-3148.2007.00805.x. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The authors confirm that that the data supporting the findings are available within the article. Raw data that support the findings of this study are available from the corresponding author, upon reasonable request.