Of plasma donation and emergency room visits

Miscellaneous and Personal Stuff I Must Share
1

I’m mostly writing this to have reasonably contemporaneous documentation of events occurring on Saturday, Feb. 24, 2018, as best as I recall.

My husband and I are in a financial bind right now, admittedly largely self-inflicted by debt. We had decided to tackle plasma donation, so went to our local plasma center. DH is a Type 2 diabetic, so was asked to have his doctor fill out forms approving this. I went through the health screening, passing all vitals and blood tests done there and truthfully answering all questions about my medical and personal history. I had read their website the day before, so had followed pre-donation instructions regarding breakfast, hydration, etc., and felt quite healthy at the outset of this process. I was deemed an acceptable donor, and the process began. Most of the time, it seemed fine, but near the end, I suddenly started feeling dizzy, with vision getting a bit dark. I alerted a nearby staff member to my symptoms and they immediately decided to stop the donation and get me off the machine.

My next memory is of several more people surrounding me, quite concerned, and my husband (still in the waiting area) being summoned. I was told that I had turned bluish and apparently lost consciousness. EMTs had been summoned. Once they arrived and checked me over, the decision was made to take me to the emergency room. The gentleman tending me in the ambulance told me he was considering starting an IV, but we arrived before that decision was made.

The ER doctor told me it was most likely “vasovagal syncope”. My blood pressure is apparently normally a bit elevated, which I do need to follow up on. My first attempt to leave resulted in almost passing out again. Ringing ears and weakness while dressing became darkened vision, muffled hearing, and confusion when in the wheelchair. A liter of IV saline (which took about another hour) did get me into good enough shape to actually go home.

As of today, my biggest complaints are fatigue and a sore left arm, due to the donation needle and the blood pressure cuff that was on my arm checking me periodically for several hours. I may still be somewhat dehydrated, which is being addressed.

My husband states that he and EMTs were told by the plasma center that while I had had ca. 900ml of plasma removed, my blood cells and equivalent fluid volume had been returned. I went about 9 hours (from plasma center to nearly ready to leave ER) before noticing any bladder pressure. Between that and the need for the IV saline, I have to question whether I really did get back proper fluid volume. Today, even after deliberately downing a liter of oral fluid in the first hour I was up, restroom visits are at lower frequency than normal for me.

I’ve received two calls today from the plasma center (one a quick couple of additional questions). I was asked about such things as what meds had been administered (none, unless the IV counts), results of EKG (the word “great” was used by ER staff), and any prior history of seizure disorder (IIRC, I had already answered that during the pre-donation screening, with a truthful negative). I honestly thought the nurse I was speaking with seemed disappointed to not find that I’d had some pre-existing problem, which is why I decided I needed to document all this before anything significant slips out of my mind that I might need later on. I find myself wondering if the center may be planning to try to weasel out of any liability for what happened to me by claiming I had a pre-existing health issue. The only thing I can think of is a very mild congenital heart murmur, which a cardiologist assured me 20 years ago was not significant, and ER staff yesterday didn’t even comment on hearing it. As stated, I was informed my EKG was healthy. I have not been informed as yet of any significant findings in hospital bloodwork.

I have received the $50 this center pays for a first-time donation. I do plan to suggest to my medical insurance that they should talk to the plasma center about covering medical expenses that the insurance may not. I did walk in healthy and pass the center’s evaluation, having taken the suggested pre-donation prep advice. I left in an ambulance, with my blood volume apparently down about a liter from where it should have been.

No, I will not be doing this again, TYVM. This was not an instruction from the ER doctor, BTW (the plasma center nurse asked). I made that decision on my own, but ER staff in general thought my position on the matter is reasonable.

2

Why do you think the blood center has any liability for anything? You didn’t mention any negligence or bad acts on their part.

3

Aside from having a liter less fluid in my body when I was taken out than when I arrived, when I had been informed the process involved returning an equal volume to my body? If I got back as much as they kept, I would not have been passing out due to being a liter low.

4

If you took your car in for an oil change, and on leaving, it shortly seized up, you had it towed to a mechanic, where it was found to have the oil plug in place, the oil filter in place, but no oil in the crankcase, what would you think had happened? I’d think it’s obvious. They’re supposed to have drained out the old oil, which they did. They were supposed to put in an equivalent amount of new oil, which, rather obviously, they did not.

Seanette underwent a procedure in which about a liter of her blood was supposed to be removed; followed by the return of her red blood cells in an equivalent amount of saline solution of equal volume to that of the blood that was removed. As the crisis played out, I specifically asked if the fluid had been returned to her, as was supposed to have happened, and was told that it had.

So, she left in an ambulance, and arrived at the hospital, very ill, and it ultimately turned out that her blood volume was deficient by about a liter. I don’t know why it took so long to figure that out at the hospital, but once they gave her an IV consisting of a liter of saline solution, she very quickly recovered.

So, what happened? At the plasma place, they were supposed to take out a liter of her blood, and replace it with a liter of saline solution containing the red blood cells from that blood. I asked,and was told that they had done so. Rather obviously, I think, they did not replace the, lost blood, as they were supposed to, and as they said that they had.

5

If you’re thinking that since they gave you a liter of saline that means you were a liter low, I don’t think that’s actually how that works. And yes, every time I’ve given plasma (it’s lovely being that broke isn’t it) i overhydrate for two days before going in and then don’t pee nearly at all the day of or often even the day after until I get back to equilibrium. They replace your fluids, but it’s still tough on the system.

If your docs called it as vasovagal syncope then there’s very likely nothing the plasma place owes you, i’m sorry to say. That just means your body is very sensitive to blood pressure changes and to stresses. They might even refuse to let you donate any longer to be on the safe side.

I do have the same issue but i learned about it before i started donating so i have lots of tricks to keep conscious until they are done with what they need to pull and i can get back to my car or my house and then fall over. It’s an icky feeling and I’m sorry you were surprised by it - it is really an unpleasant experience but it’s not actually dangerous and doesn’t even need treatment most of the time. You just either pass out for a moment and things reset immediately, or you white knuckle thru it and refuse to pass out (for safety or just because you’re too lazy to get up) and feel like utter ass for an hour or so and then things reset.

Edit to add that the timing here seems very typical for vasovagal syncope and regardless of what you do, the symptoms clear up after a few hours or so and then are gone nearly immediately and completely.

I’m not saying that they didn’t mess up - i have no way to know that. But you passing out, and you getting fluids from the hospital doesn’t necessarily imply that they did mess up, and you should be aware of that.

6

Perhaps the plasma machine had a liter of your blood in it when they stopped the procedure because you passed out.
If you hadn’t passed out, it would have been returned to you before were unhooked.

7

I specifically asked the staff there if the saline/red blood cell replacement had been completed, and was told that it had been.

8

She left the plasma facility in a very bad state. That very bad state continued until, at the hospital, many hours later, they finally gave her a saline IV, whereupon she recovered very quickly.

I simply do not see how this evidence is in any way consistent with any other circumstance other than that the plasma facility failed to replace her fluids as they were supposed to have done, leaving her blood volume dangerously low.

9

When I was in my 20s and poor, I would sell any body fluid there was a buyer for. At one of the plasma centers where I was registered (I used two different names to register at two plasmapheresis sites) I saw someone hauled out via ambulance. It’s one of those things that happens.

The only time I got dizzy was when I sold plasma the day after selling a unit of whole blood at another facility. Even then I was able to complete the procedure, but I was on the edge of passing out for a bit.

10

The evidence presented is absolutely consistent with a diagnosis of vasovagal syncope.

It’s practically a textbook example. Do you really think that if she was ‘dangerously’ dehydrated that the hospital was somehow short on IV saline and that’s why you guys had to wait for hours? No, they were checking for any actual problems, and not finding any, and finally offered the saline as a means to help reset her system, which it did.

I’m not meaning to sound flip and yes, “in a very bad state” sounds EXACTLY like what the symptoms are. It’s awful. It makes you feel weak and dizzy and fragile and sometimes badly nauseated and generally feel like shit. It’s also not actually dangerous in any way unless you fall over and hurt yourself by hitting something when you fall.

What you guys did is the same thing as going to the hospital for a panic attack, thinking it’s a heart attack.

It’s a totally reasonable conclusion that unfortunately is 1) wrong, 2) costs an arm and a leg and 3) is stressful and can even be traumatic. Even more unfortunate, none of those things gets you off the hook for paying for the ER visit.

I’m truly very sorry that she had to discover her condition like that, but I really want y’all to consider the very real possibility that you will waste more time and energy trying to ‘fight this’ than just accepting that she has had a bad reaction to donating that no one could reasonably have expected.

11

The evidence is consistent with the OP being somewhat dehydrated at the start, or simply reacting to the process. The blood center says they replaced the fluids, the hospital didn’t tell you the fluids hadn’t been replaced, that’s simply your conclusion. If you think either or both the hospital and blood center are lying to you then get a lawyer, but it doesn’t sound like you have any evidence of misconduct, just an assumption on your part. These incidents happen to people who make even the simplest donations of a pint of whole blood, improvement from a saline IV doesn’t mean that fluids were removed without replacement. If you think there’s some malpractice here you’ll need more evidence.

12

They don’t work like that. They’re continually recirculating machines and other than the bit that’s currently being spun out, the machine returns the unwanted parts back continually.

There might be … i dunno. A cup? Maaaaybe a pint? Total. Of whole blood, blood-in-process, and returning parts in saline still in the machine and tubes that would have been interrupted by a faint, but the whole processing time is very quick and they start the saline immediately - it’s fun to watch it cloud over and then red-up as the blood parts get added in.

13

IANAL, but I think in order for “malpractice” to be considered, there has to be “practice” (of medicine) going on. It varies from state to state whether an MD has to be on the premises. In PA there does, and 35 years ago I remember a retired doctor was present at the plasma place. He was unshaven, wearing a dirty whitel lab coat, and smelled of liquor, but he met the state’s requirement.

In addition, the release you sign covers things like what the OP experienced.

ETA: maybe “negligence” instead of “malpractice”? (I don’t think either was evident)

14

Yeah, ‘negligence’ is what I was going for (unless there was a doctor involved). I’m not sure of the requirements here in RI, there isn’t always an MD on site at the blood center I go to, but one will be available by phone and they’re pretty restrictive for a lot of procedures when the MD is not present. There will be someone with more qualifications than a simple technician there though.

15

But what if you took your car to the oil change place, they drained the oil and before they could replace it, you had an something that needed to be dealt with so you drove away? It wouldn’t be their fault if there was a problem with your car after that.

Same thing here, in the middle of all of this she had to leave. I’m not sure what you want done. As others have said, just because they put in a liter of saline doesn’t mean she was a liter low on blood. You can go get a liter of saline put into you right now, you’re not low on blood. Also, consider the other option. Would you prefer if they continued what they were doing even though she just passed out for yet unknown reasons? Wouldn’t it make more sense to stop what they’re doing and let EMTs and ER staff take it from there?
What exactly do you think they did wrong that caused this problem?

As for getting them to reimburse it, I wouldn’t even try.
On top of all this, isn’t passing out while donating blood (and probably plasma as well) somewhat common? I’ll bet it’s even listed as a possible risk in something she read or signed off on.

16

Thanks for the clarification. I wasn’t sure how much blood was required to circulate through the machine. Even though I’ve personally had apheresis for stem cell collection I don’t remember that part.

17

Are you sure about that? When I donated plasma it was a draw/return cycle, but more recently I’ve done a platelet donation where I had a needle in each arm and the draw/return is simultaneous. Point being, there seems to be some variation in how the machines work. Also, back when I donated plasma the last part of the process after the final return was complete was a bag of saline by itself. It sounds like the OP might have conked out before that part.

18

It seemed clear that the reason that we waited so long was simply a matter of the hospital not having the staff and resources to process all the waiting patients any faster than they were. We were there for a total of about eight or nine hours, during which time we received what couldn’t have been as much as an hour of actual work done on our behalf. She was on a gurney in a hallway for more than two hours before anyone was able to see her at all. At least another hour or two before she was moved into a room, and connected to a machine that monitored her vitals; and at least two or three hours after that before a doctor finally saw her. I consider this rather an annoyance that what attention was given to her was so slow and drawn out. With adequate staffing, everything that took place over that eight or nine hours would surely have taken place in less than two hours.
When the doctor finally did see her, he rather hastily diagnosed her as having vasovagal syncope, and began the process of discharging her.

She had been laying down the entire time, and although she did not feel well, she was alert and conscious up to this point. As soon as she sat up (for the first time in several hours) she reported feeling dizzy. They moved her to a wheelchair, and began wheeling her toward the exit, and after perhaps a few dozen seconds, she was nearly unconscious. She was conscious and aware, but in a very mentally-confused state, and unable to respond coherently to questions. At that point, the doctor decided to put her back in the room, and give her the IV.

The IV took, perhaps, about half an hour to three quarters of an hour to empty into her. It was probably at least half an hour or so past that point when we were able to get the doctor to come in and see her again. While we were waiting, she decided to cautiously sit up; and on doing so, experienced no symptoms. We did wait for the doctor to return, and for the IV to be removed, before she tried standing up and walking. No dizziness, no fainting, no other related symptoms. She remained conscious, alert, and up to her full mental function.

So, for the several hours that she was in the ER (and probably from some time while she was in the ambulance on the way) she was able to remain conscious and alert, but very noticeably unwell, as long as she stayed laying down, suffered dizziness and near-fainting if she sat up. After she received the IV, she seemed to recover almost completely.

I have to assume that if she had received the IV immediately on arrival at the ER, she would have recovered almost immediately. Whatever was wrong with her as of the time that she finally did receive the IV, it rather obviously was something for which the treatment needed to correct it was that IV.

Now what else would that IV have corrected, other than her having insufficient blood volume?

And how would her blood volume have been insufficient, if the plasma place had been replacing it in the manner that they were supposed to be doing?

19

I’d wondered about that, but didn’t really ask. I did pick up, somewhere during the course of that day, the factoid that the typical human body contains about five liters of blood. The machines at the plasma place each had a liter-sized bottle on them, in which the plasma was being collected. The bottle on Seanette’s machine was nearly full.

I know that in whole-blood donation, it is not usually taken in amounts more than a pint. They got about twice that much plasma from Seanette—about a fifth of her total blood volume, assuming she has about the average five liters to begin with. It seems rather obvious that the reason it would be safe to take more plasma than whole blood would be that the fluid was being replaced, and the red blood cells returned.

What would happen if, due to a malfunction of that machine, or an error on the part of the person operating it, her blood was not replaced as it was supposed to be, with her red blood cells mixed into an equivalent amount of saline? I think it’s rather obvious.

20

It seemed clear that the reason…

… would surely have…

…she seemed to…

I have to assume…

It seems rather obvious…

…I think it’s rather obvious.

Those are six assumptions you made, just in your last two posts. You have to stop making assumptions as well as knowing that you’re correct about everything. People faint during blood draws, it happens.

Also, when you ask they they didn’t give her the IV right away, you said yourself they were understaffed (busy?). Why should she get an IV before the people that got there before her?

Anyway, for someone that knows so much, why didn’t you just take her to a different, better staffed hospital. One with better doctors that know to give her an IV right away? Maybe you should have told them she needed an IV since you’re the only one that figured it out.

As for the machine or the phlebotimist making a mistake. If that happened, you might have a case, but I’d be willing to bet everything happened properly and she passed out. They called the EMTs and was brought to the nearest hospital. If the hospital staff screwed up, again, you might have a case, but again, I’d be willing to bet they followed protocol. But busy hospitals are busy, it’s the way it goes. She was awake, alert, not bleeding or broken so she’s not going to get any priority over the others.

In the end, if something was done wrong, that’s one thing. If you’re annoyed because you spent half a day in a hospital, it’s life.