Should plasma donation have hurt?

June 4, 2007 8:27 AM

How safe is plasma donation? Should it have hurt like it did?

I donated plasma for the first time last week. It hurt! Of course, the needle going in was painful, and the phlebotomist initially put the cuff on my arm too tight, resulting in my arm going numb. But pumping my hand like they asked resulted in an aching pain and I could not move my arm at all or even twitch it or tense it without feeling a cramp-like pain. I felt kind of a malaise through most of the process. My arm ached for hours afterward. When I took off the bandage later that evening, I only had a tiny hole and no bleeding, and today there is only a tiny bruise.

Upon speaking with my experienced donor SO afterward, I was told that it should not have hurt or ached whatsoever and that the person who poked me was a noob--she screwed up both of my SO's arms one time, and he requested not to have her, but failed to warn me. He said she must have pushed the needle in too far, but wouldn't I have a huge bruise if that were true?

I don't have any basis of comparison. I'm not scared of needles. Did I just have a bad phlebotomist? Should plasma donation have hurt so bad? Or am I just a big wuss? Any suggestions for having it not hurt so much in the future? Anecdotes?

Also, is this safe? I searched plasma donation on Google and came across a few sites like this, so now I'm getting a vibe like these places exist to exploit the poor for their plasma and to employ inexperienced, needle-wielding nurses-in-training. Have I missed some big legal issue in the news regarding plasma donation?

posted by sian to health & fitness (19 comments total)

I have never donated plasma, but I'm a relatively experienced blood donor. Blood centers don't like to talk about the fact that it CAN be a painful experience, depending on the phlebotomist.

I have experienced the sort of deep-vein arm-ache that you describe, although perhaps not so intense, when the phlebotomist messes up the insertion. Ideally, you should hardly feel it, but if the needle is pushed in slightly too far, it can put some pressure on the other side of the vein wall. A messed-up insertion is sometimes (BUT NOT ALWAYS) accompanied by lots of bruising around the area. A good insertion is usually (BUT NOT ALWAYS) signified by very little to no bruising. My arm does ache a bit afterwards, as well.

Next time, I'd tell the blood center that you had a bad experience the first time, and would like the most experienced staffer, if possible. Is this a pay-for-plasma center? I try to avoid blood centers that pay, since you should be able to donate for free through the Red Cross and other places. The BloodCenter of Wisconsin looks like the type of place that I usually donate to.
posted by muddgirl at 8:51 AM on June 4, 2007

No, it should not have hurt like that. It's not what I'd call a comfortable experience, but what you experienced isn't normal. No basis of comparison... have you not ever donated blood or had blood drawn before? The feeling isn't much different, it just takes longer.

I donated three times a month for several months during my starving-artist period. I definitely got the vibe that the poor were being harvested and that the people working there were, shall we say, disaffected. For starters, the movies they showed to keep people entertained while donating were questionable: "Half-Baked" and "Starship Troopers" and "Blade". I'm telling you, you haven't lived until you've been hooked up to a machine sucking your blood out while you watch vampires writhe appreciatively under sprinklers that are pumping it out over the dance-floor.

One day I was waiting in line for money with my arm bandaged up, cradling my full jug of body-temperature plasma (it always seemed perverse to me that they made ME carry it to the desk), and I felt a weird tingling sensation in my arm. Oh God, I thought, Please don't let that be what I think it is. Sure enough, when I looked down, I was bleeding ALL OVER THE GODDAM PLACE. The bandage had slipped or something and I was expressing a rather lurid amount of gore all over their shiny linoleum.

I looked up and gulped and said, "...Um." An attendant caught sight of me and rushed me off to the side. My shirt and pants were covered in blood; I tried to focus on his neck-tattoo while he cleaned off my arm and brusquely re-applied my bandage. Then he put $30 in my hand and said, "Okay, there you go," and pointed me toward the door.

I was totally flabbergasted. I actually laughed in the parking lot as I drove away, because I couldn't believe the events of the last five minutes (well, the last five months really, but that's a longer story). Suffice to say that was my last visit, though I actually have a small scar on my inner arm to remind me of the good old days.
posted by hermitosis at 8:54 AM on June 4, 2007

I donate plasma regularly and have never experienced what you're describing. There's a numbness in my lips and the cuff is uncomfortable, but not arm-numbing. The process is long enough that I can almost watch an entire 90 minute movie (I have seen many movies 3/4 of the way through). I wouldn't do it again if it were painful or it made my appendages numb.

However, I always go to the Red Cross, so YMMV.
posted by parilous at 8:54 AM on June 4, 2007

Also, it might be that the vein in whatever arm they used is a little small. There are two ways to overcome this - one is to try using the other arm next time! The second is to use a warm compress over the site of the injection for 10 minutes or so before you go in to donate. I've read that that can "draw the vein" up to the surface, although I've never tried it.
posted by muddgirl at 8:55 AM on June 4, 2007

I donated platelets -- not plasma, but I believe the process is very similar -- almost biweekly for almost a year and a half a few years ago. My arm was a little sore afterward pretty regularly -- I think it was just keeping my elbow locked in one position for so long. There was occasionally a bit of bruising, nothing major. I don't think yours should have hurt as much as it did, so maybe the phlebotomist messed up.

For me, the most regular discomfort came from occasional vibrations of the needle while it was inside the vein. Very odd feeling. The phlebotomists told me it was caused by improper placement. They'd adjust it a bit and then there was no more vibration.

The worst experiences I had were a couple bad sticks. The fluid (blood, plasma and an anti-coagulant) being pumped back into my arm leaked out of my vein and between it and the skin of my arm. That's a peculiar and hair-raising kind of pain. These bad sticks came towards the end of my platelet-donating days. I'm not sure if my veins just got weaker as a result of repeated donations or what, but they were decidedly unpleasant. I only donate whole blood anymore.

Regarding the whole exploitation thing, it's probably as you suspect, but not having donated plasma for money I can't say for sure what for-pay donation centers are really like. If you're donating just to be donating, look into donating platelets and going to a hospital or non-profit location to do so. Here are a couple databases of donation locations: Blood Bank Locator and America's Blood. (These are nominally blood donation centers, but many places do both whole blood and platelets.)
posted by cog_nate at 9:27 AM on June 4, 2007

I was a phlebotomist at a plasma donation center when I was in college. It sounds like either your vein is very close to a nerve, so the needle put pressure on the nerve, or that the tip of the needle was resting on a valve in your vein. You can't really fix the first problem, you would just have to use a different vein. The second problem could be fixed by adjusting the position of the needle (either deeper or more shallow could work).

I've seen tens of thousands of plasma donors, and it is a safe process. Some people react poorly to the change in blood volume when donating. The only bad complication that I've seen was an infection at the venipuncture site, but there were no lasting effects. I'm certain, though, that if you dig enough you would find a horror story or two, but that's true about blood donation as well.

The social implications are complicated. The industry does tend to market plasma donation to poor people. However, plasma is used to make a number of critical care drugs that people would die without. I've witnessed it. Of course, those drugs are sold for profit, so that adds another complexity.

Sidebar to parilous: The numbness in your lips was caused by the sodium citrate that is used as an anti-coagulant. If they turn down the flow of the plasmapheresis machine, you probably won't feel it.
posted by kamikazegopher at 9:28 AM on June 4, 2007

I've donated whole blood and plasma, and I've never had that problem. I am a horrible bruiser- only the most experienced needle sticker would leave me with a tiny bruise. Otherwise, I would get a three by four inch bruise that would turn very interesting colors for the next week or so. Even so, I have never felt pain while donating, except where the needle was in my skin.

I've been told to wear a sweater in advice complimentary to muddgirl's, and also to drink a lot of water in the 24 hours before donation to make it go faster.

They usually have you donate from your dominant arm in the theory that you use that arm more and the veins are bigger. It may be different for you, so if you continue to have problems, try switching.
posted by Monday at 9:35 AM on June 4, 2007

I've done this twice. It's not supposed to hurt but will if they mess up. The first time I did it it was painless. The second time,, they messed up with the needle on the left arm and had to put it in the right arm (where I had smaller veins) and it hurt the entire time.
posted by mustcatchmooseandsquirrel at 9:40 AM on June 4, 2007

I regularly donate blood and plasma at my local Red Cross, not a paying facility, so I can only speak from that experience.

In my opinion, donating blood is the easiest of the two, so most suited for a beginner. It only hurts when they stick the needle in and it's relatively quick. You only have to make sure to drink a soda and stay flat on the bed long enough if you're at risk for fainting, but that's it. I always encourage people who've never donated before to join me to give blood, not plasma, so they can get used to the process.

Donating plasma is most of the time painless, it just takes a bit longer. However, I've had one really painful experience. Sometimes, it can be a bit painful, but the pain goes away immediately after adjusting the needle. The nurse explained it was the tip of the needle touching the other side of my vein. The really painful experience was again related to the position of the needle, but it became so painful we decided to stop the transfer. (This decision was partly made because they already had to stick a few times in the beginning to get a good vein, after which the flow was too slow and they had to stick in yet another vein, so I really couldn't take it anymore.) However, the pain stopped after the needle was pulled out.

Mind you, this is my only truly painful experience in 7 years of donating blood and 3 years of donating plasma.

Sometimes, my arm is a bit sore afterwards or the next day, but it's not at all like the pain you described. Another downside of donating plasma is that the anti-coagulant can give you a weird metallicy taste in your mouth, or apparently in your case, numb lips.

However, and I feel this is the most important point of my post, the staff didn't treat you very well. If you're experiencing discomfort or pain, you should be able to tell the staff without feeling silly, and they should be doing something about it. They should explain why it hurts and if needed, stop the transfer. If you feel relieved the donation is over, than it was most certainly not a normal donation. It shouldn't hurt so much.

I can't comment on the safety of donating in paying facilities, but if you are concerned, maybe you could consider donating at a local Red Cross or similar, if you're not depending on the money you would otherwise get.

Donating plasma can be a discomfort and in some cases a bit painful, but it should stop being so very quickly. However, usually it feels just fine or at most a bit uncomfortable. You shouldn't have had to experience the pain you've had and I hope this doesn't stop you from donating again. This extends to everone reading this, donating is a very worthy cause and this truly is an exception, so don't let this stop you from possibly donating. (And I say this as a needle and pain fearing person!)
posted by lioness at 10:39 AM on June 4, 2007

No it shouldn't have hurt and I'm seconding lioness that the facility should have been checking up on your every 5-10 minutes or so to make sure that you were comfortable. It sounds as if you got poor service as well as an experienced individual, to boot. I donate plasma and platelets monthly through the American Red Cross and the individuals at the facility I visit here in Southern California are extremely persistant when it comes to the comfort of the donor. I would encourage you to try it again, at a different location if possible, and if you experience any odd physical feelings, numbing or tingling, let them know that they need to clear it right up or that you would to discontinue the donation immediately.

FYI, the worse symptoms I ever get are a little sleepy in the afternoons when I do it in the morning and the tingly lips at the beginning of the donation. The RNs clear this feeling up by giving Tums or Rolaids.
posted by Asherah at 12:12 PM on June 4, 2007

Er...inexperienced individual.
posted by Asherah at 12:12 PM on June 4, 2007

I used to donate plasma regularly for money (twice a week, for two years). I never experienced the problem you did, but if it happens next time you go in I'd ask the nurse to try a different vein, or switch arms. It took a few sessions before I found the best veins in each arm to donate with.

The process was rarely uncomfortable. I switched arms each session, and also chewed up two baby aspirin just before going in - that seemed to help make it go faster.
posted by wearyaswater at 12:42 PM on June 4, 2007

That muscle-ache you experienced with squeezing during donation was almost certainly hypocalcemia associated with your citrated blood (post-plasmapheresis) being returned to your body. The sodium citrate is added to prevent clotting, and works by chelating calcium (and removing it as a cofactor for many of the various clotting enzymes/cascades). It's an extremely common reaction to donating platelets/plasma (anytime you have citrated blood returned back to your body - so therefore anytime you donate an apheresis product).

This most likely had nothing to do with your phlebotomist. You should have been provided with tums or equivalent (calcium containing).

Next time you donate, tell them about your prior experience and make sure you eat the tums. The director of that blood donor center should be able to counsel you regarding the dangers/concerns of donating.

This google search should be good reading.
posted by i_am_a_Jedi at 12:55 PM on June 4, 2007 [1 favorite has favorites]

Here's a pretty good read on apheresis, targetted at people undergoing therapeutic apheresis (basically the same procedure, but used to treat a variety of conditions). The relevant portion:

Nausea, cramps, and tingling in the fingers or around the mouth may occasionally be experienced. These symptoms are usually caused by the citrate that prevents the blood from clotting while outside the body. It is infused into the patient with the components that are not discarded, but the body rapidly removes citrate from the blood stream, usually making this a very brief phenomenon. It can generally be overcome by slowing the rate of return of the components or by giving calcium, either by mouth or (rarely) by infusion into the blood stream.

Here's another one.

Anyways the important thing is to make sure you tell them about this when you go to donate apheresis units in the future, so you can be on top of getting calcium into. Of course, you shouldn't have any of these problems if you donate whole blood.

This is a part of my medical specialty, FWIW.
posted by i_am_a_Jedi at 1:35 PM on June 4, 2007

One more thing, it is far more useful to the medical community (blood banks, etc) for you to donate platelets, as opposed to plasma. It is basically the same procedure, and takes as long (1.5-2 hours).

Platelets have a shelf-life of 5 days, whereas packed red cells are 42 days, frozen plasma is anywhere from 1 to 10 years depending on temp.

We are always scrambling for platelets.

Ok I'll shut up now.
posted by i_am_a_Jedi at 1:40 PM on June 4, 2007

I have donated plasma many times, and I have to disagree with the answer that you already marked as best. When I had a muscle ache, I told someone, and they made an adjustment that made it go away. Nobody ever gave me any tums.
posted by bingo at 3:41 PM on June 4, 2007

they made an adjustment that made it go away.

That's because (from above):

It can generally be overcome by slowing the rate of return of the components

the liver clearance rate for citrate is pretty brisk. They just slowed the rate they were introducing citrate into your body (ie. the rate of return of your citrated blood).
posted by i_am_a_Jedi at 4:02 PM on June 4, 2007

I've never actually seen a situation where someone had a citrate reaction that only included muscle pain. In every citrate reaction that I've seen, the donor complained first of numbness in lips or fingers. If the reaction progressed further, then muscle cramping occurred, easily reversed with a calcium supplement. However, IANAD.
posted by kamikazegopher at 6:35 PM on June 4, 2007

I've experienced several blown veins when donating plasma. They resulted in a rainbow of bruises for several weeks each time. Finally, it was enough to make me not go back.
Some people are better skilled at venipuncture than others, and the volunteer place where I donated plasma could never get it right. I just don't want to put myself through that again. It hurts!
Don't feel badly if you don't want to donate again. It's your body.
posted by FergieBelle at 3:25 PM on June 5, 2007