Blood donor went into cardiac arrest. Were risks of component donation clearly communicated?

In May, a 50-year-old man who was donating blood at a blood donation center in Seoul suffered cardiac arrest and was transported to the emergency room (ER) after receiving CPR.

This incident occurred during “component blood donation,” which differs from general blood donation. There have been six such incidents involving grave symptoms, including cardiac arrest, during blood donation in the past three years.

According to the Korean Red Cross, on May 5, during a “platelet component blood donation (250 mL)” procedure at a blood donation center in Seoul, the donor went into cardiac arrest. At around 12:35 p.m., the donor went into cardiac arrest, and the blood donation center immediately began CPR.

At around 12:40 p.m., emergency medical personnel arrived at the scene, conducted CPR, performed endotracheal intubation and secured a venous line, administered intravenous fluids, and transported the donor to the ER of a nearby medical facility.

The donor was admitted to the hospital on the day of the accident, and the ER doctor explained the circumstances of the incident to the donor's family. On May 7, the director of the blood center visited the donor's family to explain the situation, and on May 8, the manufacturing manager (a doctor) visited the donor again to provide a detailed explanation of the circumstances of the accident.

On May 9, the director of the Blood Management Headquarters (physician) visited the medical institution to confirm the patient's condition and treatment process and met with the patient's family. Following this process, the patient was discharged on May 15. On May 21, an outpatient visit confirmed that the patient was in good condition and showed no discomfort. The patient is scheduled for an additional outpatient visit in August.

On May 25, at another blood donation center in Seoul, a 30-year-old man experienced abnormal symptoms during platelet-rich plasma donation (250 mL of platelets + 300 mL of plasma), leading to an immediate halt in blood collection. The donor's symptoms subsided one to two minutes after the needle was removed, but he had to receive medical treatment.

In May alone, there were consecutive accidents related to component blood donation at blood donation centers in Seoul, resulting in donors requiring medical treatment at healthcare facilities, with one individual even reaching a life-threatening condition, including cardiac arrest.

According to the Red Cross, emergency measures are administered in the event of an accident during blood donation. If the donor does not recover, they are transported to a medical facility for further treatment. Records of donors exhibiting symptoms related to blood donation are documented through the Blood Information Management System (BIMS), which includes the management of donors with symptoms, registration of donors with symptoms, and post-donation management of symptoms.

During this process, the responsible staff member confirms the donor's condition with symptoms related to blood donation, records the information, registers the date of symptom resolution, and concludes the procedure. In cases of severe symptoms related to blood donation, the staff member identifying the symptoms must immediately report to the department head and the manufacturing management director. The blood center's quality control team must also report to the Blood Management Headquarters' Safety Policy Team and subsequently to the Ministry of Health and Welfare. Fortunately, the confirmed results show that these procedures were followed in the incidents, saving the donor's life and leaving a record.

Serious accidents can occur even if pre-donation screening shows no issues

However, resolving issues during blood donation according to procedures does not necessarily mean there are no problems. According to the Red Cross, both the 50-year-old man and the 30-year-old man involved in the incident had no unusual findings during the pre-donation screening process and were deemed eligible for donation.

According to the Red Cross, the number of cases where treatment costs were paid due to symptoms related to blood donation was 376 in 2023, 398 in 2024, and 225 as of June 2025, totaling 999 cases over the past three years and approaching 1,000 cases. Notably, the number of cases where “serious” symptoms, including cardiac arrest, occurred during blood donation, similar to the incident involving the 50-year-old male at the first blood donation center, totaled six over the past three years: two 2 cases in 2023; one case in 2024, and three cases as of June 2025.

According to guidelines on the protection and safety of blood donors, symptoms classified as “serious” include deep vein thrombosis, arteriovenous fistula, compartment syndrome, systemic allergic reactions (anaphylaxis), and significant cardiovascular-related symptoms, all of which can pose a threat to life.

This means that even donors who are deemed eligible after pre-donation screening may face life-threatening situations such as cardiac arrest during the donation process.

Were the risks associated with component blood donation properly notified?

The Red Cross explained that the reason for the occurrence of severe symptoms, such as cardiac arrest, during component blood donation is “issues related to the administration of anticoagulants, which are essential during the blood collection process.” It stated that the citric acid component in anticoagulants can cause various symptoms when administered to blood donors.

The problem is whether the possibility of such symptoms occurring is adequately communicated to component blood donors.

The Red Cross stated that the “Guidelines for the Protection and Safety of Blood Donors” include information that, in addition to mild symptoms such as abnormal sensations around the mouth, numbness, tremors, or numbness in the hands, “muscle spasms in the hands and feet, vomiting, generalized muscle rigidity, shock, arrhythmia, and cardiac arrest” may occur.

However, the pamphlet created and distributed by the Red Cross to inform people about the side effects of blood donation only mentions symptoms that may occur after donation, such as “citric acid reaction (during component blood donation),” stating that "citric acid in the anticoagulant administered to the donor during component blood donation may cause symptoms such as numbness in the hands, nausea, vomiting, lip tremors, and a cold sensation in the back of the throat." However, there is no mention of symptoms, including arrhythmia or cardiac arrest.

Additionally, the brochure includes phrases such as “consuming milk or other calcium-containing foods can prevent this,” which may lead donors to perceive citric acid reactions as non-serious side effects. Given this situation, it appears necessary to conduct a thorough review to ensure that blood donation centers are adequately informing donors about the symptoms that may arise from citric acid reactions during component blood donation.

“The anticoagulants used in component blood donation contain citric acid to prevent blood clotting, and the injection volume is precisely controlled automatically through the blood collection equipment,” the Red Cross said in response to these concerns. “To prevent human error leading to overdose of anticoagulants, we protect donor safety by attaching labels indicating the anticoagulant solution, activating solution weight detection sensors when setting the anticoagulant, and other measures.”

“However, some donors may experience hypocalcemia reactions caused by citric acid, and the severity of symptoms may vary from person to person,” it added. “We inform donors about the possibility of citric acid reactions, symptoms, and coping methods before donation. During blood collection, nurses continuously monitor the donor’s condition and take measures, including adjusting the blood collection speed or providing calcium-containing beverages if any abnormal signs occur.”