Ferritin testing to characterize and address iron deficiency in young donors

Abstract

BACKGROUND: Iron deficiency is observed in blood donors who meet hemoglobin requirements for donation. Frequent donation results in negative iron balance, and teenage donors may thus be at risk for adverse health consequences. STUDY DESIGN AND METHODS: Blood Systemsimplemented ferritin testing on all successful 16-to 18-year-old (teen) donations. Low ferritin (LF) was defined as less than 20 ng/mL in females and less than 30 ng/mL in males. Donors with LF were deferred from red blood cell (RBC) donations (12 months for females, and 6 for males) and counseled to take lowdose iron for 60 days. A ferritin value less than 26 ng/mL indicated iron-deficient erythropoiesis and less than 12 ng/mL absent iron stores. RESULTS:Over 16 months, 110,417 teen donations were tested and represented 10.5% of all successful donations. The rate of absent iron stores was 9.0% (1.9% male; 15.9% female) and of iron-deficient erythropoiesis, 31.9% (12.4% male; 50.6% female). The rate of LF deferrals was 26.9% (16.7% male; 36.6% female). The proportion of LF donors decreased with increasing predonation hemoglobin and rose with increasing RBC donations in the prior 24 months. Seasonality in LF deferrals and the RBC contribution from teen donors was observed. CONCLUSIONS: Ferritin testing of teen donorsidentified individuals with LF who might benefit from risk mitigation. LF is more common in teenage female than male donors and those with RBC donations in the prior 24 months. An appreciable number of new/lapsed donors presented with LF, however. These data may be useful in guiding future risk mitigation efforts. ABBREVIATIONS: AIS = absent iron stores; CHILL = Comparison of the History of Donation and Iron Levels in Teen Blood Donors; FS = finger-stick; FTDs = first-time donors; HEIRS = Hemoglobin Iron and Recovery Study; ID = iron deficiency; IDE = iron-deficient erythropoiesis; LDs = lapsed donors; LF = low ferritin; NIH = National Institutes of Health; RDs = repeat donors; STRIDE = Strategies to Reduce Iron Deficiency

Association of blood donation with iron deficiency among adolescent and adult females in the United States: a nationally representative study

“…Actionable interventions beyond education must also be considered to protect blood donors from iron deficiency . Possibilities include extending the interdonation interval, performing ferritin testing prior to donation, and providing iron supplementation . The efficacy of these interventions is well established, and there is growing evidence to support the feasibility of implementing these interventions.…”

Variations in hemoglobin measurement and eligibility criteria across blood donation services are associated with differing low‐hemoglobin deferral rates: a BEST Collaborative study

“…Iron monitoring, mainly through ferritin measurement, is increasingly being implemented in blood donation services because of established effects of repeated donations on iron stores . Recently, a study of ferritin monitoring in young U.S. donors demonstrated a decrease in Hb deferrals from 9.2 to 7.5% and an increase in young donorsʼ Hb levels from 14.32 to 14.45 g/dL . A potential benefit of iron monitoring is to identify donors with a high risk for low‐Hb deferral at the next donation.…”

“…[14][15][16] Recently, a study of ferritin monitoring in young U.S. donors demonstrated a decrease in Hb deferrals from 9.2 to 7.5% and an increase in young donorsʼ Hb levels from 14.32 to 14.45 g/dL. 17 A potential benefit of iron monitoring is to identify donors with a high risk for low-Hb deferral at the next donation. An extensive literature review suggested that studies performed so far have shown partially predictive value of iron monitoring.…”

Changes in minimum hemoglobin and interdonation interval: impact on donor hemoglobin and donation frequency

“…These include selective ferritin testing accompanied by donor deferral and/or iron supplementation alone or combined with increased interdonation intervals . Recent data from blood centers that have implemented selective ferritin testing in teenage donors demonstrated that temporary deferral of donors with low ferritin resulted in a decrease in Hb deferrals and an increase in mean Hb levels in donors . This mitigation strategy may also result in negative operational impacts, such as donation loss and reduced donor return …”

“…2 Recent data from blood centers that have implemented selective ferritin testing in teenage donors demonstrated that temporary deferral of donors with low ferritin resulted in a decrease in Hb deferrals and an increase in mean Hb levels in donors. 23 This mitigation strategy may also result in negative operational impacts, such as donation loss and reduced donor return. 24 In summary, changes in the minimum interdonation interval for female donors and Hb cutoff in males had an overall positive effect, resulting in fewer presenting donors with a Hb level below 120 g/L, and for female donors, an increase in overall Hb levels.…”