Ascertainment of iron deficiency and depletion in blood donors through screening questions for pica and restless legs syndrome

Abstract

Background Pica and restless legs syndrome (RLS) are associated with iron depletion and deficiency. The presence of pica and RLS was prospectively assessed in blood donors. Methods During a 39-month period, 1236 donors deferred for fingerstick hemoglobin <12.5 g/dL and 400 non-deferred “control” donors underwent health screening and laboratory testing (CBC, ferritin, iron, transferrin). Pica and RLS were assessed by direct questioning. Deferred donors and iron-deficient control donors were given ferrous sulfate 325 mg daily for 60 days. Reassessments were performed and additional iron tablets dispensed at subsequent visits. Results Pica was reported in 11% of donors with iron depletion/deficiency, compared with 4% of iron-replete donors (p<0.0001). Pagophagia (ice pica) was most common and often of extraordinary intensity. Female sex, younger age, and lower MCV and transferrin saturation values were strongly associated with pica. Donors with pica given iron reported a marked reduction in the desire to consume the non-nutritive substance by day 5–8 of therapy, with disappearance of symptoms by day 10–14. RLS was reported in 16% of subjects with iron depletion/deficiency compared with 11% of iron-replete donors (p=0.012). Iron replacement generally resulted in improvement of RLS symptoms, however, at least 4–6 weeks of iron therapy was necessary. Conclusion The presence of pica is associated with a high probability of iron depletion/deficiency in blood donors; however, RLS lacks a strong correlation in this population. Screening questions for pagophagia may be useful in the ascertainment of iron deficiency in donors and may identify those who would benefit from oral iron.

Prevalence and determinants of declining versus stable hemoglobin levels in whole blood donors

“…2,[30][31][32][33] Restless legs syndrome, a neurologic disorder with irresistible need to move the legs, and pica, a disorder in which a person is craving and consuming nonnutritive substances, have also been repeatedly linked to blood donation-related iron deficiency. [34][35][36][37] Future research should indicate whether adverse health effects of donation are different for donors with stable or declining Hb levels.…”

The donation interval of 56 days requires extension to 180 days for whole blood donors to recover from changes in iron metabolism

“…However, despite several reports on association between ferritin levels and symptoms of ID in blood donors, [17][18][19] it remains uncertain below which exact ferritin level complaints of ID occur. Recommended cutoffs differ between guidelines of various authorities and vary from 12 to 40 and even 100 mg/L to identify (possible) ID in the general population.…”

“…on April 29, 2019. by guest www.bloodjournal.org From decreases upon blood donation in the present study and (2) has been found to be associated with symptomatic ID in blood donors. 17,18 Alternatively, and in the absence of point-of-care ferritin platforms, development of ID in donors may be prevented by (1) prolongation of donation intervals to 180 days in all donors as suggested by both the current and the REDS-III study 16 and/or (2) (low) dose iron supplementation. 24 …”

Iron stores in blood donors: A literature mini review

“…Iron replacement generally resulted in improvement of RLS symptoms, however, at least 4-6 weeks of iron therapy was necessary. Bryant et al, (42) found an important association of pica with finger sticks Hb of less 11.5 g/dL in female and less than 12.5 g/dL in male donors.…”