Effect of iron supplementation on iron stores and total body iron after whole blood donation

Abstract

Background Understanding the effect of blood donation and iron supplementation on iron balance will inform strategies to manage donor iron status Study Design and Methods 215 donors were randomized to receive ferrous gluconate daily (37.5 mg iron) or no iron for 24 weeks after blood donation. Iron stores were assessed using ferritin and soluble Transferrin Receptor. Hemoglobin iron was calculated from total body hemoglobin. Total Body Iron (TBI) was estimated by summing iron stores and hemoglobin iron. Results At 24 weeks, TBI in donors taking iron increased by 281.0 mg (95% Confidence Interval [CI]: 223.4, 338.6) compared to pre-donation, while TBI in donors not on iron decreased by 74.1 mg (CI: −112.3, −35.9), p<0.0001, iron vs. no iron. TBI increased rapidly following blood donation with iron supplementation, especially in iron depleted donors. Supplementation increased TBI compared to controls during the first 8 weeks after donation: 367.8 mg (CI: 293.5, 442.1) versus −24.1 mg (CI: −82.5, 34.3) for donors with baseline ferritin ≤26 ng/mL; and 167.8 mg (95%CI: 116.5, 219.2) versus −68.1 mg (CI: −136.7, 0.5) for donors with baseline ferritin >26 ng/mL. 88% of the benefit of iron supplementation occurred during the first 8 weeks after blood donation. Conclusion Donors on iron supplementation replaced donated iron while donors not on iron did not. Eight weeks of iron supplementation provided nearly all of the measured improvement in TBI. Daily iron supplementation after blood donation allows blood donors to recover the iron loss from blood donation and prevents sustained 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.…”

“…44 Possibilities include extending the interdonation interval, 45 performing ferritin testing prior to donation, 46-50 and providing iron supplementation. 49,[51][52][53][54] The efficacy of these interventions is well established, and there is growing evidence to support the feasibility of implementing these interventions.…”

How do we manage iron deficiency after blood donation?

“…Indeed, two‐thirds of donors not taking iron had not attained pre‐donation ferritin values by 24 weeks (Fig ). Analysis of the iron‐treated donors (who received iron throughout the 24‐week study period) revealed that at least 87% of iron repletion occurred within the first 8 weeks of iron therapy (Cable et al , ). Thus, daily low‐dose iron for 56‐60 days appears to be an effective strategy to replace iron lost during blood donation.…”

Genetic and behavioral modification of hemoglobin and iron status among first‐time and high‐intensity blood donors

“…Regardless of the dosing frequency, essentially all donors will benefit from oral iron supplements . It is important to emphasize iron is most effective in the 4 to 8 weeks immediately following donation, when its absorption is greatest …”

“…33,34 It is important to emphasize iron is most effective in the 4 to 8 weeks immediately following donation, when its absorption is greatest. 35 Cigarette smoking is associated with increased hemoglobin in the general public, 36 first-time blood donors, 37 and high-intensity blood donors. 6 The effect in first-time donors varies from 0.26 to 0.59 g/dL depending on smoking intensity.…”