Elevated risk for iron depletion in high‐school age blood donors

Abstract

BACKGROUND High school students 16 to 18 years‐old contribute 10% of the US blood supply. Mitigating iron depletion in these donors is important because they continue to undergo physical and neurocognitive development. STUDY DESIGN AND METHODS Study objectives were to determine the prevalence of iron depletion in 16‐ to 18‐year‐old donors and whether their risk for iron depletion was greater than adult donors. Successful, age‐eligible donors were enrolled from high school blood drives at two large US blood centers. Plasma ferritin testing was performed with ferritin less than 12 ng/mL as our primary measure of iron depletion and ferritin less than 26 ng/mL a secondary measure. Multivariable repeated‐measures logistic regression models evaluated the role of age and other demographic/donation factors. RESULTS Ferritin was measured from 4265 enrollment donations September to November 2015 and 1954 follow‐up donations through May 2016. At enrollment, prevalence of ferritin less than 12 ng/mL in teenagers was 1% in males and 18% in females making their first blood donation, and 8% in males and 33% in females with prior donations. Adjusted odds for ferritin less than 12 ng/mL were 2.1 to 2.8 times greater in 16‐ to 18‐year‐olds than in 19‐ to 49‐year‐olds, and for ferritin less than 26 ng/mL were 3.3‐ to 4.7‐fold higher in 16‐ to 18‐year‐olds. Progression to hemoglobin deferral was twice as likely in 16‐ to 18‐year‐old versus 19‐ to 49‐year‐old females. CONCLUSION Age 16 to 18 years‐old is an independent risk factor for iron deficiency in blood donors at any donation frequency. Blood centers should implement alternate eligibility criteria or additional safety measures to protect teenage donors from iron depletion.

Supplemental findings of the 2017 National Blood Collection and Utilization Survey

“…In part because over half of plasma donors are aged 18‐34 years, some concerns have been reported that younger donors are donating plasma rather than blood because of financial compensation with plasma donation . Additionally, evidence indicates that adolescent (aged ≤18 years) donors face a greater risk of iron depletion and vasovagal reactions than adult donors . Blood collection facilities might potentially be recruiting fewer adolescent donors as a result of these concerns.…”

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

“…18 Numerous cross-sectional and longitudinal studies have shown that younger age, female sex, and increased frequency of blood donation are factors associated with lower SF levels in blood donor populations. [22][23][24][25][26][27][28][29][30] In the Recipient Epidemiology and Donor Evaluation Study (REDS)-II Donor Iron Status Evaluation (RISE) study of adult blood donors from six US blood collection centers, there was a significant association between female sex and iron deficiency, with nearly 1 in 5 female adult blood donors having absent iron stores at the time of enrollment (i.e., prior to blood donation). 24 More recently, the Comparison of the History of Donation and Iron Levels in Teen Blood Donors (CHILL) study of adolescent and adult blood donors from two US blood collection centers confirmed that iron deficiency is more common in adolescent as compared to adult donors.…”

“…24 More recently, the Comparison of the History of Donation and Iron Levels in Teen Blood Donors (CHILL) study of adolescent and adult blood donors from two US blood collection centers confirmed that iron deficiency is more common in adolescent as compared to adult donors. 26 The prevalence of iron deficiency and iron deficiency anemia in US blood donors, however, has not been well characterized using nationally representative data. 18 In addition, there are limited populationbased studies comparing the prevalence of iron deficiency and iron deficiency anemia between blood donor and nondonor populations.…”

Iron supplementation? Ferritin screening? Why questions persist

“…Convincing evidence of damaging intellectual sequelae due to storage iron deficiency was also disputed by the AABB Donor Iron Deficiency Assessment Working Group. In their report, risk for cognitive performance in adolescents, as well as risk for ongoing brain development, adverse pregnancy outcomes, and fetal development, was described as “theoretical.” A similarly judicious assessment appears in the current paper by Spencer and coworkers concerning the risk for iron depletion in high school blood donors, which notes that any clinical impact “may be subtle and challenging to detect.”…”