Evaluation of low red blood cell mean corpuscular volume in an apheresis donor population

Abstract

BACKGROUND Apheresis donors are routinely evaluated with a complete blood count (CBC). Low red blood cell mean corpuscular volume (MCV) values (<80 fL) in the presence of an acceptable hemoglobin (Hb; ≥12.5 g/dL) could be due to iron deficiency or hemoglobinopathy. The etiology of a low MCV in a healthy apheresis donor population was assessed. METHODS Predonation samples for CBC were obtained from 1162 consecutive apheresis donors. Donors with a MCV of less than 80 fL were evaluated by CBC, iron studies (ferritin, serum iron, transferrin, percentage of transferrin saturation), and hemoglobin (Hb) electrophoresis. Iron deficiency was defined as a ferritin value below the reference range. Beta chain Hb variants were determined by Hb electrophoresis. Alpha thalassemia trait was presumed if the red blood cell (RBC) count was elevated, no variant Hbs were detected, and the iron studies were within normal ranges. RESULTS In a 19-month period, 33 of 1162 apheresis donors had low MCV values. Iron deficiency was present in 64%; 49% had isolated iron deficiency and 15% had iron deficiency plus hemoglobinopathy. Hemoglobinopathy without concomitant iron deficiency was found in the remaining 36%. CONCLUSION Iron deficiency is present in the majority of apheresis donors with repeatedly low MCV values and Hb levels of 12.5 g/dL or more. Hemoglobinopathy is also commonly present but may not be easily recognized in the setting of iron deficiency. The MCV is a useful screening tool to detect iron deficiency and hemoglobinopathy. Low MCV values should be investigated to determine if iron replacement therapy is indicated.

International Forum regarding practices related to donor haemoglobin and iron

“…At the time of the next donation, serum ferritin and iron panel are obtained, and oral iron replacement (ferrous gluconate 324 mg once daily for 60 days) is dispensed. In our experience, iron deficiency is the most common cause for low MCV in this donor group . If on review of the laboratory results, there is no indication of insufficient iron stores, these donors may be approved for donation.…”

“…NIH has studied iron status of blood donors for several years . The first time that whole blood or apheresis donors fail the haemoglobin screening level of 12·5 g/dl on the day of donation, they are asked to complete a questionnaire which inquires about symptoms and potential causes of iron deficiency such as heavy menses, vegetarian diet, gastrointestinal blood loss and use of proton pump inhibitors.…”

Prognostic value of red blood cell parameters and ferritin in predicting deferral due to low hemoglobin in whole blood donors

“…A recent prospective evaluation in a cohort of 2,425 whole blood donors detected absent iron stores (defined as a serum ferritin <12 ng/ml) in 15% of donors [1]. As routine ferritin testing is comparatively costly, various RBC parameters such as mean corpuscular volume (MCV) [2], mean corpuscular hemoglobin (MCH) [3], percentage of hypochromic RBCs [4], reticulocyte hemoglobin content (CHr) [5], or red cell distribution width (RDW) [6] have been proposed as surrogate markers for low ferritin/iron depletion. While significant correlations between ferritin and RBC parameters were shown in these analyses, no study has so far examined which marker is most useful in identifying donors at risk of developing low hemoglobin levels.…”

The Radioprotective and Anticancer Effects of Banana Peels Extract on Male Mice

“…Our results coincidence with the previous study of Nunia and Goyal, [31] reported that radiation exposure significantly reduced the, hemoglobin (Hb), hematocrit (Hct), packed cell volume (PCV) another study of Billings et al, [30] reported that red blood cell (RBC) counts stopped stable after radiation exposure In the current study, there was a significant reduction in WBC counts in irradiated group at 24 h after radiation at dose levels of 3 GY compared to the control group This result was agreed with that of Thrall et al, [32] who showed a significant reduction in WBC counts at 24 h after radiation . this study showed that significant increase in platelets count (p<0.05) compared to control group may be related to iron deficiency anemia Nagai et al, [33] stated a case of severe iron deficiency anemia with marked thrombocytosis increase in platelet count also Alexander, [34] reported that bone marrow megakaryocyte counts were increased and the plausible explanation of the thrombocytosis might be an increased production of platelets The low red blood cell mean corpuscular (MCV) in the existence of an adequate hemoglobin (Hb; ≥12.5 g/dL) may be due to iron deficiency (Barbara et al, [35] in current study our result revealed that administration of banana peels extracts ameliorated the alteration in hematological parameters this effect may be due to that banana peels rich with phytoconstituent like flavonoids, tannins, phlobatannins, alkaloids, glycosides, anthocyanins, and terpenoids, also banana peels high in iron that can excite the production of hemoglobin in the blood and helps in cases of anemia [36].…”