Iron deficiency in blood donors: analysis of enrollment data from the REDS‐II Donor Iron Status Evaluation (RISE) study

Abstract

Background Regular blood donors are at risk of iron deficiency, but characteristics which predispose to this condition are poorly defined. Methods 2425 red cell donors, either first time (FT) or reactivated donors (no donations for 2 years) or frequent donors were recruited for follow-up. At enrollment, ferritin, soluble transferrin receptor (sTfR), and hemoglobin were determined. Donor variables included demographics, smoking, dietary intake, use of iron supplements, and menstrual/pregnancy history. Models to predict two measures of iron deficiency were developed: Absent iron stores (AIS) were indicated by ferritin < 12 ng/mL and iron deficient erythropoiesis (IDE) by log (sTfR/ferritin) ≥ 2.07. Results 15.0% of donors had AIS, 41.7% IDE. In frequent donors, 16.4% and 48.7% of males had AIS and IDE, respectively, with corresponding proportions of 27.1% and 66.1% for females. Donation intensity was most closely associated with AIS/IDE (ORs from 5.3 to 52.2 for different donation intensity compared to FT donors). Being female, younger, and/or menstruating also increased the likelihood of having AIS/IDE, as did having a lower weight. Marginally significant variables for AIS and/or IDE were being a non-smoker, previous pregnancy and not taking iron supplements. Dietary variables were in general unrelated to AIS/IDE, as was race/ethnicity. Conclusion A large proportion of both female and male frequent blood donors have iron depletion. Donation intensity, gender/menstrual status, weight, and age are important independent predictors of AIS/IDE. Reducing the frequency of blood donation is likely to reduce the prevalence of iron deficiency among blood donors, as might implementing routine iron supplementation.

Hepcidin level predicts hemoglobin concentration in individuals undergoing repeated phlebotomy

“…9,10 Institutional Review Boards from all sites approved the study protocol. A subset of subjects was selected from the RISE cohort to examine the relationship between plasma hepcidin, plasma ferritin and venous hemoglobin levels.…”

“…The enrollment and longitudinal phases of the RISE study have been described in detail previously. 9,10 During routine volunteer blood donation in the United States, approximately 500 mL of whole blood containing between 200 and 250 mg of iron is removed from the donor. This amount of iron is approximately equal to the total available iron stores in females and one-fourth of the available iron stores in males.…”

Iron deficiency: new insights into diagnosis and treatment

“…Also regular blood donors may develop iron deficiency and anemia after multiple donations. 3 Insufficient iron intake, diets containing poorly bioavailable sources of iron, and parasitic infections account for most cases in low-income countries. 1 In high-income countries, iron deficiency anemia, usually with the exception of groups with increased iron needs, may point to pathologic conditions associated with poor iron absorption and/or chronic blood loss.…”

Evaluation of Iron Deficiency Using Reticulocyte Indices in Dogs Enrolled in a Blood Donor Program

“…The cut‐off of 5 donations over 12 months was selected because people have progressive development of iron deficiency following the third, fourth, and fifth donations in a 12‐month period 3, 4, 5. To participate in UWVC blood donor program, dogs were required to be >23 kg, between 1 and 9 years of age, and deemed healthy on the basis of physical examination and annual CBC, serum chemistry profile, and infectious disease screening.…”