Iron supplementation and 2‐unit red blood cell apheresis: a randomized, double‐blind, placebo‐controlled study

“…Elemental iron doses of 39 or 40 mg per day 67,115 as ferrous iron salts have been well tolerated, with minimal or no increase in side effects, and have been quite effective over an 8‐week period. One‐hundred milligrams of elemental iron per day delivered as a ferrous iron salt (ferro sanol duodenal, Sanol, Schwarz Pharma, Monheim, Germany) that is absorbed in the duodenum rather than the stomach 117 was also well tolerated in one study, 8.7 percent gastrointestinal side effects versus 5.2 percent in the placebo group 116 . One‐hundred milligrams of elemental iron delivered as carbonyl iron for 56 days was tolerated but still had a significantly higher percentage of gastrointestinal side effects in comparison to a placebo group 110 .…”

Section: Short‐term Iron Replacement With Oral Iron: Supplementation mentioning

confidence: 99%

Iron depletion by whole‐blood donation harms menstruating females: The current whole‐blood‐collection paradigm needs to be changed

Newman

2006

Transfusion

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ABBREVIATIONS: log(TfR/F) = mean log of the serum transferrin receptor factor/ferritin; sTfR = serum transferrin receptor. From the American Red Cross, Southeastern Michigan Region, Detroit, Michigan.Address reprint requests to: Bruce Newman, MD, American Red Cross, Southeastern Michigan Region-he collection of 450 or 500 mL of whole blood, plus an additional 30 to 50 mL for blood tests, results in 480 to 550 mL of blood loss per wholeblood donation. These losses leads to a 60-to 88-g loss of hemoglobin (Hb) per whole-blood donation in women, based on a Hb range of 12.5 to 16.0 g per dL, and 204 to 299 mg of iron loss, based on 3.4 mg of iron per gram of Hb. 1 This iron loss is 9 to 13 percent of the total body iron in an average woman (2300 mg), 2 and it is 66 to 97 percent of the total stored iron in an average menstruating woman (309 mg). 3 Therefore, whole-blood donation is an iron depletion event that causes significant iron loss in women.Menstruating women, even before blood donation, are at risk for iron depletion because of ongoing blood loss, recent pregnancies, and inadequate dietary iron. In Caucasian women, nonanemic iron deficiency is quantitatively defined as normal Hb concentration (≥12 g/dL), low ferritin (≤12 µg/L), and a second test that is consistent with iron deficiency. 4 Iron-deficiency anemia is defined as the same, except the Hb concentration is less than 12 g per dL. A number of studies have been performed, mainly on adult women, to determine the effect of iron-deficiency anemia or nonanemic iron deficiency on one's health. These studies have evaluated the effect of these two conditions on fatigue, 5-15 physical endurance and work capac-T ity, 16-28 restless leg syndrome, 29-37 adverse events related to pregnancy, 38-48 and cognitive changes. 12,13,14,15,[49][50][51][52][53][54][55][56] Many of these studies have shown harm from iron-deficiency anemia and nonanemic iron deficiency.The status of the current whole-blood-collection paradigm is to have a Hb cutoff that is slightly above the low end of normal in women and to not replace the iron that is lost during donation. This paradigm prevents severe anemia, but it does not prevent iron-deficiency anemia or nonanemic iron deficiency and their associated harms. A superior paradigm would be short-term iron replacement for menstruating women donors after successful wholeblood donation.The present commentary will review the topic of iron deficiency in women, iron deficiency induced by wholeblood donation, and the harmful effects of the present collection paradigm (no iron replacement) on female donor health. It will then review early and recent studies on the use of oral iron supplements to replace iron after whole-blood donation, discuss an iron-rich diet versus short-term oral iron supplements, review issues related to iron supplementation, and review the potential of iron supplementation coupled with slightly lower Hb acceptance standards for women to increase the whole-blood supply. IRON DEPLETION IN WOMENFortification of food with iron ha...

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“…24 Clearly, 2RBC donors, especially young donors, must be encouraged to replace iron lost through blood donation with appropriate diet or possibly iron supplementation. Radtke and coworkers 25 have shown that daily iron supplementation between 2RBC donations resulted in stable ferritin levels and reduced the deferral rates due to low Hb. The transfusion community has an incomplete understanding of the optimal approach to Hb screening and iron balance in blood donors; consequently, several studies, including the NIHfunded RISE (REDSII Donor Iron Status Evaluation) study are currently under way.…”

Section: Discussionmentioning

confidence: 98%

The relative safety of automated two‐unit red blood cell procedures and manual whole‐blood collection in young donors

Benjamin

Kennedy

et al. 2009

Transfusion

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Iron supplementation and 2‐unit red blood cell apheresis: a randomized, double‐blind, placebo‐controlled study

Abstract: Regular iron supplementation prevents iron depletion in the majority of donors after 2-unit RBC apheresis within an 8- to 10-week period.

Cited by 31 publications

References 18 publications

Blood donation, blood supply, iron deficiency and anemia - It is time to shift attention back to donor health

Blood donation, blood supply, iron deficiency and anemia - It is time to shift attention back to donor health

Iron depletion by whole‐blood donation harms menstruating females: The current whole‐blood‐collection paradigm needs to be changed

The relative safety of automated two‐unit red blood cell procedures and manual whole‐blood collection in young donors

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