Iron supplementation? Ferritin screening? Why questions persist

Sayers, Merlyn

doi:10.1111/trf.15303

Cited by 9 publications

(10 citation statements)

References 22 publications

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“…Oral iron supplementation has been shown to reduce the risk of LHD, elevating Hb and iron stores in blood donors [81]. However, the prospect of implementing iron supplementation in blood donors is a matter of some controversy [82,83]. Depleted iron stores are more common in female and young donors as well as those who donate regularly [84], and it has been suggested that low iron is associated with cognitive impairment [85].…”

Section: Discussionmentioning

confidence: 99%

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Donor Deferral Due to Low Hemoglobin—An Updated Systematic Review

Browne

Fisher

Masconi

et al. 2020

Transfusion Medicine Reviews

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Background/Objectives: Blood donors attending a donation session may be deferred from donating blood due to a failure to meet low hemoglobin (Hb) thresholds. This costs the blood donor service, and donors, valuable time and resources. In addition, donors who are deferred may have more symptoms and as a direct and/or indirect effect of their experience return rates of donors deferred for low Hb are reduced, even in repeat donors. It is therefore vital that low Hb deferral (LHD) is minimized. The aim of this updated systematic review is to expand the evidence base for factors which affect a donor's risk of deferral due to low Hb. Materials/Methods: Studies were identified by searching MEDLINE, Embase, The Cochrane Library and the WHO International Clinical Trials Registry to March 2019. Demographic data, donor history, hematological/biological factors and the primary outcome of deferral due to low Hb were extracted. Our primary outcome was deferral due to low Hb. Analyses were descriptive and quantitative; pooled odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by meta-analysis using random effects models. Results: A total of 116 studies met the inclusion criteria. Meta-analysis showed a significantly greater risk of LHD in females compared with males in studies applying universal Hb thresholds for males and females (OR 14.62 95%CI 12.43-17.19) and in those which used sex-specific thresholds (OR 5.73, 95%CI 4.36-7.53). Higher rates of LHD were also associated with increasing age in men, low body weight, shorter inter-donation interval, donors of Hispanic or African descent, higher ambient temperature, donors with low ferritin levels and donation in a fixed donor center. There was conflicting evidence on the effect of new and repeat donor status, and blood group. Conclusion: This work has strengthened the evidence of the previous review in identifying factors that should be considered in studies of donor deferral and highlighting areas in need of further study, including ABO and Rh blood groups, previous platelet donation, diet, smoking, time of day, and genetic data. These factors may lead to individually tailored donation criteria for safe and efficient donation in the future.

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Section: Discussionmentioning

confidence: 99%

“…Targeted iron supplementation in these high risk groups has been recommended [86]. However, this comes with cost implications, associated adverse effects and compliance issues as well as possible health risks associated with regular iron intake [83].…”

Section: Discussionmentioning

confidence: 99%

Donor Deferral Due to Low Hemoglobin—An Updated Systematic Review

Browne

Fisher

Masconi

et al. 2020

Transfusion Medicine Reviews

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“…As many donors become iron‐deficient despite this Hb monitoring, ferritin measurements, combined with donation interval extension or iron supplementation in case of low iron stores, are increasingly implemented in blood services, including Sanquin in the Netherlands 3,6–9 . Nonetheless, there is considerable debate about the usefulness of these measures as these interventions have negative effects for blood services such as donor lapse due to lack of comprehension and the costs of testing and iron supplementation 10–12 …”

Section: Introductionmentioning

confidence: 99%

Donation‐induced iron depletion is significantly associated with low hemoglobin at subsequent donations

et al. 2021

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Background: Blood donation is associated with a loss of hemoglobin (Hb)-bound iron. Hb levels recover relatively fast by using stored iron. However, it takes more time to replenish iron stores, potentially resulting in iron deficiency.Study design: Hb and ferritin levels were measured in 5056 new, first-time, and repeat whole blood donors. We investigated whether increasing numbers of donations are associated with lower ferritin levels. Furthermore, we tested whether low ferritin levels are associated with low-Hb deferral at the subsequent donation attempt by performing logistic regression adjusted for age and stratified by sex. Results: Whereas mean Hb levels are relatively stable, ferritin levels significantly decrease with increasing numbers of donations and were approximately 50% lower for donors with >50 donations compared with those with 2-10 donations. Despite the poor correlation of ferritin and Hb levels, cross-sectional, iron-deficient donors (ferritin <15 ng/ml) had 21.8 (8.5-55.6) higher odds in men, 10.1 (6.1-16.5) in premenopausal women, and 11.7 (5.2-26.4) in postmenopausal women for Hb deferral at a subsequent visit.Discussion: To conclude, repeated donations may induce iron deficiency, which corresponds with an over tenfold increased risk of having insufficiently restored Hb levels at a subsequent donation attempt. Longer donation intervals and/or higher dietary or supplemental iron intake are warranted to prevent accumulated iron depletion and subsequent low-Hb deferral in whole blood donors.

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“…With the recognition of donors as a finite resource has come increasing attention to considerations of donor safety, especially to donor iron management. [2][3][4] Other concerns relate to the collection of blood from donors aged 16-19 years, especially in countries where iron deficiency anaemia is already a public health issue. There is an inherent tension between the need for donations and the establishment of policies that protect donor health.…”

Section: Ironing Out Frequent Blood Donationmentioning

confidence: 99%

Ironing out frequent blood donation

Devine

2019

The Lancet Haematology

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Iron supplementation? Ferritin screening? Why questions persist

Cited by 9 publications

References 22 publications

Donor Deferral Due to Low Hemoglobin—An Updated Systematic Review

Donor Deferral Due to Low Hemoglobin—An Updated Systematic Review

Donation‐induced iron depletion is significantly associated with low hemoglobin at subsequent donations

Ironing out frequent blood donation

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