Postdonation iron replacement for maintaining iron stores in female whole blood donors in routine donor practice: results of two feasibility studies in Australia

Abstract

BACKGROUND Iron deficiency represents a risk to donor health and the blood supply. Efficacy trials indicate that postdonation iron replacement improves iron stores but they do not account for complexities of implementation in the routine collection context. We therefore conducted two prospective feasibility studies in Australian donor centers. STUDY DESIGN AND METHODS In both studies we recruited female donors between 18 and 45 years who had made at least one donation in the previous 12 months. In READ (replacement advice), female donors were given a recommendation to self‐procure postdonation iron. In DIRECT (donor iron replacement), donors were provided with a course of iron supplements. Donors could return to donate at their discretion and were surveyed after the recruitment visit and again toward the end of the 13‐month follow‐up. Donor uptake, adverse effects, effectiveness in maintaining iron stores, and workflow impact were assessed. RESULTS We recruited 1404 (70.9% of invited) donors to READ and 768 (53.2% of invited) to DIRECT. READ and DIRECT extended predonation interviews by 1 and 5 minutes, respectively. Among participants, 44 and 88% took iron in READ and DIRECT, respectively. Adverse effects were common but usually mild. READ failed to maintain iron stores in the population, but was effective in donors who consumed more than 75% of the recommended dose. DIRECT was effective in preventing declines in ferritin concentration. CONCLUSION Trade‐offs between cost, complexity, uptake, and effectiveness must be considered in the implementation of postdonation iron supplementation.

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

“…Actionable interventions beyond education must also be considered to protect blood donors from iron deficiency . Possibilities include extending the interdonation interval, performing ferritin testing prior to donation, and providing iron supplementation . The efficacy of these interventions is well established, and there is growing evidence to support the feasibility of implementing these interventions.…”

“…44 Possibilities include extending the interdonation interval, 45 performing ferritin testing prior to donation, 46-50 and providing iron supplementation. 49,[51][52][53][54] The efficacy of these interventions is well established, and there is growing evidence to support the feasibility of implementing these interventions.…”

How do we manage iron deficiency after blood donation?

“…As previously mentioned, recent well‐designed cohort trials have characterized the magnitude of the risk of ID in a number of donor subgroups (Table ) (Cable et al , ; FDA ). In addition, interventional trials have demonstrated a slow recovery of post‐donation iron stores with diet alone or in combination with lengthening inter‐donation intervals, their rapid repletion with iron supplements, and the effectiveness of strategies to educate/motivate donors about ways to prevent worsening ID (Kiss et al , ; Mast et al , ; Pasricha et al , ). Armed with several strategies to intervene, it seems prudent to employ them in individuals at risk (Table II), especially groups that are considered potentially more vulnerable to cognitive dysfunction that may or may not be reversible: young blood donors and the infants of female donors of childbearing potential.…”

“…In a 2017 association bulletin, AABB has asked collectors to enhance materials to include the benefits of iron supplementation and provide specific recommendations on iron preparations, doses and duration, as well as the applicability of supplements in particular donor subgroups (AABB ). A 13‐month Australian study in female donors of childbearing potential demonstrated that education alone did not prevent worsening Hb and ferritin values (Pasricha et al , ). However, in the 26% of donors who purchased and took the majority of the recommended iron dose, post‐donation iron stores were maintained.…”

The effects of intravenous iron supplementation on fatigue and general health in non-anemic blood donors with iron deficiency: a randomized placebo-controlled superiority trial

“…Among frequent donors in one US study, almost 20% and 30% of men and women, respectively, were found to have absent iron stores (ferritin < 12 µg/L) 5 . To prevent blood donation deferral due to iron deficiency anemia, measures to detect and correct low iron stores, including regular assessment of serum ferritin or iron supplementation [6][7][8][9][10][11][12][13][14] , have been proposed as routine measures by blood bankers [15][16][17] . Currently, however, iron supplementation for blood donors is not a standard of care in many blood donation services.…”