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

Abstract

Risk factors for deferral from red blood cell (RBC) donation due to low hemoglobin are not well defined. We analyzed in a large cohort of returning donors the prognostic value of RBC parameters and serum ferritin regarding low hemoglobin levels at the subsequent visit. Between 2004 and 2009, RBC indices and serum ferritin were recorded in 45,533 visits by 7,994 donors. In 689 instances, donation was deferred at the subsequent visit due to low hemoglobin levels (<123 g/l for female donors, <133 g/l for male donors). Pre-donation hemoglobin at the current visit correlated best with hemoglobin at the subsequent visit (R (2) = 0.63), whereas other RBC indices and serum ferritin correlated only poorly (R (2) ≤ 0.15). Similar results were obtained in ROC curve analysis and in multivariable binary logistic regression. A pre-donation hemoglobin within 5 g/l from the deferral threshold (<128 g/l for female, <138 g/l for male donors) predicted below-threshold hemoglobin levels at the subsequent visit with a sensitivity of 52% and a specificity of 94%. In conclusion, pre-donation hemoglobin is a useful marker identifying donors at risk of developing low hemoglobin levels. Diagnostic and therapeutic interventions should be aimed at donors presenting with hemoglobin levels near the threshold of donor deferral.

Blood donor iron status

“…The Advisory Committee for Blood Safety and Availability noted that a uniform cutoff of 12.5 g/dl allowed ‘anemic’ men to donate while excluding normal women [17], conclusions supported by the analyses of large population-based datasets [18]. Although the RISE study found a high prevalence of iron deficiency (77%) in Hb-deferred donors [11 ⦾⦾ ], other recent analyses show generally poor prognostic value of ferritin in predicting anemia [19 ⦾ ] and of venous Hb values in predicting low ferritin [20]. The clear lesson from the accumulated evidence is that donor Hb is a lagging indicator and highly imperfect proxy for donor iron status, and that where the latter is of interest it should be directly measured.…”

Anemia and the Blood Donor

“…As ferritin testing is comparatively costly, various red blood cell (RBC) parameters have been proposed as markers for low ferritin/iron depletion (13) . Significant correlations between ferritin and RBC parameters were shown in these analyses, but no study has determined which marker is the most useful to identify donors at risk of developing anemia (13) .…”

“…Significant correlations between ferritin and RBC parameters were shown in these analyses, but no study has determined which marker is the most useful to identify donors at risk of developing anemia (13) . …”

“…After donation of 450 mL of blood, a male donor loses 242 ± 17 mg and a female 217 ± 11 mg of iron (5,15) . Since the 1970s, various investigators documented the decrease in serum ferritin levels in association with blood donation (5,11,13,16-18) . …”

“…Because of this, many researches have prescribed iron supplementation with good results (15,19,20) . However, the majority of regular blood donors with low or absent iron stores will never develop IDA (13) . …”