51
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van den Berg K, Swanevelder R, Ingram C, Lawrie D, Glencross DK, Hilton C, Nieuwoudt M. The iron status of South African blood donors: balancing donor safety and blood demand. Transfusion 2018; 59:232-241. [PMID: 30383295 DOI: 10.1111/trf.15001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Several studies in developed countries have demonstrated high levels of iron deficiency (ID) among blood donors. There is a paucity of data for developing countries where blood shortages remain a major concern. STUDY DESIGN AND METHODS A total of 4412 donors were enrolled in the study. Specimens were collected for full blood count, iron, transferrin saturation, and ferritin assessment. Donor demographics were recorded. ID was indicated by a ferritin level of less than 20 ng/mL for men and less than 12 ng/mL for women. Anemia was defined as hemoglobin levels less than 12.5 g/dL. Regression models for predictors of ID were developed. RESULTS A total of 17.5% of all donors had ID, with 16.3% prevalence in women and 18.6% in men. Low hemoglobin had the highest association with ID (adjusted odds ratio [AOR], 11.078; 95% confidence interval [CI], 7.915-15.505); male donors had twice the odds of ID compared to female donors (AOR, 2.501; 95% CI, 1.964-3.185), while increasing age was associated with lower odds (AOD, 0.965; 95% CI, 0.956-0.975). Among male donors, an interdonation interval of less than 3 months (AOR, 2.679; 95% CI, 1.929-3.720) was associated with ID. Compared to other females combined, colored female donors (AOR, 2.335; 95% CI, 1.310-4.160) had higher odds and black female donors (AOR, 0.559; 95% CI, 0.369-0.845) lower odds of ID. CONCLUSION ID is common among South African donors; low hemoglobin, gender, ethnicity, and past donation history is independently associated with ID. Recommendations aimed at protecting donor health may increase blood shortages in South Africa.
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Affiliation(s)
- Karin van den Berg
- Medical Department, South African National Blood Service, Port Elizabeth, South Africa
| | - Ronel Swanevelder
- Business Intelligence Department, South African National Blood Service, Roodepoort, South Africa
| | - Charlotte Ingram
- South African Bone Marrow Registry (SABMR), Cape Town, South Africa
| | - Denise Lawrie
- Department of Molecular Medicine and Haematology, National Health Laboratory Services and University of the Witwatersrand, Johannesburg, South Africa
| | - Deborah Kim Glencross
- Department of Molecular Medicine and Haematology, National Health Laboratory Services and University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Hilton
- Medical Department, Western Province Blood Transfusion Service, Cape Town, South Africa
| | - Martin Nieuwoudt
- South African Department of Science and Technology/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch, South Africa.,Institute for Biomedical Engineering (IBE), Stellenbosch University, Stellenbosch, South Africa
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52
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Malard L, Richard P, Maire F, Djoudi R, Gross S, Fillet A. Factors associated with recovery of haemoglobin levels after whole‐blood donation in the French West Indies in 2015. Transfus Med 2018; 29 Suppl 1:72-75. [DOI: 10.1111/tme.12563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/21/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- L. Malard
- Medical DepartmentEFS Siège La Plaine Saint‐Denis France
| | | | - F. Maire
- ETS Guadeloupe‐Guyane Pointe à Pitre France
| | | | - S. Gross
- Medical DepartmentEFS Siège La Plaine Saint‐Denis France
| | - A.‐M. Fillet
- Medical DepartmentEFS Siège La Plaine Saint‐Denis France
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53
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Gammon RR, Kozel T, Morel P, Kendrick C. Evaluation of Iron Stores by Zinc Protoporphyrin Analysis in Blood Donors. Lab Med 2018; 49:311-315. [PMID: 29757413 DOI: 10.1093/labmed/lmy007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Zinc protoporphyrin (ZPP) testing has been studied previously as a substitute for ferritin (fer) testing of blood donors in determining iron stores. Objective To determine whether ZPP testing could be performed using specimens collected via the capillary (cap) finger-stick (FS) method, similar to predonation hemoglobin (HB) testing. Also, we evaluated the correlation among FS HB, venous (ven) ZZP, FS ZPP, and ven fer levels as predictors of iron depletion. Methods Blood donations from 328 study participants were evaluated using FS HB assay; we also performed ven ZPP, cap ZPP, and ven fer testing. We assessed the donors for subclinical iron deficiency (fer levels <26 ng/mL and ZPP levels >100 μmol/mol heme). Results Subclinical iron deficiency was present among first-time and repeat blood donors at all HB levels. Variation among test results (FS HB, ven fer, ven ZPP, and FS ZPP) was statistically significant (P <.001). Conclusion Insufficient correlation existed regarding FS HB and ven fer test results to support use of ZPP to determine iron stores in blood donors.
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Affiliation(s)
- Richard R Gammon
- Scientific Medical and Technical Administration, Orlando, Florida
| | - Tania Kozel
- Immunohematology Laboratory, OneBlood, Inc., Orlando, Florida
- College of Health, Massey University, Palmerston North, New Zealand
| | - Patrick Morel
- College of Health, Massey University, Palmerston North, New Zealand
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54
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Dijkstra A, van den Hurk K, Bilo HJG, Slingerland RJ, Vos MJ. Repeat whole blood donors with a ferritin level of 30 μg/L or less show functional iron depletion. Transfusion 2018; 59:21-25. [DOI: 10.1111/trf.14935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Henk J. G. Bilo
- Department of Internal MedicineIsala Hospital Zwolle The Netherlands
- Department of Internal MedicineUniversity Medical Center Groningen Groningen The Netherlands
| | - Robbert J. Slingerland
- Department of Clinical ChemistryIsala Hospital Zwolle The Netherlands
- European Reference Laboratory for GlycohemoglobinIsala Hospital Zwolle The Netherlands
| | - Michel J. Vos
- Department of Clinical ChemistryIsala Hospital Zwolle The Netherlands
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55
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Vassallo RR, Bravo MD, Kamel H. Ferritin testing to characterize and address iron deficiency in young donors. Transfusion 2018; 58:2861-2867. [DOI: 10.1111/trf.14921] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 12/18/2022]
Affiliation(s)
| | | | - Hany Kamel
- Corporate Medical Affairs; Blood Systems, Inc.; Scottsdale Arizona
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56
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Granfone MC, Walker JM, Smith LJ. Evaluation of an intramuscular butorphanol and alfaxalone protocol for feline blood donation: a pilot study. J Feline Med Surg 2018; 20:793-798. [PMID: 28948901 PMCID: PMC11104132 DOI: 10.1177/1098612x17732484] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Objectives The purpose of this pilot study was to evaluate the use of an intramuscular (IM) sedation protocol with butorphanol and alfaxalone in cats undergoing blood donation. We hypothesized that this drug combination would provide sufficient sedation to perform phlebotomy without causing hypotension or significant changes in heart rate. Methods Six purpose-bred, healthy adult cats were sedated using IM butorphanol (0.4 mg/kg) and alfaxalone (2-3 mg/kg). Pulse and Doppler blood pressure (BP) were recorded at baseline, after sedation and immediately following phlebotomy. Once laterally recumbent, 12 ml/kg blood was collected from the jugular vein. Sedation scores, duration of lateral recumbency and the ability to successfully perform phlebotomy were recorded. Results There was no significant change in heart rate post-sedation (median 190 beats per min [bpm], range 160-224 bpm) or post-phlebotomy (median 200 bpm, range 180-220 bpm) compared with baseline values (median 200 bpm, range 180-220 bpm) ( P = 0.395). A statistically significant change in BP was detected ( P = 0.029), attributed to a difference between post-sedation (median 113.3 mmHg, range 110.7-130.0) and baseline (median 133.3 mmHg, range 130.0-183.3) measurements. Hypotension was not observed in any cat. Collection of at least 80% of the target volume was achieved in 5/6 cats, although all were adequately sedated to allow jugular venous phlebotomy. Median recumbency time was 53 mins (range 43-83 mins). Phlebotomy duration lasted a median of 13 mins (range 5-21 mins). Conclusions and relevance The administration of IM alfaxalone and butorphanol provided sufficient restraint for blood donation without causing hypotension or significant changes in heart rate before or after phlebotomy.
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Affiliation(s)
- Marcella C Granfone
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Julie M Walker
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Lesley J Smith
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
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57
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Kiss JE, Vassallo RR. How do we manage iron deficiency after blood donation? Br J Haematol 2018; 181:590-603. [DOI: 10.1111/bjh.15136] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Joseph E. Kiss
- Hemapheresis and Blood Services; The institute for Transfusion Medicine; Pittsburgh PA USA
| | - Ralph R. Vassallo
- Chief Medical and Scientific Officer; Blood Systems, Inc.; Scottsdale AZ USA
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58
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Sapiano MRP, Savinkina AA, Ellingson KD, Haass KA, Baker ML, Henry RA, Berger JJ, Kuehnert MJ, Basavaraju SV. Supplemental findings from the National Blood Collection and Utilization Surveys, 2013 and 2015. Transfusion 2018; 57 Suppl 2:1599-1624. [PMID: 28591471 DOI: 10.1111/trf.14168] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Mathew R P Sapiano
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion.,Surveillance Branch, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Alexandra A Savinkina
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion.,Oak Ridge Institute for Science and Education
| | - Katherine D Ellingson
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion.,The University of Arizona College of Public Health, Tucson, Arizona
| | - Kathryn A Haass
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion
| | - Misha L Baker
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion.,Northrop Grumman Corporation, Atlanta, Georgia
| | - Richard A Henry
- Office of HIV/AIDS and Infectious Disease Policy, Office of the Assistant Secretary for Health, U.S. Department of Health & Human Services, Washington, DC
| | - James J Berger
- Office of HIV/AIDS and Infectious Disease Policy, Office of the Assistant Secretary for Health, U.S. Department of Health & Human Services, Washington, DC
| | - Matthew J Kuehnert
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion
| | - Sridhar V Basavaraju
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion
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59
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Schreiber GB, Brinser R, Rosa-Bray M, Yu ZF, Simon T. Frequent source plasma donors are not at risk of iron depletion: the Ferritin Levels in Plasma Donor (FLIPD) study. Transfusion 2018. [DOI: 10.1111/trf.14489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Roger Brinser
- BioLife Plasma Services LP/Shire; Bannockburn Illinois
| | | | - Zi-Fan Yu
- Statistics Collaborative; Washington DC
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60
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Mast AE. Putting donor health first in strategies to mitigate donor iron deficiency. Transfusion 2018; 57:495-498. [PMID: 28297079 DOI: 10.1111/trf.14074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Alan E Mast
- Blood Research Institute, Blood Center of Wisconsin, Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI
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61
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Gybel-Brask M, Seeberg J, Thomsen LL, Johansson PI. Intravenous iron isomaltoside improves hemoglobin concentration and iron stores in female iron-deficient blood donors: a randomized double-blind placebo-controlled clinical trial. Transfusion 2018; 58:974-981. [PMID: 29424441 DOI: 10.1111/trf.14521] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/07/2017] [Accepted: 12/20/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND This trial evaluated the efficacy and safety of intravenous (IV) iron isomaltoside (Monofer) in comparison with placebo in first-time female blood donors. STUDY DESIGN AND METHODS The trial was a prospective, double blind, placebo-controlled, randomized, comparative, single-center trial of 85 first-time female blood donors. The subjects were randomly assigned 1:1 to either 1000 mg IV iron isomaltoside infusion or placebo. The primary endpoint of the trial was change in hemoglobin (Hb) from baseline to right before the third blood donation. RESULTS The increase in Hb was significantly higher for iron isomaltoside compared with placebo right before both the second blood donation (p = 0.0327) and the third blood donation (primary endpoint, p < 0.0001). Improvements in other iron-related variables (plasma iron, plasma ferritin, transferrin saturation, and reticulocyte count) in favor of iron isomaltoside were also observed. The trial was not powered on patient-reported outcomes. However, improvements in iron stores and Hb levels after iron isomaltoside administration were supported by the fact that several of the fatigue symptoms scores showed numerical differences in favor of iron isomaltoside. There were no differences in side effects between the groups. CONCLUSION In iron-deficient female blood donors a single IV iron isomaltoside administration resulted in an improvement in Hb concentration and iron stores and demonstrated a favorable safety profile comparable to placebo.
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Affiliation(s)
- Mikkel Gybel-Brask
- Section for Transfusion Medicine, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Seeberg
- Section for Transfusion Medicine, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars L Thomsen
- Aalborg University, Aalborg, Denmark.,Pharmacosmos A/S, Holbaek, Denmark
| | - Pär I Johansson
- Section for Transfusion Medicine, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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62
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63
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Rigas AS, Pedersen OB, Magnussen K, Erikstrup C, Ullum H. Iron deficiency among blood donors: experience from the Danish Blood Donor Study and from the Copenhagen ferritin monitoring scheme. Transfus Med 2017; 29 Suppl 1:23-27. [PMID: 29024114 DOI: 10.1111/tme.12477] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 08/14/2017] [Accepted: 08/31/2017] [Indexed: 12/19/2022]
Abstract
Blood components collected from blood donors are an invaluable part of modern-day medicine. A healthy blood donor population is therefore of paramount importance. The results from the Danish Blood Donor Study (DBDS) indicate that gender, number of previous donations, time since last donation and menopausal status are the strongest predictors of iron deficiency. Only little information on the health effects of iron deficiency in blood donors exits. Possibly, after a standard full blood donation, a temporarily reduced physical performance for women is observed. However, iron deficiency among blood donors is not reflected in a reduced self-perceived mental and physical health. In general, the high proportion of iron-deficient donors can be alleviated either by extending the inter-donation intervals or by guided iron supplementation. The experience from Copenhagen, the Capital Region of Denmark, is that routine ferritin measurements and iron supplementation are feasible and effective ways of reducing the proportion of donors with low haemoglobin levels.
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Affiliation(s)
- A S Rigas
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - O B Pedersen
- Department of Clinical Immunology, Naestved Hospital, Naestved, Denmark
| | - K Magnussen
- Department of Clinical Immunology, Hvidovre Hospital, Hvidovre, Denmark
| | - C Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - H Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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64
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Cable RG, Birch RJ, Spencer BR, Wright DJ, Bialkowski W, Kiss JE, Rios J, Bryant BJ, Mast AE. The operational implications of donor behaviors following enrollment in STRIDE (Strategies to Reduce Iron Deficiency in blood donors). Transfusion 2017; 57:2440-2448. [PMID: 28703859 PMCID: PMC5612857 DOI: 10.1111/trf.14226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/18/2017] [Accepted: 05/22/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Donor behaviors in STRIDE (Strategies to Reduce Iron Deficiency), a trial to reduce iron deficiency, were examined. STUDY DESIGN AND METHODS Six hundred ninety-two frequent donors were randomized to receive either 19 or 38 mg iron for 60 days or an educational letter based on their predonation ferritin. Compliance with assigned pills, response to written recommendations, change in donation frequency, and future willingness to take iron supplements were examined. RESULTS Donors who were randomized to receive iron pills had increased red blood cell donations and decreased hemoglobin deferrals compared with controls or with pre-STRIDE donations. Donors who were randomized to receive educational letters had fewer hemoglobin deferrals compared with controls. Of those who received a letter advising of low ferritin levels with recommendations to take iron supplements or delay future donations, 57% reported that they initiated iron supplementation, which was five times as many as those who received letters lacking a specific recommendation. The proportion reporting delayed donation was not statistically different (32% vs. 20%). Of donors who were assigned pills, 58% reported taking them "frequently," and forgetting was the primary reason for non-compliance. Approximately 80% of participants indicated that they would take iron supplements if provided by the center. CONCLUSIONS Donors who were assigned iron pills had acceptable compliance, producing increased red blood cell donations and decreased low hemoglobin deferrals compared with controls or with pre-STRIDE rates. The majority of donors assigned to an educational letter took action after receiving a low ferritin result, with more donors choosing to take iron than delay donation. Providing donors with information on iron status with personalized recommendations was an effective alternative to directly providing iron supplements.
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Affiliation(s)
- Ritchard G. Cable
- New England Region, American Red Cross Blood Services, Dedham, Massachusetts
| | | | - Bryan R. Spencer
- New England Region, American Red Cross Blood Services, Dedham, Massachusetts
| | | | - Walter Bialkowski
- Blood Research and Medical Sciences Institutes, Blood Center of Wisconsin, Milwaukee, Wisconsin
| | - Joseph E. Kiss
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | - Jorge Rios
- New England Region, American Red Cross Blood Services, Dedham, Massachusetts
| | - Barbara J. Bryant
- Blood Research and Medical Sciences Institutes, Blood Center of Wisconsin, Milwaukee, Wisconsin
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | - Alan E. Mast
- Blood Research and Medical Sciences Institutes, Blood Center of Wisconsin, Milwaukee, Wisconsin
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
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65
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Bialkowski W, Kiss JE, Wright DJ, Cable R, Birch R, D'Andrea P, Bryant BJ, Spencer BR, Mast AE. Estimates of total body iron indicate 19 mg and 38 mg oral iron are equivalent for the mitigation of iron deficiency in individuals experiencing repeated phlebotomy. Am J Hematol 2017; 92:851-857. [PMID: 28494509 DOI: 10.1002/ajh.24784] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 01/08/2023]
Abstract
Iron deficiency anemia is a common clinical condition often treated with tablets containing 65 mg of elemental iron. Such doses can elicit gastrointestinal side effects lowering patient compliance. Oral iron supplements also increase hepcidin production causing decreased fractional absorption of subsequent doses. Frequent blood donors often become iron deficient. Therefore, they were enrolled in a two-year study involving continued blood donations and randomization to receive no pill, placebo, 19, or 38 mg ferrous gluconate for 60 days. Total body iron (TBI) did not change for the subset of donors in the no pill and placebo groups who completed both enrollment and final visits (P = .21 and P = .28, respectively). However, repeated measures regression analysis on the complete dataset estimated a significant decrease in TBI of 52 mg/year for the placebo and no pill groups (P = .001). The effects of 19 and 38 mg iron supplementation on TBI were indistinguishable (P = .54). TBI increased by 229 mg after the initial 60 days of iron supplementation (P < .0001) and was maintained at this higher level with continued iron supplementation following each subsequent donation. The TBI increase was apportioned 51 mg to red cell iron (P < .0001) and 174 mg to storage iron (P < .0001). Changes in storage iron were negatively impacted by 57 mg due to concurrent antacid use (P = .04). These findings in blood donors suggest that much lower doses of iron than are currently used will be effective for clinical treatment of iron deficiency anemia.
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Affiliation(s)
- Walter Bialkowski
- Blood Research and Medical Sciences Institutes, Blood Center of Wisconsin; Milwaukee Wisconsin
| | - Joseph E. Kiss
- The Institute for Transfusion Medicine; Pittsburgh Pennsylvania
| | | | - Ritchard Cable
- New England Region, American Red Cross Blood Services; Dedham Massachusetts
| | | | - Pam D'Andrea
- The Institute for Transfusion Medicine; Pittsburgh Pennsylvania
| | - Barbara J. Bryant
- Department of Pathology; University of Texas Medical Branch; Galveston Texas
| | - Bryan R. Spencer
- New England Region, American Red Cross Blood Services; Dedham Massachusetts
| | - Alan E. Mast
- Blood Research and Medical Sciences Institutes, Blood Center of Wisconsin; Milwaukee Wisconsin
- Department of Cell Biology, Neurobiology and Anatomy; Medical College of Wisconsin; Milwaukee Wisconsin
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66
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Kiss JE, Birch RJ, Steele WR, Wright DJ, Cable RG. Quantification of body iron and iron absorption in the REDS-IIDonor Iron Status Evaluation (RISE) study. Transfusion 2017; 57:1656-1664. [DOI: 10.1111/trf.14133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Joseph E. Kiss
- Institute for Transfusion Medicine; Pittsburgh Pennsylvania
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67
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Yazer MH, Vassallo R, Delaney M, Germain M, Karafin MS, Sayers M, van de Watering L, Shaz BH. Trends in age and red blood cell donation habits among several racial/ethnic minority groups in the United States. Transfusion 2017; 57:1644-1655. [DOI: 10.1111/trf.14108] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Mark H. Yazer
- The Institute for Transfusion Medicine; Pittsburgh Pennsylvania
| | | | | | | | | | - Merlyn Sayers
- Carter BloodCare and the University of Texas Southwestern; Dallas Texas
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68
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Sayers MH. To Fe, or not to Fe. Transfusion 2017; 57:234-237. [PMID: 28194853 DOI: 10.1111/trf.14002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Merlyn H Sayers
- Carter BloodCare, Bedford, Texas.,Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
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69
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Comparison of Criteria for Choosing the Number of Classes in Bayesian Finite Mixture Models. PLoS One 2017; 12:e0168838. [PMID: 28081166 PMCID: PMC5231325 DOI: 10.1371/journal.pone.0168838] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 12/07/2016] [Indexed: 11/29/2022] Open
Abstract
Identifying the number of classes in Bayesian finite mixture models is a challenging problem. Several criteria have been proposed, such as adaptations of the deviance information criterion, marginal likelihoods, Bayes factors, and reversible jump MCMC techniques. It was recently shown that in overfitted mixture models, the overfitted latent classes will asymptotically become empty under specific conditions for the prior of the class proportions. This result may be used to construct a criterion for finding the true number of latent classes, based on the removal of latent classes that have negligible proportions. Unlike some alternative criteria, this criterion can easily be implemented in complex statistical models such as latent class mixed-effects models and multivariate mixture models using standard Bayesian software. We performed an extensive simulation study to develop practical guidelines to determine the appropriate number of latent classes based on the posterior distribution of the class proportions, and to compare this criterion with alternative criteria. The performance of the proposed criterion is illustrated using a data set of repeatedly measured hemoglobin values of blood donors.
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70
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O'Brien SF, Goldman M. Understanding iron depletion and overload in blood donors. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- S. F. O'Brien
- Canadian Blood Services; Ottawa ON Canada
- School of Epidemiology, Public Health and Preventive Medicine; University of Ottawa; Ottawa ON Canada
| | - M. Goldman
- Canadian Blood Services; Ottawa ON Canada
- Department of Pathology & Laboratory Medicine; University of Ottawa; Ottawa ON Canada
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71
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Rigas AS, Pedersen OB, Erikstrup C, Hjalgrim H, Ullum H. Blood donation and iron deficiency. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A. S. Rigas
- Department of clinical immunologi; University Hospital Copenhagen; Rigshospitalet; Copenhagen Denmark
| | - O. B. Pedersen
- Department of clinical immunology; Naestved Hospital; Naestved Denmark
| | - C. Erikstrup
- Department of clinical immunology; University Hospital Aarhus; Aarhus Denmark
| | - H. Hjalgrim
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
| | - H. Ullum
- Department of clinical immunologi; University Hospital Copenhagen; Rigshospitalet; Copenhagen Denmark
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72
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Macher S, Drexler C, Lindenau I, Sareban N, Schlenke P, Amrein K. High-dose intravenously administered iron versus orally administered iron in blood donors with iron deficiency: study protocol for a randomised, controlled trial. Trials 2016; 17:527. [PMID: 27793204 PMCID: PMC5084417 DOI: 10.1186/s13063-016-1648-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 10/07/2016] [Indexed: 01/01/2023] Open
Abstract
Background About 2–3 % of the population participates in blood donation programmes. Each whole blood donation or ten apheresis donations cause a loss of 200–250 mg of iron. As a result, one of the most common risks of regular blood donors is iron deficiency. Although this has been known for decades, in most countries, iron status is currently not assessed or treated in this population. Premenopausal women are particularly affected, as they have lower iron reserves and higher daily requirements. Besides anaemia, iron deficiency may lead to fatigue and impaired cognitive and physical performance. Current iron preparations for intravenous administration are well tolerated and allow for application of large doses up to 1 g in one visit. Our hypothesis is that in blood donors with iron deficiency, intravenously administered iron is more efficient and as safe as oral iron supplementation. Since anaemia is one of the most frequent reasons for permanent or intermittent donor deferral, maintaining an iron-replete donor pool may help to prevent shortages in blood supply and to avoid iron deficiency-related comorbidities. Methods/design In this randomised clinical trial we include male and female blood donors aged ≥18 and ≤65 years with a ferritin value of ≤30 ng/ml. Stratified by gender, participants are randomized with a web-based randomisation tool in a 1:1 ratio to either 1 g of intravenously administered ferric carboxymaltose or 10 g of iron fumarate supplements at one to two daily doses of 100 mg each. Eight to 12 weeks after the first visit, iron status, blood count and symptoms are assessed in both groups. The primary endpoint is the difference in transferrin saturation (%) following the intervention between both groups. Secondary endpoints include other parameters of iron metabolism and red blood cell count, the number of patients with drug-related adverse events, and subjective symptoms including those of the restless legs syndrome, quality of life, and fatigue. Discussion Iron supplementation administered intravenously in non-anaemic but iron-deficient blood donors could represent an effective strategy to protect blood donors from comorbidities related with iron deficiency and therefore improve blood donor wellbeing. Furthermore, iron supplementation will help to maintain an iron-replete blood donor pool. Trial registration EudraCT: 2013-000327-14, Clinical Trials Identifier: NCT01787526. Registered on 6 February 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1648-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanne Macher
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Camilla Drexler
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Ines Lindenau
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria.,Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Nazanin Sareban
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Peter Schlenke
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Karin Amrein
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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73
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Blood Donor Medical Assessment and Blood Collection. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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74
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Hoad V, Bentley P, Bell B, Pathak P, Chan HT, Keller A. The infectious disease blood safety risk of Australian hemochromatosis donations. Transfusion 2016; 56:2934-2940. [PMID: 27662424 DOI: 10.1111/trf.13802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/14/2016] [Accepted: 07/17/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND It has been suggested that blood donors with hereditary hemochromatosis may pose an increased infectious disease risk and adversely affect recipient outcomes. This study compares the infectious disease risk of whole blood (WB) donors enrolled as therapeutic (T) donors to voluntary WB donors to evaluate the safety of blood products provided by the T donors. STUDY DESIGN AND METHODS This was a retrospective cohort study of all WB donations at the Australian Red Cross Blood Service who donated between January 1, 2011, and December 31, 2013, comparing a yearly mean of 11,789 T donors with 107,773 total donations and a yearly mean of 468,889 voluntary WB donors with 2,584,705 total donations. We compared postdonation notification of infectious illnesses, bacterial contamination screening results, and positive tests for blood borne viruses in T and WB donors. RESULTS Rates of transfusion-transmissible infections in donations destined for component manufacture were significantly lower in therapeutic donations compared to voluntary donations (8.4 vs. 21.6 per 100,000 donations). Bacterial contamination (43.0 vs. 45.9 per 100,000 donations) and postdonation illness reporting (136.2 vs. 110.8 per 100,000 donations) were similar in both cohorts. CONCLUSIONS The Australian therapeutic venisection program enables T donors to provide a safe and acceptable source of donated WB that has a low infectious disease risk profile.
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Affiliation(s)
- Veronica Hoad
- Australian Red Cross Blood Service, Perth, Western Australia, Australia
| | - Peter Bentley
- Australian Red Cross Blood Service, Perth, Western Australia, Australia
| | - Barbara Bell
- Australian Red Cross Blood Service, Perth, Western Australia, Australia
| | - Praveen Pathak
- Australian Red Cross Blood Service, Perth, Western Australia, Australia
| | - Hiu Tat Chan
- Australian Red Cross Blood Service, Perth, Western Australia, Australia
| | - Anthony Keller
- Australian Red Cross Blood Service, Perth, Western Australia, Australia
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75
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Germain M, Delage G, Robillard P, Katz LM, Grégoire Y. The association between frequency of blood donation and the occurrence of low birthweight, preterm delivery, and stillbirth: a retrospective cohort study. Transfusion 2016; 56:2760-2767. [PMID: 27515226 DOI: 10.1111/trf.13762] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Women who donate blood on a regular basis are at high risk of becoming iron depleted. Iron deficiency anemia has been shown to increase the risk of low birthweight and possibly preterm birth. Therefore, there is a concern that regular blood donation by female donors might adversely impact the well-being of their offspring. This retrospective cohort study examined the association between blood donation and the occurrence of adverse pregnancy outcomes. STUDY DESIGN AND METHODS The study sample included 18,483 female blood donors in their childbearing years (age 18 to 45 years) who delivered during the period 2001 to 2011 in the province of Québec (Canada). The occurrence of low birthweight (<2500 g), preterm delivery (<37 weeks of gestation), and stillbirth was ascertained by linking the donor information with provincial birth and stillbirth registries. RESULTS There was no association between the frequency of donation in the 2-year period before pregnancy and adverse pregnancy outcomes; compared to women who did not donate during that period, those who donated three or more donations (mean, 3.9 donations) had a relative risk of 0.83 (95% confidence interval [CI], 0.65-1.06) for low birthweight, 0.91 (95% CI, 0.75-1.11) for preterm birth, and 0.62 (95% CI, 0.18-2.12) for stillbirth. These associations remained unchanged after adjusting for baseline characteristics. CONCLUSION Women who donate blood on a regular but moderate basis do not appear to be at higher risk of adverse pregnancy outcomes. These findings, while reassuring, will need to be replicated in different settings.
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Affiliation(s)
- Marc Germain
- Medical Affairs, Héma-Québec, Montréal, Québec, Canada
| | - Gilles Delage
- Medical Affairs, Héma-Québec, Montréal, Québec, Canada
| | | | - Louis M Katz
- America's Blood Centers, Washington, DC.,Carver College of Medicine Division of Infectious Diseases, Iowa City, Iowa
| | - Yves Grégoire
- Medical Affairs, Héma-Québec, Montréal, Québec, Canada
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76
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Cable RG, Brambilla D, Glynn SA, Kleinman S, Mast AE, Spencer BR, Stone M, Kiss JE. Effect of iron supplementation on iron stores and total body iron after whole blood donation. Transfusion 2016; 56:2005-12. [PMID: 27232535 PMCID: PMC4980154 DOI: 10.1111/trf.13659] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/12/2016] [Accepted: 04/16/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Understanding the effect of blood donation and iron supplementation on iron balance will inform strategies to manage donor iron status. STUDY DESIGN AND METHODS A total of 215 donors were randomized to receive ferrous gluconate daily (37.5 mg iron) or no iron for 24 weeks after blood donation. Iron stores were assessed using ferritin and soluble transferrin receptor. Hemoglobin (Hb) iron was calculated from total body Hb. Total body iron (TBI) was estimated by summing iron stores and Hb iron. RESULTS At 24 weeks, TBI in donors taking iron increased by 281.0 mg (95% confidence interval [CI], 223.4-338.6 mg) compared to before donation, while TBI in donors not on iron decreased by 74.1 mg (95% CI, -112.3 to -35.9; p < 0.0001, iron vs. no iron). TBI increased rapidly after blood donation with iron supplementation, especially in iron-depleted donors. Supplementation increased TBI compared to controls during the first 8 weeks after donation: 367.8 mg (95% CI, 293.5-442.1) versus -24.1 mg (95% CI, -82.5 to 34.3) for donors with a baseline ferritin level of not more than 26 ng/mL and 167.8 mg (95% CI, 116.5-219.2) versus -68.1 mg (95% CI, -136.7 to 0.5) for donors with a baseline ferritin level of more than 26 ng/mL. A total of 88% of the benefit of iron supplementation occurred during the first 8 weeks after blood donation. CONCLUSION Donors on iron supplementation replaced donated iron while donors not on iron did not. Eight weeks of iron supplementation provided nearly all of the measured improvement in TBI. Daily iron supplementation after blood donation allows blood donors to recover the iron loss from blood donation and prevents sustained iron deficiency.
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Affiliation(s)
| | | | - Simone A Glynn
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Steven Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Alan E Mast
- BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | | | - Mars Stone
- Blood Systems Research Institute, San Francisco, California
| | - Joseph E Kiss
- Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
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77
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Spencer BR, Johnson B, Wright DJ, Kleinman S, Glynn SA, Cable RG. Potential impact on blood availability and donor iron status of changes to donor hemoglobin cutoff and interdonation intervals. Transfusion 2016; 56:1994-2004. [PMID: 27237451 PMCID: PMC4980222 DOI: 10.1111/trf.13663] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/07/2016] [Accepted: 04/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND A minimum male hemoglobin (Hb) level of 13.0 g/dL becomes a Food and Drug Administration requirement effective May 2016. In addition, extending whole blood (WB) interdonation intervals (IDIs) beyond 8 weeks has been considered to reduce iron depletion in repeat blood donors. This study estimates the impact these changes might have on blood availability and donor iron status. STUDY DESIGN AND METHODS Six blood centers participating in Retrovirus Epidemiology Donor Study-II (REDS-II) collected information on all donation visits from 2006 to 2009. Simulations were developed from these data using a multistage approach that first sought to adequately reproduce the patterns of donor return, Hb and ferritin levels, and outcomes of a donor's visit (successful single- or double-red blood cell donation, deferral for low Hb) observed in REDS-II data sets. Modified simulations were used to predict the potential impact on the blood supply and donor iron status under different Hb cutoff and IDI qualification criteria. RESULTS More than 10% of WB donations might require replacement under many simulated scenarios. Longer IDIs would reduce the proportion of donors with iron depletion, but 80% of these donors may remain iron-depleted if minimal IDIs increased to 12 or 16 weeks. CONCLUSION Higher Hb cutoffs and longer IDIs are predicted to have a potentially large impact on collections but only a modest impact on donor iron depletion. Efforts to address iron depletion should be targeted to at-risk donors, such as iron supplementation programs for frequent donors, and policy makers should try to avoid broadly restrictive donation requirements that could substantially reduce blood availability.
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Affiliation(s)
- Bryan R. Spencer
- American Red Cross Blood Services, Massachusetts Region, Dedham, MA
| | | | | | | | | | - Ritchard G. Cable
- American Red Cross Blood Services, Connecticut Region, Farmington, CT
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78
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Duggan F, O'Sullivan K, Power JP, Healy M, Murphy WG. Serum ferritin in plateletpheresis and whole blood donors. Transfus Apher Sci 2016; 55:159-63. [PMID: 27339300 DOI: 10.1016/j.transci.2016.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/06/2016] [Accepted: 06/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES We performed a prospective analysis of iron status in plateletpheresis donors, using whole blood donors as a control group, to assess the haematinic effects of regular anti-coagulated extracorporeal circulation and platelet collection. MATERIALS AND METHODS Ferritin levels were measured in samples from 31 regular male plateletpheresis donors and from 14 first time male whole blood donors, immediately before and immediately after donation, and immediately before the next donation. An additional 33 regular male plateletpheresis donors and 17 first time male whole blood donors had serum ferritin levels checked predonation. RESULTS Male plateletpheresis donors had a statistically significant fall in serum ferritin after donation (P = 0.005)*. In addition, male platelet donors had significantly lower serum ferritin levels than first time male blood donors: ferritin <20 µg/L was found in 6/64 (9%) of regular platelet donors and 1/31 (3%) of first time blood donors (P < 0.001)*. DISCUSSION Our studies support the value of serum ferritin measurement in apheresis donor management.
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Affiliation(s)
- Frances Duggan
- Irish Blood Transfusion Service, Munster Regional Transfusion Centre, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | | | - Joan P Power
- Irish Blood Transfusion Service, Munster Regional Transfusion Centre, St. Finbarr's Hospital, Douglas Road, Cork, Ireland; School of Medicine, University College Cork, College Road, Cork, Ireland
| | - Michael Healy
- Dept. of Biological Sciences, Cork Institute of Technology, Rossa Avenue, Bishopstown, Cork, Ireland
| | - William G Murphy
- Irish Blood Transfusion Service, National Blood Centre, James's Street, Dublin 8, Ireland; School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
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79
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Foy DS, Friedrichs KR, Bach JF. Evaluation of Iron Deficiency Using Reticulocyte Indices in Dogs Enrolled in a Blood Donor Program. J Vet Intern Med 2016; 29:1376-80. [PMID: 26340143 PMCID: PMC4858052 DOI: 10.1111/jvim.13598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 05/07/2015] [Accepted: 07/21/2015] [Indexed: 11/28/2022] Open
Abstract
Background People donating blood more than twice annually are at risk of developing iron deficiency. Little is known about the iron status of dogs enrolled in blood donor programs. Hypothesis Dogs donating blood ≥6 times annually will show evidence of iron deficiency based on their reticulocyte indices. Animals Thirteen dogs enrolled in a blood donor program donating ≥6 times over the preceding 12 months and 20 healthy nondonor control dogs. Methods Prospective observational study. Mature red blood cell (RBC) indices, reticulocyte indices, serum iron, serum ferritin, and total iron‐binding capacity (TIBC) were compared between groups. Results Packed cell volume (median 47%, range 40–52%, P < .01), hematocrit (median 46.4%, range 40.3–52.5%, P < .01), and reticulocyte count (median 16,000/μL, range 9,000–38,000/μL, P < .01) were significantly lower in the blood donor dogs. No statistically significant differences were noted in the mature RBC indices between groups. Both reticulocyte mean corpuscular volume (median 88.8 fL, range 83.4–95.5 fL, P = .03) and reticulocyte hemoglobin content (median 24.6 pg, range 23.1–26.6 pg, P < .01) were significantly lower in the blood donor group. Serum iron and ferritin were similar between groups; however, TIBC was significantly higher in the control group (median 403 μg/dL, range 225–493 μg/dL, P = .02). Conclusions The findings in dogs donating ≥6 times annually suggest the presence of iron‐deficient erythropoiesis in this population.
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Affiliation(s)
- D S Foy
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI
| | - K R Friedrichs
- Deptartment of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI
| | - J F Bach
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI
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80
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Li H, Condon F, Kessler D, Nandi V, Rebosa M, Westerman M, Shaz BH, Ginzburg Y. Evidence of relative iron deficiency in platelet- and plasma-pheresis donors correlates with donation frequency. J Clin Apher 2016; 31:551-558. [PMID: 26915437 DOI: 10.1002/jca.21448] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 01/06/2016] [Accepted: 01/11/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The loss of iron stores and resulting iron deficiency is well documented in whole blood or red blood cell donors. We hypothesized that relative iron deficiency also occurs as a result of more frequent platelet- and plasma-pheresis (apheresis) donation. MATERIALS AND METHODS To test this hypothesis, we proposed a pilot cross-sectional study to analyze erythropoiesis- and iron-related parameters in white male apheresis donors: (1) relative to controls, (2) in correlation with apheresis donation frequency, and (3) in correlation with pre-donation platelet count. RESULTS Fifty eligible apheresis donors and eight controls were enrolled in the study. Apheresis donors were found to have a lower serum ferritin and serum hepcidin and exhibited evidence of iron restricted erythropoiesis relative to controls. Furthermore, among donors, lower MCV, CHr , hepcidin concentration, and serum ferritin were observed in more frequent apheresis donors. Correlations between donation frequency and hepcidin and ferritin were noted in apheresis donors. CONCLUSIONS This pilot study demonstrates that apheresis donors are relatively iron deficient compared to controls and supports the premise that frequent apheresis donation correlates with relatively iron restricted erythropoiesis. An analysis of iron- and erythropoiesis-related parameters in a broader population of frequent apheresis donors (i.e., female and non-white donors) may demonstrate larger deficits and an even greater potential benefit of iron replacement. J. Clin. Apheresis 31:551-558, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Huihui Li
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Frances Condon
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Debra Kessler
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Vijay Nandi
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Mark Rebosa
- Blood Operations, New York Blood Center, New York, New York
| | | | - Beth H Shaz
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Yelena Ginzburg
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
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81
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Mast AE, Bialkowski W, Bryant BJ, Wright DJ, Birch R, Kiss JE, D'Andrea P, Cable RG, Spencer BR. A randomized, blinded, placebo-controlled trial of education and iron supplementation for mitigation of iron deficiency in regular blood donors. Transfusion 2016; 56:1588-97. [PMID: 26813849 DOI: 10.1111/trf.13469] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/04/2015] [Accepted: 11/06/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The historical approach of offering dietary advice to donors with low hemoglobin (Hb) is ineffective for preventing iron deficiency in frequent donors. Alternative approaches to maintaining donor iron status were explored. STUDY DESIGN AND METHODS Frequent blood donors were randomly assigned into five arms for 2 years of follow-up. Three double-blinded arms provided 60 once-daily pills after each donation (38, 19, or 0 mg of iron). Two single-blinded arms provided iron status (ferritin) or no information letters after each donation. Ferritin, soluble transferrin receptor, and complete blood count were measured at each donation. RESULTS There were 692 subjects enrolled and 393 completed the study. Subjects in pill groups deenrolled more than those in letter groups (39% vs. 7%). Adverse events occurred equally in subjects receiving iron or placebo pills. Of those completing the study, the prevalence of ferritin of less than 12 or less than 26 ng/mL declined by more than 50% and was statistically indistinguishable in the three intervention groups (19 or 38 mg of iron; iron status letter). Longitudinal analyses of all subjects showed improved iron status in iron pill groups and worsening iron status in control groups (placebo; no information letter). The iron pill groups experienced a net increase of approximately 0.6 g/dL Hb compared to control groups. The iron status letter group had little change in Hb. CONCLUSION Providing 19 or 38 mg of daily iron or iron status information were effective and mostly equivalent interventions for mitigating iron deficiency in regular donors when compared at the end of the 2-year longitudinal phase of the study. Donors without intervention had worsened iron deficiency with continued donation.
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Affiliation(s)
- Alan E Mast
- Blood Research and Medical Sciences Institutes, BloodCenter of Wisconsin.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Walter Bialkowski
- Blood Research and Medical Sciences Institutes, BloodCenter of Wisconsin
| | - Barbara J Bryant
- Blood Research and Medical Sciences Institutes, BloodCenter of Wisconsin
| | | | | | - Joseph E Kiss
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | - Pam D'Andrea
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | - Ritchard G Cable
- New England Region, American Red Cross Blood Services, Dedham, Massachusetts
| | - Bryan R Spencer
- New England Region, American Red Cross Blood Services, Dedham, Massachusetts
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82
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Sørensen E, Rigas AS, Thørner LW, Burgdorf KS, Pedersen OB, Petersen MS, Hjalgrim H, Erikstrup C, Ullum H. Genetic factors influencing ferritin levels in 14,126 blood donors: results from the Danish Blood Donor Study. Transfusion 2015; 56:622-7. [DOI: 10.1111/trf.13397] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Erik Sørensen
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | - Andreas S. Rigas
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | - Lise W. Thørner
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | | | - Ole B. Pedersen
- Department of Clinical Immunology; Naestved Hospital; Naestved Denmark
| | - Mikkel S. Petersen
- Department of Clinical Immunology; Aarhus University Hospital; Aarhus Denmark
| | - Henrik Hjalgrim
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology; Aarhus University Hospital; Aarhus Denmark
| | - Henrik Ullum
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
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83
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Nasserinejad K, van Rosmalen J, de Kort W, Rizopoulos D, Lesaffre E. Prediction of hemoglobin in blood donors using a latent class mixed-effects transition model. Stat Med 2015; 35:581-94. [PMID: 26467774 DOI: 10.1002/sim.6759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/26/2015] [Accepted: 09/24/2015] [Indexed: 11/10/2022]
Abstract
Blood donors experience a temporary reduction in their hemoglobin (Hb) value after donation. At each visit, the Hb value is measured, and a too low Hb value leads to a deferral for donation. Because of the recovery process after each donation as well as state dependence and unobserved heterogeneity, longitudinal data of Hb values of blood donors provide unique statistical challenges. To estimate the shape and duration of the recovery process and to predict future Hb values, we employed three models for the Hb value: (i) a mixed-effects models; (ii) a latent-class mixed-effects model; and (iii) a latent-class mixed-effects transition model. In each model, a flexible function was used to model the recovery process after donation. The latent classes identify groups of donors with fast or slow recovery times and donors whose recovery time increases with the number of donations. The transition effect accounts for possible state dependence in the observed data. All models were estimated in a Bayesian way, using data of new entrant donors from the Donor InSight study. Informative priors were used for parameters of the recovery process that were not identified using the observed data, based on results from the clinical literature. The results show that the latent-class mixed-effects transition model fits the data best, which illustrates the importance of modeling state dependence, unobserved heterogeneity, and the recovery process after donation. The estimated recovery time is much longer than the current minimum interval between donations, suggesting that an increase of this interval may be warranted.
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Affiliation(s)
| | | | - Wim de Kort
- Department of Donor Studies, Sanquin Research, Amsterdam, the Netherlands.,Department of Public Health, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Emmanuel Lesaffre
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands.,L-Biostat, KU Leuven, Leuven, Belgium
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84
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Waldvogel S, Rochat B, Peduzzi D, Vaucher P, Tissot JD, Favrat B. Effects of oral supplementation of iron on hepcidin blood concentrations among non-anaemic female blood donors: a randomized controlled trial. Vox Sang 2015; 110:166-71. [DOI: 10.1111/vox.12348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 01/01/2023]
Affiliation(s)
- S. Waldvogel
- Division of Hematology; University Hospital of Geneva; Geneva Switzerland
| | - B. Rochat
- Quantitative Mass Spectrometry Facility; University Hospital of Lausanne; Lausanne Switzerland
| | - D. Peduzzi
- Quantitative Mass Spectrometry Facility; University Hospital of Lausanne; Lausanne Switzerland
| | - P. Vaucher
- University Center of Legal Medicine Lausanne-Geneva; University Hospital of Lausanne (CHUV); Lausanne Switzerland
| | - J.-D. Tissot
- Blood Transfusion Service of the Swiss Red Cross; Lausanne Switzerland
| | - B. Favrat
- University Center of Legal Medicine Lausanne-Geneva; University Hospital of Lausanne (CHUV); Lausanne Switzerland
- Department of Ambulatory Care and Community Medicine; University Hospital of Lausanne; Lausanne Switzerland
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85
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Moiz B, Salman M, Anwar M. Frequent anemic blood donors: What should we do? Transfus Apher Sci 2015; 53:393-5. [PMID: 26297189 DOI: 10.1016/j.transci.2015.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 07/06/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Bushra Moiz
- Section of Hematology, Pathology and Laboratory Medicine, The Aga Khan University, Stadium Road, Karachi 74800, Pakistan.
| | - Muhammad Salman
- Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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86
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Aardal Eriksson E, Mobäck C, Jakobsson S, Hoffmann JJ. Iron depletion in blood donors – Have extended erythrocyte and reticulocyte parameters diagnostic utility? Transfus Apher Sci 2015; 53:76-81. [DOI: 10.1016/j.transci.2015.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
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87
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Affiliation(s)
- M. Goldman
- Donor & Clinical Services; Canadian Blood Services; Ottawa ON Canada
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88
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Rigas AS, Pedersen OB, Sørensen CJ, Sørensen E, Kotzé SR, Petersen MS, Thørner LW, Hjalgrim H, Erikstrup C, Ullum H. No association between iron status and self-reported health-related quality of life in 16,375 Danish blood donors: results from the Danish Blood Donor Study. Transfusion 2015; 55:1752-6. [DOI: 10.1111/trf.13085] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 11/12/2014] [Accepted: 12/10/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Andreas S. Rigas
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | - Ole B. Pedersen
- Department of Clinical Immunology; Naestved Hospital; Naestved Denmark
| | - Cecilie J. Sørensen
- Department of Clinical Immunology; Aarhus University Hospital; Aarhus Denmark
| | - Erik Sørensen
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | - Sebastian R. Kotzé
- Department of Clinical Immunology; Aarhus University Hospital; Aarhus Denmark
| | - Mikkel S. Petersen
- Department of Clinical Immunology; Aarhus University Hospital; Aarhus Denmark
| | - Lise W. Thørner
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | - Henrik Hjalgrim
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology; Aarhus University Hospital; Aarhus Denmark
| | - Henrik Ullum
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
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89
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Nasserinejad K, van Rosmalen J, van den Hurk K, Baart M, Hoekstra T, Rizopoulos D, Lesaffre E, de Kort W. Prevalence and determinants of declining versus stable hemoglobin levels in whole blood donors. Transfusion 2015; 55:1955-63. [DOI: 10.1111/trf.13066] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/01/2015] [Accepted: 02/01/2015] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Katja van den Hurk
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
| | - Mireille Baart
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
| | - Trynke Hoekstra
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research; VU University Medical Center; Amsterdam the Netherlands
- Department of Health Sciences; Faculty of Earth and Life Sciences; VU University; Amsterdam the Netherlands
| | | | - Emmanuel Lesaffre
- Department of Biostatistics; Erasmus MC; Rotterdam the Netherlands
- L-Biostat; KU Leuven; Leuven Belgium
| | - Wim de Kort
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
- Department of Public Health; Academic Medical Center; Amsterdam the Netherlands
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90
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Abstract
More than 9 million individuals donate blood annually in the United States. Between 200 and 250 mg of iron is removed with each whole blood donation, reflecting losses from the hemoglobin in red blood cells. Replenishment of iron stores takes many months, leading to a high rate of iron depletion. In an effort to better identify and prevent iron deficiency, blood collection centers are now considering various strategies to manage donor iron loss. This article highlights laboratory and genetic tests to assess the iron status of blood donors and their applicability as screening tests for blood donation.
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Affiliation(s)
- Joseph E Kiss
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, and The Institute for Transfusion Medicine, 3636 Boulevard of The Allies, Pittsburgh, Pittsburgh, PA 15213, USA.
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91
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Kiss JE, Brambilla D, Glynn SA, Mast AE, Spencer BR, Stone M, Kleinman SH, Cable RG. Oral iron supplementation after blood donation: a randomized clinical trial. JAMA 2015; 313:575-83. [PMID: 25668261 PMCID: PMC5094173 DOI: 10.1001/jama.2015.119] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although blood donation is allowed every 8 weeks in the United States, recovery of hemoglobin to the currently accepted standard (12.5 g/dL) is frequently delayed, and some donors become anemic. OBJECTIVE To determine the effect of oral iron supplementation on hemoglobin recovery time (days to recovery of 80% of hemoglobin removed) and recovery of iron stores in iron-depleted ("low ferritin," ≤26 ng/mL) and iron-replete ("higher ferritin," >26 ng/mL) blood donors. DESIGN, SETTING, AND PARTICIPANTS Randomized, nonblinded clinical trial of blood donors stratified by ferritin level, sex, and age conducted in 4 regional blood centers in the United States in 2012. Included were 215 eligible participants aged 18 to 79 years who had not donated whole blood or red blood cells within 4 months. INTERVENTIONS One tablet of ferrous gluconate (37.5 mg of elemental iron) daily or no iron for 24 weeks (168 days) after donating a unit of whole blood (500 mL). MAIN OUTCOMES AND MEASURES Time to recovery of 80% of the postdonation decrease in hemoglobin and recovery of ferritin level to baseline as a measure of iron stores. RESULTS The mean baseline hemoglobin levels were comparable in the iron and no-iron groups and declined from a mean (SD) of 13.4 (1.1) g/dL to 12.0 (1.2) g/dL after donation in the low-ferritin group and from 14.2 (1.1) g/dL to 12.9 (1.2) g/dL in the higher-ferritin group. Compared with participants who did not receive iron supplementation, those who received iron supplementation had shortened time to 80% hemoglobin recovery in both the low-ferritin (mean, 32 days, interquartile range [IQR], 30-34, vs 158 days, IQR, 126->168) and higher-ferritin groups (31 days, IQR, 29-33, vs 78 days, IQR, 66-95). Median time to recovery to baseline ferritin levels in the low-ferritin group taking iron was 21 days (IQR, 12-84). For participants not taking iron, recovery to baseline was longer than 168 days (IQR, 128->168). Median time to recovery to baseline in the higher-ferritin group taking iron was 107 days (IQR, 75-141), and for participants not taking iron, recovery to baseline was longer than 168 days (IQR, >168->168). Recovery of iron stores in all participants who received supplements took a median of 76 days (IQR, 20-126); for participants not taking iron, median recovery time was longer than 168 days (IQR, 147->168 days; P < .001). Without iron supplements, 67% of participants did not recover iron stores by 168 days. CONCLUSIONS AND RELEVANCE Among blood donors with normal hemoglobin levels, low-dose iron supplementation, compared with no supplementation, reduced time to 80% recovery of the postdonation decrease in hemoglobin concentration in donors with low ferritin (≤26 ng/mL) or higher ferritin (>26 ng/mL). TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01555060.
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Affiliation(s)
- Joseph E Kiss
- Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | | | - Simone A Glynn
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | | | - Mars Stone
- Blood Systems Research Institute, San Francisco, California
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92
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Ferreira RRF, Gopegui RR, Araujo MMRC, de Matos AJF. Effects of repeated blood donations on iron status and hematologic variables of canine blood donors. J Am Vet Med Assoc 2015; 244:1298-303. [PMID: 24846430 DOI: 10.2460/javma.244.11.1298] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the bone marrow regenerative response and iron status of canine blood donors subjected to repeated blood collections for 1 year. DESIGN Prospective cohort study. ANIMALS 57 blood donor dogs. PROCEDURES Hematologic variables, including reticulocyte percentage, were evaluated before and 10 days after each blood collection in 16 dogs donating 13% of total blood volume (TBV) every 2 months (group 1), 16 dogs donating 13% of TBV every 3 months (group 2), and 25 dogs donating 15% of TBV every 3 months (group 3) for 1 year. Serum concentrations of iron, transferrin, and ferritin were analyzed before inclusion in the study and 10 days after the last donation. RESULTS Significant increases in RBC distribution width, platelet count, WBC count, and reticulocyte percentage were detected after blood donation in all groups. Dogs of group 2 had a significantly higher serum ferritin concentration than did dogs of group 1; dogs of group 1 had a significant decrease in serum ferritin concentration. A positive correlation between the number of blood donations and both RBC distribution width and reticulocyte percentage was found for all groups. CONCLUSIONS AND CLINICAL RELEVANCE All blood donation regimens induced a bone marrow regenerative response, which was able to restore depleted blood cells within 10 days after blood donation while maintaining iron status within the calculated reference range. However, dogs donating 13% of TBV every 2 months had a significant decrease in iron stores, which suggested that iron-related variables must be monitored during prolonged blood donor programs.
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Affiliation(s)
- Rui R F Ferreira
- Department of Veterinary Clinics, Institute for Biomedical Sciences of Abel Salazar, University of Porto, 4050-313 Porto, Portugal
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93
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Camaschella C. Iron deficiency: new insights into diagnosis and treatment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:8-13. [PMID: 26637694 DOI: 10.1182/asheducation-2015.1.8] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Iron deficiency and iron deficiency anemia are common conditions worldwide affecting especially children and young women. In developing countries, iron deficiency is caused by poor iron intake and/or parasitic infection, whereas vegetarian dietary choices, poor iron absorption, and chronic blood loss are common causes in high-income countries. Erythropoiesis stimulating agents can result in functional iron deficiency for erythropoiesis even when stores are iron-replete. Diagnosis of iron deficiency is straightforward, except when it occurs in the context of inflammatory disorders. Oral iron salts correct absolute iron deficiency in most patients, because low hepcidin levels facilitate iron absorption. Unfortunately frequent side effects limit oral iron efficacy. Intravenous iron is increasingly utilized, because currently available preparations allow rapid normalization of total body iron even with a single infusion and are effective also in functional iron deficiency and in iron deficiency associated with inflammatory disorders. The evidence is accumulating that these preparations are safe and effective. However, long-term safety issues of high doses of iron need to be further explored.
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Affiliation(s)
- Clara Camaschella
- Vita Salute University, San Raffaele Scientific Institute, Milan, Italy
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94
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Bialkowski W, Bryant BJ, Schlumpf KS, Wright DJ, Birch R, Kiss JE, D'Andrea P, Cable RG, Spencer BR, Vij V, Mast AE. The strategies to reduce iron deficiency in blood donors randomized trial: design, enrolment and early retention. Vox Sang 2014; 108:178-85. [PMID: 25469720 DOI: 10.1111/vox.12210] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/08/2014] [Accepted: 09/16/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Repeated blood donation produces iron deficiency. Changes in dietary iron intake do not prevent donation-induced iron deficiency. Prolonging the interdonation interval or using oral iron supplements can mitigate donation-induced iron deficiency. The most effective operational methods for reducing iron deficiency in donors are unknown. MATERIALS AND METHODS 'Strategies To Reduce Iron Deficiency' (STRIDE) was a two-year, randomized, placebo-controlled study in blood donors. 692 donors were randomized into one of two educational groups or one of three interventional groups. Donors randomized to educational groups either received letters thanking them for donating, or, suggesting iron supplements or delayed donation if they had low ferritin. Donors randomized to interventional groups either received placebo, 19-mg or 38-mg iron pills. RESULTS Iron deficient erythropoiesis was present in 52·7% of males and 74·6% of females at enrolment. Adverse events within 60 days of enrolment were primarily mild gastrointestinal symptoms (64%). The incidence of de-enrolment within 60 days was more common in the interventional groups than in the educational groups (P = 0·002), but not more common in those receiving iron than placebo (P = 0·68). CONCLUSION The prevalence of iron deficient erythropoiesis in donors enrolled in the STRIDE study is comparable to previously described cohorts of regular blood donors. De-enrolment within 60 days was higher for donors receiving tablets, although no more common in donors receiving iron than placebo.
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Affiliation(s)
- W Bialkowski
- Blood Research and Medical Sciences Institutes, BloodCenter of Wisconsin, Milwaukee, WI, USA
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95
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Ngoma AM, Goto A, Nollet KE, Sawamura Y, Ohto H, Yasumura S. Blood Donor Deferral among Students in Northern Japan: Challenges Ahead. Transfus Med Hemother 2014; 41:251-6. [PMID: 25254020 PMCID: PMC4164101 DOI: 10.1159/000365406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/29/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As Japan's aging society needs more blood, young students comprise a progressively smaller portion of the donor pool. To ensure a safe and sustainable blood supply, it is crucial to select suitable donors. This study aims to evaluate donor deferral rates, causes of deferral, and characteristics of deferred Japanese students. METHODS Computerized records of blood centers in northern Japan (Miyagi and Fukushima Prefectures) from March 2010 through March 2011 were retrospectively analyzed. RESULTS Among 231,361 individuals visiting during the 12-month period, 24,778 were students. Of these, 19,193 (77%) attempted donation, and 5,585 (23%) were deferred. Low hemoglobin, questionnaire-based interview decisions, and medication were the main reasons for temporary deferral. Age, sex, and blood center location were associated with low hemoglobin; donation history and blood center location were associated with medication-based deferral. The odds ratio among female students deferred for low hemoglobin was 35.48 with a 95% CI of 27.74-45.38. CONCLUSIONS These results suggest that continued efforts are needed to motivate deferred potential donors to return, to prevent low hemoglobin especially among females, and to review medical interview decisions, while paying close attention to regional differences.
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Affiliation(s)
| | - Aya Goto
- Department of Public Health, Fukushima, Japan
| | - Kenneth E. Nollet
- Department of Blood Transfusion and Transplantation Immunology, Fukushima, Japan
- Department of International Cooperation, Radiation Medical Science Center, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshihiro Sawamura
- Department of Blood Transfusion and Transplantation Immunology, Fukushima, Japan
- Japanese Red Cross, Miyagi Blood Center, Sendai, Japan
| | - Hitoshi Ohto
- Department of Blood Transfusion and Transplantation Immunology, Fukushima, Japan
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96
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Sayers M, Centilli J. Concerning iron balance in blood donors. Transfusion 2014; 54:3010-3. [PMID: 24894150 DOI: 10.1111/trf.12709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/27/2014] [Accepted: 03/28/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Merlyn Sayers
- Carter BloodCare, Bedford, Texas; University of Texas Southwestern Medical Center, Dallas, Texas
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97
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Salvin HE, Pasricha SR, Marks DC, Speedy J. Iron deficiency in blood donors: a national cross-sectional study. Transfusion 2014; 54:2434-44. [PMID: 24738792 DOI: 10.1111/trf.12647] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Iron deficiency (ID) is an important consequence of blood donation. The epidemiology of this problem in the blood donor population was therefore studied to enable appropriate targeting of potential solutions to donor ID. STUDY DESIGN AND METHODS A nationally representative, cluster-based cross-sectional study of Australian blood donors was performed. Donors were eligible for inclusion if they fulfilled criteria for blood donation or were deferred due to low or falling hemoglobin. Ferritin was measured and demographic and donation data were collected. RESULTS A total of 3094 blood donors were recruited, of which samples were collected from 3049 donors; 1873 had exclusively donated whole blood (WB only), 242 had exclusively made apheresis donations, and 530 had not donated ("new" donors) in the previous 24 months. The prevalence of ID in new female donors was 12.0% compared with 1.3% in males. The prevalence of ID in female WB-only donors was 26.4%; it increased with donation frequency and decreased with age. The prevalence in male WB-only donors was 6.3% with no evident change with age or donation frequency. The prevalence of ID in apheresis-only donors (females 6.3%; males 2.2%) did not significantly exceed that of new donors nor did it change with donation frequency. Importantly, the risk of ID could not be satisfactorily predicted in an individual donor by his or her anemia status or with predictive modeling incorporating demographic and donation data. CONCLUSION ID is especially prevalent in female, premenopausal, frequent WB donors. Strategies to combat ID should be implemented, specifically targeting this group.
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Affiliation(s)
- Hannah E Salvin
- Iron Taskforce, The Australian Red Cross Blood Service, Adelaide, SA, Australia
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98
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Abstract
PURPOSE OF REVIEW This review examines the recent research on the prevalence, determinants and importance of low iron in blood donors, and on the efforts to reduce or prevent iron depletion in donor populations. RECENT FINDINGS Female donors, especially younger women, are at highest risk for donation-induced low iron, but menopausal women and high-frequency donors of both sexes also face considerable risk for iron depletion. Predonation screening for hemoglobin contributes little information on donor iron status. Consumption of supplemental iron is helpful in preventing or reversing low iron, and waiting longer between donations also facilitates the recovery of the iron lost through donation. SUMMARY Although the impact of phlebotomy-related iron depletion on donor health requires better documentation, measures are available now that can be deployed on a targeted or standardized basis. Blood centers, regulators, and donors should continue to evaluate different approaches for addressing this problem, with the likely outcome that no single measure is optimal for maintaining adequate collections while safeguarding donor health.
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99
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Madrona DP, Herrera MDF, Jiménez DP, Giraldo SG, Campos RR. Women as whole blood donors: offers, donations and deferrals in the province of Huelva, south-western Spain. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 12 Suppl 1:s11-s20. [PMID: 23245721 PMCID: PMC3934236 DOI: 10.2450/2012.0117-12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 09/12/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Women seem more willing to donate blood than men despite the limitations that affect their donation rate. The aim of our study was to determine the role of women in altruistic donation of blood in Huelva, a province in south-western Spain. MATERIALS AND METHODS We registered 87,601 offers to donate whole blood between January 1st, 2005 and December 31st, 2009. We statistically analysed variables such as sex, age, offers, deferrals and donations, problems in venous access, vasovagal reactions, weight and blood pressure to establish their significance according to donor gender. RESULTS With regards to gender, 52.3% of donors were women and 47.7% men. Of the 87,601 offers to donate blood, 46.5% were from females and 53.5% from males. More females than males made their first donation during the study period. However, 43.9 % of donations were from women, whereas 56.1% were from men. Overall 8.7% of offers were deferred, 62.7% of which due to a low haemoglobin concentration, which was the most frequent cause of deferral in women. Difficulties in venous access and vasovagal reactions were also more frequent in female donors than in male donors. By the end of the study period, donor fidelity was 58.6% for men and 48.6% for women. DISCUSSION In the province of Huelva, women are more altruistically inclined than men to give blood, with the percentages of donors and first-time donors being higher among females. However, there are restrictions to women giving blood, especially low haemoglobin concentration, which reduce the number of female blood donations. Women also have more difficulty when blood is withdrawn and are more susceptible to vasovagal reactions, which negatively affect their experience as donors. Measures should be taken to reduce these barriers to encourage women to continue to offer to donate blood, thereby ensuring that they become regular donors, which is a key factor in guaranteeing an adequate supply of blood within the region of Andalusia.
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Affiliation(s)
- Dalmiro Prados Madrona
- Correspondence: Dalmiro Prados Madrona, Finca Santa Catalina, 9, 21110 Aljaraque, Spain, e-mail:
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100
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Rigas AS, Sørensen CJ, Pedersen OB, Petersen MS, Thørner LW, Kotzé S, Sørensen E, Magnussen K, Rostgaard K, Erikstrup C, Ullum H. Predictors of iron levels in 14,737 Danish blood donors: results from the Danish Blood Donor Study. Transfusion 2013; 54:789-96. [PMID: 24372094 PMCID: PMC4209803 DOI: 10.1111/trf.12518] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/07/2013] [Accepted: 09/07/2013] [Indexed: 12/13/2022]
Abstract
Background Dietary studies show a relationship between the intake of iron enhancers and inhibitors and iron stores in the general population. However, the impact of dietary factors on the iron stores of blood donors, whose iron status is affected by blood donations, is incompletely understood. Study Design and Methods In the Danish Blood Donor Study, we assessed the effect of blood donation frequency, physiologic factors, lifestyle and supplemental factors, and dietary factors on ferritin levels. We used multiple linear and logistic regression analyses stratified by sex and menopausal status. Results Among high-frequency donors (more than nine donations in the past 3 years), we found iron deficiency (ferritin below 15 ng/mL) in 9, 39, and 22% of men, premenopausal women, and postmenopausal women, respectively. The strongest predictors of iron deficiency were sex, menopausal status, the number of blood donations in a 3-year period, and the time since last donation. Other significant factors included weight, age, intensity of menstruation, iron tablets, vitamin pills, and consumption of meat and wine. Conclusion The study confirms iron deficiency as an important problem, especially among menstruating women donating frequently. The risk of iron depletion was largely explained by sex, menopausal status, and donation frequency. Other factors, including dietary and supplemental iron intake, had a much weaker effect on the risk of iron depletion.
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