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Petersen P, Hakimjavadi H, Chamala S, Mathur G. Evaluating utility of routine ferritin testing in blood donors: A hospital-based blood donor centre experience. Transfus Med 2024. [PMID: 39183386 DOI: 10.1111/tme.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/30/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND AND OBJECTIVES Iron deficiency (ID) poses a prevalent concern among blood donors, especially impacting young donors, premenopausal females and frequent donors. In alignment with recommendations to address ID, routine ferritin testing was implemented in a hospital-based donor centre. MATERIALS AND METHODS Data set, encompassing 26 164 ferritin values from 16 464 blood donors over 33 months, were analysed retrospectively. Ferritin levels were assessed concerning donor characteristics such as sex, age, ethnicity and donation frequency. RESULTS Ferritin testing revealed age, sex and ethnicity variations, emphasising the heightened risk of ID in young females meeting all donation criteria under 23 year of age who demonstrated the lowest mean baseline ferritin (41% [CI: 34%-48%] < 26 ng/mL; 20% [CI: 14%-25%] < 15 ng/mL). Postmenopausal females exhibited ferritin levels similar to similarly aged males. Irrespective of sex, donors showcased mean ferritin recovery within 6 months. Analysis of ferritin recovery post-donation showed a five-fold increase in risk (compared with first visit) of ID when donors return at a 2-month interval. 'Regular' donors (≥10 visits) approach a median steady ferritin level (~30-35 ng/mL) by the sixth visit. CONCLUSION As reliance on regular blood donors increases, donation policies must strike a balance between blood centre resources and the risks posed to both regular and at-risk donors. Frequent blood donation led to donors attaining a mean steady state ferritin level above the threshold for ID. At-risk groups, particularly premenopausal females, were several times more likely to experience ID after donation but demonstrated recovery rates similar to their group's baseline levels. This valuable information informed the development of new donor deferral policies.
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Affiliation(s)
- Philip Petersen
- Department of Pathology, University of Southern California, Los Angeles, California, USA
| | - Hesamedin Hakimjavadi
- Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Srikar Chamala
- Department of Pathology, University of Southern California, Los Angeles, California, USA
- Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Gagan Mathur
- Department of Pathology, University of Southern California, Los Angeles, California, USA
- Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
- University of California Irvine, School of Medicine, Irvine, California, USA
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2
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Wachsmuth NB, Haupt S, Bauer P, Schierbauer JR, Treff G, Steinacker JM, Rilstone S, Schmidt WFJ. Impact of a single blood donation on hemoglobin mass, iron stores, and maximum oxygen uptake in pre-menopausal women-A pilot study. Transfusion 2024; 64:1481-1491. [PMID: 38884363 DOI: 10.1111/trf.17917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/24/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND During whole blood donation (BD), 500 mL of blood is drawn. The time interval between two BDs is at least 8-12 weeks. This period might be insufficient for restoring hemoglobin mass (Hbmass) and iron especially in women, who generally have lower Hbmass and iron availability. Since both variables influence physical performance, this pilot study aimed to monitor Hbmass, iron status, and maximum oxygen uptake (V̇O2max) recovery in women after a single BD. STUDY DESIGN AND METHODS In 10 women (24.7 ± 1.7 years), Hbmass, hemoglobin concentration [Hb], iron status, and V̇O2max were assessed before and up to 12 weeks after a single BD. RESULTS BD reduced Hbmass from 562 ± 70 g to 499 ± 64 g (p < .001). Although after 8 weeks no significant mean difference was detected, 7 women had not returned to baseline after 12 weeks. [Hb] did not return to initial values (13.4 ± 0.7 g/dL) after 12 weeks (12.9 ± 0.7 g/dL, p < .01). Ferritin decreased from baseline until week 6 (40.9 ± 34.2 ng/mL vs. 12.1 ± 6.9 ng/mL, p < .05) and was not restored after 12 weeks (18.4 ± 12.7 ng/mL, p < .05), with 6 out of 10 women exhibiting iron deficiency (ferritin <15 ng/mL). V̇O2max was reduced by 213 ± 47 mL/min (7.2 ± 1.2%; p < .001) and remained below baseline after 12 weeks (3.2 ± 1.4%, p < .01). DISCUSSION For most pre-menopausal women, 12 weeks were not sufficient to recover from BD and achieve baseline Hbmass and iron stores resulting in prolonged reduction of aerobic capacity. A subsequent BD might lead to a severe anemia.
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Affiliation(s)
- Nadine B Wachsmuth
- Division of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, Germany
- Division of Exercise Physiology and Metabolism, Bayreuth Center of Sport Science, University of Bayreuth, Bayreuth, Germany
| | - Sandra Haupt
- Division of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, Germany
- Division of Exercise Physiology and Metabolism, Bayreuth Center of Sport Science, University of Bayreuth, Bayreuth, Germany
- Division of Molecular Exercise Physiology, University of Bayreuth, Bayreuth, Germany
| | - Philipp Bauer
- Division of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | - Janis R Schierbauer
- Division of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, Germany
- Division of Exercise Physiology and Metabolism, Bayreuth Center of Sport Science, University of Bayreuth, Bayreuth, Germany
| | - Gunnar Treff
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, Ulm University, Ulm, Germany
- Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Jürgen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, Ulm University, Ulm, Germany
| | - Sian Rilstone
- Department of Nutrition & Dietetics, Imperial College Healthcare NHS Trust, London, UK
| | - Walter F J Schmidt
- Division of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, Germany
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Odajima T, Tsuno NH, Ishimaru F, Okubo R, Murakami J, Kitsukawa K, Ikuta K, Matsuzaki K, Muroi K, Satake M, Kino S. Iron deficiency among Japanese whole-blood donors measured by serum ferritin. Vox Sang 2024. [PMID: 38872445 DOI: 10.1111/vox.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND OBJECTIVES A more restrictive blood donation criterion has been applied in Japan, with a maximum volume of whole blood (WB) donation of 400 mL, allowing twice a year for female donors and thrice a year for male donors. However, iron deficiency was as high as 20.5% among female donors prior to donation, increasing to 37.7% after blood donation. More than 20 years have passed since then, so we set out to investigate the present situation. MATERIALS AND METHODS A total of 2659 (male/female: 1496/1163) donors of 400 mL WB who gave informed consent to join the study were enrolled. Serum ferritin (sFer) of first-time/reactivated (FT/RA) donors were compared with those of repeat donors, according to gender and age; those who returned for subsequent donations during the study period were also followed up. RESULTS About one-third of FT/RA female donors had iron deficiency, possibly reflecting its high incidence among the general population. Interestingly, although sFer levels were low among pre-menopausal FT/RA female donors, these values were not much different in repeat donors, whereas significant differences were observed between FT/RA and repeat donors among post-menopausal females and in most age groups among males. As expected, donors with a normal initial sFer (≥26 ng/mL) recovered faster than those with a low initial sFer. CONCLUSION Female donors, especially, have iron deficiency even before donation, and the rate increased compared to what was found previously. Measures to prevent iron deficiency of blood donors is required, and studies are going on in Japan.
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Affiliation(s)
| | - Nelson H Tsuno
- Japanese Red Cross Central Blood Institute, Tokyo, Japan
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, Tokyo, Japan
| | | | - Rie Okubo
- Kanagawa Red Cross Blood Center, Yokohama, Japan
| | | | - Kaori Kitsukawa
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, Tokyo, Japan
| | | | - Koji Matsuzaki
- Japanese Red Cross Kyushu Block Blood Center, Kurume, Japan
| | - Kazuo Muroi
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, Tokyo, Japan
| | | | - Shuichi Kino
- Japanese Red Cross Blood Service Headquarters, Tokyo, Japan
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Kao YR, Chen J, Kumari R, Ng A, Zintiridou A, Tatiparthy M, Ma Y, Aivalioti MM, Moulik D, Sundaravel S, Sun D, Reisz JA, Grimm J, Martinez-Lopez N, Stransky S, Sidoli S, Steidl U, Singh R, D'Alessandro A, Will B. An iron rheostat controls hematopoietic stem cell fate. Cell Stem Cell 2024; 31:378-397.e12. [PMID: 38402617 PMCID: PMC10939794 DOI: 10.1016/j.stem.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/20/2023] [Accepted: 01/30/2024] [Indexed: 02/27/2024]
Abstract
Mechanisms governing the maintenance of blood-producing hematopoietic stem and multipotent progenitor cells (HSPCs) are incompletely understood, particularly those regulating fate, ensuring long-term maintenance, and preventing aging-associated stem cell dysfunction. We uncovered a role for transitory free cytoplasmic iron as a rheostat for adult stem cell fate control. We found that HSPCs harbor comparatively small amounts of free iron and show the activation of a conserved molecular response to limited iron-particularly during mitosis. To study the functional and molecular consequences of iron restriction, we developed models allowing for transient iron bioavailability limitation and combined single-molecule RNA quantification, metabolomics, and single-cell transcriptomic analyses with functional studies. Our data reveal that the activation of the limited iron response triggers coordinated metabolic and epigenetic events, establishing stemness-conferring gene regulation. Notably, we find that aging-associated cytoplasmic iron loading reversibly attenuates iron-dependent cell fate control, explicating intervention strategies for dysfunctional aged stem cells.
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Affiliation(s)
- Yun-Ruei Kao
- Department of Oncology, Albert Einstein College of Medicine, New York, NY, USA.
| | - Jiahao Chen
- Department of Cell Biology, Albert Einstein College of Medicine, New York, NY, USA
| | - Rajni Kumari
- Department of Cell Biology, Albert Einstein College of Medicine, New York, NY, USA
| | - Anita Ng
- Karches Center for Oncology Research, the Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Aliona Zintiridou
- Department of Cell Biology, Albert Einstein College of Medicine, New York, NY, USA
| | - Madhuri Tatiparthy
- Department of Cell Biology, Albert Einstein College of Medicine, New York, NY, USA
| | - Yuhong Ma
- Department of Cell Biology, Albert Einstein College of Medicine, New York, NY, USA
| | - Maria M Aivalioti
- Department of Cell Biology, Albert Einstein College of Medicine, New York, NY, USA
| | - Deeposree Moulik
- Department of Cell Biology, Albert Einstein College of Medicine, New York, NY, USA
| | - Sriram Sundaravel
- Department of Cell Biology, Albert Einstein College of Medicine, New York, NY, USA
| | - Daqian Sun
- Department of Cell Biology, Albert Einstein College of Medicine, New York, NY, USA
| | - Julie A Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Juliane Grimm
- Department of Cell Biology, Albert Einstein College of Medicine, New York, NY, USA
| | - Nuria Martinez-Lopez
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, CA, USA; Comprehensive Liver Research Center at University of California Los Angeles, CA, USA
| | - Stephanie Stransky
- Department of Biochemistry, Albert Einstein College of Medicine, New York, NY, USA
| | - Simone Sidoli
- Department of Biochemistry, Albert Einstein College of Medicine, New York, NY, USA
| | - Ulrich Steidl
- Department of Oncology, Albert Einstein College of Medicine, New York, NY, USA; Department of Cell Biology, Albert Einstein College of Medicine, New York, NY, USA; Ruth L. and David S. Gottesman Institute for Stem Cell Research and Regenerative Medicine, Albert Einstein College of Medicine, New York, NY, USA; Blood Cancer Institute, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA; Cancer Dormancy and Tumor Microenvironment Institute, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rajat Singh
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, CA, USA; Comprehensive Liver Research Center at University of California Los Angeles, CA, USA
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Britta Will
- Department of Oncology, Albert Einstein College of Medicine, New York, NY, USA; Department of Cell Biology, Albert Einstein College of Medicine, New York, NY, USA; Ruth L. and David S. Gottesman Institute for Stem Cell Research and Regenerative Medicine, Albert Einstein College of Medicine, New York, NY, USA; Blood Cancer Institute, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA; Cancer Dormancy and Tumor Microenvironment Institute, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA; Institute for Aging Studies, Albert Einstein College of Medicine, New York, NY, USA.
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5
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Rennert WP, Smith M J, Cormier KA, Austin AE. Supportive Care of Hematopoietic Stem Cell Donors. Clin Hematol Int 2024; 6:43-50. [PMID: 38817695 PMCID: PMC11086998 DOI: 10.46989/001c.92460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/21/2023] [Indexed: 06/01/2024] Open
Abstract
Supportive care needs for hematopoietic stem cell recipients have been studied. Less is known about the care needs of stem cell donors. Care challenges arise at donor selection, preparation for the donation, the donation procedure and the immediate and long-term after-care. Care needs were analyzed for 1,831 consecutive bone marrow and peripheral stem cell donors at MedStar Georgetown University Hospital between January 2018 and August 2023 in support of a review of the current literature. During the selection, related donors may experience psychological pressures affecting their motivation, while donation centers may be willing to accept co-morbidities in these donors which might preclude donation in unrelated peers. For bone marrow donations, it is important to select donors not only according to optimal genetic matching criteria but also according to suitable donor/recipient weight ratios, to facilitate sufficient stem cell yields. During the donation preparation phase, side effects and complications related to stem cell stimulation must be anticipated and managed for peripheral cell donors, while the pros and cons of autologous blood donation should be evaluated carefully for bone marrow donors. The stem cell donation procedure itself carries potential side effects and complications as well. Peripheral cell donors may require a central line and may encounter hypocalcemia, thrombocytopenia, and anemia. Bone marrow donors face risks associated with anesthesia, blood loss and pain. Post-procedure care focusses on pain management, blood cell recovery and the psychological support necessary to regain a high quality-of-life existence. Hematopoietic stem donors are giving part of themselves to save another's life. They deserve comprehensive supportive care to accompany them throughout the donation process.
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Affiliation(s)
- Wolfgang P Rennert
- Blood and Marrow Collection ProgramMedStar Georgetown University Hospital
| | - Jenna Smith M
- Blood and Marrow Collection ProgramMedStar Georgetown University Hospital
| | - Katie A Cormier
- Blood and Marrow Collection ProgramMedStar Georgetown University Hospital
| | - Anne E Austin
- Stem Cell Transplant and Cellular TherapyVanderbilt University Medical Center
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Karpova D. Clonal hematopoiesis in frequent whole blood donors. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:299-304. [PMID: 38066913 PMCID: PMC10727091 DOI: 10.1182/hematology.2023000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Healthy volunteer donors are committed to contributing key medical resources. Repeated, regular donation of whole blood represents a specific trigger of hematopoietic stress. Hematopoietic stem cells (HSCs) are known to respond to environmental triggers by altering their differentiation and/or proliferative behavior. This can manifest in long-term changes in the clonal dynamics of HSCs, such as the age-associated expansion of HSCs carrying somatic mutations in genes associated with hematologic cancers-that is, clonal hematopoiesis (CH). A recent study revealed a higher prevalence of CH in frequent donors driven by low-risk mutations in genes encoding for epigenetic modifiers, with DNMT3A and TET2 being the most common. No difference in the prevalence of known preleukemic driver mutations was detected between the cohorts, underscoring the safety of repetitive blood donations. Functional analyses suggest a link between the presence of selected DNMT3A mutations found in the frequent donor group and the responsiveness of the cells to the molecular mediator of bleeding stress, erythropoietin (EPO), but not inflammation. These findings define EPO as one of the environmental factors that provide a fitness advantage to specific mutant HSCs. Analyzing CH prevalence and characteristics in other donor cohorts will be important to comprehensively assess the health risks associated with the different types of donation.
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Affiliation(s)
- Darja Karpova
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
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Drechsler LØ, Boldsen JK, Hindhede L, Aagaard B, Harritshøj LH, Mikkelsen C, Brodersen T, Brøns N, Schwinn M, Hjalgrim H, Rostgaard K, Topholm Bruun M, Ostrowski SR, Pedersen OB, Mikkelsen S, Erikstrup C. The effect of ferritin-guided iron supplementation among Danish female first-time blood donors. Transfusion 2023; 63:1710-1718. [PMID: 37452554 DOI: 10.1111/trf.17484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The identification of blood donors at risk of developing low hemoglobin (Hb) and subsequent intervention is expected to reduce donation-induced iron deficiency and low Hb among blood donors. This study explores the effects of ferritin-guided iron supplementation for female first-time donors implemented in four of five administrative regions in Denmark. STUDY DESIGN AND METHODS We included 45,919 female first-time donors in this study. Hb values were determined in donations of included donors during a 2-year follow-up period. For each region, an intervention group (after implementation) and a control group (before implementation) were defined. The primary outcome was Hb below the donation threshold (7.8 mmol/L ~ 12.5 g/dL) at the time of donation, in the control group, and the intervention group, using logistic regression. The secondary outcome was the number of donations per donor given during the follow-up period. RESULTS We observed a statistically significant decrease in the risk of female first-time donors experiencing a donation with low Hb after ferritin-guided iron supplementation was introduced: Odds ratio, 0.82; 95% confidence interval (CI), 0.71-0.95. We found a statistically significant increase in the number of donations per donor during the follow-up period after intervention; rate ratio: 1.05, 95% CI: 1.02-1.08. DISCUSSION Ferritin-guided iron supplementation led to a significant reduction in the occurrence of low hemoglobin (Hb) levels among Danish female first-time blood donors. The intervention was additionally associated with an increase in the number of donations per donor.
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Affiliation(s)
| | - Jens Kjaergaard Boldsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus N, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus C, Denmark
| | - Lotte Hindhede
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus N, Denmark
| | - Bitten Aagaard
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Lene Holm Harritshøj
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen Ø, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christina Mikkelsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen Ø, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Copenhagen University, Copenhagen, Denmark
| | - Thorsten Brodersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Nanna Brøns
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Michael Schwinn
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Henrik Hjalgrim
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Haematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mie Topholm Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen Ø, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Birger Pedersen
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Susan Mikkelsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus N, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus N, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
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Torreiter PP, Drexler-Helmberg C, Schimetta W, Krakowitzky P, Helmberg W, Schlenke P. Pilot Study to Gain First Indications for the Impact of a 3-Month's Oral Intake of a Sucrosomial Iron Supplement on Hemoglobin in Iron-Deficient Blood Donors. Transfus Med Hemother 2023; 50:286-293. [PMID: 37767276 PMCID: PMC10521237 DOI: 10.1159/000527577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/14/2022] [Indexed: 09/29/2023] Open
Abstract
Introduction Regular whole blood donors often suffer from iron deficiency (ID) or iron deficiency anemia due to the loss of 200-300 mg of iron with each donation. Hemoglobin (Hb) as donor eligibility criterion reflects iron stores only poorly. ID in blood donors is typically prevented or treated with orally administered ferrous salts, which frequently cause gastrointestinal side effects. A high daily oral iron dose is counterproductive due to hepcidin upregulation. Oral sucrosomial iron (sucriron) is encapsulated ferric pyrophosphate that may be an option for blood donors due to its supposed high bioavailability and good tolerability. Methods This monocentric single-cohort pilot study included fifty whole blood donors (divided into premenopausal women, postmenopausal women, and men) who did not meet Hb donation criteria. Participants aged 18-65 years with ferritin <30 ng/mL and venous Hb <12.5 g/dL in women and Hb <13.5 g/dL in men received oral sucriron (30 mg iron) for 90-120 days. Primary endpoints were the increase of Hb and ferritin. Results Forty-seven participants completed the study. With the limitation that no control group was included, there was a substantial overall median increase of 0.94 g/dL Hb and 4.97 ng/mL ferritin (standardized on 90 days of iron intake). These value improvements were likewise observed in each of the subgroups. sucriron was very well tolerated, with almost no gastrointestinal side effects identified. Conclusion A clear increase of Hb and ferritin was observed after the intake of sucriron, so it may be a reasonable and useful alternative to traditional oral iron therapy. The ease of administration, pleasant taste, dietary supplement status, and, most importantly, good tolerability highlight the value of sucriron supplementation.
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Affiliation(s)
- Patrick Paul Torreiter
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Camilla Drexler-Helmberg
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Wolfgang Schimetta
- Department of Applied Systems Research and Statistics, Johannes Kepler University, Linz, Austria
| | - Petra Krakowitzky
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Wolfgang Helmberg
- 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
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Martin NM, von Hurst PR, Conlon CA, Smeele RJM, Mugridge OAR, Beck KL. Body Fat Percentage and Blood Donation are the Strongest Determinants of Iron Stores in Premenopausal Women Joining the New Zealand Army. Mil Med 2023; 188:e2550-e2556. [PMID: 36794880 PMCID: PMC10363006 DOI: 10.1093/milmed/usad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/22/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Suboptimal iron status is an issue for women joining the military because of its association with impaired aerobic performance, yet no studies have investigated dietary and non-dietary determinants of iron status simultaneously in this population. The purpose of this study was to explore associations between iron stores, dietary patterns (DPs), and potential non-dietary determinants of iron status in premenopausal women at the commencement of basic military training (BMT) in the New Zealand Army. METHODS During week 1 of BMT, demographic, body composition, lifestyle, medical history, and dietary data were measured as potential determinants of serum ferritin (SF) in 101 participants. Following univariate analysis, age, body fat percentage, previous blood donation, at least 6 h of exercise per week that raised the heart rate, and a vegetarian DP were analyzed using a multiple linear regression model. RESULTS An increase in body fat percentage was associated with increased SF (P < .009), although blood donation in the past year decreased SF (P < .011) compared to those participants who did not donate blood. There was no association between SF and a vegetarian DP or hours of exercise per week. The model explained 17.5% of the variance in SF at the commencement of BMT. CONCLUSION Body fat percentage and blood donation in the past year were the strongest determinants of iron stores in healthy premenopausal women commencing BMT. It is recommended that women joining the New Zealand Army are provided information to maintain or improve their iron status based on these findings. This includes clinical screening of iron status, advice for women considering blood donation, and dietary advice regarding total energy requirements and iron bioavailability.
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Affiliation(s)
- Nicola M Martin
- New Zealand Defence Force, Defence House, Wellington 6011, New Zealand
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Sir Neil Waters Lecture Theatres, Auckland 0632, New Zealand
| | - Pamela R von Hurst
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Sir Neil Waters Lecture Theatres, Auckland 0632, New Zealand
| | - Cathryn A Conlon
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Sir Neil Waters Lecture Theatres, Auckland 0632, New Zealand
| | | | - Owen A R Mugridge
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Sir Neil Waters Lecture Theatres, Auckland 0632, New Zealand
| | - Kathryn L Beck
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Sir Neil Waters Lecture Theatres, Auckland 0632, New Zealand
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10
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Dragcevic D, Jaksic O. Blood doping — physiological background, substances and techniques used, current and future detection methods. Sci Sports 2023. [DOI: 10.1016/j.scispo.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Crowder LA, Cable RG, Spencer BR. Validity of donor-reported iron supplementation practices obtained at the time of donation. Transfusion 2023; 63:470-475. [PMID: 36606513 DOI: 10.1111/trf.17235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Iron supplementation (IS) improves blood donors' iron stores and allows more frequent blood donation. Understanding the accuracy of self-reported IS is helpful for potential application of IS practices to donor eligibility or donation intervals. METHODS Successful whole blood and red cell apheresis donors completed a survey at donation on the use of select dietary supplements. Respondents reporting use of either iron pills (IP) or multivitamins (MV) were invited by email to complete a similar follow-up survey 6-8 weeks later and to provide the quantitative iron content of IS by referring the donor to the pill bottle label. Consistency between baseline and follow-up responses was assessed overall and by pill type and demographic variables. RESULTS Of 2444 donors answering the baseline survey, 40% (978) reported MV or IP at donation, 354 of whom completed the follow-up survey. A majority of survey respondents (56%-61%) reported taking iron across the two surveys, and 21%-24% took MV but were uncertain if their pills contained iron. Of 215 reporting IS at baseline, overall concordance at follow-up was 68% and was higher for donors who were female, ≥50-years old, and taking iron as an iron pill rather than in a multivitamin. CONCLUSION Consistency of donor responses may be insufficient for use in guiding donor eligibility. Referring donors to their pill bottles was unsuccessful in improving the high frequency of uncertain responses. Incorporating IS into donor eligibility determinations is a complex endeavor that will benefit from careful planning and from post-implementation monitoring.
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Affiliation(s)
- Lauren A Crowder
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
| | - Ritchard G Cable
- Scientific Affairs, American Red Cross, Farmington, Connecticut, USA
| | - Bryan R Spencer
- Scientific Affairs, American Red Cross, Dedham, Massachusetts, USA
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12
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Kim LG, Bolton T, Sweeting MJ, Bell S, Fahle S, McMahon A, Walker M, Ferguson E, Miflin G, Roberts DJ, Di Angelantonio E, Wood AM. Impact of a post-donation hemoglobin testing strategy on efficiency and safety of whole blood donation in England: A modeling study. Transfusion 2023; 63:541-551. [PMID: 36794597 PMCID: PMC10952564 DOI: 10.1111/trf.17277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Deferrals due to low hemoglobin are time-consuming and costly for blood donors and donation services. Furthermore, accepting donations from those with low hemoglobin could represent a significant safety issue. One approach to reduce them is to use hemoglobin concentration alongside donor characteristics to inform personalized inter-donation intervals. STUDY DESIGN AND METHODS We used data from 17,308 donors to inform a discrete event simulation model comparing personalized inter-donation intervals using "post-donation" testing (i.e., estimating current hemoglobin from that measured by a hematology analyzer at last donation) versus the current approach in England (i.e., pre-donation testing with fixed intervals of 12-weeks for men and 16-weeks for women). We reported the impact on total donations, low hemoglobin deferrals, inappropriate bleeds, and blood service costs. Personalized inter-donation intervals were defined using mixed-effects modeling to estimate hemoglobin trajectories and probability of crossing hemoglobin donation thresholds. RESULTS The model had generally good internal validation, with predicted events similar to those observed. Over 1 year, a personalized strategy requiring ≥90% probability of being over the hemoglobin threshold, minimized adverse events (low hemoglobin deferrals and inappropriate bleeds) in both sexes and costs in women. Donations per adverse event improved from 3.4 (95% uncertainty interval 2.8, 3.7) under the current strategy to 14.8 (11.6, 19.2) in women, and from 7.1 (6.1, 8.5) to 26.9 (20.8, 42.6) in men. In comparison, a strategy incorporating early returns for those with high certainty of being over the threshold maximized total donations in both men and women, but was less favorable in terms of adverse events, with 8.4 donations per adverse event in women (7.0, 10,1) and 14.8 (12.1, 21.0) in men. DISCUSSION Personalized inter-donation intervals using post-donation testing combined with modeling of hemoglobin trajectories can help reduce deferrals, inappropriate bleeds, and costs.
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Affiliation(s)
- Lois G. Kim
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Thomas Bolton
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
- BHF Data Science CentreHealth Data ResearchUK
| | | | - Steven Bell
- Dept of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
| | - Sarah Fahle
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Amy McMahon
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Matthew Walker
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Eamonn Ferguson
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- School of PsychologyUniversity of NottinghamNottinghamUK
| | | | - David J. Roberts
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- NHS Blood & TransplantJohn Radcliffe HospitalOxfordUK
- Radcliffe Dept of MedicineUniversity of OxfordOxfordUK
| | - Emanuele Di Angelantonio
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of CambridgeCambridgeUK
- Health Data Science Research CentreHuman TechnopoleMilanItaly
| | - Angela M. Wood
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of CambridgeCambridgeUK
- Cambridge Centre of Artificial Intelligence in MedicineCambridgeUK
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13
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Diaz-Canestro C, Montero D. Sex-specific improvement in cardiac phenotype in older females combining blood withdrawal and exercise training. J Appl Physiol (1985) 2023; 134:296-304. [PMID: 36519567 DOI: 10.1152/japplphysiol.00328.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This study determined whether an intervention combining hematological and exercise stimuli may overcome the prevailing limitations to improve the cardiac phenotype and orthostatic tolerance (OT) of females with advanced age. Healthy females (n = 15) and males (n = 14) matched by age (63.7 ± 7.0 vs. 63.6 ± 8.7 yr) and moderate physical activity were recruited. OT, transthoracic echocardiography, and central hemodynamics were assessed during incremental lower body negative pressure (LBNP) levels (up to -50 mmHg) for 1 h or until presyncope, prior to and after an intervention comprising standard (10%) blood withdrawal and an 8-wk exercise training program designed to maximize central hemodynamic adaptations. OT time was lower in females compared with males (48.1 ± 10.6 vs. 57.0 ± 4.8 min, P = 0.008) before the intervention. Improved OT time (+11%) in females (48.1 ± 10.6 vs. 53.5 ± 6.1 min, P = 0.021) but not in males (57.0 ± 4.8 vs. 56.7 ± 5.6 min, P = 0.868) was found following the intervention, resulting in similar OT time between females and males (P = 0.156). The intervention induced improvements in left ventricular (LV) diastolic function (+13% for myocardial e') along with increased LV mass (+13%) in females (P ≤ 0.039) but not in males (P ≥ 0.257). During the initial LBNP stages (0 to -20 mmHg), LV stroke volume and cardiac output were exclusively increased in females after the intervention (P ≤ 0.034). In conclusion, the cardiac phenotype of females with advanced age can be structurally and functionally modified in parallel to improved OT via short-term hematological and central hemodynamic stimuli.NEW & NOTEWORTHY Based on previous studies, main features of the cardiac phenotype in females with advanced age are generally unresponsive to lifestyle interventions. The present findings reveals that the cardiac phenotype of middle-age and older females is amenable to large modification in a short-term period when hematological stimuli are combined with those induced by exercise training. The same intervention only induced minor adaptations in males matched by age and potential confounding factors.
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Affiliation(s)
- Candela Diaz-Canestro
- Department of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - David Montero
- Faculty of Medicine, School of Public Health, University of Hong Kong, Hong Kong, People's Republic of China.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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14
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Review of blood donor deferral with emphasis on donor and patient safety. Transfus Clin Biol 2023; 30:56-62. [PMID: 35835317 DOI: 10.1016/j.tracli.2022.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Blood donor deferral is a part and parcel of the commitment of the blood transfusion services to assure the safety and health of the blood donor as well as the recipient. Periodic review of blood donor deferral is to incorporate or revoke deferral reasons based on the evidence generated in the process of review. Therefore, emphasis must be laid on preparing strategies to only judiciously defer blood donors, recruit and retain first time blood donors, which needs critical appraisal of the existing deferral policies, so that the evidence based changes can be done. MATERIAL AND METHODS A retrospective analysis of deferral in blood donors who presented at the blood donation centre of an institute of national importance over a span of nine years (2011-2019). Donors were screened as per the Drugs and Cosmetics Act 1940 and Rules 1945 given by the Ministry of Health and Family Welfare, Govt of India. RESULTS There were 1,37,935 donors attempts, out of which 20,167 (14.6%) donors were deferred from donating blood. Most of the deferred donors were male (88.5%), first time (86.1%) and temporarily deferred (87.6%). Almost comparable number of donors (49.1 % & 48.5%) were deferred for donor safety and patient safety reasons respectively. Overall the three most common reasons for deferral were low hemoglobin (21.6%), hypertension (11.4%) and history of jaundice (9%). In donor safety reasons, low hemoglobin (43.4%), hypertension (22.9%) and low blood pressure (4.5%), and in patient safety, a history of jaundice (18.6%), common cold (15.8%), and high-risk behavior (8.8%) emerged as the three most common reasons for deferral respectively. CONCLUSION Blood donor deferral is an essential quality indicator of the blood donor selection process. Initiatives like fortification of dietary ingredients with iron, optimizing protein in diet served in schools under mid-day meal program, screening for iron deficiency, hypertension and education about high-risk behavior in schools and colleges may have long term effects of promotion of better health.
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15
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Lee SS, Lee J, Moon YW. Efficacy of immediate postoperative intravenous iron supplementation after staged bilateral total knee arthroplasty. BMC Musculoskelet Disord 2023; 24:17. [PMID: 36611148 PMCID: PMC9824915 DOI: 10.1186/s12891-023-06133-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Approximately 26% of patients undergoing major orthopedic elective procedures have preoperative anemia. This study aimed to investigate the effect of intravenous (IV) iron supplementation on the hemoglobin (Hb) level after staged bilateral total knee arthroplasty (TKA) in patients with or without preoperative anemia. METHODS We retrospectively analyzed 418 patients who underwent staged bilateral TKA (1 week interval). The iron group (n = 220) received IV iron isomaltoside immediately after each TKA. The no-iron group (n = 198) was recommended to receive transfusion if postoperative anemia was diagnosed between the first and second TKA. Preoperative anemia was present in 42 (21.2%) and 50 (22.7%) patients in the no-iron and iron groups, respectively. Demographic data, preoperative and postoperative Hb levels, Hb level change (preoperative minus postoperative 6-week Hb level), and blood drainage amount were compared between groups. RESULTS The transfusion rate was lower in the iron group than in the no-iron group (96.5% vs. 58.6%, P < 0.001). Overall, the demographic data, preoperative and postoperative 6-week Hb levels, Hb level change, and blood drainage amount were not significantly different between the two groups. Among patients with preoperative anemia, the iron group showed lower Hb level change (0.6 ± 0.9 vs. 0.1 ± 1.1, P = 0.016). CONCLUSION Patients with preoperative anemia treated with IV iron showed lower Hb level change than did those without IV iron treatment. Despite the lower transfusion rate, the iron group showed similar postoperative 6-week Hb level and Hb level change to the no-iron group.
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Affiliation(s)
- Sung-Sahn Lee
- grid.411612.10000 0004 0470 5112Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Gyeonggido Goyangsi, South Korea
| | - Jeounghun Lee
- grid.264381.a0000 0001 2181 989XDepartment of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon street, Gangnam-Gu, 06351 Seoul, South Korea
| | - Young-Wan Moon
- grid.264381.a0000 0001 2181 989XDepartment of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon street, Gangnam-Gu, 06351 Seoul, South Korea
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16
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Richard P, Fillet AM, Malard L, Leclerc C, Chanut C, Woimant G, Jacquot C, Leleu H, Morel P, Vimont A. Impact of donor ferritin testing on iron deficiency prevention and blood availability in France: A cohort simulation study. Vox Sang 2023; 118:24-32. [PMID: 36427060 DOI: 10.1111/vox.13377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Implementing a ferritin testing policy for whole blood (WB) donors may prevent iron deficiency (ID, ferritin <26 ng/mL) and anaemia, but may induce donation losses. As part of a national prevention plan in France, we aimed to estimate its impact on ID, anaemias and WB donations among donors at high risk of ID. MATERIALS AND METHODS A micro-simulation model was developed to evaluate different scenarios compared to the current situation without ferritin testing as a reference scenario. The following scenarios were simulated: a minimum scenario with a 6-month deferral for donors with absent iron store (AIS, ferritinemia <15 ng/ml), a main scenario with additional delayed invitations for donors with ferritinemia 15-25 ng/ml and a supplementation scenario with additional iron supplementation for 50% of the donors with AIS. RESULTS In the main scenario, 52,699 WB donations per year were estimated to be lost after 1 year (-8%), falling to 27,687 (-4.7%) after 5 years. IDs and anaemias were reduced by 13.6% and 29.3%, respectively, after 1 year. The supplementation scenario increased the number of prevented IDs and anaemias to 24.1% and 35.4%, respectively, after 1 year, and halved the number of anaemias at 5 years. The latter scenario also had the least impact on the number of donations (-3.2% after 5 years). CONCLUSION A ferritin testing policy resulting in delayed donations for ID donors is effective in reducing IDs and anaemias, but significantly impacts the number of donations, thereby posing a self-sufficiency challenge.
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Affiliation(s)
- Pascale Richard
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Anne-Marie Fillet
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Lucile Malard
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Carole Leclerc
- Blood Product Collection Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Claire Chanut
- Innovation and Projects Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Geneviève Woimant
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Chantal Jacquot
- Blood Product Collection Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | | | - Pascal Morel
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
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17
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Spencer BR, White JL, Patel EU, Goel R, Bloch EM, Tobian AA. Eligibility Considerations for Female Whole Blood Donors: Hemoglobin Levels and Iron Status in a Nationally Representative Population. Transfus Med Rev 2023; 37:27-35. [PMID: 36528466 PMCID: PMC10787604 DOI: 10.1016/j.tmrv.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
Blood collection from minority populations improves the transfusion support of patients with sickle cell disease and thalassemia, but efforts are challenged by high deferral rates for hemoglobin (Hb) eligibility thresholds. This study sought to evaluate hemoglobin and iron status of a representative US female population to assess the suitability of 12.0 g/dL as minimum hemoglobin. Data were extracted from the National Health and Nutrition Examination Surveys (NHANES), 1999-2010. A national sample designed to reflect potential female blood donors (weight ≥110 lbs, not pregnant, no infectious marker reactivity, and no blood donation in past year) aged 16 to 49 years was analyzed for Hb and serum ferritin (SF) measures by race/ethnicity (N = 6937). Mean Hb and SF and the prevalence of iron deficiency ([ID] SF<12 ng/mL and SF<26 ng/mL) and low Hb (<12.5 g/dL and <12.0 g/dL) were estimated. Multivariable modified Poisson regression compared the prevalence for ID or low Hb at each cutoff by race/ethnicity. Mean SF values were higher and ID prevalence was lower in Non-Hispanic (NH) White (SF = 45.3 ng/mL, SF<12 ng/mL = 8.2%) than NH Black (SF = 39.6 ng/mL, SF<12 ng/mL = 14.2%) and Hispanic (SF = 36.5 ng/mL, SF<12 ng/mL = 12.7%) females. Compared to NH White females (13.7 g/dL), mean Hb was lower in NH Black (12.6 g/dL) and Hispanic females (13.4 g/dL). The percentage with Hb<12.5 g/dL was >4 times greater in NH Black (39.1%) and >2 times greater in Hispanic females (16.5%) compared to NH White (8.6%). Within 0.5 g/dL incremental categories of Hb, NH Black had higher mean SF levels and lower prevalence of SF<12 ng/mL or <26 ng/mL compared to NH White and Hispanic females. At Hb of 12.0 to 12.4g/dL, NH Black females had better measures of iron status (SF = 39.1 ng/mL, %SF<12 ng/mL = 12.0%) than NH White (SF = 33.6 ng/mL, %SF<12 ng/mL=15.8%) and Hispanic (SF = 30.4 ng/mL, %SF<12 ng/mL=15.5%) females whose Hb was 12.5 to 12.9 g/dL. Adjusting for age and Hb, the prevalence ratio for low SF was significantly lower in NH Black compared to NH White females at both SF<26 ng/mL (adjusted prevalence ratio [aPR] = 0.83, 95%CI = 0.76-0.92) and SF<12 ng/mL (aPR = 0.66, 95%CI = 0.52-0.83). NH Black females with Hb 12.0 to 12.4g/dL have better iron stores than NH White and Hispanic females whose Hb is 12.5 to 12.9 g/dL. The distribution of Hb and iron may support the safe collection of blood for female donors below the current Hb eligibility requirement of 12.5 g/dL.
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Affiliation(s)
| | - Jodie L White
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Eshan U Patel
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Aaron Ar Tobian
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
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18
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Belizaire R, Stowell SR. To Fe, or not to Fe, that is the question. Blood 2022; 140:2658-2660. [PMID: 36548014 PMCID: PMC9837427 DOI: 10.1182/blood.2022017881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Mantadakis E, Panagopoulou P, Kontekaki E, Bezirgiannidou Z, Martinis G. Iron Deficiency and Blood Donation: Links, Risks and Management. J Blood Med 2022; 13:775-786. [PMID: 36531435 PMCID: PMC9749410 DOI: 10.2147/jbm.s375945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/05/2022] [Indexed: 01/08/2024] Open
Abstract
The purpose of this review is to raise awareness about the frequently underappreciated association of blood donation with iron deficiency, and to describe methods for its prevention and management. Blood donors cannot expect any health benefits from the donation but have justified expectations of no harm. Iron deficiency without anemia (IDWA) and iron deficiency anemia (IDA) are common consequences of regular blood donation, and this activity is the most important factor affecting iron status in regular blood donors. Awareness of blood donation as a primary cause of sideropenia is surprisingly low among physicians. Blood donation screening identifies potential donors with IDA but is frequently inadequate to detect IDWA. For the assessment of body iron stores, plasma or serum ferritin, transferrin saturation (TSAT) and soluble transferrin receptors (sTfR) concentrations are the most widely used biochemical markers, although the percentage of hypochromic mature erythrocytes and the hemoglobin content of reticulocytes are also useful. IDWA can be prevented by limiting the total volume of blood collected, by iron deficiency screening and deferral of sideropenic donors, by prolonging the interdonation intervals, and by iron supplementation between donations. IDWA tends to be more prevalent in younger people, females, and high-intensity donors. A potentially effective strategy to address sideropenia in blood donors is serum ferritin testing, but this may lead to a higher rate of deferral. Most regular blood donors cannot replenish their iron deficit by an iron-rich diet alone and will benefit from low-dose oral iron administration with various commercially available products post-donation, a well-tolerated strategy. However, valid concerns exist regarding the possibility of worsening the iron overload in donors with undiagnosed hemochromatosis or masking the symptoms of a clinically important gastrointestinal hemorrhage or other underlying medical condition. Finally, educational efforts should be intensified to improve the awareness of blood donation as a primary cause of iron deficiency among physicians of all specialties.
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Affiliation(s)
- Elpis Mantadakis
- Department of Pediatrics, Hematology/ Oncology Unit, University General Hospital of Alexandroupolis, Thrace, Greece
| | - Paraskevi Panagopoulou
- Department of Pediatrics, Aristotle University of Thessaloniki, Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Eftychia Kontekaki
- Blood Transfusion Centre, University General Hospital of Alexandroupolis, Thrace, Greece
| | - Zoe Bezirgiannidou
- Department of Hematology, University General Hospital of Alexandroupolis, Thrace, Greece
| | - Georges Martinis
- Blood Transfusion Centre, University General Hospital of Alexandroupolis, Thrace, Greece
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20
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Abstract
PURPOSE OF REVIEW This review examines recent research on the prevalence and importance of iron deficiency in blood donors, and on efforts to mitigate it. RECENT FINDINGS Premenopausal females, teenagers, and high-frequency donors are at the highest risk for donation-induced iron deficiency, in both high-resource and low-resource settings. The physiology relating iron stores to hemoglobin levels and low hemoglobin deferral is well elucidated in blood donor populations, yet the clinical effects attributable to iron loss in the absence of anemia are challenging to identify. Expanded adoption of ferritin testing is improving donor management but may cause decreases in the blood supply from temporary donor loss. The potential for personalized donor management is emerging with development of computational models that predict individual interdonation intervals that aim to optimize blood collected from each donor while minimizing low hemoglobin deferrals. SUMMARY Measures to reduce iron deficiency are available that can be deployed on a standardized or, increasingly, personalized basis. Blood centers, regulators, and donors should continue to evaluate different tactics for addressing this problem, to obtain a balanced approach that is optimal for maintaining adequate collections while safeguarding donor health.
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Affiliation(s)
| | - Alan E. Mast
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI
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21
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Matzek LJ, LeMahieu AM, Madde NR, Johanns DP, Karon B, Kor DJ, Warner MA. A Contemporary Analysis of Phlebotomy and Iatrogenic Anemia Development Throughout Hospitalization in Critically Ill Adults. Anesth Analg 2022; 135:501-510. [PMID: 35977360 PMCID: PMC9395123 DOI: 10.1213/ane.0000000000006127] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Anemia is common in critically ill patients and may be exacerbated through phlebotomy-associated iatrogenic blood loss. Differences in phlebotomy practice across patient demographic characteristics, clinical features, and practice environments are unclear. This investigation provides a comprehensive description of contemporary phlebotomy practices for critically ill adults. METHODS This is an observational cohort study of adults ≥18 years of age requiring intensive care unit (ICU) admission between January 1, 2019, and December 31, 2019, at a large academic medical center. Descriptive statistics were utilized to summarize all phlebotomy episodes throughout hospitalization, with each phlebotomy episode defined by unique peripheral venous, central venous, or arterial accesses for laboratory draws, exclusive of finger sticks. Secondarily, financial costs of phlebotomy and the relationships between phlebotomy practices, hemoglobin concentrations, and red blood cell (RBC) transfusions were evaluated. RESULTS A total of 6194 patients were included: 59% were men with a median (interquartile range) age of 66 (54-76) years and median ICU and hospital durations of 2.1 (1.4-3.9) and 7.1 (4.3-11.8) days, respectively. The median number of unique laboratory draws was 41 (18-88) throughout hospitalization, with a median volume of 232 (121-442) mL, corresponding to 5.2 (2.6-8.8) draws and 29 (19-43) mL per day. Waste (ie, discard) volume was responsible for 10.8% of total phlebotomy volume. Surgical patients had a higher number of phlebotomy episodes and greater total phlebotomy volumes compared to nonsurgical patients. Phlebotomy practices differed across ICU types, with the greatest frequency of laboratory draws in the cardiac surgical ICU and the greatest daily phlebotomy volume in the medical ICU. Across hospitalization, ICU environments had the greatest frequency and volumes of laboratory draws, with the least intensive phlebotomy practice observed in the general hospital wards. Patients in the highest quartile of cumulative blood drawn experienced the longest hospitalizations, lowest nadir hemoglobin concentrations, and greatest RBC transfusion utilization. Differences in phlebotomy practice were limited across patient age, gender, and race. Hemoglobin concentrations declined during hospitalization, congruent with intensity of phlebotomy practice. Each 100 mL of phlebotomy volume during hospitalization was associated with a 1.15 (95% confidence interval [CI], 1.14-1.17; P < .001) multiplicative increase in RBC units transfused in adjusted analyses. Estimated annual phlebotomy costs exceeded $15 million (approximately $2500 per patient admission). CONCLUSIONS Phlebotomy continues to be a major source of blood loss in hospitalized patients with critical illness, and more intensive phlebotomy practices are associated with lower hemoglobin concentrations and greater transfusion utilization.
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Affiliation(s)
- Luke J Matzek
- From the Department of Anesthesiology and Perioperative Medicine
- Division of Critical Care Medicine
| | | | | | | | - Brad Karon
- Department of Laboratory Medicine and Pathology
| | - Daryl J Kor
- From the Department of Anesthesiology and Perioperative Medicine
- Division of Critical Care Medicine
- Patient Blood Management Program, Mayo Clinic, Rochester, Minnesota
| | - Matthew A Warner
- From the Department of Anesthesiology and Perioperative Medicine
- Division of Critical Care Medicine
- Patient Blood Management Program, Mayo Clinic, Rochester, Minnesota
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22
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Vinkenoog M, de Groot R, Lakerveld J, Janssen M, van den Hurk K. Individual and environmental determinants of serum ferritin levels: A structural equation model. Transfus Med 2022; 33:113-122. [PMID: 37009681 DOI: 10.1111/tme.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/24/2022] [Accepted: 07/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Serum ferritin levels are increasingly being used to assess iron stores. Considerable variation in ferritin levels within and between individuals has been observed, but our current understanding of factors that explain this variation is far from complete. We aim to combine multiple potential determinants in an integrative model, and investigate their relative importance and potential interactions. METHODS We use ferritin measurements collected by Sanquin Blood Bank on both prospective (N = 59 596) and active blood donors (N = 78 318) to fit a structural equation model with three latent constructs (individual characteristics, donation history, and environmental factors). Parameters were estimated separately by sex and donor status. RESULTS The model explained 25% of ferritin variance in prospective donors, and 40% in active donors. Individual characteristics and donation history were the most important determinants of ferritin levels in active donors. The association between environmental factors and ferritin was smaller but still substantial; higher exposure to air pollution was associated with higher ferritin levels, and this association was considerably stronger for active blood donors than for prospective donors. DISCUSSION In active donors, individual characteristics explain 20% (17%) of ferritin variation, donation history explains 14% (25%) and environmental factors explain 5% (4%) for women (men). Our model presents known ferritin determinants in a broader perspective, allowing for comparison with other determinants as well as between new and active donors, or between men and women.
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Affiliation(s)
- Marieke Vinkenoog
- Transfusion Technology Assessment, Department of Donor Medicine Research Sanquin Research Amsterdam The Netherlands
- Leiden Institute of Advanced Computer Science Leiden University Leiden The Netherlands
| | - Rosa de Groot
- Donor Studies, Department of Donor Medicine Research Sanquin Research Amsterdam The Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC VU University Amsterdam The Netherlands
- Upstream Team, Amsterdam UMC VU University Amsterdam The Netherlands
| | - Mart Janssen
- Transfusion Technology Assessment, Department of Donor Medicine Research Sanquin Research Amsterdam The Netherlands
| | - Katja van den Hurk
- Donor Studies, Department of Donor Medicine Research Sanquin Research Amsterdam The Netherlands
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23
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Paalvast Y, Moazzen S, Sweegers M, Hogema B, Janssen M, van den Hurk K. A computational model for prediction of ferritin and haemoglobin levels in blood donors. Br J Haematol 2022; 199:143-152. [PMID: 35855538 DOI: 10.1111/bjh.18367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
Blood donors are at risk of iron deficiency anaemia. While this risk is decreased through ferritin-based deferral, ideally ferritin monitoring should also aid in optimising donation frequencies. We extended an existing model of haemoglobin (Hb) synthesis with iron homeostasis and validated the model on a cohort of 300 new donors whose ferritin levels were measured from stored blood samples collected over a 2-year period. We then used the donor's gender, body weight, height, and baseline Hb and ferritin levels to predict subsequent Hb and ferritin levels. The prediction error was within measurement variability in 88% of Hb level predictions and 64% of ferritin level predictions. A sensitivity analysis of the model revealed that baseline ferritin level was the most important in predicting future ferritin levels. Finally, we used the model to calculate the annual donation frequency at which donors would keep their ferritin level >15 ng/ml when measured after donating for 2 years. The mean annual donation frequency would then be 1.9 for women and 4.1 for men. The computational model, requiring baseline values only, can predict future Hb and ferritin levels remarkably well. This enables determination of optimal donation frequencies for individual donors at the start of their donation career.
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Affiliation(s)
- Yared Paalvast
- Donor Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - Sara Moazzen
- Donor Medicine Research - Donor Studies, Sanquin Research, Amsterdam, the Netherlands.,Molecular Epidemiology Research Group, MDC Berlin-Buch, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Maike Sweegers
- Donor Medicine Research - Donor Studies, Sanquin Research, Amsterdam, the Netherlands
| | - Boris Hogema
- Donor Medicine Research - Blood-borne Infections, Sanquin Research, Amsterdam, the Netherlands
| | - Mart Janssen
- Donor Medicine Research - Transfusion Technology Assessment, Sanquin Research, Amsterdam, the Netherlands
| | - Katja van den Hurk
- Donor Medicine Research - Donor Studies, Sanquin Research, Amsterdam, the Netherlands
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24
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Ning S, Li N, Barty R, Arnold D, Heddle NM. Database-driven research and big data analytic approaches in transfusion medicine. Transfusion 2022; 62:1427-1434. [PMID: 35689523 DOI: 10.1111/trf.16939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Shuoyan Ning
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Canadian Blood Services, Ancaster, Ontario, Canada
| | - Na Li
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca Barty
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Donald Arnold
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Nancy M Heddle
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Canadian Blood Services, Center for Innovation, Ottawa, Ontario, Canada
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25
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Moazzen S, Sweegers MG, Janssen M, Hogema BM, Hoekstra T, Van den Hurk K. Ferritin Trajectories over Repeated Whole Blood Donations: Results from the FIND+ Study. J Clin Med 2022; 11:3581. [PMID: 35806867 PMCID: PMC9267857 DOI: 10.3390/jcm11133581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Depending on post-donation erythropoiesis, available iron stores, and iron absorption rates, optimal donation intervals may differ between donors. This project aims to define subpopulations of donors with different ferritin trajectories over repeated donations. METHODS Ferritin levels of 300 new whole blood donors were measured from stored (lookback) samples from each donation over two years in an observational cohort study. Latent classes of ferritin level trajectories were investigated separately using growth mixture models for male and female donors. General linear mixed models assessed associations of ferritin levels with subsequent iron deficiency and/or low hemoglobin. RESULTS Two groups of donors were identified using group-based trajectory modeling in both genders. Ferritin levels showed rather linear reductions among 42.9% of male donors and 87.7% of female donors. For the remaining groups of donors, steeper declines in ferritin levels were observed. Ferritin levels at baseline and the end of follow-up varied greatly between groups. CONCLUSIONS Repeated ferritin measurements show depleting iron stores in all-new whole blood donors, the level at which mainly depends on baseline ferritin levels. Tailored, less intensive donation strategies might help to prevent low iron in donors, and could be supported with ferritin monitoring and/or iron supplementation.
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Affiliation(s)
- Sara Moazzen
- Molecular Epidemiology Research Group, Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft, 13125 Berlin, Germany;
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, 1066CX Amsterdam, The Netherlands;
| | - Maike G. Sweegers
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, 1066CX Amsterdam, The Netherlands;
| | - Mart Janssen
- Transfusion Technology Assessment, Department of Donor Medicine Research, Sanquin Research, 1066CX Amsterdam, The Netherlands;
| | - Boris M. Hogema
- Blood-Borne Infections, Department of Donor Medicine Research, Sanquin Research, 1066CX Amsterdam, The Netherlands;
| | - Trynke Hoekstra
- Department of Health Sciences or Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1007MB Amsterdam, The Netherlands;
| | - Katja Van den Hurk
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, 1066CX Amsterdam, The Netherlands;
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26
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Toivonen J, Koski Y, Turkulainen E, Prinsze F, della Briotta Parolo P, Heinonen M, Arvas M. Prediction and impact of personalized donation intervals. Vox Sang 2022; 117:504-512. [PMID: 34825380 PMCID: PMC9299493 DOI: 10.1111/vox.13223] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Deferral of blood donors due to low haemoglobin (Hb) is demotivating to donors, can be a sign for developing anaemia and incurs costs for blood establishments. The prediction of Hb deferral has been shown to be feasible in a number of studies based on demographic, Hb measurement and donation history data. The aim of this paper is to evaluate how state-of-the-art computational prediction tools can facilitate nationwide personalized donation intervals. MATERIALS AND METHODS Using donation history data from the last 20 years in Finland, FinDonor blood donor cohort data and blood service Biobank genotyping data, we built linear and non-linear predictors of Hb deferral. Based on financial data from the Finnish Red Cross Blood Service, we then estimated the economic impacts of deploying such predictors. RESULTS We discovered that while linear predictors generally predict Hb relatively well, they have difficulties in predicting low Hb values. Overall, we found that non-linear or linear predictors with or without genetic data performed only slightly better than a simple cutoff based on previous Hb. However, if any of our deferral prediction methods are used to assign temporary prolongations of donation intervals for females, then our calculations indicate cost savings while maintaining the blood supply. CONCLUSION We find that even though the prediction accuracy is not very high, the actual use of any of our predictors in blood collection is still likely to bring benefits to blood donors and blood establishments alike.
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Affiliation(s)
| | - Yrjö Koski
- Finnish Red Cross Blood Service (FRCBS)HelsinkiFinland
| | | | | | | | - Markus Heinonen
- Department of Computer ScienceAalto UniversityHelsinkiFinland
| | - Mikko Arvas
- Finnish Red Cross Blood Service (FRCBS)HelsinkiFinland
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27
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Karregat J, Sweegers MG, Quee FA, Weekamp HH, Swinkels DW, Novotny VMJ, Zaaijer HL, van den Hurk K. Ferritin-guided iron supplementation in whole blood donors: optimal dosage, donor response, return and efficacy (FORTE)-a randomised controlled trial protocol. BMJ Open 2022; 12:e056316. [PMID: 35264362 PMCID: PMC8915278 DOI: 10.1136/bmjopen-2021-056316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Frequent whole blood donors have an increased risk of developing iron deficiency. Iron deficiency can have detrimental health effects when left untreated. Donation intervals are commonly too short to replenish iron stores and extending these reduces donor availability. Oral iron supplementation is known to shorten iron store recovery time but may also induce gastrointestinal complaints. We aim to optimise the effectiveness of iron supplements while minimising the risks of side effects. Therefore, we will evaluate the impact of different iron supplementation protocols in terms of dosage and frequency on ferritin and haemoglobin levels, gastrointestinal side effects, iron deficiency-related symptoms and donor return compared with placebo supplementation. METHODS Twelve hundred whole blood donors with ferritin levels ≤30 µg/L are included into a double-blind, randomised controlled trial. Participants are randomly allocated to one of six arms, administering capsules containing 0 mg, 30 mg or 60 mg of iron, either on alternate days or daily for 56 days. At baseline and 56, 122 and 182 days of follow-up, ferritin and haemoglobin levels are measured, and compliance, donor return, dietary iron intake, gastrointestinal, iron deficiency-related symptoms and general health are assessed by questionnaire. ETHICS AND DISSEMINATION This study will provide a comprehensive overview of the effects of different frequencies and dosages of administration of iron supplements on iron status and health effects, thereby considering individual differences in treatment adherence and lifestyle. The outcome will provide scientific evidence to guide the debate if and how oral iron supplements may support the recovery of whole blood donors with low ferritin levels. TRIAL REGISTRATION NUMBER NL8590; The Dutch trial registry.
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Affiliation(s)
- Jan Karregat
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Maike G Sweegers
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Franke A Quee
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Henriëtte H Weekamp
- Medical Donor Affairs, Sanquin Blood Supply Foundation, Zwolle, Noord-Holland, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
- Center for Iron Disorders Sanquin, Sanquin Blood Supply Foundation, Amsterdam, Noord-Holland, The Netherlands
| | - Vĕra M J Novotny
- Department of Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, Noord-Holland, The Netherlands
| | - Hans L Zaaijer
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Clinical Virology, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Katja van den Hurk
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
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28
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Gestsdottir E, Magnusson MK, Lund SH, Johannsdottir V, Jonsson T, Gudmundsson S, Halldorsdottir AM. Monitoring iron stores in Icelandic blood donors from 1997 through 2019. Transfus Med 2022; 32:128-134. [PMID: 35212061 DOI: 10.1111/tme.12856] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/13/2022] [Accepted: 02/01/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To estimate the frequency of iron deficiency (ID) and anaemia in blood donors in Iceland and the impact of serum ferritin (SF) testing policy change. BACKGROUND Blood donations contribute to ID and/or anaemia in whole blood donors (WBD). SF may be used to monitor blood donor iron stores. MATERIALS AND METHODS The study included WBD and new donors (ND) in the Icelandic Blood Bank in 1997-2019. SF was measured for ND and intermittently for WBD until October 2017, but thereafter for all WBD and ND at every visit. In January 2018, the SF threshold increased from 14 to 16 μg/L for ND and from 8 to 10 μg/L for WBD. RESULTS The study included 85 370 SF results from 243 369 visits of 32 910 donors. Median SF was higher for males than females, both for ND (88.0 vs. 31.2 μg/L, p < 0.001) and WBD (before 2018: 43.0 vs. 22.0 μg/L, p < 0.001). After the policy change in 2018, median SF increased for both male WBD (to 45.2 μg/L, p < 0.001) and female WBD (to 25.7 μg/L, p < 0.001). ID (SF <15 μg/L) was present in 10.6% of female ND and 0.5% of male ND. After policy change, the proportion of WB donations associated with ID decreased for males (from 6.4% to 4.0%) and females (from 18.9% to 14.1%). ID anaemia was present at some time in 3.7% of female WBD and 1.2% of male WBD. CONCLUSION This nationwide study showed that ID in WB donors is common, especially among females, but monitoring SF may improve donor management.
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Affiliation(s)
- Erla Gestsdottir
- Department of Medicine, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Magnus Karl Magnusson
- Department of Medicine, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,deCODE genetics/Amgen Inc., Reykjavík, Iceland
| | | | - Vigdis Johannsdottir
- The Blood Bank, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland
| | - Thorbjörn Jonsson
- Department of Medicine, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,The Blood Bank, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland
| | - Sveinn Gudmundsson
- The Blood Bank, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland
| | - Anna Margret Halldorsdottir
- Department of Medicine, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,The Blood Bank, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland
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29
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France JL, France CR, Rebosa M, Shaz BH, Kessler DA. Promoting awareness of donation-related iron depletion among high risk blood donors. Transfusion 2021; 61:3353-3360. [PMID: 34605554 DOI: 10.1111/trf.16694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The potential for iron deficiency is a known blood donor health concern and suggests the need to inform donors about the potential risks of low iron levels as well as strategies to address these risks. STUDY DESIGN AND METHODS Frequent (n = 904) and young (n = 629) donors were randomly assigned within risk group to either a control (n = 548) or an intervention (n = 985) group. The control group answered questions at baseline and 6-month follow-up regarding their awareness of the risk of donation-related iron depletion and whether they were taking actions to address their iron status. The intervention group answered the same questions at baseline and follow-up, but after completing the baseline survey, they received information regarding their risk of iron depletion and behaviors they could adopt to mitigate this risk. Intervention group participants were also offered the opportunity to develop an action plan to help them supplement their iron intake. RESULTS The intervention enhanced overall awareness of donation-related iron loss (OR = 1.5, 95% CI 1.171-1.864, p = .001), with no negative impact on retention. Reported iron health behaviors (iron supplementation, speaking with a doctor) showed significant increases when action planning was paired with the educational information. CONCLUSION These findings suggest that it is possible to increase awareness of donation-related risk for iron depletion without negatively influencing retention, and combining education with encouragement to develop an action plan may increase the likelihood of both retention and behavioral changes to promote healthy iron levels.
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Affiliation(s)
- Janis L France
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | | | - Mark Rebosa
- New York Blood Center, New York, New York, USA
| | - Beth H Shaz
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA
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30
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Prinsze FJ, de Groot R, Timmer TC, Zalpuri S, van den Hurk K. Donation-induced iron depletion is significantly associated with low hemoglobin at subsequent donations. Transfusion 2021; 61:3344-3352. [PMID: 34596892 DOI: 10.1111/trf.16688] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Blood donation is associated with a loss of hemoglobin (Hb)-bound iron. Hb levels recover relatively fast by using stored iron. However, it takes more time to replenish iron stores, potentially resulting in iron deficiency. STUDY DESIGN Hb and ferritin levels were measured in 5056 new, first-time, and repeat whole blood donors. We investigated whether increasing numbers of donations are associated with lower ferritin levels. Furthermore, we tested whether low ferritin levels are associated with low-Hb deferral at the subsequent donation attempt by performing logistic regression adjusted for age and stratified by sex. RESULTS Whereas mean Hb levels are relatively stable, ferritin levels significantly decrease with increasing numbers of donations and were approximately 50% lower for donors with >50 donations compared with those with 2-10 donations. Despite the poor correlation of ferritin and Hb levels, cross-sectional, iron-deficient donors (ferritin <15 ng/ml) had 21.8 (8.5-55.6) higher odds in men, 10.1 (6.1-16.5) in premenopausal women, and 11.7 (5.2-26.4) in postmenopausal women for Hb deferral at a subsequent visit. DISCUSSION To conclude, repeated donations may induce iron deficiency, which corresponds with an over tenfold increased risk of having insufficiently restored Hb levels at a subsequent donation attempt. Longer donation intervals and/or higher dietary or supplemental iron intake are warranted to prevent accumulated iron depletion and subsequent low-Hb deferral in whole blood donors.
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Affiliation(s)
- Femmeke J Prinsze
- Department of Donor Medicine Research, Donor Studies, Sanquin Research, Amsterdam, the Netherlands
| | - Rosa de Groot
- Department of Donor Medicine Research, Donor Studies, Sanquin Research, Amsterdam, the Netherlands
| | - Tiffany C Timmer
- Department of Donor Medicine Research, Donor Studies, Sanquin Research, Amsterdam, the Netherlands
| | - Saurabh Zalpuri
- Department of Donor Medicine Research, Donor Studies, Sanquin Research, Amsterdam, the Netherlands.,UCB Pharma, Real World Evidence, Breda, the Netherlands
| | - Katja van den Hurk
- Department of Donor Medicine Research, Donor Studies, Sanquin Research, Amsterdam, the Netherlands
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31
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Should We Stop Collecting the Preoperative Autologous Blood before Bone Marrow Harvest? J Clin Med 2021; 10:jcm10102134. [PMID: 34069241 PMCID: PMC8156284 DOI: 10.3390/jcm10102134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/02/2021] [Accepted: 05/10/2021] [Indexed: 01/05/2023] Open
Abstract
Preoperative autologous blood donation (PAD) in bone marrow (BM) donors is performed to meet potential post-harvest transfusion needs and to avoid the risk of allogeneic transfusions. We reviewed retrospectively bone marrow harvests in 216 healthy donors during a ten-year period to determine the use of autologous blood. All donors except four had undergone PAD. The initial hemoglobin level of 153 g/L (male donors) and 135 g/L (female donors), respectively, decreased by about 8 g/L after preoperative blood donation and by 23 g/L after bone marrow harvest (medians). Autologous blood was administered to 70% of donors, 30% of the units remained unused. The evaluation of the risk of reaching transfusion threshold (<115 g/L males, <105 g/L females) revealed that donors with initial hemoglobin above 145 g/L and those weighing above 75 kg have minimal risk of requiring blood substitution (about 10%). A larger volume of bone marrow was obtained from male compared to female donors (1300 vs. 1100 mL) because of their higher body weight, which resulted in a higher number of procured nucleated cells (362 vs. 307 × 106/kg TNC, ns). The donor-recipient weight difference predicted the probability of sufficient collection. Only 1.5% of donors weighing ≥ 20 kg more than recipients failed to reach ≥3 × 108/kg TNC recipient. Our findings affirm previous data that PAD is unnecessary for healthy marrow donors and may be indicated individually after considering the pre-collection hemoglobin level, donor and recipient weight, and expected blood loss. Reasonable substitution cut-offs have to be set together with clinical symptom evaluation. The effective use of PAD also requires an adequate time interval between PAD and BM harvest.
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32
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Efficacy of intra-operative administration of iron isomaltoside for preventing postoperative anaemia after total knee arthroplasty: A randomised controlled trial. Eur J Anaesthesiol 2021; 38:358-365. [PMID: 33259451 DOI: 10.1097/eja.0000000000001389] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postoperative anaemia is common after total knee arthroplasty (TKA). Emerging evidence shows the beneficial effects of peri-operative iron supplementation in patients at risk of postoperative anaemia. OBJECTIVE To evaluate the efficacy of intra-operative administration of iron isomaltoside for the prevention of postoperative anaemia in patients undergoing TKA. DESIGN Randomised, controlled, double-blind, parallel-group study. SETTING A tertiary care teaching hospital; between 29 March 2018 and 16 April 2019. PATIENTS Eighty-nine patients scheduled for unilateral TKA were included. INTERVENTION Iron isomaltoside or placebo were administered intravenously over 30 min during surgical wound closure. MAIN OUTCOME MEASURES The primary outcome measure was the incidence of anaemia at 30 days after TKA: anaemia was defined as haemoglobin less than 12 g dl-1 for female and less than 13 g dl-1 for male. RESULTS In total, 89 patients were included in the final analysis (44 in the treatment group; 45 in the control group). The administered dose of iron isomaltoside in the treatment group was 1136 ± 225 mg. The incidence of anaemia at 30 days after TKA was significantly lower in the treatment group (34.1%, 15/44) than that in the control group (62.2%, 28/45): relative risk 0.55 (95% confidence interval, 0.34 to 0.88), P = 0.008. Haemoglobin concentration, serum ferritin concentrations, and transferrin saturation were also significantly higher in the treatment group at 30 days after TKA. CONCLUSION The intra-operative administration of iron isomaltoside effectively prevents postoperative anaemia in patients undergoing TKA, and thus it can be included in patient blood management protocols for reducing postoperative anaemia in these population. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03470649.
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Multistage feedback-driven compartmental dynamics of hematopoiesis. iScience 2021; 24:102326. [PMID: 33889822 PMCID: PMC8050392 DOI: 10.1016/j.isci.2021.102326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/02/2021] [Accepted: 03/15/2021] [Indexed: 11/22/2022] Open
Abstract
Human hematopoiesis is surprisingly resilient to disruptions, providing suitable responses to severe bleeding, long-lasting immune activation, and even bone marrow transplants. Still, many blood disorders exist which push the system past its natural plasticity, resulting in abnormalities in the circulating blood. While proper treatment of such diseases can benefit from understanding the underlying cell dynamics, these are non-trivial to predict due to the hematopoietic system's hierarchical nature and complex feedback networks. To characterize the dynamics following different types of perturbations, we investigate a model representing hematopoiesis as a sequence of compartments covering all maturation stages-from stem to mature cells-where feedback regulates cell production to ongoing necessities. We find that a stable response to perturbations requires the simultaneous adaptation of cell differentiation and self-renewal rates, and show that under conditions of continuous disruption-as found in chronic hemolytic states-compartment cell numbers evolve to novel stable states.
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34
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Batagello CA, Vicentini FC, Monga M, Miller AW, Marchini GS, Torricelli FCM, Danilovic A, Coelho RF, Srougi M, Nahas WC, Mazzucchi E. Tranexamic acid in patients with complex stones undergoing percutaneous nephrolithotomy: a randomised, double-blinded, placebo-controlled trial. BJU Int 2021; 129:35-47. [PMID: 33630393 DOI: 10.1111/bju.15378] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To assess the efficacy and safety of single-dose tranexamic acid on the blood transfusion rate and outcomes of patients with complex kidney stones undergoing percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS In a randomised, double-blinded, placebo-controlled trial, 192 patients with complex kidney stone (Guy's Stone Scores III-IV) were prospectively enrolled and randomised (1:1 ratio) to receive either one dose of tranexamic acid (1 g) or a placebo at the time of anaesthetic induction for PCNL. The primary outcome measure was the occurrence rate of perioperative blood transfusion. The secondary outcome measures included blood loss, operative time, stone-free rate (SFR), and complications. ClinicalTrials.gov identifier: NCT02966236. RESULTS The overall risk of receiving a blood transfusion was reduced in the tranexamic acid group (2.2% vs 10.4%; relative risk, 0.21, 95% confidence interval [CI] 0.03-0.76, P = 0.033; number-needed-to-treat: 12). Patients randomised to the tranexamic acid group had a higher immediate and 3-month SFR compared with those in the placebo group (29% vs 14.7%, odds ratio [OR] 2.37, 95% CI 1.15-4.87, P = 0.019, and 46.2% vs 28.1%, OR 2.20, 95% CI 1.20-4.02, P = 0.011, respectively). Faster haemoglobin recovery occurred in patients in the tranexamic acid group (mean, 21.3 days; P = 0.001). No statistical differences were found in operative time and complications between groups. CONCLUSIONS Tranexamic acid administration is safe and reduces the need for blood transfusion by five-times in patients with complex kidney stones undergoing PCNL. Moreover, tranexamic acid may contribute to better stone clearance rate and faster haemoglobin recovery without increasing complications. A single dose of tranexamic acid at the time of anaesthetic induction could be considered standard clinical practice for patients with complex kidney stones undergoing PCNL.
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Affiliation(s)
- Carlos A Batagello
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Fabio C Vicentini
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Endourology, Hospital Brigadeiro, Sao Paulo, Brazil
| | - Manoj Monga
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Stevan B. Streem Center for Endourology and Stone Disease, Cleveland Clinic, Cleveland, OH, USA.,Urology Division, University of California San Diego, San Francisco, CA, USA
| | - Aaron W Miller
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Stone Translational Research Laboratory, Cleveland Clinic, Cleveland, OH, USA.,Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Giovanni S Marchini
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Fabio C M Torricelli
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alexandre Danilovic
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Rafael F Coelho
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Willian C Nahas
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Pasricha SR, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet 2021; 397:233-248. [PMID: 33285139 DOI: 10.1016/s0140-6736(20)32594-0] [Citation(s) in RCA: 358] [Impact Index Per Article: 119.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023]
Abstract
Iron deficiency is one of the leading contributors to the global burden of disease, and particularly affects children, premenopausal women, and people in low-income and middle-income countries. Anaemia is one of many consequences of iron deficiency, and clinical and functional impairments can occur in the absence of anaemia. Iron deprivation from erythroblasts and other tissues occurs when total body stores of iron are low or when inflammation causes withholding of iron from the plasma, particularly through the action of hepcidin, the main regulator of systemic iron homoeostasis. Oral iron therapy is the first line of treatment in most cases. Hepcidin upregulation by oral iron supplementation limits the absorption efficiency of high-dose oral iron supplementation, and of oral iron during inflammation. Modern parenteral iron formulations have substantially altered iron treatment and enable rapid, safe total-dose iron replacement. An underlying cause should be sought in all patients presenting with iron deficiency: screening for coeliac disease should be considered routinely, and endoscopic investigation to exclude bleeding gastrointestinal lesions is warranted in men and postmenopausal women presenting with iron deficiency anaemia. Iron supplementation programmes in low-income countries comprise part of the solution to meeting WHO Global Nutrition Targets.
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Affiliation(s)
- Sant-Rayn Pasricha
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Diagnostic Haematology, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
| | - Jason Tye-Din
- Immunology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Martina U Muckenthaler
- Department of Pediatric Oncology, Hematology, and Immunology and Molecular Medicine Partnership Unit, University of Heidelberg, Heidelberg, Germany; Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany; Translational Lung Research Center, German Center for Lung Research, Heidelberg, Germany; German Centre for Cardiovascular Research, Partner Site Heidelberg, Mannheim, Germany
| | - Dorine W Swinkels
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
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Chae MS, Lee M, Choi MH, Park JU, Park M, Kim YH, Choi H, Joo J, Moon YE. Preemptive intravenous iron therapy versus autologous whole blood therapy for early postoperative hemoglobin level in patients undergoing bimaxillary orthognathic surgery: a prospective randomized noninferiority trial. BMC Oral Health 2021; 21:16. [PMID: 33413311 PMCID: PMC7791750 DOI: 10.1186/s12903-020-01359-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have reported the efficacy and safety of intravenous (IV) iron therapy during the perioperative period as an alternative and adjunct to allogeneic blood transfusion. Preemptive IV iron therapy provides noninferior hemoglobin levels on postoperative day (POD) 1 compared to autologous whole blood therapy (AWBT) in healthy patients who had undergone bimaxillary orthognathic surgery. METHODS This was a prospective, patient-randomized, noninferiority trial. After excluding 2 patients, 64 patients were divided into two groups: the IV iron therapy group (patients received IV iron infusion 4 weeks before surgery; n = 32) and the AWBT group (2 units of autologous whole blood were collected 4 and 2 weeks before surgery; n = 32). The primary outcome was hemoglobin level on POD 1 and the prespecified noninferiority limit was - 1 g/dL. RESULTS Baseline data were comparable, including hemoglobin and iron levels, between the two groups. Immediately before surgery, the levels of hemoglobin, iron, and ferritin were higher in the IV iron group than in the AWBT group. The mean treatment difference (iron group-whole blood group) in hemoglobin level on POD 1 between the two groups was 0.09 (95% CI = - 0.83 to 1.0). As the lower limit of the 95% CI (- 0.83) was higher than the prespecified noninferiority margin (δ = - 1), noninferiority was established. On POD 2, the hemoglobin level became lower in the iron group, which eventually led to greater requirement of allogeneic blood transfusion compared to the whole blood group. However, the iron group did not require allogeneic blood transfusion during or early after surgery, and the whole blood group showed continuously higher incidence of overt iron deficiency compared to the iron group. CONCLUSION As collection of autologous whole blood caused overt iron loss and anemia before surgery and intraoperative transfusion of whole blood was not able to prevent the occurrence of persistent iron deficiency after surgery, IV iron therapy was found to have potential benefits for iron homeostasis and subsequent erythropoiesis in healthy patients early after bimaxillary orthognathic surgery. TRIAL REGISTRATION Clinical Research Information Service, Republic of Korea, approval number: KCT0003680 on March 27, 2019. https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=15769&sLeft=2<ype=my&rtype=my .
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Affiliation(s)
- Min Suk Chae
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Mihyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Min Ho Choi
- Department of Oral and Maxillofacial Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Je Uk Park
- Department of Oral and Maxillofacial Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Misun Park
- Department of Biostatistics, Clinical Research Coordinating Center, Catholic Medical Center, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Hoon Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hoon Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jin Joo
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Young Eun Moon
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Poor iron store recovery in voluntary blood donors in the northern zone of Ghana; a five-month three-centre cohort study. Transfus Apher Sci 2020; 60:103040. [PMID: 33358358 DOI: 10.1016/j.transci.2020.103040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/11/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In Ghana, although iron deficiency is endemic, post blood donation iron supplementation is not routine. We sought to determine whether at five months post-donation of a single unit of whole blood, donors were able to recover iron stores. MATERIALS AND METHODS This three-centre cohort study recruited 164 blood donors at the Lawra, Nandom, and Bimbila communities in the northern zone of Ghana. Venous blood samples were drawn at baseline to estimate full blood count (FBC), haemoglobin variants, qualitative G6PD status, and serum ferritin. Five months post-donation, venous blood samples were drawn for a repeat measurement of FBC and serum ferritin. Data were analysed using SPSS and GraphPad prism to assess recovery of iron stores. RESULTS Whereas 26.8 % had inherited haemoglobin variants, 18.9 % of the donors had qualitative G6PD deficiency. Overall, mean difference between pre-donation and five months post donation iron stores significantly differed from zero (p < 0.001; one sample t-test). After five months post donation, 76.8 % of the blood donors could not achieve pre-donation iron stores. Whereas 6.1 % and 8.5 % blood donors had depleted iron stores and iron deficient erythropoiesis at baseline, these increased to 9.8 % and 21.3 % respectively at five-month post donation. Moreover, at five months post donation, 11 % of these blood donors would have been disqualified per haemoglobin screening cut off of 12.5 g/dl. CONCLUSION Reliance on food intake to replenish iron store lost per blood donation may not adequately assure donor health in the study area; iron supplementation should be considered.
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Vassallo RR. Donor iron depletion in context. Transfusion 2020; 61:318-321. [PMID: 33294973 DOI: 10.1111/trf.16219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Ralph R Vassallo
- Corporate Medical Affairs, Vitalant, Scottsdale, Arizona, USA.,University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Steuer LV, Kondo AT, Cipolletta AN, Sakashita AM, Hamerschlak N, Kutner JM. Predictive factors for the development of anemia after hematopoietic stem cell donation. Transfusion 2020; 61:159-166. [PMID: 33052621 DOI: 10.1111/trf.16124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although Hematopoietic Stem Cells (HSC) donation through bone marrow (BM) and peripheral blood (PB) are usually safe procedures, adverse events are expected. One of the most common events especially among BM donors (BMD) is the development of anemia. To protect the BMD and preserve the hemoglobin levels, many centers collect autologous pre-procedure blood, but the actual benefits of this procedure is controversial. METHODS AND MATERIALS This study analyzed retrospectively data to observe what factors may influence the occurrence of post-donation anemia and also evaluate the relevance of autologous red blood cell pre procedure donation (PAD). RESULTS The development of immediately post donation anemia (IP) was higher in BMD than in PB donors (64.2% BMD and 10.7% PBD, P < .001) and also in late post donation (LP) (28.4% BMD and 3.6% PBD, P = .007). The study demonstrated an association between PAD and anemia in IP (72.7% with anemia and 27.3% without anemia, P = .006) and an association between the volume of red blood cells in the donated hematopoietic product and the development of anemia in LP (356.3 mL and 297.8 mL, P = .037). CONCLUSION In conclusion, collection of HSC through BM is a risk factor for anemia and PAD is a risk factor for IP anemia.
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Affiliation(s)
- Lia V Steuer
- Hemotherapy and Cell Therapy Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andrea T Kondo
- Hemotherapy and Cell Therapy Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andrea N Cipolletta
- Hemotherapy and Cell Therapy Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Araci M Sakashita
- Hemotherapy and Cell Therapy Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nelson Hamerschlak
- Hemotherapy and Cell Therapy Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - José M Kutner
- Hemotherapy and Cell Therapy Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
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40
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Iron supplementation limits the deleterious effects of repeated blood donation on endurance sport performance but not on iron status. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:334-347. [PMID: 32931412 DOI: 10.2450/2020.0087-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Every day, blood banks worldwide face the challenge of ensuring an adequate blood supply. Iron deficiency is by far the most common cause of deferral of blood donors. The aim of the present study was to determine the effect of iron supplementation after repeated blood donation on iron status and physiological performance. MATERIALS AND METHODS Forty-four moderately trained and iron-replete subjects were randomly divided into a whole blood donation (n=36) and a placebo donation (n=8) group. One third of the donation group received no iron supplementation, whereas one third received 20 mg iron and one third received 80 mg iron daily for 28 days. The subjects were intended to make three donations 3 months apart, and recovery of endurance capacity, assessed by an incremental maximal cycling test, and haematological parameters was monitored up to 28 days after each donation. RESULTS Negative effects of repeated blood donation were found for markers of iron storage, markers of functional iron and/or iron metabolism regulation, and physiological markers. Iron supplementation did not affect iron storage but did limit, at the highest dose of 80 mg, the effect of blood donations on functional iron and/or iron metabolism regulation, and at both 20 and 80 mg the negative effects on maximal power output and peak oxygen consumption. DISCUSSION Iron supplementation limited the deleterious effects of repeated blood donation on endurance sport performance but not on decline in iron status in iron-replete young men. These results underline the importance of iron supplementation to minimise the deleterious effects of blood donation on physiological functions, and the necessity to optimise the supplementation strategy to preserve iron status.
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Oral iron and blood donation: cui bono? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:329-331. [PMID: 32931411 PMCID: PMC7592162 DOI: 10.2450/2020.0239-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Chueca M, Bouvet G, Duron-Martinaud S, Doyen M, Poirrier L, Martinaud C. Iron-deficiency among blood donors: Donors' opinion on iron supplementation strategy. Transfus Clin Biol 2020; 27:218-221. [PMID: 32841738 DOI: 10.1016/j.tracli.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Each donation of a single whole blood unit causes a 200-250mg iron loss. The main clinical manifestation of iron deficiency among blood donors is anemia, and every blood collection establishment must have measures in place to minimize and prevent iron depletion in blood donors, according to the European guidelines. However, iron deficiency without anemia is also associated with clinical manifestations. The management of iron deficiency is an acute issue; still, no consensus on its managements exists. One possibility is iron supplementation; however, the acceptability of such a measure is still unknown, so we asked donors' opinions on this topic. MATERIALS AND METHODS Over a 2-month period, a questionnaire was voluntarily completed by blood donors at the French Military Blood Institute. Gender, age, number of donations in the last 12 months, and preference between iron supplementation and general practitioner consultation for management of iron deficiency were recorded. RESULTS One thousand nine hundred and seventy-four questionnaires were returned. Donors between ages 18-50 represented 89% of respondents. Altogether, 49% declared that they would rather visit their general practitioner and 46% would rather receive iron supplementation. There were no significant differences correlated with gender or age. However, a higher number of prior donations was significantly associated with a preference for iron supplementation. Frequent female donors had an even stronger preference for iron supplementation. CONCLUSION Our results showed that there are no strong objections to iron supplementation, which could be an acceptable option for frequent donors - the main population at risk for iron deficiency.
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Affiliation(s)
- M Chueca
- French Military Blood Institute, 1, rue Raoul-Batany, 92140 Clamart, France
| | - G Bouvet
- French Military Blood Institute, 1, rue Raoul-Batany, 92140 Clamart, France
| | - S Duron-Martinaud
- French Military Health Service Directorate, Fort-de-Montrouge, 94000 Arcueil, France
| | - M Doyen
- French Military Blood Institute, 1, rue Raoul-Batany, 92140 Clamart, France
| | - L Poirrier
- French Military Blood Institute, 1, rue Raoul-Batany, 92140 Clamart, France
| | - C Martinaud
- French Military Blood Institute, 1, rue Raoul-Batany, 92140 Clamart, France.
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Vinkenoog M, van den Hurk K, van Kraaij M, van Leeuwen M, Janssen MP. First results of a ferritin-based blood donor deferral policy in the Netherlands. Transfusion 2020; 60:1785-1792. [PMID: 32533600 PMCID: PMC7496980 DOI: 10.1111/trf.15906] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Whole blood donors are at risk of becoming iron deficient. To monitor iron stores, Sanquin implemented a new deferral policy based on ferritin levels, in addition to the traditional hemoglobin measurements. METHODS Ferritin levels are determined in every fifth donation, as well as in all first-time donors. Donors with ferritin levels <15 ng/mL (WHO threshold) are deferred for 12 months; those ≥15 and ≤30 ng/mL for 6 months. The first results were analyzed and are presented here. RESULTS The results show that 25% of women (N = 20151, 95% CI 24%-25%) and 1.6% of men (N = 10391, 95% CI 1.4%-1.8%) have ferritin levels ≤30 ng/mL at their first blood center visit. For repeat (non-first-time) donors, these proportions are higher: 53% of women (N = 28329, 95% CI 52%-54%) and 42% of men (N = 31089, 95% CI 41%-43%). After a 6-month deferral, in 88% of returning women (N = 3059, 95% CI 87%-89%) and 99% of returning men (N = 3736, 95% CI 98%-99%) ferritin levels were ≥15 ng/mL. After a 12-month deferral, in 74% of returning women (N = 486, 95% CI 70%-78%) and 95% of returning men (N = 479, 95% CI 94%-97%) ferritin levels increased to ≥15 ng/mL. CONCLUSION Deferral of donors whose pre-donation ferritin levels were ≤30 ng/mL might prevent donors from returning with ferritin levels <15 ng/mL. This policy is promising to mitigate effects of repeated donations on iron stores.
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Affiliation(s)
- Marieke Vinkenoog
- Donor Medicine Research, Sanquin ResearchAmsterdamThe Netherlands
- Leiden Institute of Advanced Computer ScienceLeiden UniversityLeidenThe Netherlands
| | | | | | - Matthijs van Leeuwen
- Leiden Institute of Advanced Computer ScienceLeiden UniversityLeidenThe Netherlands
| | - Mart P. Janssen
- Donor Medicine Research, Sanquin ResearchAmsterdamThe Netherlands
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Nielsen P. [Risk of iron deficiency caused by blood donation]. MMW Fortschr Med 2020; 162:22-24. [PMID: 32780394 DOI: 10.1007/s15006-020-0732-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Peter Nielsen
- Institut für Biochemie und Molekulare Zellbiologie (IBMZ) Interdisziplinäre Arbeitsgruppe Eisenstoffwechsel, Martinistr. 52, D-20246, Hamburg, Deutschland.
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Mast AE, Szabo A, Stone M, Cable RG, Spencer BR, Kiss JE. The benefits of iron supplementation following blood donation vary with baseline iron status. Am J Hematol 2020; 95:784-791. [PMID: 32243609 DOI: 10.1002/ajh.25800] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022]
Abstract
Whole blood donation rapidly removes approximately 10% of a donor's blood volume and stimulates substantial changes in iron metabolism and erythropoiesis. We sought to identify donors who benefit from iron supplementation, describe the nature of the benefit, and define the time course for recovery from donation. Blood samples were collected over 24 weeks following whole blood donation from 193 participants, with 96 participants randomized to 37.5 mg daily oral iron. Changes in total body, red blood cell (RBC), and storage iron, hepcidin, erythropoietin, and reticulocyte count were modeled using semiparametric curves in a mixed model. and the changes were compared among six groups defined by baseline ferritin (<12; 12-50; ≥50 ng/mL) and iron supplementation. The effect of oral iron on storage and RBC iron recovery was minimal in donors with baseline ferritin ≥50 ng/mL, but sizeable when ferritin was <50 ng/mL. Iron initially absorbed went to RBC and storage iron pools when ferritin was <12 ng/mL but went mostly to RBCs when ferritin was ≥12 ng/mL. Donors with ferritin ≥12 ng/mL had a "ripple" increase in reticulocytes ~100 days after donation indicating physiological responses occur months following donation. Thus, iron supplements markedly enhance recovery from whole blood donation in donors with ferritin <50 ng/mL. However, full recovery from donation requires over 100 days when taking iron. The findings also highlight the value of the study of blood donors for understanding human hemoglobin and iron metabolism and their usefulness for future studies as additional biomarkers are discovered.
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Affiliation(s)
- Alan E. Mast
- Blood Research Institute, Versiti Milwaukee Wisconsin USA
- Department of Cell Biology, Neurobiology and AnatomyMedical College of Wisconsin Milwaukee Wisconsin USA
| | - Aniko Szabo
- Division of BiostatisticsMedical College of Wisconsin Milwaukee Wisconsin USA
| | - Mars Stone
- Vitalant Research Institute San Francisco California USA
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Vassallo RR, Hilton JF, Bravo MD, Vittinghoff E, Custer B, Kamel H. Recovery of Iron Stores After Adolescents Donate Blood. Pediatrics 2020; 146:peds.2019-3316. [PMID: 32503934 DOI: 10.1542/peds.2019-3316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Teenagers aged 16 to 18 are at increased risk for iron deficiency, exacerbated by losses with whole blood (WB) or double red blood cell (2RBC) donations. Required 56-day (WB) or 112-day (2RBC) interdonation intervals (IDIs) are too short for many to replace lost iron without supplements. METHODS Teenagers donating WB or 2RBCs at Vitalant, a national blood provider, had serum ferritin measured at their first and immediately subsequent successful donation from December 2016 to 2018. We modeled postindex log-ferritin as a function of IDI to estimate the shortest intervals that corresponded with 50% to 95% prevalence of adequate donor iron stores (ferritin ≥20 ng/mL female donors, ≥30 ng/mL male donors) at the subsequent donation. RESULTS Among 30 806 teenagers, 11.4% of female and 9.7% of male donors had inadequate iron stores at index donation. Overall, 92.6% had follow-up ferritin values within 13 months. Approximately 12 months after WB index donations, >60% of female and >80% of male donors had adequate iron stores (>50% and >70% after 2RBC donations). Follow-up-donation iron stores were highly dependent on index ferritin. Less than half of WB donors with low ferritin at index achieved adequate stores within 12 months. Achieving a ≥90% prevalence of adequate ferritin at 12 months required index values >50 ng/mL. CONCLUSIONS These findings suggest that postdonation low-dose iron supplements should be strongly encouraged in teenagers with borderline or low iron stores to permit donation without increased risk for symptoms of mild iron depletion. Increasing the minimum recommended IDI to allow time for replacing donation-related iron losses may be desirable for teenagers.
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Affiliation(s)
| | - Joan F Hilton
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California; and
| | | | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California; and
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California
| | - Hany Kamel
- Corporate Medical Affairs, Vitalant, Scottsdale, Arizona
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Pagano MB, Allen ES, Chou ST, Dunbar NM, Gniadek T, Goel R, Harm SK, Hopkins CK, Jacobson J, Lokhandwala PM, Metcalf RA, Raval JS, Schwartz J, Shan H, Spinella PC, Storch E, Cohn CS. Current advances in transfusion medicine: a 2019 review of selected topics from the AABB Clinical Transfusion Medicine Committee. Transfusion 2020; 60:1614-1623. [PMID: 32472580 DOI: 10.1111/trf.15848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The AABB Clinical Transfusion Medicine Committee (CTMC) compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine (TM) for the board of director's review. This synopsis is now made available as a manuscript published in TRANSFUSION. STUDY DESIGN AND METHODS CTMC committee members review original manuscripts including TM-related topics published in different journals between late 2018 and 2019. The selection of topics and manuscripts are discussed at committee meetings and are chosen based on relevance and originality. After the topics and manuscripts are selected, committee members work in pairs to create a synopsis of the topics, which is then reviewed by two committee members. The first and senior authors of this manuscript assembled the final manuscript. Although this synopsis is comprehensive, it is not exhaustive, and some papers may have been excluded or missed. RESULTS The following topics are included: infectious risks to the blood supply, iron donor studies, pre-transfusion testing interference and genotyping, cold agglutinin disease (CAD), HLA alloimmunization in platelet transfusions, patient blood management, updates to TACO and TRALI definitions, pediatric TM, and advances in apheresis medicine. CONCLUSION This synopsis provides easy access to relevant topics and may be useful as an educational tool.
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Affiliation(s)
- Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Stella T Chou
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Ruchika Goel
- Transfusion Medicine Division, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Division of Hematology/Oncology, Simmons Cancer Institute at Southern Illinois University School of Medicine and Mississippi Valley Regional Blood Center, Springfield, Illinois, USA
| | - Sarah K Harm
- Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont
| | | | - Jessica Jacobson
- Department of Pathology, New York University Grossman School of Medicine, New York, New York
| | - Parvez M Lokhandwala
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan A Metcalf
- Clinical Pathology Division, Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Jay S Raval
- Transfusion Medicine Service, Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Joseph Schwartz
- Transfusion Medicine & Cellular Therapy, Department of Pathology & Cell Biology, Columbia University, New York, New York
| | - Hua Shan
- Department of Pathology, Stanford University, Stanford, California
| | - Philip C Spinella
- Division of Pediatric Critical Care, Washington University in St Louis, St Louis, Missouri, USA
| | - Emily Storch
- Office of Blood Research and Review, Food and Drug Administration, Silver Spring, Maryland
| | - Claudia S Cohn
- Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
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48
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Schirm S, Scholz M. A biomathematical model of human erythropoiesis and iron metabolism. Sci Rep 2020; 10:8602. [PMID: 32451387 PMCID: PMC7248076 DOI: 10.1038/s41598-020-65313-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 04/23/2020] [Indexed: 11/09/2022] Open
Abstract
Anaemia therapy or perisurgical support of erythropoiesis often require both, EPO and iron medication. However, excessive iron medication can result in iron overload and it is challenging to control haemoglobin levels in a desired range. To support this task, we develop a biomathematical model to simulate EPO- and iron medication in humans. We combine our previously established model of human erythropoiesis including comprehensive pharmacokinetic models of EPO applications with a newly developed model of iron metabolism including iron supplementation. Equations were derived by translating known biological mechanisms into ordinary differential equations. Qualitative model behaviour is studied in detail considering a variety of interventions such as bleeding, iron malnutrition and medication. The model can explain time courses of erythrocytes, reticulocytes, haemoglobin, haematocrit, red blood cells, EPO, serum iron, ferritin, transferrin saturation, and transferrin under a variety of scenarios including EPO and iron application into healthy volunteers or chemotherapy patients. Unknown model parameters were determined by fitting the predictions of the model to time series data from literature. We demonstrate how the model can be used to make predictions of untested therapy options such as cytotoxic chemotherapy supported by iron and EPO. Following our ultimate goal of establishing a model of anaemia treatment in chronic kidney disease, we aim at translating our model to this pathological condition in the near future.
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Affiliation(s)
- Sibylle Schirm
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany.
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49
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Macher S, Herster C, Holter M, Moritz M, Matzhold EM, Stojakovic T, Pieber TR, Schlenke P, Drexler C, Amrein K. The Effect of Parenteral or Oral Iron Supplementation on Fatigue, Sleep, Quality of Life and Restless Legs Syndrome in Iron-Deficient Blood Donors: A Secondary Analysis of the IronWoMan RCT. Nutrients 2020; 12:nu12051313. [PMID: 32380660 PMCID: PMC7284357 DOI: 10.3390/nu12051313] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/25/2020] [Accepted: 04/30/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Besides anemia, iron deficiency may cause more subtle symptoms, including the restless legs syndrome (RLS), the chronic fatigue syndrome (CFS) or sleeping disorders. Objective: The aim of this pre-planned secondary analysis of the IronWoMan randomized controlled trial (RCT) was to compare the frequency and severity of symptoms associated with iron deficiency before and after (intravenous or oral) iron supplementation in iron deficient blood donors. Methods/Design: Prospective, randomized, controlled, single-centre trial. (ClinicalTrials.gov: NCT01787526). Setting: Tertiary care center in Graz, Austria. Participants: 176 (138 female and 38 male) whole-blood and platelet apheresis donors aged ≥ 18 and ≤ 65 years with iron deficiency (ferritin ≤ 30ng/mL at the time of blood donation). Interventions: Intravenous iron (1 g ferric carboxymaltose, n = 86) or oral iron supplementation (10 g iron fumarate, 100 capsules, n = 90). Measurements: Clinical symptoms were evaluated by a survey before iron therapy (visit 0, V0) and after 8–12 weeks (visit 1, V1), including questions about symptoms of restless legs syndrome (RLS), chronic fatigue syndrome (CFS), sleeping disorders, quality of life and symptoms like headaches, dyspnoea, dizziness, palpitations, pica and trophic changes in fingernails or hair. Results: We found a significant improvement in the severity of symptoms for RLS, fatigue and sleep quality (p < 0.001). Furthermore, a significant decrease in headaches, dyspnoea, dizziness and palpitations was reported (p < 0.05). There was no difference between the type of iron supplementation (intravenous versus oral) and clinical outcome data. Conclusion: Iron supplementation in iron-deficient blood donors may be an effective strategy to improve symptoms related to iron deficiency and the wellbeing of blood donors.
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Affiliation(s)
- Susanne Macher
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, 8036 Graz, Austria; (S.M.); (C.H.); (M.M.); (E.M.M.); (P.S.); (C.D.)
- Laboratory of the ÖGK, Friedrichgasse 18, 8010 Graz, Austria
| | - Cornelia Herster
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, 8036 Graz, Austria; (S.M.); (C.H.); (M.M.); (E.M.M.); (P.S.); (C.D.)
| | - Magdalena Holter
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria;
| | - Martina Moritz
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, 8036 Graz, Austria; (S.M.); (C.H.); (M.M.); (E.M.M.); (P.S.); (C.D.)
| | - Eva Maria Matzhold
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, 8036 Graz, Austria; (S.M.); (C.H.); (M.M.); (E.M.M.); (P.S.); (C.D.)
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Graz, 8036 Graz, Austria;
| | - Thomas R. Pieber
- Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
| | - Peter Schlenke
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, 8036 Graz, Austria; (S.M.); (C.H.); (M.M.); (E.M.M.); (P.S.); (C.D.)
| | - Camilla Drexler
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, 8036 Graz, Austria; (S.M.); (C.H.); (M.M.); (E.M.M.); (P.S.); (C.D.)
| | - Karin Amrein
- Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
- Correspondence:
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50
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Farhadfar N, Murthy HS, Logan BR, Sees JA, Ayas M, Battiwalla M, Beitinjaneh AM, Chhabra S, Diaz MA, Engles K, Frangoul H, Ganguly S, Gergis U, Kamani NR, Kamble RT, Kasow KA, Lazarus HM, Liesveld JL, Norkin M, O' Donnell PV, Olsson RF, Rossmann S, Savani BN, Schears R, Seo S, Solh MM, Spitzer T, Sugrue M, Yared JA, Linenberger M, Schwartz J, Pulsipher MA, Shah NN, Switzer GE, Confer DL, Shaw BE, Wingard JR. Impact of autologous blood transfusion after bone marrow harvest on unrelated donor's health and outcome: a CIBMTR analysis. Bone Marrow Transplant 2020; 55:2121-2131. [PMID: 32355289 DOI: 10.1038/s41409-020-0911-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/03/2020] [Accepted: 04/15/2020] [Indexed: 01/28/2023]
Abstract
Pre-harvest autologous blood collection from bone marrow (BM) donors is performed to meet potential post-operative transfusion needs. This study examines the impact of autologous blood transfusion on BM donor's health and safety. The study included first-time unrelated BM donors from the United States whose BM harvest was facilitated by the National Marrow Donor Program (NMDP) centers between 2006 and 2017. Examination of 7024 BM donors revealed that 60% received at least one unit of autologous blood. The donors who received autologous blood were older, had lower hemoglobin pre-harvest, underwent longer duration of anesthesia, and higher volume BM harvest. Only donors who underwent high-volume BM harvest, defined as a BM harvest volume >27% of donor's blood volume, benefited from autologous transfusion. After a high-volume BM harvest, autologous blood transfusion was shown to decrease grade 2 to 4 collection-associated toxicities within 48 h of BM donation (p = 0.010) and shorten the time to donor-reported "complete" recovery from donation-associated symptoms (p < 0.001). Therefore, autologous transfusion could be avoided as support of marrow donation in the majority of unrelated BM donors and should be limited to cases where the planned BM harvest volume is expected to exceed 27% of donor's blood volume.
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Affiliation(s)
- Nosha Farhadfar
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Brent R Logan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Sees
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | | | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Katie Engles
- CW Bill Young Marrow Donor Program, Kensington, MD, USA
| | - Haydar Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA
| | | | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | | | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jane L Liesveld
- Strong Memorial Hospital-University of Rochester Medical Center, Rochester, NY, USA
| | - Maxim Norkin
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| | | | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raquel Schears
- Department of Emergency Medicine, Mayo Medical School, Rochester, MN, USA
| | | | - Melhem M Solh
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | | | | | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA
| | | | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Dennis L Confer
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA.,National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Bronwen E Shaw
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - John R Wingard
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
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