A study of the iron and HFE status of blood donors, including a group who failed the initial screen for anaemia

Iron Deficiency and Blood Donation: Links, Risks and Management

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.

Assessment of serum iron stores in regular plateletpheresis donors

BACKGROUND

Iron deficiency anaemia is the most common nutritional deficiency disorder in the world. Iron deficiency is a potential complication in repeated apheresis donation. The present study was aimed to evaluate serum iron stores in regular plateletpheresis donors.

MATERIALS AND METHODS

A total of 60 donors were included in this study, which included 30 regular plateletpheresis donors as cases and controls were 30 first time donors. The donor samples were collected before donation for complete hemogram, transfusion transmissible infections screening and serum iron, total iron binding capacity, percentage saturation of transferrin and serum ferritin.

RESULTS

Out of 60 donors, more than half of the donors (56.6 %) had serum ferritin less than 30 ng/mL. Out of these 34 donors, 25 were from the case group and 9 donors in the control group. The median serum ferritin level in cases and controls was 11.86 ng/mL (Interquartile range 4.18-17.34 ng/mL) and 37.92 ng/mL (Interquartile range 27.87-86.20 ng/mL) respectively (p < 0.001). The mean serum iron in cases and controls was 71.23 ± 31.32 μg/dL and 93.53 ± 33.53 μg/dL respectively (p = 0.016). The mean percentage saturation in cases and controls was 20.09 ± 9.31 % and 26.26 ± 9.03 % respectively (p = 0.012). A significant decline in mean serum ferritin with increase in number of annual donations and decrease in donation interval was observed.

DISCUSSION

Regular plateletpheresis donation may lead to depletion of iron stores and subclinical iron deficiency. Donors with high platelet count are more likely to exhibit iron deficiency. Periodic serum ferritin estimation in donors participating in regular plateletpheresis donation is warranted.

The impact of analytical variation of hemoglobin measurement on blood donors' hemoglobin and deferral rates

BACKGROUND

Donors' hemoglobin (Hb) level must be tested before blood donation. Low Hb is the leading reason for donor deferral. Many donor-related and external factors associated with low Hb are known, but no studies have been conducted concerning the effects of analytical variation on donor Hb measurements and deferrals.

STUDY DESIGN AND METHODS

The effects of donors' age, the seasonal and daily distribution of donations, and batch-to-batch variation in HemoCue Hb 201+ cuvettes on donors' capillary Hb (cHb) measurements and deferrals were analyzed for more than 1.7 million donor visits in 2010 to 2016 at a national blood establishment. Furthermore, approximately 3.1 million cHb measurements from the years 2000 to 2009 were included in analyses to correlate measured cHb value and Hb deferral rate.

RESULTS

A significant correlation between the mean annual cHb and Hb deferral rate was observed in both women and men. The season of the donation was the strongest explanatory factor for the monthly variation of predonation cHb (explaining 25 and 31% of the variation in women and men, respectively). Batch-to-batch variation in HemoCue cuvettes explained 6.8% of monthly variation in women and 7.4% in men. Monthly changes in donors' age distribution explained 2.5% of monthly variation in women and 2.4% in men.

CONCLUSION

Small and, in most clinical settings, negligible analytical variation in Hb measurement methods can have significant consequences when used for Hb screening of blood donors. This should be minimized by using methods in which analytical variation is under control and kept as low as possible.

Low hemoglobin deferral in blood donors

Low hemoglobin deferral occurs in about 10% of attempted whole blood donations and commonly is a consequence of iron deficiency anemia. Pre-menopausal women often have iron deficiency anemia caused by menstruation and pregnancy and have low hemoglobin deferral on their first donation attempt. Frequent donors also develop iron deficiency and iron deficiency anemia because blood donation removes a large amount of iron from the donor and the 56-day minimum inter-donation interval for donors in the United States is not sufficient for recovery of hemoglobin and iron stores. Other causes for low hemoglobin deferral range from a medically insignificant deferral of a woman with hemoglobin between 12.0 and 12.4 g/dL, which is within the normal reference range but below the 12.5 g/dL needed to donate blood, to anemia caused by an unrecognized malignancy in a "healthy" individual attempting to donate blood. The diverse causes of anemia in blood donors make it difficult to provide accurate information to donors about the cause of their low hemoglobin deferral and complicate implementation of programs to prevent them by blood collecting agencies. This article reviews how hemoglobin is measured and the demographics and causes of low hemoglobin deferral in blood donors. It provides recommendations for how blood collection agencies can provide donors with accurate information about the cause of their deferral and discusses programs that can be implemented to decrease these deferrals in regular donors.

Relationship between blood donors' iron status and their age, body mass index and donation frequency

CONTEXT AND OBJECTIVE

Regular blood donation may decrease body iron storage and lead to anemia. The aim here was to evaluate the iron status of Iranian male blood donors and the impact of age, body mass index (BMI) and donation frequency over one year, on iron status indices.

DESIGN AND SETTING

Cross-sectional, descriptive and analytical study at Tehran Blood Transfusion Center, Tehran, Iran.

METHODS

Between July and September 2011, 117 male blood donors were selected and divided into four groups according to their frequency of blood donation. Thirty male non-donors were also recruited as controls after adjusting for age, weight, height, smoking habits and monthly income. Iron status indices and some criteria such as general health and dietary measurements were determined among all subjects.

RESULTS

The values of the iron-related parameters were significantly lower among donors than among non-donors. Only total iron binding capacity (TIBC) was found to be significantly higher among different donor groups than in the controls. A significant positive correlation was observed between age and serum ferritin (SF) only among the donors who had donated once within the preceding year. The iron status indices did not show any significant relationship with BMI among donors or non-donors.

CONCLUSION

A donation frequency of more than twice a year had a significant influence on iron-related parameters. Therefore, without annual measurement of these parameters, further phlebotomies may lead to iron deficiency and donor rejection in the future.

Effect of increasing hemoglobin cutoff in male donors and increasing interdonation interval in whole blood donors at a hospital-based blood donor center

BACKGROUND

The NHANES-III survey found hemoglobin (Hb) concentrations of more than 13.5 g/dL and more than 12.0 g/dL in normal Caucasian males and females. In the United States, a Hb of least 12.5 g/dL is required for blood donation, which allows "anemic" males to donate while excluding "normal" females. Low Hb is the major cause of deferral in donors and deferrals are associated with decreased donor return rates. Additionally, frequent blood donations are associated with depletion of body iron stores. Analysis of the effect of various Hb cutoffs and interdonation intervals on our center's blood supply is presented.

STUDY DESIGN AND METHODS

Whole blood donor data for a 12-month period were studied. Potential effects on the blood supply by increasing male Hb eligibility levels and/or increasing the interdonation interval were analyzed.

RESULTS

A total of 13,519 individuals (females, 56%) donated 30,678 units (mean frequency, male 2.7 and females 2.1) with the majority (42%) donating once. Increasing the male Hb eligibility to at least 13.5 g/dL will decrease collections by 1457 (5%) units. In addition, decreasing the female Hb eligibility to at least 12.0 g/dL will result in total gain of 307 (1%) units. Considering 12-week interdonation interval and Hb eligibility of at least 13.5 g/dL (male) and at least 12.5 g/dL (female) results in decrease of 11% (3352) units.

CONCLUSIONS

Increasing the Hb cutoff for male donors and/or interdonation interval for all donors will decrease available blood, some of which may be reduced by decreasing the Hb cutoff for females to at least 12.0 g/dL. As a majority of the donors donate only once with mean donation frequency being 2.4, it may be possible to overcome this shortfall by targeted recruitment of donors donating once.

The impact of HFE mutations on haemoglobin and iron status in individuals experiencing repeated iron loss through blood donation*

Frequent blood donors become iron deficient. HFE mutations are present in over 30% of donors. A 24-month study of 888 first time/reactivated donors and 1537 frequent donors measured haemoglobin and iron status to assess how HFE mutations impact the development of iron deficiency erythropoiesis. Donors with two HFE mutations had increased baseline haemoglobin and iron stores as did those with one mutation, albeit to a lesser extent. Over multiple donations haemoglobin and iron status of donors with HFE mutations paralleled those lacking mutations. The prevalence of HFE mutations was not increased in higher intensity donors. Thus, in general, HFE mutations do not temper donation-induced changes in haemoglobin and iron status. However, in Black donors there was an increase of H63D carriers at baseline, from 3·7% in first time/reactivated donors to 15·8% in frequent donors, suggesting that the relative effects of HFE mutations on iron absorption may vary between racial/ethnic groups. In secondary analyses, venous haemoglobin decreased more slowly in donors with ferritin ≥12μg/l; and haemoglobin recovery time was shorter in donors with reticulocyte haemoglobin (CHr) ≥32·6pg, indicating that these biochemical measures are better indicators of a donor's response to phlebotomy than their HFE mutation status.

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

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

Demographic correlates of low hemoglobin deferral among prospective whole blood donors

BACKGROUND

Approximately 10% of attempted blood donations are not allowed because of low hemoglobin (Hb) deferral.

STUDY DESIGN AND METHODS

Low Hb deferrals were tracked in more 715,000 whole blood donors at six blood centers across the United States. A multivariable logistic regression model was developed to comprehensively assess demographic correlates for low Hb deferral.

RESULTS

Demographic factors significantly associated with low Hb deferral include female sex (11 times greater odds than males), increasing age in men (men over 80 have 29 times greater odds than men under 20), African American race (2-2.5 times greater odds than Caucasians), Hispanic ethnicity in women (1.29 times greater odds than Caucasian women), and weight in men (men under 124 pounds have 2.5 times greater odds than men over 200 pounds). Interestingly, increasing donation frequency is associated with decreased odds for low Hb deferral (women with one donation in the previous 12 months have two times greater odds than those with six donations).

CONCLUSIONS

Low Hb deferral is associated with female sex, older age, African American race/ethnicity, and lower body weight in men. An inverse association with donation frequency suggests a selection bias in favor of donors able to give more frequently. These data provide useful information that can be utilized to manage blood donors to limit low Hb deferrals and assist in policy decisions such as changing the Hb cutoff or permissible frequency of donation. They also generate hypotheses for new research of the causes of anemia in defined groups of donors.

Anaemia, iron deficiency and iron deficiency anaemia among blood donors in Port Harcourt, Nigeria

BACKGROUND

There is paucity of information on the effect of blood donation on iron stores in Port Harcourt, Nigeria. The present study was, therefore, designed to assess, using a combination of haemoglobin and iron status parameters, the development of anaemia and prevalence of iron deficiency anaemia in this area of Nigeria.

MATERIALS AND METHODS

Three hundred and forty-eight unselected consecutive whole blood donors, comprising 96 regular donors, 156 relatives of patients and 96 voluntary donors, constituted the study population. Three haematological parameters (haemoglobin, packed cell volume, and mean cell haemoglobin concentration) and four biochemical iron parameters (serum ferritin, serum iron, total iron binding capacity and transferrin saturation) were assessed using standard colorimetric and ELISA techniques.

RESULTS

The prevalence of anaemia alone (haemoglobin <11.0 g/dL) was 13.7%. The prevalence of isolated iron deficiency (serum ferritin <12 ng/mL) was 20.6% while that of iron-deficiency anaemia (haemoglobin <11.0 g/dL + serum ferritin <12.0 ng/mL) was 12.0%. Among the three categories of the donors, the regular donors were found to be most adversely affected as shown by the reduction in mean values of both haematological and biochemical iron parameters. Interestingly, anaemia, iron deficiency and iron-deficiency anaemia were present almost exclusively among regular blood donors, all of whom were over 35 years old.

CONCLUSION

Anaemia, iron deficiency and iron-deficiency anaemia are highly prevalent among blood donors in Port Harcourt, Nigeria. It will be necessary to review the screening tests for the selection of blood donors and also include serum ferritin measurement for the routine assessment of blood donors, especially among regular blood donors.

Iron deficiency and frequency of HFE C282Y gene mutation in Brazilian blood donors

Limited data are available about iron deficiency (ID) in Brazilian blood donors. This study evaluated the frequencies of ID and iron-deficiency anaemia (IDA) separately and according to frequency of blood donations. The protective effect of the heterozygous genotype for HFE C282Y mutation against ID and IDA in female blood donors was also determined. Five hundred and eight blood donors were recruited at the Blood Bank of Santa Casa in Sao Paulo, Brazil. Haemoglobin and serum ferritin concentrations were measured. The genotype for HFE C282Y mutation was determined by polymerase chain reaction followed by restriction fragment length polymorphism analysis. The ID was found in 21.1% of the women and 2.6% of the men whereas the IDA was found in 6.8 and 0.3%, respectively. The ID was found in 11.9% of the women in group 1 (first-time blood donors) and the frequency increased to 38.9% in women of the group 3 (blood donors donating once or more times in the last 12 months). No ID was found in men from group 1; however the ID frequency increased to 0.9% in group 2 (who had donated blood before but not in the last 12 months) and 5.0% in group 3. In summary, the heterozygous genotype was not associated with reduction of ID or IDA frequencies in both genders, but in male blood donors it was associated with a trend to elevated ferritin levels (P = 0.060). ID is most frequent in Brazilian women but was also found in men of group 3.

Approach to blood donors with microcytosis

The aim of this paper is to find microcytosis in donors, to establish prevalence of iron deficiency anaemia (IDA) and beta-thalassemia trait (BTT) in them and to evaluate which index is most effective in differentiating these two conditions. IDA and BTT are the most common causes of microcytic anaemia. Traditional approach is trial of iron treatment. Where thalassemias are common, this can lead to iron overload and failure to provide diagnosis/counselling in BTT. Initially 925 donor samples were evaluated on cell counter. Of these, 50 were found microcytic. These were subjected to Ferritin and HbA2 determination. Subsequently, additional 51, age- and sex-matched normocytic donor samples were selected as controls. These were subjected to the same tests. Nine indices namely RBC, RDW, Mentzer's, Shine and Lal, England and Fraser, Srivastava, Green and King, RDW index and Ricerca were used to differentiate IDA and BTT. Prevalence of microcytosis was 5.4%. Of these microcytic samples, 52% were IDA, 36% were BTT, 8% had both and 4% were undiagnosed. IDA had significantly lower Hb, mean corpuscular volume (MCV) and Ferritin levels than the control group. BTT had lower MCV, higher Ferritin and comparable Hb levels with control group. The Youden's index of Mentzer's was highest and RBC was the only index which had both sensitivity and specificity more than 80% for both IDA and BTT. It is desirable to routinely perform hemograms for all blood donors and further analyse the microcytic samples for Ferritin and HbA2 to diagnose IDA and BTT and to provide appropriate counselling/treatment.

Effect of iron supplementation on iron status during the first week after blood donation

INTRODUCTION

Frequent blood donations may lead to a negative iron balance. Iron depletion may be prevented by iron supplementation after whole blood donations. The aim of this study was to compare the short time changes in iron status after donation in two groups randomized to iron supplementation or no additional iron. A second objective was to evaluate the effect of iron supplementation in donors having HFE-variants compared to HFE wild types.

METHODS

Subjects of both genders (199 women, 200 men) were randomised to receive iron supplementation or no additional iron after donation. Iron status, defined by the concentration of haemoglobin, serum ferritin, soluble transferrin receptor, concentration of haemoglobin in reticulocytes (CHr) and percent hypochrome mature red blood cells, was determined at the start of donation and 8 +/- 2 days after donation. HFE genotyping was performed at reappearance.

RESULTS

There was a significant difference between the two study groups on all the iron status parameters. CHr was an efficient, early marker of ongoing synthesis of haemoglobin. Heterozygosity for the HFE variants C282Y and H63D had no statistically significant influence on the iron status. The donor's baseline serum ferritin value may be basis for an individual iron supplementation regimen, as donors with serum ferritin >50 microg/l do not seem to utilize the iron supplementation, but prefer endogenous iron to restore the loss of haemoglobin.

CONCLUSION

Iron supplementation had a significant positive impact on the restoration of iron status one week after donation.

Blood loss is a stronger predictor of iron status in men than C282Y heterozygosity or diet

OBJECTIVE

To determine the relative importance of HFE gene, diet, lifestyle, and blood loss characteristics for predicting iron status in a sample of men aged 40 years or over.

DESIGN

Iron status (serum ferritin, transferrin saturation, soluble transferrin receptor) was measured in 44 C282Y heterozygote and 85 age- and BMI-matched wildtype men aged 40 years or over. Dietary intake of iron (total, heme and non-heme), and components known to influence iron bioavailability, was determined using a validated Meal-Based Intake Assessment Tool. Information on lifestyle and blood loss was obtained by questionnaire. Height and weight were measured to determine Quetelet's body mass index. Linear mixed models were used to determine the extent to which these variables predicted iron status.

RESULTS

C282Y heterozygosity was associated with 17% higher transferrin saturation (95% CI: 6%, 29%) but no difference in serum ferritin or soluble transferrin receptor concentrations. Blood donation was negatively associated with transferrin saturation (-13% (- 3%, -22%)) and serum ferritin (-58% (-44%, -68%)), and had a marginally significant positive association with soluble transferrin receptor concentration. Self-reported fecal blood loss was negatively associated with serum ferritin concentration (-35% (-54%, -7%)). Alcohol was the only dietary variable associated with iron status and was associated with all three of the iron status indices. Serum ferritin concentration was positively associated with body mass index (10% per unit increase (6%, 15%)).

CONCLUSIONS

Blood loss was a stronger predictor of iron status than either C282Y heterozygosity or diet in this population of men aged 40 years and over.

Evidence-based criteria for the care and selection of blood donors, with some comments on the relationship to blood supply, and emphasis on the management of donation-induced iron depletion

Blood Services, which, in the UK, spend over 0.5% of the NHS budget, are generally subject to quality, regulatory, economic and political authority. As only persons in good health should give blood, Services have refined donor selection criteria and aim to base them on evidence; but they also have to balance the number of donations collected with product demand. Applying selection criteria inevitably leads to deferrals, which donors experience very negatively. Compared with successful donors, even temporary deferrals reduce return rates significantly, especially of first attenders. In order to encourage donor return and sustain supplies, selection criteria should be optimal. However, a major tool for managing patients--evidence from randomized controlled trials (RCTs)--cannot apply to donor selection, so criteria have to be defined by alternatives, such as clinical studies, epidemiology and even what experts deem to be pathophysiologically feasible. The recommended volume of blood taken from each donor at each attendance (450 mL, which was based on old studies) was increased because of greater processing losses (buffy-coat derived platelets, leucofiltration etc.). Although faint rates and donation-induced iron depletion are reduced by lowering bleeding volume and bleeding less frequently, other optimizing strategies including iron supplementation have been trialled and could be enhanced by more RCTs. Better but more complex indicators of donor iron status than one-off Hb thresholds are possible. Regulators and decision-makers must encourage more studies. This review does not consider aphaeresis donors of blood components other than red cells in detail, or the prevention of transfusion-transmitted infections.

A study of the prevalence of iron deficiency and its related factors in blood donors of Yazd, Iran, 2003

Iron deficiency anaemia is an important limiting factor for the number of donations in regular donors. Limited data is available on the iron status in Iranian donors. This study was conducted to evaluate the prevalence of iron deficiency and its related factors in blood donors at Yazd blood transfusion centre, Iran. In this descriptive study, 337 persons accepted for donation in 2003 were selected randomly. Haemoglobin, serum iron, total iron-binding capacity and ferritin concentrations were measured. Results showed that the prevalence of reduction in iron stores increased with an increase in the number of donations (P = 0.0001), such that reduction in iron stores was seen in all regular female donors (100%) and 48% of regular male blood donors. The prevalence of iron deficiency in female and male regular donors was 78 and 28%, whereas 55.6 and 16% of these donors had iron deficiency anaemia. Just one blood donation resulted in a significant increase in the prevalence of iron deficiency in women (P < 0.05), but in men, a significant increase was seen only in regular donors (P < 0.05). It is therefore recommended that blood donors should be educated about iron deficiency, and research studies should be performed to determine the best method of iron supplementation with minimal complications for all regular blood donors and women of childbearing age on their first donation.

Rapid identification of iron deficiency in blood donors with red cell indexes provided by Advia 120

BACKGROUND

A new generation of automated hematology analyzers allows the rapid determination of various red cell (RBC) indexes, including the percentage of hypochromic mature RBCs (HYPOm) and the hemoglobin (Hb) content of reticulocytes (CHr). These indexes have not yet been validated as measures for the detection of iron deficiency in blood donors.

STUDY DESIGN AND METHODS

Iron status was evaluated in a total of 1142 unselected prospective blood donors based on measurement of serum ferritin, soluble transferrin receptor, and Hb compared to RBC indexes provided by an automated hematology analyzer (Advia 120, Bayer HealthCare) including HYPOm and CHr.

RESULTS

Assuming that the most precise measure for body iron storage is related to the logarithm of the ratio of soluble transferrin receptor to ferritin, the sensitivity of ferritin for the diagnosis of iron depletion was 89 percent compared to 57 percent for HYPOm and CHr, respectively, to 69 percent for the combination of both RBC indexes, and to 26 percent for Hb concentration.

CONCLUSION

The RBC indexes HYPOm und CHr are significantly better screening measures for identification of iron depletion in blood donors than Hb.

Daily doses of 20 mg of elemental iron compensate for iron loss in regular blood donors: a randomized, double-blind, placebo-controlled study

BACKGROUND

A considerable number of regular blood donors develops an iron deficiency, and the exact amount of iron required to compensate for the iron loss from whole-blood donation in males and females is still unknown.

STUDY DESIGN AND METHODS

A total of 526 regular blood donors (289 male and 237 female) were randomly assigned to treatment with either 40 mg, 20 mg, or 0 mg per day of elemental iron as ferrous gluconate for a period of 6 months, during which one unit of whole blood was collected on four occasions (males) or three occasions (females). Hemoglobin level, serum ferritin, and soluble transferrin receptor levels were measured before each donation.

RESULTS

Daily doses of either 40 mg or 20 mg of elemental iron adequately compensated for iron loss in males, who gave blood at 2-month intervals, but did not result in a positive iron balance or an increase in storage iron as reflected by the logarithm of the ratio of transferrin receptor to ferritin concentration. In females, who donated at 3-month intervals, the same daily doses not only restored the iron balance but also led to an increase in storage iron. The number of gastrointestinal side effects due to iron supplementation (12%) was only slightly higher in both iron groups than in the placebo group.

CONCLUSION

The results of this study indicate that 20 mg of elemental iron per day can adequately compensate for iron loss in males and females who donate whole blood up to four (females) or six times per year (males).

Transferrin receptor in serum. A new tool in the diagnosis and prevention of iron deficiency in blood donors

BACKGROUND

Transferrin receptor mediates cellular uptake of iron, and the expression on cells reflects iron needs and erythropoietic activity. The results of measuring transferrin receptor in serum (sTfR) in blood donors are presented.

STUDY DESIGN AND METHODS

Haemoglobin, serum-ferritin and sTfR were measured in 172 female and 174 male donors that had donated whole blood six or more times during the previous 3 years and in 96 female and 56 male new donors.

RESULTS

Haemoglobin and sTfR were not significant different in new and repeat donors. New donors had significantly higher s-ferritin than repeat donors. Twenty donors had a Hb above the low limit for normal, but below the determined cut-off for donation. Only three of these had high sTfR and/or low serum-ferritin. Hence, of the total 492 donors 3.5% were below the Hb cut-off, but having Hb, s-ferritin and sTfR within normal ranges. 11.6% of new female donors belonged in this category.

CONCLUSION

STfR is better than s-ferritin as a screening for iron deficiency. Most donors with low tissue iron neither have high sTfR, nor anaemia. There is probably no need to have a separate, higher than the lower normal range, requirement for Hb in donors. STfR measurements are probably most valuable in a setting where most donors are repeat donors.

Statistical analysis of inappropriate results from current Hb screening methods for blood donors

BACKGROUND

The objective was to apply statistical analysis to the false passes and fails that occur with the primary and secondary Hb-screening methods used at blood-donor sessions.

STUDY DESIGN AND METHODS

Venous samples from 1513 potential donors who had undergone primary CuSO4 screening using capillary blood (Hb cut-offs: women, 125 g/L; men, 135 g/L) were tested at the session by a secondary method (HemoCue; cut-offs: women, 120 g/L; men, 130 g/L) and again at the base laboratory using another system (Beckman Coulter General S system), which generated the "true" Hb value.

RESULTS

False-pass and -fail rates for women and men, respectively, were 11.2 and 6.3 percent (women) and 5.2 and 1.8 percent (men) for CuSO4; 1.9 and 3.7 percent (women) and 1.5 and 0.4 percent (men) for HemoCue; and 2.7 and 2.4 percent (women) and 1.8 and 0.2 percent (men) for a combined procedure that mimicked current practice of only testing CuSO4 fails by HemoCue.

CONCLUSION

CuSO4 Hb screening gives large numbers of false passes, particularly in women. Using venous samples, the majority correctly pass at the lower HemoCue cut-offs. The current dual-testing policy appears convenient for donor sessions, but because small percentages of false passes and fails represent large numbers of donors, every effort should be made to improve the accuracy of Hb screening.

Multiple blood donations associated with iron deficiency in patients with restless legs syndrome

OBJECTIVE

To describe a series of patients with restless legs syndrome (RLS) and iron deficiency with and without anemia related to repeated blood donations.

PATIENTS AND METHODS

Study patients were identified by asking consecutive patients with RLS seen at the Mayo Clinic in Rochester, Minn, from February 1 to December 31, 2001, whether they donated blood. All patients who fulfilled the International Restless Legs Syndrome Study Group criteria for RLS, had donated blood a minimum of 3 times a year the preceding 3 years, and had iron deficiency (serum ferritin concentration <20 microg/L) were included in the study.

RESULTS

Eight patients met the study criteria. The mean +/- SD serum ferritin concentration was 8.1 +/- 3.5 microg/L, and 4 patients had anemia. In 6 of the 8 patients, RLS began at about the same time of or after blood donation. Patients had donated blood for 4.2 +/- 13 times a year (range, 3-6 times a year) for 15.2 +/- 83 years (range, 5-25 years). Hemoglobin concentrations were 12.8 +/- 1.8 g/dL (range, 10.6-15.5 g/dL). In 2 patients, RLS essentially resolved with correction of iron stores alone, and medications for RLS were successfully discontinued in 2 other patients.

CONCLUSIONS

Repeated blood donation is associated with induction or perpetuation of RLS due to iron deficiency with or without coexisting anemia. Potential blood donors should be questioned about RLS, and donation should not be allowed until the serum ferritin concentration has been measured and iron stores replenished if necessary.

Donor selection in Japan: a trial of new criteria with predonation haemoglobin testing

BACKGROUND AND OBJECTIVES

In Japan, eligibility for blood donation depends on blood specific gravity, which does not directly measure blood haemoglobin. Additionally, the criteria are not based on normal values. Therefore, we investigated the feasibility of predonation screening by using actual haemoglobin levels, and adopted a new criterion based on the normal range for men.

MATERIALS AND METHODS

Using a portable device, we measured haemoglobin in 1032 prospective blood donors, then applied this method to all blood donations. The criterion for men was set at the 95th percentile of haemoglobin distribution, namely 13.0 g/dl and 13.5 g/dl, respectively, for 200-ml and 400-ml donations. That for women remained unchanged.

RESULTS

The percentage of men ineligible by these criteria increased from 0.6 to 1.5%, while that of women decreased from 16.5 to 14.6%. Donors with abnormal haemoglobin levels were referred to hospitals.

CONCLUSION

Predonation measurement of haemoglobin concentration, combined with the referral of those with abnormal values, provided a health benefit to that population.

Iron deficiency and iron overload: effects of diet and genes

Like most essential nutrients, Fe needs to be maintained in the body at a defined level for optimal health, with appropriate adaptation to varying Fe needs and supply. The primary mechanism for controlling Fe level is the regulation of Fe absorption. Several different proteins have been identified as contributors to the process. Despite a complex regulatory system, Fe disorders (both Fe deficiency and Fe overload) occur. Fe deficiency is a common problem worldwide, resulting from inadequate dietary Fe and blood loss. Complications include pre-term labour, developmental delay, and impaired work efficiency. No specific genetic syndromes causing isolated Fe deficiency have been described, but animal studies and clinical observations suggest that such a relationship may be a possibility. Conversely, the known causes of Fe overload are genetic. Fe overload is less common than Fe deficiency, but can result in serious medical complications, including cirrhosis, primary liver cancer, diabetes, cardiomyopathy and arthritis. The most common and best characterized syndrome of Fe overload is hereditary haemochromatosis (HHC), an autosomal recessive disorder. Mutations in the HFE protein cause HHC, but the clinical presentation is variable. Of particular interest is the factor that some FIFE genotypes appear to be associated with protection from Fe deficiency. Other genetic variants in the regulatory pathway may influence the likelihood of Fe deficiency and Fe overload. Studies of genetic variants in HFE and other regulatory proteins provide important tools for studying the biological processes in Fe regulation. This work is likely to lead to new insights into Fe disorders and potentially to new therapeutic approaches. It will not be complete, however, until coordinated study of both genetic and nutritional factors is undertaken.