1
|
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.
Collapse
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
| |
Collapse
|
2
|
Kracalik I, Sapiano MRP, Wild RC, Ortiz JC, Stewart P, Berger JJ, Basavaraju SV, Free RJ. Supplemental findings of the 2021 National Blood Collection and Utilization Survey. Transfusion 2023; 63 Suppl 4:S19-S42. [PMID: 37702255 PMCID: PMC10783319 DOI: 10.1111/trf.17509] [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: 05/31/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND The Department of Health and Human Services' National Blood Collection and Utilization Survey (NBCUS) has been conducted biennially since 1997. Data are used to estimate national blood collection and use. Supplemental data from the 2021 NBCUS not presented elsewhere are presented here. METHODS Data on survey participation, donor characteristics, blood component cost, transfusion-associated adverse reactions, and implementation of blood safety measures, including pathogen-reduction of platelets, during 2021, were analyzed. Comparisons are made to 2019 survey data where available (2013-2019 for survey participation). RESULTS During 2021, there were 11,507,000 successful blood donations in the United States, a 4.8% increase from 2019. Persons aged 45-64 years accounted for 42% of all successful blood donations. Donations by persons aged 65 years and older increased by 40.7%, while donations among minorities and donors aged <25 years decreased. From 2019 to 2021, the median price hospitals paid per unit of leukoreduced red blood cells, leukoreduced and pathogen-reduced apheresis platelets, and fresh frozen plasma increased. The largest increase in price per unit of blood component in 2021 was for leukoreduced apheresis platelets, which increased by ~$51. Between 2019 and 2021, the proportion of transfusing facilities reporting use of pathogen-reduced platelets increased, from 13% to 60%. Transfusion-related adverse reactions declined slightly between 2019 and 2021, although the rate of transfusion-transmitted bacterial infections remained unchanged. CONCLUSION During 2021, blood donations increased nationally, although donations from those aged <25 years and minorities declined. The prices hospitals paid for most blood products increased, as did the use of pathogen-reduced platelets.
Collapse
Affiliation(s)
- Ian Kracalik
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
| | - Mathew R. P. Sapiano
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
- Lantana Consulting Group, East Thetford, Vermont, USA
| | - Robert C. Wild
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
- CACI International, Reston, Virginia, USA
| | - Joel Chavez Ortiz
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
- Oakridge Institute for Science and Education, Atlanta,
Georgia, USA
| | - Phylicia Stewart
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
- Chenega Corporation, Atlanta, Georgia, USA
| | - James J. Berger
- Office of Infectious Disease and HIV/AIDS Policy, Office of
the Assistant Secretary for Health, Department of Health and Human Services,
Washington, District of Columbia, USA
| | - Sridhar V. Basavaraju
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
| | - Rebecca J. Free
- Division of Healthcare Quality Promotion, National Center
for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
| |
Collapse
|
3
|
Mowat Y, Hoad V, Haire B, Masser B, Kaldor J, Heywood A, Thorpe R, McManus H, McGregor S. Prevalence of blood donation eligibility in Australia: A population survey. Transfusion 2023; 63:1519-1527. [PMID: 37464879 PMCID: PMC10952191 DOI: 10.1111/trf.17474] [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: 04/02/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Reliable estimates of the population proportion eligible to donate blood are needed by blood collection agencies to model the likely impact of changes in eligibility criteria and inform targeted population-level education, recruitment, and retention strategies. In Australia, the sole estimate was calculated 10+ years ago. With several subsequent changes to the eligibility criteria, an updated estimate is required. STUDY DESIGN AND METHODS We conducted a cross-sectional national population survey to estimate eligibility for blood donation. Respondents were aged 18+ and resident in Australia. Results were weighted to obtain a representative sample of the population. RESULTS Estimated population prevalence of blood donation eligibility for those aged 18-74 was 57.3% (95% CI 55.3-59.3). The remaining 42.7% (95% CI 40.7-44.7) were either temporarily (25.3%, 95% CI 23.5-27.2) or permanently ineligible (17.4%, 95% CI 16.1-18.9). Of those eligible at the time of the survey, that is, with the UK geographic deferral for variant Creutzfeldt-Jakob disease included, (52.9%, 95% CI 50.8-54.9), 14.2% (95% CI 12.3-16.3) reported donating blood within the previous 2 years. Eligibility was higher among men (62.6%, 95% CI 59.6-65.6) than women (52.8%, 95% CI 50.1-55.6). The most common exclusion factor was iron deficiency/anemia within the last 6 months; 3.8% (95% CI 3.2-4.6) of the sample were ineligible due to this factor alone. DISCUSSION We estimate that approximately 10.5 million people (57.3% of 18-74-year-olds) are eligible to donate blood in Australia. Only 14.2% of those eligible at the time of survey reported donating blood within the previous 2 years, indicating a large untapped pool of potentially eligible blood donors.
Collapse
Affiliation(s)
- Yasmin Mowat
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | | | - Bridget Haire
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Barbara Masser
- Australian Red Cross LifebloodMelbourneAustralia
- School of PsychologyThe University of QueenslandBrisbaneAustralia
| | - John Kaldor
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Anita Heywood
- School of Population HealthUniversity of New South WalesSydneyAustralia
| | | | - Hamish McManus
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Skye McGregor
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Urbina A, García-Otálora MA, Mendoza-Romero D, Rocha F, Rodriguez A, Palomino F, Weinauer F. Deferral due to low hemoglobin and predictors of permanence in the blood donation system of repeat female blood donors. Transfus Apher Sci 2021; 61:103340. [PMID: 34896008 DOI: 10.1016/j.transci.2021.103340] [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: 08/18/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the deferral rate due to low hemoglobin (Hb) in repeat female blood donors and identify the factors affecting their permanence in the blood donation system. MATERIALS AND METHODS 8,368 repeat female blood donors who donated from January 2012 to December 2018 were included. Bivariate analysis and Kaplan-Meier curves were used to identify the covariates possibly associated with developing low Hb, and Cox proportional hazards modeling was used to adjust for all confounders. RESULTS The global deferral rate due to low Hb was 2.4 %. According to baseline Hb, the frequency of low Hb was 0.7-4.1 %, and it was higher in platelet donors (5.8-9.1 %) than in whole blood donors (1.9 %). The main predictors were baseline Hb (compared to the first quartile; hazard ratio [HR] = 0.487 for the second quartile; 0.234 for the third; and 0.095 for the fourth); change in Hb (HR = 2.689 for a >0.49 g/dL change, compared to smaller changes); the type of donation (compared to whole blood donors, HR = 2.317 for platelet donors); and donation interval (compared to >12.5 month intervals; HR = 2.220 for 8.0-12.5 months; HR = 5.658 for 5.4-8.0 months; and HR = 9.452 for <5.4 months). CONCLUSIONS In female blood donors at moderate altitude, the probability of developing low Hb increases with a baseline Hb of 13.5-14.0 g/dL, with a change in Hb >0.49 g/dL, in platelet donors, and with donation intervals <12.5 months. These four predictive factors can be used together for early identification of donors at risk of developing low Hb, to institute appropriate measures.
Collapse
Affiliation(s)
- Adriana Urbina
- Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Carrera 24 #63C-69, Quinta Mutis, Bogotá, D.C., Colombia.
| | - Michel-Andrés García-Otálora
- Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Carrera 24 #63C-69, Quinta Mutis, Bogotá, D.C., Colombia
| | - Dario Mendoza-Romero
- Fundación Universitaria del Area Andina, Facultad de Ciencias de la Salud y el Deporte, Calle 69 #15-40, Bogotá, Colombia
| | - Felix Rocha
- Banco Nacional de Sangre, Cruz Roja Colombiana, Av Carrera 68 #68B-31, Bogotá, D.C., Colombia
| | - Ayda Rodriguez
- Banco Nacional de Sangre, Cruz Roja Colombiana, Av Carrera 68 #68B-31, Bogotá, D.C., Colombia
| | | | - Franz Weinauer
- German RC Blood Services, Working Group of the GRC, Am Mühlberg 14 B Starnberg, D- 82319, Germany
| |
Collapse
|
6
|
Mowla SJ, Sapiano MRP, Jones JM, Berger JJ, Basavaraju SV. Supplemental findings of the 2019 National Blood Collection and Utilization Survey. Transfusion 2021; 61 Suppl 2:S11-S35. [PMID: 34337759 DOI: 10.1111/trf.16606] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Supplemental data from the 2019 National Blood Collection and Utilization Survey (NBCUS) are presented and include findings on donor characteristics, autologous and directed donations and transfusions, platelets (PLTs), plasma and granulocyte transfusions, pediatric transfusions, transfusion-associated adverse events, cost of blood units, hospital policies and practices, and implementation of blood safety measures, including pathogen reduction technology (PRT). METHODS National estimates were produced using weighting and imputation methods for a number of donors, donations, donor deferrals, autologous and directed donations and transfusions, PLT and plasma collections and transfusions, a number of crossmatch procedures, a number of units irradiated and leukoreduced, pediatric transfusions, and transfusion-associated adverse events. RESULTS Between 2017 and 2019, there was a slight decrease in successful donations by 1.1%. Donations by persons aged 16-18 decreased by 10.1% while donations among donors >65 years increased by 10.5%. From 2017 to 2019, the median price paid for blood components by hospitals for leukoreduced red blood cell units, leukoreduced apheresis PLT units, and for fresh frozen plasma units continued to decrease. The rate of life-threatening transfusion-related adverse reactions continued to decrease. Most whole blood/red blood cell units (97%) and PLT units (97%) were leukoreduced. CONCLUSION Blood donations decreased between 2017 and 2019. Donations from younger donors continued to decline while donations among older donors have steadily increased. Prices paid for blood products by hospitals decreased. Implementation of PRT among blood centers and hospitals is slowly expanding.
Collapse
Affiliation(s)
- Sanjida J Mowla
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education (ORISE), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jefferson M Jones
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James J Berger
- U.S. Department of Health and Human Services, Office of HIV/AIDS and infectious Disease Policy, Office of the Assistant Secretary for Health, Washington, District of Columbia, USA
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
7
|
Blake JT, O'Brien SF, Goldman M. The impact of donor ferritin testing on blood availability in Canada. Vox Sang 2021; 117:17-26. [PMID: 34060092 DOI: 10.1111/vox.13126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Iron depletion is a side effect of blood donation. Agencies have developed policies to test donors and to extend inter-donation intervals (IDIs) for individuals with low ferritin levels. Ferritin testing, however, has an impact on product availability due to longer IDIs and the effect of test results on donor behaviour. In this paper we apply a model to evaluate the impact of ferritin testing in the Canadian donor population on whole blood donations. MATERIALS AND METHODS A discrete event simulation was adopted for the study. The model represents a population of individuals that donate blood, are tested for ferritin levels, and may exit the system. Data for the simulation was derived from operational data, donor research studies from Canadian Blood Services and previously published sources. RESULTS Red cell collections will decline by at least 3.1% and could decline by as much as 19.2% after ferritin testing is put in place. Requirements for new donors could rise by as much as 36.0%. CONCLUSION The impact of ferritin testing on repeat donor behaviour, rather than extensions to the mandated inter-donation interval, is the largest factor influencing declines in whole blood donations. Because behaviour changes following the receipt of a low ferritin result, blood agencies must ensure that donors with low ferritin are motivated to modify their lifestyle and, when healthy, return to the donor pool.
Collapse
Affiliation(s)
- John T Blake
- Industrial Engineering, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Blood Services, Centre for Innovation, Ottawa, Ontario, Canada
| | - Sheila F O'Brien
- Canadian Blood Services, Centre for Innovation, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Mindy Goldman
- Canadian Blood Services, Centre for Innovation, Ottawa, Ontario, Canada.,Department of Pathology & Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
8
|
Sweegers MG, Zalpuri S, Quee FA, Huis In 't Veld EMJ, Prinsze FJ, Hoogendijk EO, Twisk JWR, van Weert AWM, de Kort WLAM, van den Hurk K. Ferritin measurement IN Donors-Effectiveness of iron Monitoring to diminish iron deficiency and low haemoglobin in whole blood donors (FIND'EM): study protocol for a stepped wedge cluster randomised trial. Trials 2020; 21:823. [PMID: 32998766 PMCID: PMC7528293 DOI: 10.1186/s13063-020-04648-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 07/31/2020] [Indexed: 11/15/2022] Open
Abstract
Background Blood donors are at risk for reduced iron stores, because of which donor iron monitoring received increased attention in the last decade. Despite the importance for donor health, international consensus on an appropriate policy for iron monitoring is lacking. Therefore, we conduct a trial to evaluate to what extent ferritin-guided donation intervals are effective in increasing haemoglobin and ferritin levels, decreasing low-haemoglobin deferral, increasing donor return and improving the health of whole blood donors in the Netherlands. Methods Sanquin Blood Bank is implementing ferritin-guided donation intervals to prevent donors from increasing iron loss at repeated donations. Using a stepped wedge cluster randomised trial approach, the design involves a random crossover of 29 clusters of blood collection centres from the existing policy without ferritin measurements to a ferritin-guided donation interval policy. This new policy includes ferritin measurements for all new donors and at every 5th whole blood donation, extending donation intervals to 6 months if ferritin is 15–≤ 30 ng/mL and to 12 months if ferritin is < 15 ng/mL. We measure ferritin levels of whole blood donors from stored plasma samples and collect haemoglobin levels and information on low-haemoglobin deferral and donor return from the donor database before, during and after the implementation period. We measure donor health during and after the implementation period using questionnaires, assessing physical and mental wellbeing and iron deficiency- and donation-related symptoms. We use multilevel analyses to investigate differences in ferritin and haemoglobin levels, low-haemoglobin deferral rates, donor return and donor health from whole blood donors, between blood collection centres that have versus those that have not yet implemented the ferritin-guided donation interval policy. Discussion This stepped wedge cluster randomised trial will provide insight into the effectiveness of ferritin-guided donation intervals in lowering iron deficiency, decreasing donor deferrals due to low haemoglobin and improving donor health. We will evaluate a policy that is implemented nationwide in a real-life setting. Our study is therefore not limited to a small experimental setting and the results will guide policymakers seeking an appropriate policy for iron monitoring. Trial registration The Dutch trial registry NTR6738. Registered on 29 September 2017. Retrospectively registered.
Collapse
Affiliation(s)
| | | | - Franke A Quee
- Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Elisabeth M J Huis In 't Veld
- Donor Studies, Sanquin Research, Amsterdam, The Netherlands.,Department of Cognitive Science & Artificial Intelligence, Tilburg University, Tilburg, The Netherlands
| | | | - Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Centre, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Centre, Amsterdam, The Netherlands
| | - Anton W M van Weert
- National Screening Laboratory Sanquin, Sanquin Research and Labservices, Amsterdam, The Netherlands
| | | | | |
Collapse
|
9
|
Kasraian L, Ashkani-Esfahani S, Foruozandeh H. Reasons of under-representation of Iranian women in blood donation. Hematol Transfus Cell Ther 2020; 43:256-262. [PMID: 32674980 PMCID: PMC8446245 DOI: 10.1016/j.htct.2020.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/12/2020] [Accepted: 03/26/2020] [Indexed: 12/04/2022] Open
Abstract
The under-representation of women in blood donation can lead to blood shortages. We aimed to determine the factors, which encourage or impede blood donations in women. The findings can help us in designing effective recruitment strategies that could encourage women to donate blood to cover the patients’ needs. This cross-sectional study was conducted in Shiraz, Iran, from the 1st of January 2017 to the 1st of August 2017 on women aged 18–60 years old. The demographic characteristics of the participants, the reasons that motivate blood donors and the factors that discourage non-donors were surveyed. Reasons for lapses in donors were also mentioned. The most frequent reasons for blood donation were altruistic causes (94.4%), moral and personal obligations (89.1%), the feeling of responsibility (82.7%), and awareness of the positive effects on their health (77.4%). The most common deterrents in non-donors were fear of developing anemia (68.4%) or weakness and dizziness (66%), unsuitability due to certain medical conditions (62.4%), and lack of a situation in which they were asked to donate blood (61.8%). Although altruistic reasons are the chief motivating factors for women to donate blood, the overall female contribution in blood donation remains low. Therefore, it is necessary to take measures aiming at informing women about the importance of blood donation and to reduce fears based on misinformation. Confidence in the blood donation organization must be a major consideration in future recruitment strategies to reassure women about the safety of blood donation.
Collapse
Affiliation(s)
- Leila Kasraian
- Blood Transfusion Research Centre, High Institute for Research and Education on Transfusion Medicine-Microbiology Department, Shiraz, Iran
| | | | - Hossein Foruozandeh
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran; Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Shiraz, Iran.
| |
Collapse
|
10
|
Sweegers MG, Kraaij MG, Hurk K. First do no harm: iron loss in whole blood donors. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/voxs.12527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Marian G.J. Kraaij
- Centre for Clinical Transfusion Research Sanquin Research Leiden the Netherlands
- Department of Transfusion Medicine and Department of Donor Affairs Sanquin Blood Bank Amsterdam the Netherlands
| | - Katja Hurk
- Donor Studies Sanquin Research Amsterdam the Netherlands
| |
Collapse
|
11
|
Zalpuri S, Schotten N, Baart AM, Watering LM, Hurk K, Kraaij MG. Iron deficiency–related symptoms in whole blood donors: a systematic review. Transfusion 2019; 59:3275-3287. [DOI: 10.1111/trf.15509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Saurabh Zalpuri
- Department Donor StudiesSanquin Research Amsterdam The Netherlands
| | - Nienke Schotten
- Department Donor StudiesSanquin Research Amsterdam The Netherlands
| | | | - Leo M. Watering
- Sanquin ResearchCentre for Clinical Transfusion Research Leiden The Netherlands
| | - Katja Hurk
- Department Donor StudiesSanquin Research Amsterdam The Netherlands
| | - Marian G.J. Kraaij
- Sanquin Blood BankUnits Donor Affairs and Transfusion Medicine Amsterdam The Netherlands
| |
Collapse
|
12
|
Hu W, Meng H, Hu Q, Feng L, Qu X. Blood donation from 2006 to 2015 in Zhejiang Province, China: annual consecutive cross-sectional studies. BMJ Open 2019; 9:e023514. [PMID: 31110081 PMCID: PMC6530455 DOI: 10.1136/bmjopen-2018-023514] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To describe the basic demographical characteristics of whole blood donors in Zhejiang Province, China, from 2006 to 2015 and to examine the trends in individual characteristics associated with blood donation and the relationship between weight and donation. DESIGN Cross-sectional study comparing characteristics of blood donors and annual donations for the period 2006 to 2015. SETTING Urban and rural communities in Zhejiang, China (11 cities, 89 districts or counties and 1379 townships). PARTICIPANTS 3 226 571 volunteer blood donors. OUTCOME MEASURES Volume of each whole blood donation and donation frequency. All data were collected by trained staff and entered into a standardised electronic information system. RESULTS The number of blood donations generally trended up in Zhejiang Province from 2006 to 2015. Donors were predominately males aged 18 to 25 years, but this major donor age group shifted to the 26 to 45 year range by 2015. The rate of repeated blood donation was 30.8 per cent. The blood volume per donation concentrated in 200 mL and 400 mL categories has been gradually shifted to 300 mL and 400 mL. Approximately one-third of donors had a college education. The average weight of donors increased over time for both men and women. Both the blood volume of each donation and donation frequency were proportional to weight. CONCLUSIONS The trend of voluntary non-remunerated blood donation in Zhejiang province is positive. However, given the expected growth in demand for whole blood, more research is needed to increase both the donor pool and the rate of repeated donation. The relationship between body weight and blood donation warrants further study because while improving nutritional status is associated with higher average donation volume and more frequent donations, overnutrition may lead to poorer quality of donated blood. Blood donation may present a unique opportunity for health education and body weight management to monitor and improve population health.
Collapse
Affiliation(s)
- Wei Hu
- Blood Center of Zhejiang Province, Hangzhou, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Hongdao Meng
- School of Ageing Studies, University of South Florida, Tampa, Florida, USA
| | - Qiuyue Hu
- Blood Center of Zhejiang Province, Hangzhou, China
| | - Lijuan Feng
- School of Ageing Studies, University of South Florida, Tampa, Florida, USA
| | - Xianguo Qu
- The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| |
Collapse
|
13
|
Patel EU, White JL, Bloch EM, Grabowski MK, Gehrie EA, Lokhandwala PM, Brunker PAR, Goel R, Shaz BH, Ness PM, Tobian AAR. Association of blood donation with iron deficiency among adolescent and adult females in the United States: a nationally representative study. Transfusion 2019; 59:1723-1733. [PMID: 30779173 PMCID: PMC6791124 DOI: 10.1111/trf.15179] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Blood donation results in a loss of iron stores, which is particularly concerning for young female blood donors. This study examines the association of blood donation and iron deficiency among adolescent and adult females in the United States. STUDY DESIGN AND METHODS A cross-sectional analysis was performed using data from the 1999-2010 National Health and Nutrition Examination Survey (NHANES). Females who reported their blood donation history in the preceding year and had serum ferritin (SF) measurements were included. Analyses were weighted and stratified by adolescents (16-19 years; n = 2419) and adults (20-49 years; n = 7228). Adjusted prevalence ratios (aPRs) were estimated by multivariable Poisson regression. Standard errors were estimated by Taylor series linearization. RESULTS Geometric mean SF levels (ng/mL) were lower in blood donors compared to nondonors among adolescents (21.2 vs. 31.4; p < 0.001) and among adults (26.2 vs. 43.7; p < 0.001). The prevalence of absent iron stores (SF < 12 ng/mL) was higher in blood donors compared to nondonors among adolescents (22.6% vs. 12.2%; aPR = 2.03 [95% confidence interval (CI) = 1.45-2.85]) and among adults (18.3% vs. 9.8%; aPR = 2.06 [95% CI = 1.48-2.88]). Additionally, the prevalence of iron deficiency anemia (SF < 26 ng/mL and hemoglobin < 12.0 g/dL) was also higher in blood donors compared to nondonors among adolescents (9.5% vs. 6.1%; aPR = 2.10 [95% CI = 1.13-3.90]) and among adults (7.9% vs. 6.1%; aPR = 1.74 [95% CI = 1.06-2.85]). Similar results were observed in a sensitivity analysis restricted to adolescents aged 16 to 18 years. CONCLUSIONS Blood donation is associated with iron deficiency among adolescent and adult females in the United States. These national data call for further development and implementation of blood donation practices aimed toward mitigating iron deficiency.
Collapse
Affiliation(s)
- Eshan U. Patel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jodie L White
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Evan M. Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary K. Grabowski
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric A. Gehrie
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Parvez M. Lokhandwala
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patricia A. R Brunker
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Biomedical Services, Greater Chesapeake and Potomac Region, The American Red Cross, Baltimore, Maryland
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Hematology/Oncology, Simmons Cancer Institute at SIU School of Medicine, Springfield, Illinois
| | | | - Paul M. Ness
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aaron A. R. Tobian
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
14
|
|
15
|
Kiss JE, Vassallo RR. How do we manage iron deficiency after blood donation? Br J Haematol 2018; 181:590-603. [DOI: 10.1111/bjh.15136] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Joseph E. Kiss
- Hemapheresis and Blood Services; The institute for Transfusion Medicine; Pittsburgh PA USA
| | - Ralph R. Vassallo
- Chief Medical and Scientific Officer; Blood Systems, Inc.; Scottsdale AZ USA
| |
Collapse
|
16
|
Gybel-Brask M, Seeberg J, Thomsen LL, Johansson PI. Intravenous iron isomaltoside improves hemoglobin concentration and iron stores in female iron-deficient blood donors: a randomized double-blind placebo-controlled clinical trial. Transfusion 2018; 58:974-981. [PMID: 29424441 DOI: 10.1111/trf.14521] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/07/2017] [Accepted: 12/20/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND This trial evaluated the efficacy and safety of intravenous (IV) iron isomaltoside (Monofer) in comparison with placebo in first-time female blood donors. STUDY DESIGN AND METHODS The trial was a prospective, double blind, placebo-controlled, randomized, comparative, single-center trial of 85 first-time female blood donors. The subjects were randomly assigned 1:1 to either 1000 mg IV iron isomaltoside infusion or placebo. The primary endpoint of the trial was change in hemoglobin (Hb) from baseline to right before the third blood donation. RESULTS The increase in Hb was significantly higher for iron isomaltoside compared with placebo right before both the second blood donation (p = 0.0327) and the third blood donation (primary endpoint, p < 0.0001). Improvements in other iron-related variables (plasma iron, plasma ferritin, transferrin saturation, and reticulocyte count) in favor of iron isomaltoside were also observed. The trial was not powered on patient-reported outcomes. However, improvements in iron stores and Hb levels after iron isomaltoside administration were supported by the fact that several of the fatigue symptoms scores showed numerical differences in favor of iron isomaltoside. There were no differences in side effects between the groups. CONCLUSION In iron-deficient female blood donors a single IV iron isomaltoside administration resulted in an improvement in Hb concentration and iron stores and demonstrated a favorable safety profile comparable to placebo.
Collapse
Affiliation(s)
- Mikkel Gybel-Brask
- Section for Transfusion Medicine, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Seeberg
- Section for Transfusion Medicine, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars L Thomsen
- Aalborg University, Aalborg, Denmark.,Pharmacosmos A/S, Holbaek, Denmark
| | - Pär I Johansson
- Section for Transfusion Medicine, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
17
|
Pasricha SR, Marks DC, Salvin H, Brama T, Keller AJ, Pink J, Speedy J. Postdonation iron replacement for maintaining iron stores in female whole blood donors in routine donor practice: results of two feasibility studies in Australia. Transfusion 2017; 57:1922-1929. [DOI: 10.1111/trf.14173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 02/28/2017] [Accepted: 03/28/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Sant-Rayn Pasricha
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine; University of Oxford; Oxford UK
- Clinical Services and Research
| | - Denese C. Marks
- Research and Development; Australian Red Cross Blood Service; Adelaide Australia
| | | | | | | | | | | |
Collapse
|
18
|
Macher S, Drexler C, Lindenau I, Sareban N, Schlenke P, Amrein K. High-dose intravenously administered iron versus orally administered iron in blood donors with iron deficiency: study protocol for a randomised, controlled trial. Trials 2016; 17:527. [PMID: 27793204 PMCID: PMC5084417 DOI: 10.1186/s13063-016-1648-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 10/07/2016] [Indexed: 01/01/2023] Open
Abstract
Background About 2–3 % of the population participates in blood donation programmes. Each whole blood donation or ten apheresis donations cause a loss of 200–250 mg of iron. As a result, one of the most common risks of regular blood donors is iron deficiency. Although this has been known for decades, in most countries, iron status is currently not assessed or treated in this population. Premenopausal women are particularly affected, as they have lower iron reserves and higher daily requirements. Besides anaemia, iron deficiency may lead to fatigue and impaired cognitive and physical performance. Current iron preparations for intravenous administration are well tolerated and allow for application of large doses up to 1 g in one visit. Our hypothesis is that in blood donors with iron deficiency, intravenously administered iron is more efficient and as safe as oral iron supplementation. Since anaemia is one of the most frequent reasons for permanent or intermittent donor deferral, maintaining an iron-replete donor pool may help to prevent shortages in blood supply and to avoid iron deficiency-related comorbidities. Methods/design In this randomised clinical trial we include male and female blood donors aged ≥18 and ≤65 years with a ferritin value of ≤30 ng/ml. Stratified by gender, participants are randomized with a web-based randomisation tool in a 1:1 ratio to either 1 g of intravenously administered ferric carboxymaltose or 10 g of iron fumarate supplements at one to two daily doses of 100 mg each. Eight to 12 weeks after the first visit, iron status, blood count and symptoms are assessed in both groups. The primary endpoint is the difference in transferrin saturation (%) following the intervention between both groups. Secondary endpoints include other parameters of iron metabolism and red blood cell count, the number of patients with drug-related adverse events, and subjective symptoms including those of the restless legs syndrome, quality of life, and fatigue. Discussion Iron supplementation administered intravenously in non-anaemic but iron-deficient blood donors could represent an effective strategy to protect blood donors from comorbidities related with iron deficiency and therefore improve blood donor wellbeing. Furthermore, iron supplementation will help to maintain an iron-replete blood donor pool. Trial registration EudraCT: 2013-000327-14, Clinical Trials Identifier: NCT01787526. Registered on 6 February 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1648-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Susanne Macher
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Camilla Drexler
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Ines Lindenau
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria.,Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Nazanin Sareban
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Peter Schlenke
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Karin Amrein
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| |
Collapse
|
19
|
van Rensburg SJ, van Toorn R, Moremi KE, Peeters AV, Oguniyi A, Kotze MJ. Multiple sclerosis-like diagnosis as a complication of previously treated malaria in an iron and vitamin D deficient Nigerian patient. Metab Brain Dis 2016; 31:197-204. [PMID: 26746433 DOI: 10.1007/s11011-015-9788-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/28/2015] [Indexed: 02/06/2023]
Abstract
In contrast to malaria, multiple sclerosis (MS) is infrequently found in Black Africans. We describe a 29 year old Nigerian female who developed an MS-like condition with symptoms similar to relapsing-remitting MS following malaria infection, leading to a diagnosis of MS. However, absence of hyperintense lesions in the brain and spinal cord presented a conundrum since not all the diagnostic criteria for MS were met. Pathology supported genetic testing (PSGT) was applied to combine family and personal medical history, lifestyle factors, and biochemical test results for interpretation of genetic findings. This approach provides a means of identifying risk factors for different subtypes of demyelinating disease. The patient was subsequently treated according to an individualised intervention program including nutritional supplementation as well as a change in diet and lifestyle. Deficiencies of vitamin B12, iron and vitamin D were addressed. Genetic analysis revealed absence of the HLA DRB1*1501 allele, considered to be the most prominent genetic risk factor for MS. Extended mutation analysis identified variations in three genes in the folate-vitamin B12 metabolic pathway, which could have increased the patient's sensitivity to the antifolate drugs used to treat the malaria. A glutathione-S-transferase GSTM1 null allele, previously associated with neurological complications of malaria, was also detected. Furthermore, a heterozygous variation in the iron-related transmembrane protease serine 6 (TMPRSS6) gene, rs855791 was found, which could have impacted the patient's iron status following two successive blood donations and exposure to malaria preceding the MS diagnosis. PSGT identifies relevant risk factors for demyelinating disorders resembling MS and uses the data for individualised treatment programs, and to systematically build a database that can provide evidence in large patient cohorts. Follow-up investigations may be suggested, such as whole exome sequencing in selected cases, to ensure that remyelination and restoration of function are achieved.
Collapse
Affiliation(s)
- Susan J van Rensburg
- Chemical Pathology, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa.
| | - Ronald van Toorn
- Paediatric Medicine and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Kelebogile E Moremi
- Chemical Pathology, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa
| | - Armand V Peeters
- Anatomical Pathology, Stellenbosch University, Cape Town, South Africa
| | - Adesola Oguniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Maritha J Kotze
- Anatomical Pathology, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
20
|
Gür-Özmen S, Karahan-Özcan R. Iron Deficiency Anemia Is Associated with Menstrual Migraine: A Case–Control Study. PAIN MEDICINE 2015; 17:596-605. [DOI: 10.1093/pm/pnv029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
21
|
Aardal Eriksson E, Mobäck C, Jakobsson S, Hoffmann JJ. Iron depletion in blood donors – Have extended erythrocyte and reticulocyte parameters diagnostic utility? Transfus Apher Sci 2015; 53:76-81. [DOI: 10.1016/j.transci.2015.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
|
22
|
Delage G, Grégoire Y, Lebrun A. Double red blood cell donors with increased ferritin levels: a descriptive study. Transfusion 2015; 55:2842-6. [PMID: 26174004 DOI: 10.1111/trf.13234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/09/2015] [Accepted: 06/09/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND One of the measures proposed to mitigate iron loss in blood donors is monitoring of their ferritin levels. Occasionally, high ferritin levels are found in monitored donors. We report the results of the clinical and laboratory investigation of 80 double red blood cell (DRBC) donors with high ferritin levels. STUDY DESIGN AND METHODS All DRBC donors' ferritin levels were measured during each visit for a donation. Donors with high ferritin levels who agreed to participate underwent a clinical and laboratory evaluation. RESULTS A total of 165 of 2757 DRBC donors had at least one high ferritin level. Five were already known to suffer from hemochromatosis. A full investigation was available for 80 other donors. A total of 61 of 80 donors had normalized their ferritin level at the time of their laboratory evaluation. Only 16 donors had high serum iron levels, of whom four had increased saturation index. Genetic analysis gave the following results: C282Y homozygous, two; H63D homozygous, six; C282Y/HC3D double heterozygote, six; C282Y heterozygote, six; H63D heterozygote, 19; and no mutations, 39. None of the other laboratory investigations contributed data explaining the high ferritin levels observed. CONCLUSION In most donors with high ferritin levels, the phenomenon was transient, with normal ferritin levels found in follow-up. Less than 10% of these donors had evidence of iron overload. Only eight were homozygous for mutations associated with hemochromatosis. An extensive laboratory investigation by the treating physician should only be recommended in donors with persistently high ferritin levels.
Collapse
Affiliation(s)
- Gilles Delage
- Medical Affairs, Héma-Québec, Saint-Laurent, Quebec, Canada
| | - Yves Grégoire
- Medical Affairs, Héma-Québec, Saint-Laurent, Quebec, Canada
| | - André Lebrun
- Medical Affairs, Héma-Québec, Saint-Laurent, Quebec, Canada
| |
Collapse
|
23
|
Ullum H, Rostgaard K, Kamper-Jørgensen M, Reilly M, Melbye M, Nyrén O, Norda R, Edgren G, Hjalgrim H. Blood donation and blood donor mortality after adjustment for a healthy donor effect. Transfusion 2015; 55:2479-85. [PMID: 26098293 DOI: 10.1111/trf.13205] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/16/2015] [Accepted: 04/20/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies have repeatedly demonstrated that blood donors experience lower mortality than the general population. While this may suggest a beneficial effect of blood donation, it may also reflect the selection of healthy persons into the donor population. To overcome this bias, we investigated the relation between blood donation frequency and mortality within a large cohort of blood donors. In addition, our analyses also took into consideration the effects of presumed health differences linked to donation behavior. STUDY DESIGN AND METHODS Using the Scandinavian Donation and Transfusion database (SCANDAT), we assessed the association between annual number of donations in 5-year windows and donor mortality by means of Poisson regression analysis. The analyses included adjustment for demographic characteristics and for an internal healthy donor effect, estimated among elderly donors exempted from continued donation because of age criteria. RESULTS Statistical analyses included 1,182,495 donors of whom 15,401 died during 9,526,627 person-years of follow-up. Analyses adjusted only for demographic characteristics showed a 18.6% reduction in mortality per additional annual donation (95% confidence interval [CI], 16.8%-20.4%). After additional adjustment for the internal healthy donor effect, each additional annual donation was associated with a 7.5% decreased mortality risk 7.5% (95% CI, 5.7%-9.4%). CONCLUSION We observed an inverse relationship between donation frequency and mortality. The magnitude of the association was reduced after adjustment for an estimate of self-selection in the donor population. Our observations indicate that repeated blood donation is not associated with premature death, but cannot be interpreted as conclusive evidence of a beneficial health effect.
Collapse
Affiliation(s)
- Henrik Ullum
- Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital
| | | | - Mads Kamper-Jørgensen
- Department of Epidemiology Research, Statens Serum Institut.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Reilly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mads Melbye
- Department of Epidemiology Research, Statens Serum Institut
| | - Olof Nyrén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rut Norda
- Department of Immunology and Transfusion Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Gustaf Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Hematology Centre, Karolinska University Hospital, Stockholm, Sweden
| | | |
Collapse
|
24
|
Magnussen K, Ladelund S. Handling low hemoglobin and iron deficiency in a blood donor population: 2 years' experience. Transfusion 2015; 55:2473-8. [DOI: 10.1111/trf.13152] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 03/29/2015] [Accepted: 04/01/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Karin Magnussen
- Department of Clinical Immunology and Blood Centre; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Steen Ladelund
- Clinical Research Centre; Copenhagen University Hospital; Hvidovre Denmark
| |
Collapse
|
25
|
Affiliation(s)
- M. Goldman
- Donor & Clinical Services; Canadian Blood Services; Ottawa ON Canada
| |
Collapse
|
26
|
White LK, Harris VJ, Cruz JL, Waxman DA. How do we design, implement, and manage an ongoing program to provide iron supplements to women blood donors? Transfusion 2014; 54:2795-801. [PMID: 25100312 DOI: 10.1111/trf.12803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 06/19/2014] [Indexed: 11/28/2022]
Abstract
Here we describe the design and management of Indiana Blood Center's 10-year Iron For Women program, an ongoing community blood center-based program with continual program and donor management providing iron supplements to healthy women blood donors. Donor iron supplementation has typically been limited to research study protocols, for a defined period, with the associated resources and funding. The results of studies have supported the utility of iron supplementation: iron supplementation will enhance dietary iron for increased gastrointestinal absorption triggered as a normal homeostatic response to blood loss, thereby providing a suitable dietary iron source in the event the donor's usual diet lacks sufficient iron. Despite proven results, blood centers have been reluctant to adopt the practice due to barriers such as donor selection, ensuring the appropriateness of iron supplementation relative to the health of the donor, supplement costs, provision logistics, and program management costs. We present here how we designed our program and why it is in the Blood Center's interest to help willing women participate in volunteer blood donation by attempting to mitigate associated iron loss.
Collapse
|
27
|
Annen K, Delaney M, Leitch D, Mast AE. The health implications of low hemoglobin deferral in infrequent blood donors. Transfusion 2014; 55:86-90. [PMID: 25082192 DOI: 10.1111/trf.12801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 06/10/2014] [Accepted: 06/10/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The causes of anemia in infrequent blood donors deferred for low hemoglobin (Hb) are not well known. We sought to assess this via surveys of infrequent, non-menstruating deferred blood donors at two institutions, BloodCenter of Wisconsin and Puget Sound Blood Center. STUDY DESIGN AND METHODS Men at least 18 years of age and women at least 50 years of age who were deferred for low Hb (≤12.5 g/dL), had not more than one donation in the year prior to deferral, and did not successfully donate in the 3 months after their deferral were surveyed. RESULTS The total response rate was 380 donors or 34% of those contacted. Of the respondents, 141 had sought medical advice about their low Hb. Of these, 90 were confirmed to have anemia and 13 reported serious disease requiring medical intervention, including mantle cell lymphoma, multiple myeloma, and gastrointestinal bleeding. CONCLUSIONS A small but concerning number of infrequent blood donors deferred for low Hb have an underlying illness that is severe and would benefit from medical attention. Donors deferred for low Hb who have a high risk for serious underlying illness should be provided targeted educational information advising them to seek additional medical care.
Collapse
Affiliation(s)
- Kyle Annen
- Medical Sciences and Blood Research Institutes, BloodCenter of Wisconsin, Milwaukee, Wisconsin; Heartland Blood Center, Aurora, Illinois; Department of Pathology, McGaw Medical Center of Northwestern University, Chicago, Illinois
| | | | | | | |
Collapse
|
28
|
Custer B, Bravo M, Bruhn R, Land K, Tomasulo P, Kamel H. Predictors of hemoglobin recovery or deferral in blood donors with an initial successful donation. Transfusion 2014; 54:2267-75. [DOI: 10.1111/trf.12628] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Brian Custer
- Blood Systems Research Institute; San Francisco California
| | | | - Roberta Bruhn
- Blood Systems Research Institute; San Francisco California
| | | | | | | |
Collapse
|
29
|
Predictors of low haematocrit among repeat donors in São Paulo, Brazil: Eleven year longitudinal analysis. Transfus Apher Sci 2013; 49:553-9. [DOI: 10.1016/j.transci.2013.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 08/23/2013] [Accepted: 09/20/2013] [Indexed: 11/22/2022]
|
30
|
Mast AE. Low hemoglobin deferral in blood donors. Transfus Med Rev 2013; 28:18-22. [PMID: 24332843 DOI: 10.1016/j.tmrv.2013.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/04/2013] [Accepted: 11/08/2013] [Indexed: 11/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- Alan E Mast
- Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI, USA; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
31
|
Bani M, Strepparava M, Giussani B. Gender differences and frequency of whole blood donation in Italian donors: even though I want to, I cannot? Transfus Apher Sci 2013; 50:81-6. [PMID: 24290783 DOI: 10.1016/j.transci.2013.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 10/28/2013] [Accepted: 11/01/2013] [Indexed: 11/16/2022]
Abstract
Women are under-represented among blood donors and this difference is particularly strong in Italy. This study explore the reasons for the gender gap using a sample of donors who had stopped donating at least two years previously and analyzing the role of frequency of donation. No significant gender differences emerged between the reasons provided by subjects but Italy was the country with the longest prescribed interval between whole blood donations for women. The gender gap is related to the lengthy interval between successive donations of whole blood and reducing this interval could help increase the proportion of women donors.
Collapse
Affiliation(s)
- Marco Bani
- Department of Health Science, University of Milano-Bicocca, Italy.
| | | | - Barbara Giussani
- AVIS (Associazione Volontari Italiani Sangue - Association Italian Blood Volonteers) sezione Provinciale Bergamo, Italy
| |
Collapse
|
32
|
|
33
|
Marks DC, Speedy J, Robinson KL, Brama T, Capper HR, Mondy P, Keller AJ. An 8-week course of 45 mg of carbonyl iron daily reduces iron deficiency in female whole blood donors aged 18 to 45 years: results of a prospective randomized controlled trial. Transfusion 2013; 54:780-8. [DOI: 10.1111/trf.12464] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/15/2013] [Accepted: 08/25/2013] [Indexed: 12/25/2022]
Affiliation(s)
| | - Joanna Speedy
- the Australian Red Cross Blood Service; Sydney Australia
| | | | - Tania Brama
- the Australian Red Cross Blood Service; Sydney Australia
| | - Hugh R. Capper
- the Australian Red Cross Blood Service; Sydney Australia
| | - Phillip Mondy
- the Australian Red Cross Blood Service; Sydney Australia
| | | |
Collapse
|
34
|
Abstract
Iron deficiency anemia arises when the balance of iron intake, iron stores, and the body's loss of iron are insufficient to fully support production of erythrocytes. Iron deficiency anemia rarely causes death, but the impact on human health is significant. In the developed world, this disease is easily identified and treated, but frequently overlooked by physicians. In contrast, it is a health problem that affects major portions of the population in underdeveloped countries. Overall, the prevention and successful treatment for iron deficiency anemia remains woefully insufficient worldwide, especially among underprivileged women and children. Here, clinical and laboratory features of the disease are discussed, and then focus is placed on relevant economic, environmental, infectious, and genetic factors that converge among global populations.
Collapse
Affiliation(s)
- Jeffery L Miller
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
| |
Collapse
|
35
|
Gandhi MJ, Duffy K, Benike M, Jenkins S, Stubbs JR. Effect of increasing hemoglobin cutoff in male donors and increasing interdonation interval in whole blood donors at a hospital-based blood donor center. Transfusion 2012; 52:1880-8. [PMID: 22313024 DOI: 10.1111/j.1537-2995.2011.03533.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
Collapse
Affiliation(s)
- Manish J Gandhi
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
| | | | | | | | | |
Collapse
|
36
|
van Rensburg SJ, Kotze MJ, van Toorn R. The conundrum of iron in multiple sclerosis--time for an individualised approach. Metab Brain Dis 2012; 27:239-53. [PMID: 22422107 PMCID: PMC3402663 DOI: 10.1007/s11011-012-9290-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 02/23/2012] [Indexed: 11/21/2022]
Abstract
Although the involvement of immune mechanisms in multiple sclerosis (MS) is undisputed, some argue that there is insufficient evidence to support the hypothesis that MS is an autoimmune disease, and that the difference between immune- and autoimmune disease mechanisms has yet to be clearly delineated. Uncertainties surrounding MS disease pathogenesis and the modest efficacy of currently used disease modifying treatments (DMTs) in the prevention of disability, warrant the need to explore other possibilities. It is evident from the literature that people diagnosed with MS differ widely in symptoms and clinical outcome--some patients have a benign disease course over many years without requiring any DMTs. Attempting to include all patients into a single entity is an oversimplification and may obscure important observations with therapeutic consequences. In this review we advocate an individualised approach named Pathology Supported Genetic Testing (PSGT), in which genetic tests are combined with biochemical measurements in order to identify subgroups of patients requiring different treatments. Iron dysregulation in MS is used as an example of how this approach may benefit patients. The theory that iron deposition in the brain contributes to MS pathogenesis has caused uncertainty among patients as to whether they should avoid iron. However, the fact that a subgroup of people diagnosed with MS show clinical improvement when they are on iron supplementation emphasises the importance of individualised therapy, based on genetic and biochemical determinations.
Collapse
Affiliation(s)
- Susan J van Rensburg
- Division of Chemical Pathology, National Health Laboratory Service and University of Stellenbosch, Tygerberg Hospital, PO Box 19113, 7505 Tygerberg, South Africa.
| | | | | |
Collapse
|
37
|
Lee CK, Wong HK, Hong J, Leung JNS, Tsoi WC, Lin CK. A study of the predonation hemoglobin and iron status among Hong Kong Chinese blood donors. Transfusion 2012; 53:322-7. [PMID: 22803771 DOI: 10.1111/j.1537-2995.2012.03788.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Predonation hemoglobin (PDH) is used to safeguard donors' welfare, and low hemoglobin (Hb) is known to be the most frequent reason for donor deferral. A study was initiated to assess the PDH and iron status of blood donors in Hong Kong. STUDY DESIGN AND METHODS This observational study was designed with four groups of whole blood donors invited (group 1-eligible first time donors, group 2-eligible repeat donors with zero or one donation in preceding 12 months, group 3-eligible repeat donors with at least two donations in preceding 12 months, group 4-repeat donors being deferred for low PDH). Predonation blood samples were obtained for blood counts and iron status. Mann-Whitney test, Kruskal-Wallis test, and chi-square test for trend were applied for statistical analysis. RESULTS A total of 836 donors were recruited, of which 35 were excluded because of hemoglobinopathy. An inverse relationship between serum ferritin level and number of donations in the preceding 12 months was observed in both sexes. Iron deficiency was significantly seen in 35.1% of male and 65.3% of female deferred donors. More importantly, up to 7.2, 5.8, and 29.5% of the female donors in groups 1, 2, and 3 were found to be iron deficient despite having a high enough PDH. CONCLUSION This is the first study to assess PDH and iron status in Chinese blood donors. Iron depletion is noted with increasing number of blood donations in the preceding 12 months. Advice on iron repletion is a necessary step for donor welfare and strategies should be developed to ensure that donors have adequate PDH.
Collapse
Affiliation(s)
- C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong SAR, China.
| | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Waldvogel S, Pedrazzini B, Vaucher P, Bize R, Cornuz J, Tissot JD, Favrat B. Clinical evaluation of iron treatment efficiency among non-anemic but iron-deficient female blood donors: a randomized controlled trial. BMC Med 2012; 10:8. [PMID: 22272750 PMCID: PMC3292842 DOI: 10.1186/1741-7015-10-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 01/24/2012] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Iron deficiency without anemia is related to adverse symptoms that can be relieved by supplementation. Since a blood donation can induce such an iron deficiency, we investigated the clinical impact of iron treatment after a blood donation. METHODS One week after donation, we randomly assigned 154 female donors with iron deficiency without anemia, aged below 50 years, to a four-week oral treatment of ferrous sulfate versus a placebo. The main outcome was the change in the level of fatigue before and after the intervention. Aerobic capacity, mood disorder, quality of life, compliance and adverse events were also evaluated. Hemoglobin and ferritin were used as biological markers. RESULTS The effect of the treatment from baseline to four weeks of iron treatment was an increase in hemoglobin and ferritin levels to 5.2 g/L (P < 0.01) and 14.8 ng/mL (P < 0.01), respectively. No significant clinical effect was observed for fatigue (-0.15 points, 95% confidence interval -0.9 points to 0.6 points, P = 0.697) or for other outcomes. Compliance and interruption for side effects was similar in both groups. Additionally, blood donation did not induce overt symptoms of fatigue in spite of the significant biological changes it produces. CONCLUSIONS These data are valuable as they enable us to conclude that donors with iron deficiency without anemia after a blood donation would not clinically benefit from iron supplementation. TRIAL REGISTRATION ClinicalTrials.gov: NCT00981877.
Collapse
Affiliation(s)
- Sophie Waldvogel
- Blood Transfusion Service of the Swiss Red Cross, Lausanne, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
40
|
Cable RG, Glynn SA, Kiss JE, Mast AE, Steele WR, Murphy EL, Wright DJ, Sacher RA, Gottschall JL, Tobler LH, Simon TL. Iron deficiency in blood donors: the REDS-II Donor Iron Status Evaluation (RISE) study. Transfusion 2011; 52:702-11. [PMID: 22023513 DOI: 10.1111/j.1537-2995.2011.03401.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Blood donors are at risk of iron deficiency. We evaluated the effects of blood donation intensity on iron and hemoglobin (Hb) in a prospective study. STUDY DESIGN AND METHODS Four cohorts of frequent and first-time or reactivated (FT/RA) blood donors (no donation in 2 years), female and male, totaling 2425, were characterized and followed as they donated blood frequently. At enrollment and the final visit, ferritin, soluble transferrin receptor (sTfR), and Hb were determined. Models to predict iron deficiency and Hb deferral were developed. Iron depletion was defined at two levels: iron deficiency erythropoiesis (IDE) [log(sTfR/ferritin) ≥ 2.07] and absent iron stores (AIS; ferritin < 12 ng/mL). RESULTS Among returning female FT and RA donors, 20 and 51% had AIS and IDE at their final visit, respectively; corresponding proportions for males were 8 and 20%. Among female frequent donors who returned, 27 and 62% had AIS and IDE, respectively, while corresponding proportions for males were 18 and 47%. Predictors of IDE and/or AIS included a higher frequency of blood donation in the past 2 years, a shorter interdonation interval, and being female and young; conversely, taking iron supplements reduced the risk of iron depletion. Predictors of Hb deferral included female sex, black race, and a shorter interdonation interval. CONCLUSIONS There is a high prevalence of iron depletion in frequent blood donors. Increasing the interdonation interval would reduce the prevalence of iron depletion and Hb deferral. Alternatively, replacement with iron supplements may allow frequent donation without the adverse outcome of iron depletion.
Collapse
Affiliation(s)
- Ritchard G Cable
- New England Region, American Red Cross Blood Services, Farmington, Connecticut 06032, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Amrein K, Valentin A, Lanzer G, Drexler C. Adverse events and safety issues in blood donation--a comprehensive review. Blood Rev 2011; 26:33-42. [PMID: 21996651 DOI: 10.1016/j.blre.2011.09.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Although blood donation is generally safe, a variety of risks and complications exist, the most common being iron deficiency, vasovagal reactions and citrate-related events. In the last decades, extensive efforts have significantly improved recipient and product safety, but there is still great potential to optimise donor care. Many therapies in modern medicine depend on the prompt availability of blood products, therefore it is crucial to maintain a motivated and healthy donor pool in view of a limited number of healthy volunteers willing and able to give blood or blood components. We present a comprehensive review on adverse events addressing all types of blood donation including whole blood, plasma, platelet, peripheral blood stem cell, leucocyte and bone marrow donation. In addition, we outline strategies for the prevention and treatment of these events and give a blueprint for future research in this field.
Collapse
Affiliation(s)
- Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Auenbruggerplatz 15, 8036 Graz, Austria.
| | | | | | | |
Collapse
|
42
|
Ziemann M, Lizardo B, Geusendam G, Schlenke P. Reliability of capillary hemoglobin screening under routine conditions. Transfusion 2011; 51:2714-9. [DOI: 10.1111/j.1537-2995.2011.03183.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
43
|
Pasricha SR, McQuilten ZK, Keller AJ, Wood EM. Hemoglobin and iron indices in nonanemic premenopausal blood donors predict future deferral from whole blood donation. Transfusion 2011; 51:2709-13. [DOI: 10.1111/j.1537-2995.2011.03173.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
44
|
|
45
|
O'Meara A, Infanti L, Stebler C, Ruesch M, Sigle JP, Stern M, Buser A. The value of routine ferritin measurement in blood donors. Transfusion 2011; 51:2183-8. [PMID: 21517893 DOI: 10.1111/j.1537-2995.2011.03148.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Iron store deficiency is a common side effect of whole blood donation. Early recognition and reversal of excessive iron loss may avoid symptomatic iron store depletion in blood donors and reduce volunteer loss due to iron deficiency (ID) anemia. STUDY DESIGN AND METHODS Between 1996 and 2009, a total of 160,612 visits with the intention to donate blood by 23,557 healthy volunteers were recorded at our center. As of 2004, routine serum ferritin testing and additional counseling of donors at risk for donation-induced anemia were implemented. We analyzed the impact of this measure on the hemoglobin (Hb) levels and anemia occurrence in our donor population and in particular in women of childbearing age. Donation rejections due to low Hb counts, the intervals to next donation, and return rates thereafter were also assessed. RESULTS The introduction of routine serum ferritin analysis resulted in an increase of mean Hb levels in blood donors particularly in women of childbearing age. The incidence of predonation anemia and donation ineligibility due to a low Hb concentration decreased significantly. The return intervals of donors rejected on account of low Hb levels were shortened; however, the return rates thereafter were also curtailed. CONCLUSIONS Systematic serum ferritin measurements allowed an optimized management of ID in our donors and efficacious prevention of ID anemia.
Collapse
Affiliation(s)
- Alix O'Meara
- Division of Hematology, Department of Internal Medicine, University Hospital Basel, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
46
|
Pittori C, Buser A, Gasser UE, Sigle J, Job S, Rüesch M, Tichelli A, Infanti L. A pilot iron substitution programme in female blood donors with iron deficiency without anaemia. Vox Sang 2010; 100:303-11. [PMID: 21091697 DOI: 10.1111/j.1423-0410.2010.01427.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Blood donation can contribute to iron deficiency. The possibly resulting anaemia importantly affects donor return rate. The determination of serum ferritin levels revealed iron deficiency in many non-anaemic premenopausal female blood donors at our Institution. We started an iron substitution programme targeting this donor group to prevent anaemia and enhance donor retain. MATERIALS AND METHODS Women aged≤50 with haemoglobin levels adequate for donation and serum ferritin≤10 ng/ml were offered iron supplementation. Substitution lasted 16 weeks and the donation interval was extended. History collection including iron deficiency-related symptoms, whole blood count and serum ferritin determination was performed at baseline and after 2 and 6 months. Data were recorded prospectively and compared with those of 108 female controls with iron deficiency not receiving iron substitution (retrospective data). RESULTS Of the 116 participating subjects, 60% completed the programme. Significant results were serum ferritin increase (from a mean value of 7.12 to 25.2 ng/ml), resolution of prostration, fatigue, sleep disturbances, tension in the neck, hair loss and nail breakage. No case of anaemia occurred. Sixty per cent of the women completed the programme and donated blood again. CONCLUSIONS Targeted iron substitution prevents the development of anaemia and enhances donation return in premenopausal female blood donors with iron deficiency.
Collapse
Affiliation(s)
- C Pittori
- Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Bani M, Giussani B. Gender differences in giving blood: a review of the literature. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2010; 8:278-87. [PMID: 20967170 PMCID: PMC2957494 DOI: 10.2450/2010.0156-09] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 02/18/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND An overview of European blood donors shows that the distribution of men and women donors is similar in many countries, with Italy being an exception in that women account for only 30% of donors. Gender medicine is a key issue in this context, even though gender studies are very limited in the transfusion field, whether considered broadly or with specific regards to the selection, management and retention of donors. It, therefore, seemed important to compare the presence of women among blood donors in different European countries and examine the roles that gender is reported to play in the donation of blood in order to identify possible implications for communication with and management of the donor. METHODS To determine the proportion of women among donors in European countries, data were collected from annual reports or documents available on the websites of national associations; furthermore, all papers related to giving blood published in the five main journals in the sector (Transfusion, Vox Sanguinis, Transfusion and Apheresis Science, Transfusion Medicine, Blood Transfusion) were considered; about 80 publications were selected and the gender variable was examined. RESULTS The published studies showed that gender plays key roles in the motivation to give blood (women being more altruistic, men being more individualistic) and in adverse reactions, which was a particularly critical problem leading to fewer women become regular donors. A few aspects specific to the management of donors in Italy also emerged. DISCUSSION Gender seems to play an important role in the aspects studied and does, therefore, merit further consideration in relation to strategies to recruit donors and the management of critical events during donation.
Collapse
Affiliation(s)
- Marco Bani
- Multimedia Health Communication Laboratory, Facoltà di Medicina e Chirurgia, Università di Milano Bicocca, Monzo, Italy.
| | | |
Collapse
|
48
|
The effect of repeated blood donations on the iron status of male Saudi blood donors. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2010; 9:167-71. [PMID: 21084007 DOI: 10.2450/2010.0040-10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 08/02/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Regular blood donation can lead to iron deficiency. Screening donors' serum ferritin levels at the time of first donation and subsequently once every year is a very rational way to pick up iron deficiency in a voluntary blood donor population. The aim of this study was to determine the effect of blood donation and the prevalence of erythropoiesis with iron deficiency (sideropenia) in Saudi male blood donors. MATERIALS AND METHODS The study was prospectively conducted, between December 2008 and March 2009, on 182 male native Saudi blood donors at King Fahd Central Hospital in Jazan region, Saudi Arabia. Each donor gave 450 ± 50 mL of whole blood. Following the donation, samples were removed into 2.5 mL EDTA tubes for measurement of mean cell volume (MCV) and mean corpuscular haemoglobin (MCH) and into 7.5 mL plain tubes for estimation of iron and serum ferritin concentrations. The blood donors were divided into five groups, according to the number of donations they had given in the preceding 3 years. The blood donors in group I were first-time donors, with no previous history of blood donation. Group II donors had donated once in the last 3 years. Subjects in groups III, IV and V had donated more than once in the preceding 3 years and were considered regular donors. RESULTS The mean serum iron was significantly higher among subjects with no previous history of blood donation (group I) than among regular donors who had donated twice or more. The difference in serum ferritin concentration was statistically significant (p<0.05) when comparing regular donors in group III (72.4 μg/L), group IV (67.4 μg/L) and group V (26.2 μg/L) with first-time blood donors (131.4 μg/L). In contrast, the difference in the concentration of serum ferritin between subjects in group II (98.9 μg/L), who had donated once in the last 3 years, and in first-time blood donors (131.4 μg/L) was not statistically significant (p<0.131). None of the group I donors suffered from iron deficiency, whereas 2.8% of the donors who had donated between two to five times had iron deficiency. The prevalence of erythropoiesis with iron deficiency in regular blood donors was 4.3%. CONCLUSION The results of this study show that an increase in the number of donations results in an increase in the frequency of depleted iron stores and subsequently in erythropoiesis with iron deficiency, although the level of haemoglobin remained acceptable for blood donation. This result may indicate the need to review the guidelines on acceptance of donors.
Collapse
|
49
|
Cable RG, Glynn SA, Kiss JE, Mast AE, Steele WR, Murphy EL, Wright DJ, Sacher RA, Gottschall JL, Vij V, Simon TL. Iron deficiency in blood donors: analysis of enrollment data from the REDS-II Donor Iron Status Evaluation (RISE) study. Transfusion 2010; 51:511-22. [PMID: 20804527 DOI: 10.1111/j.1537-2995.2010.02865.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Regular blood donors are at risk of iron deficiency, but characteristics that predispose to this condition are poorly defined. STUDY DESIGN AND METHODS A total of 2425 red blood cell donors, either first-time (FT) or reactivated donors (no donations for 2 years) or frequent donors, were recruited for follow-up. At enrollment, ferritin, soluble transferrin receptor (sTfR), and hemoglobin were determined. Donor variables included demographics, smoking, dietary intake, use of iron supplements, and menstrual and/or pregnancy history. Models to predict two measures of iron deficiency were developed: Absent iron stores (AIS) were indicated by a ferritin level of less than 12 ng/mL and iron-deficient erythropoiesis (IDE) by a log(sTfR/ferritin) value of 2.07 or greater. RESULTS A total of 15.0% of donors had AIS and 41.7% IDE. In frequent donors, 16.4 and 48.7% of males had AIS and IDE, respectively, with corresponding proportions of 27.1 and 66.1% for females. Donation intensity was most closely associated with AIS and/or IDE (odds ratios from 5.3 to 52.2 for different donation intensity compared to FT donors). Being female, younger, and/or menstruating also increased the likelihood of having AIS and/or IDE, as did having a lower weight. Marginally significant variables for AIS and/or IDE were being a nonsmoker, previous pregnancy, and not taking iron supplements. Dietary variables were in general unrelated to AIS and/or IDE, as was race and/or ethnicity. CONCLUSION A large proportion of both female and male frequent blood donors have iron depletion. Donation intensity, sex and/or menstrual status, weight, and age are important independent predictors of AIS and/or IDE. Reducing the frequency of blood donation is likely to reduce the prevalence of iron deficiency among blood donors, as might implementing routine iron supplementation.
Collapse
Affiliation(s)
- Ritchard G Cable
- New England Region, American Red Cross Blood Services, Farmington, Connecticut 06032 USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Greig AJ, Palmer MA, Chepulis LM. Hormonal contraceptive practices in young Australian women (≤ 25 years) and their possible impact on menstrual frequency and iron requirements. SEXUAL & REPRODUCTIVE HEALTHCARE 2010; 1:99-103. [PMID: 21122605 DOI: 10.1016/j.srhc.2010.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 04/15/2010] [Accepted: 06/08/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the hormonal contraceptive practices of female university students aged ≤ 25 years, their menstrual bleeding frequency, and interest in contraceptive regimens that reduce menstrual frequency or duration. STUDY DESIGN A 20-item questionnaire was distributed to female students at Griffith University, Gold Coast campus. This included questions relating to: demographics, menstrual bleeding frequency, current contraceptive practices, and interest in future oral contraceptive regimens that reduce menstrual bleeding frequency and duration. MAIN OUTCOME MEASURES Determination of hormonal contraceptive practices and menstrual bleeding frequency undertaken by the sample population. RESULTS Eight hundred and fifty one participants completed the questionnaire, ~ 2/3rds of respondents are currently using a hormonal contraceptive (66% of all respondents), with the oral contraceptive pill (OCP) being most common. Most women (73%) reported monthly menstruation, although 16% indicated that they sometimes missed their monthly period, with bleeding every two months. Of all OCP users, approximately 2/3rds have skipped their monthly period at some time, the most common reasons being for convenience (89%). Approximately 70% of respondents were interested in OCP regimens that reduced frequency or duration of menstruation. CONCLUSION OCP use is popular amongst Australian university women, with many being interested in the concept of using the OCP to delay menstruation. Given this interest and the availability of hormonal contraceptives that reduce menstrual frequency and duration, assessing the impact of reduced menstrual blood loss on iron stores may be warranted.
Collapse
Affiliation(s)
- Alecia J Greig
- School of Public Health, Griffith Health, RCCCPI, Gold Coast Campus, Griffith University, Qld 4222, Australia.
| | | | | |
Collapse
|