Combined cell index in assessing blood donor iron stores

Iron deficiency in whole blood donors in a resource-poor setting: A cross-sectional study in Uganda

BACKGROUND AND OBJECTIVE

Blood donation is known to result in iron deficiency (ID), with a higher prevalence in females. There is little published data on the frequency of ID among blood donors in resource-poor settings. We determined the prevalence of ID in blood donors in Uganda.

METHODS

We conducted a descriptive cross-sectional study at the Uganda Blood Transfusion Service, Kampala from December 2021 to February 2022. A sample of 500 whole blood donors was enrolled. The evaluation included demographic characteristics, donation history, nutritional history, complete blood count, and serum ferritin. The primary outcome was the proportion of donors with serum ferritin <15 μg/L.

RESULTS

The median (IQR) serum ferritin was 25 (12-47) μg/L and 89 (52-133) μg/L among female and male donors respectively. The prevalence of iron deficiency (serum ferritin <15 μg/L) among donating individuals was 11.5% (8.7-14.9), while among low haemoglobin deferrals, 61.5% (50.9-71.1). The prevalence was high among females [33.0% (27.9-38.6)] compared with males [2.5% (1.0-5.8)], but even higher among females younger than 24 years [35.4% (29.2-42.1)]. Factors associated with ID (adjusted odds ratio, 95% Cl, and significance) were; female donors (15.81, 5.17, 48.28, p < 0.001) and a high RDW (6.89, 2.99, 15.90, p < 0.001). We found a moderate correlation between serum ferritin and RDW (r = -0.419 and -0.487 for males and females respectively).

CONCLUSION

Iron deficiency is common among blood donors in Uganda, affecting mostly young female donors. Considerations to adopt evidence-based strategies to prevent and manage ID among blood donors-such as serum ferritin monitoring and iron supplementation are highly recommended.

Assessment of iron status in regular blood donors in a tertiary care hospital in Southern India

BACKGROUND

Regular blood donation depletes iron stores. The assertion is that the vulnerable donor population requires a predictive standard operative procedure for early detection of iron store depletion, preventing them from developing iron-deficiency anemia.

AIM

This study aims to study the potential effects of blood donation in the regular donor group using hematological and biochemical estimation of iron status parameters.

STUDY SETTINGS AND DESIGN

This was a prospective cross-sectional study on regular blood donors, defined as those who have donated at least 3 times, the last donation being within the last 12 months and continues to donate at least once a year, at a tertiary care teaching hospital in Southern India.

MATERIALS AND METHODS

The complete blood count (CBC) was performed on the Sysmex coulter, and the red cell indices were calculated. The ferritin and the soluble transferrin receptor (sTfR) assays were performed using Enzyme Immunoassays.

STATISTICAL ANALYSIS USED

The comparison of CBC, serum ferritin, and sTfR assay with donation frequency and time since the last donation was carried out using an independent student's t-test for two groups. The statistical analysis was performed using SPSS for Windows version 20.

RESULTS

A total of 323 regular blood donors (6 were females) were included in the study of which they were categorized into three, 211 donors with less than or equal to 10 donations, 84 those who had donated between 11 and 20 times and 28 who had donated more than 20 times. The red cell indices were reduced and different in the groups but not statistically significant except for mean corpuscular volume. About 15% of the study population had a transferrin level of <15 ng/ml. The Ferritin levels showed a statistically significant negative correlation with the number of donations, the correlation coefficient being -0.27. Logarithmic ratios of sTfR/ferritin also correlated with a coefficient of 0.156 with the number of donations and were statistically significant.

CONCLUSION

Our study found that regular blood donors had low iron stores, as shown by ferritin levels and other iron indicators. Using the current guidelines (hemoglobin >12.5 g/dL) for donation, or the red cell indices alone do not reflect the donor's actual iron status.

Depleted iron stores in voluntary blood donors: A three-center cross-sectional study in Ghana

BACKGROUND

Blood donation is frequently associated with iron deficiency. Although iron deficiency is endemic in Ghana, there is a scarcity of data on iron stores in blood donors to inform donor recruitment policy. This study determined the prevalence and factors predictive of depleted iron stores in blood donors.

MATERIALS AND METHODS

This cross-sectional study recruited 287 blood donors from three regions in Ghana. Venous blood samples were collected for estimation of C-reactive protein, full blood count, and serum ferritin. Questionnaires were used to capture sociodemographic data. Data were analyzed using SPSS or GraphPad Prism. Multivariate logistic regression and receiver operator characteristics (ROC) analyses were, respectively, used to determine the factors associated with depleted iron stores or sensitivities of calculated red cell indices in predicting depleted iron stores in the participants.

RESULTS

Whereas 27.4% of the blood donors had depleted iron stores (ferritin <15 ng/dL), only 11% took iron supplementation. While ferritin levels significantly increased with age, 49.5% of the blood donors were aged 20-29 years. Whereas 39.5% of participants had never donated blood, 24.9% had donated ≥3 units of whole blood in the past 2 years. Female (adjusted odds ratio [aOR]: 7.407, P = 0.005), multiple previous donations (1-2 [aOR: 1.846, P = 0.431]; ≥3 [aOR: 6.297, P = 0.016]), no iron supplementation (aOR: 17.553, P = 0.078), or platelet count ≥150 × 10⁹/L (aOR: 2.689, P = 0.354) significantly associated with iron depletion. ROC analyses showed that whereas mean cell hemoglobin (MCH) density (area under the curve [AUC]: 0.735, P < 0.01), MCH (AUC: 0.772, P < 0.01) or Shine and Lal (AUC: 0.736, P < 0.01) fairly predicted iron depletion, combined cell index (AUC: 0.660, P < 0.01) or Green and King (AUC: 0.603, P < 0.01) indices poorly predicted iron depletion.

CONCLUSIONS

More than quarter of voluntary blood donors suffers postdonation sideropenia. Calculated red cell indices should be investigated in different settings to validate usefulness in detecting iron depletion.

Hematotoxicity of intratracheally instilled arsenic trioxide in rats

The study aimed to investigate the correlation between concentration of inhaled arsenic trioxide and dynamic changes in hematotoxicity in rats. Wistar rats were randomly divided into four study groups that were treated with saline (control) or arsenic trioxide at a low (0.1 mg/mL), medium (1 mg/mL), or high (10 mg/mL) dose by intratracheal instillation. Blood samples were collected for analysis at 6, 12, 24, 48, and 72 h after exposure. Compared with the control group, intratracheal instillation of arsenic trioxide affected hematopoietic differentiation in rats, leading to blood cell changes that were related to observation time and concentration.