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Thijsen A, Gemelli CN, Hyde MK, Thorpe R, Masser BM. A rapid review of strategies to manage low iron levels in adults donating whole-blood: A focus on donor behaviour. Transfus Med 2024. [PMID: 39031713 DOI: 10.1111/tme.13060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 07/22/2024]
Abstract
In recognition of the impact of whole-blood donation on body iron stores, there has been an increased focus assessing the efficacy of strategies to minimise the risk of iron deficiency (ID). Whilst donor behaviour is an important determinant of success, this literature is yet to be fully synthesised to help guide blood collection agencies when implementing these strategies into routine practice. This rapid review identifies strategies for management of low iron, how they have been communicated to donors, donor compliance with advice, donor use of external health services and their effect on donor retention. Web of Science, Medline, CINAHL and Wiley online library databases were searched from 2012 to November 2023, with 29 studies meeting inclusion criteria. Five iron management strategies were identified: oral iron supplementation (IS), education, dietary advice, lengthening inter-donation interval and switching donation type. Most studies (n = 16) focused on IS, with only four reporting how they communicated this to donors. Donor use of IS was high in controlled research environments but has not been evaluated when implemented into routine practice. None of the four studies on dietary advice included findings on donor acceptability. The proportion of donors consulting their doctor about a low iron result or their risk of ID was found to be suboptimal. However, in general, the identified strategies and communications had a positive effect on donor retention. More evidence is needed on how to increase donor knowledge and awareness of donation-related risk of ID as well as to identify how to effectively communicate strategies to donors to ensure optimal acceptability and use.
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Affiliation(s)
- Amanda Thijsen
- Research & Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Carley N Gemelli
- Research & Development, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Melissa K Hyde
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel Thorpe
- Research & Development, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Barbara M Masser
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Research & Development, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia
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Xiao G, Dong D, Wang Y, Li C, Huang GT, Yang H, Huang J, Chen F. The risks of low hemoglobin deferral in a large retrospective cohort of plasmapheresis donors and the influence factors of return for a subsequent donation in China. PeerJ 2023; 11:e14999. [PMID: 36935911 PMCID: PMC10019327 DOI: 10.7717/peerj.14999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Background According to the Technical Operation Procedures for Plasmapheresis Collection Station (2019) in China, plasmapheresis donors with low hemoglobin (Hb) levels (men <12.0 g/dL; women <11.0 g/dL) were deferred for at least 2 weeks. The purpose of this retrospective study was to survey the demographic characteristics of plasmapheresis donors with low Hb deferral (LHD) and identify at-risk LHD donors, so as to enhance donor safety and improve donation service management. Methods From 2018 to 2020, a multi-center study involving plasmapheresis donors from 18 plasmapheresis centers in three provinces (Sichuan, Yunnan and Hunan) of China was conducted. Donor demographics (age, sex) and donation information (date of donation, first-time donors vs. repeat donors, the number of lifetime donations, the number of donations in the last 12 months, and whether the LHD donor returned for a subsequent donation) were collected. The Cochran-Mantel-Haenszel method was used to explore the risk factors for LHD while adjusting for the different provinces. Logistic regression analysis was used to investigate the factors influencing the return for a subsequent donation after LHD. Results A total of 497,039 plasmapheresis donors were included. Female donors' LHD rate was 0.15% on average, while male donors' LHD rate was 0.01%. Female donors aged 41-50 years old (OR: 2.276, 95% CI [1.333-3.887], p = 0.002) were more likely to experience LHD temporarily than those aged 18-30 years old. For female donors, compared with donations in the winter, they had a higher risk for LHD in the summer (OR: 2.217, 95% CI [1.670-2.943], p < 0.001), spring (OR: 2.402, 95% CI [1.806-3.196], p < 0.001), and fall (OR: 2.002, 95% CI [1.500-2.673], p < 0.001). Among the LHD donors, those who had donated more frequently in the past were more likely to return for a subsequent donation (p = 0.012). Conclusions Female donors were at a higher risk of LHD, particularly between the ages of 41 and 50. A clear seasonal pattern in the rate of LHD was observed. In the winter, the risk of LHD was the lowest; thus, it was advised to recruit plasmapheresis donors throughout the winter and to make the required adjustments for recruitment measures during other seasons. The number of previous donations was correlated with the return rate after LHD. Our observations could have practical implications for plasmapheresis donor management.
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Affiliation(s)
- Guanglin Xiao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Demei Dong
- Beijing Tiantan Biological Products Company Limited, Beijing, China
| | - Ya Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Changqing Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Gong tian Huang
- Shanghai RAAS Blood Products Company Limited, Shanghai, China
| | - Hui Yang
- Nanyue Biopharming Corporation Ltd, Hengyang, China
| | - Jing Huang
- Jiange Plasmapheresis Station, Sichuan Yuanda Shuyang Pharmaceutical Company Limited, Guangyuan, China
| | - Fei Chen
- Cangxi Plasmapheresis Station, Sichuan Yuanda Shuyang Pharmaceutical Company Limited, Guangyuan, China
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Mantadakis E, Panagopoulou P, Kontekaki E, Bezirgiannidou Z, Martinis G. Iron Deficiency and Blood Donation: Links, Risks and Management. J Blood Med 2022; 13:775-786. [PMID: 36531435 PMCID: PMC9749410 DOI: 10.2147/jbm.s375945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/05/2022] [Indexed: 01/08/2024] Open
Abstract
The purpose of this review is to raise awareness about the frequently underappreciated association of blood donation with iron deficiency, and to describe methods for its prevention and management. Blood donors cannot expect any health benefits from the donation but have justified expectations of no harm. Iron deficiency without anemia (IDWA) and iron deficiency anemia (IDA) are common consequences of regular blood donation, and this activity is the most important factor affecting iron status in regular blood donors. Awareness of blood donation as a primary cause of sideropenia is surprisingly low among physicians. Blood donation screening identifies potential donors with IDA but is frequently inadequate to detect IDWA. For the assessment of body iron stores, plasma or serum ferritin, transferrin saturation (TSAT) and soluble transferrin receptors (sTfR) concentrations are the most widely used biochemical markers, although the percentage of hypochromic mature erythrocytes and the hemoglobin content of reticulocytes are also useful. IDWA can be prevented by limiting the total volume of blood collected, by iron deficiency screening and deferral of sideropenic donors, by prolonging the interdonation intervals, and by iron supplementation between donations. IDWA tends to be more prevalent in younger people, females, and high-intensity donors. A potentially effective strategy to address sideropenia in blood donors is serum ferritin testing, but this may lead to a higher rate of deferral. Most regular blood donors cannot replenish their iron deficit by an iron-rich diet alone and will benefit from low-dose oral iron administration with various commercially available products post-donation, a well-tolerated strategy. However, valid concerns exist regarding the possibility of worsening the iron overload in donors with undiagnosed hemochromatosis or masking the symptoms of a clinically important gastrointestinal hemorrhage or other underlying medical condition. Finally, educational efforts should be intensified to improve the awareness of blood donation as a primary cause of iron deficiency among physicians of all specialties.
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Affiliation(s)
- Elpis Mantadakis
- Department of Pediatrics, Hematology/ Oncology Unit, University General Hospital of Alexandroupolis, Thrace, Greece
| | - Paraskevi Panagopoulou
- Department of Pediatrics, Aristotle University of Thessaloniki, Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Eftychia Kontekaki
- Blood Transfusion Centre, University General Hospital of Alexandroupolis, Thrace, Greece
| | - Zoe Bezirgiannidou
- Department of Hematology, University General Hospital of Alexandroupolis, Thrace, Greece
| | - Georges Martinis
- Blood Transfusion Centre, University General Hospital of Alexandroupolis, Thrace, Greece
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Poor iron store recovery in voluntary blood donors in the northern zone of Ghana; a five-month three-centre cohort study. Transfus Apher Sci 2020; 60:103040. [PMID: 33358358 DOI: 10.1016/j.transci.2020.103040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/11/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In Ghana, although iron deficiency is endemic, post blood donation iron supplementation is not routine. We sought to determine whether at five months post-donation of a single unit of whole blood, donors were able to recover iron stores. MATERIALS AND METHODS This three-centre cohort study recruited 164 blood donors at the Lawra, Nandom, and Bimbila communities in the northern zone of Ghana. Venous blood samples were drawn at baseline to estimate full blood count (FBC), haemoglobin variants, qualitative G6PD status, and serum ferritin. Five months post-donation, venous blood samples were drawn for a repeat measurement of FBC and serum ferritin. Data were analysed using SPSS and GraphPad prism to assess recovery of iron stores. RESULTS Whereas 26.8 % had inherited haemoglobin variants, 18.9 % of the donors had qualitative G6PD deficiency. Overall, mean difference between pre-donation and five months post donation iron stores significantly differed from zero (p < 0.001; one sample t-test). After five months post donation, 76.8 % of the blood donors could not achieve pre-donation iron stores. Whereas 6.1 % and 8.5 % blood donors had depleted iron stores and iron deficient erythropoiesis at baseline, these increased to 9.8 % and 21.3 % respectively at five-month post donation. Moreover, at five months post donation, 11 % of these blood donors would have been disqualified per haemoglobin screening cut off of 12.5 g/dl. CONCLUSION Reliance on food intake to replenish iron store lost per blood donation may not adequately assure donor health in the study area; iron supplementation should be considered.
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Browne A, Fisher SA, Masconi K, Smith G, Doree C, Chung R, Rahimzadeh M, Shah A, Rodriguez SA, Bolton T, Kaptoge S, Wood A, Sweeting M, Roberts DJ. Donor Deferral Due to Low Hemoglobin-An Updated Systematic Review. Transfus Med Rev 2020; 34:10-22. [PMID: 31806414 DOI: 10.1016/j.tmrv.2019.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/30/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
Blood donors attending a donation session may be deferred from donating blood due to a failure to meet low hemoglobin (Hb) thresholds. This costs the blood donor service and donors valuable time and resources. In addition, donors who are deferred may have more symptoms, and as a direct and/or indirect effect of their experience, return rates of donors deferred for low Hb are reduced, even in repeat donors. It is therefore vital that low Hb deferral (LHD) is minimized. The aim of this updated systematic review is to expand the evidence base for factors which affect a donor's risk of deferral due to low Hb. Studies were identified by searching MEDLINE, Embase, The Cochrane Library, and the WHO International Clinical Trials Registry to March 2019. Demographic data, donor history, hematological/biological factors, and the primary outcome of deferral due to low Hb were extracted. Our primary outcome was deferral due to low Hb. Analyses were descriptive and quantitative; pooled odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by meta-analysis using random-effects models. A total of 116 studies met the inclusion criteria. Meta-analysis showed a significantly greater risk of LHD in females compared with males in studies applying universal Hb thresholds for males and females (OR 14.62 95% CI 12.43-17.19) and in those which used sex-specific thresholds (OR 5.73, 95% CI 4.36-7.53). Higher rates of LHD were also associated with increasing age in men, low body weight, shorter interdonation interval, donors of Hispanic or African descent, higher ambient temperature, donors with low ferritin levels, and donation in a fixed donor center. There was conflicting evidence on the effect of new and repeat donor status, and blood group. This work has strengthened the evidence of the previous review in identifying factors that should be considered in studies of donor deferral and highlighting areas in need of further study, including ABO and Rh blood groups, previous platelet donation, diet, smoking, time of day, and genetic data. These factors may lead to individually tailored donation criteria for safe and efficient donation in the future.
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Affiliation(s)
- Andrew Browne
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Sheila A Fisher
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK; BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
| | - Katya Masconi
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Graham Smith
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK; BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK; BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ryan Chung
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Mana Rahimzadeh
- Oxford University Medical School, John Radcliffe Hospital, Oxford, UK
| | - Akshay Shah
- BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Silvia Alonso Rodriguez
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Thomas Bolton
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Stephen Kaptoge
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Michael Sweeting
- Department of Health Sciences, University of Leicester, University Road, Leicester
| | - David J Roberts
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK; BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Lobier M, Castrén J, Niittymäki P, Palokangas E, Partanen J, Arvas M. The effect of donation activity dwarfs the effect of lifestyle, diet and targeted iron supplementation on blood donor iron stores. PLoS One 2019; 14:e0220862. [PMID: 31408501 PMCID: PMC6692066 DOI: 10.1371/journal.pone.0220862] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/24/2019] [Indexed: 11/19/2022] Open
Abstract
The iron status of blood donors is a subject of concern for blood establishments. The Finnish Red Cross Blood Service addresses iron loss in blood donors by proposing systematic iron supplementation for demographic at-risk donor groups. We measured blood count, ferritin and soluble transferrin receptor (sTfR) and acquired lifestyle and health information from 2200 blood donors of the FinDonor 10000 cohort. We used modern data analysis methods to estimate iron status and factors affecting it with a special focus on the effects of the blood service's iron supplementation policy. Low ferritin (< 15 μg/L), an indicator of low iron stores, was present in 20.6% of pre-menopausal women, 10.6% of post-menopausal women and 6% of men. Anemia co-occurred with iron deficiency more frequently in pre-menopausal women (21 out of 25 cases) than in men (3/6) or post-menopausal women (1/2). In multivariable regression analyses, lifestyle, dietary, and blood donation factors explained up to 38% of the variance in ferritin levels but only ~10% of the variance in sTfR levels. Days since previous donation were positively associated with ferritin levels in all groups while the number of donations during the past 2 years was negatively associated with ferritin levels in pre-menopausal women and men. FRCBS-provided iron supplementation was negatively associated with ferritin levels in men only. Relative importance analyses showed that donation activity accounted for most of the explained variance in ferritin levels while iron supplementation explained less than 1%. Variation in ferritin levels was not significantly associated with variation in self-reported health. Donation activity was the most important factor affecting blood donor iron levels, far ahead of e.g. red-meat consumption or iron supplementation. Importantly, self-reported health of donors with lower iron stores was not lower than self-reported health of donors with higher iron stores.
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Affiliation(s)
- Muriel Lobier
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Johanna Castrén
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Pia Niittymäki
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Elina Palokangas
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Jukka Partanen
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Mikko Arvas
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
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D'Adamo CR, Novick JS, Feinberg TM, Dawson VJ, Miller LE. A Food-Derived Dietary Supplement Containing a Low Dose of Iron Improved Markers of Iron Status Among Nonanemic Iron-Deficient Women. J Am Coll Nutr 2018. [PMID: 29533710 DOI: 10.1080/07315724.2018.1427158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Iron deficiency is the most common nutrient deficiency in the world. While deficiency can often be resolved through dietary supplementation with iron, adverse events are common and frequently preclude compliance. The objective of this study was to determine whether a food-derived dietary supplement containing a low dose of iron and nutrients that increase iron absorption could resolve iron deficiency with fewer adverse events than reported at higher doses. METHODS A pilot clinical trial (NCT02683369) was conducted among premenopausal women with nonanemic iron deficiency that was verified by blood screening. Participants consumed a dietary supplement (Blood Builder®/Iron Response®) once daily for 8 weeks containing 26 mg of iron, vitamin C, folate, and other food-derived nutrients. Primary outcomes were markers of iron status (serum ferritin, hemoglobin, soluble transferrin receptor, total body iron stores) and secondary outcomes were self-reported fatigue and energy. All outcomes were assessed at baseline and 8 weeks. Adverse events were monitored with questionnaires, daily diaries, and contact with a physician. Dependent samples t test and Wilcoxon signed-rank test were used to analyze outcomes. RESULTS Twenty-three participants enrolled in the study. Iron deficiency was resolved in the sample (mean serum ferritin: baseline = 13.9 μg/L, 8 weeks = 21.1 μg/L, p < 0.001). All other markers of iron status, fatigue, and energy also improved during the study (p < 0.04). No adverse events were reported. CONCLUSIONS While larger and controlled studies are needed to confirm these findings, a food-derived dietary supplement with a low dose of iron and absorption-enhancing nutrients resolved iron deficiency and improved all other markers of iron status without any adverse events.
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Affiliation(s)
- Christopher R D'Adamo
- a Department of Family & Community Medicine , Center for Integrative Medicine, University of Maryland School of Medicine , Baltimore , Maryland , USA
| | - James S Novick
- b Charm City Research Group, University of Maryland St. Joseph Medical Center , Towson , Maryland , USA
| | - Termeh M Feinberg
- a Department of Family & Community Medicine , Center for Integrative Medicine, University of Maryland School of Medicine , Baltimore , Maryland , USA
| | - Valerie J Dawson
- a Department of Family & Community Medicine , Center for Integrative Medicine, University of Maryland School of Medicine , Baltimore , Maryland , USA
| | - Larry E Miller
- c Miller Scientific Consulting , Asheville , North Carolina , USA
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Goldman M, Uzicanin S, Osmond L, Scalia V, O'Brien SF. A large national study of ferritin testing in Canadian blood donors. Transfusion 2016; 57:564-570. [DOI: 10.1111/trf.13956] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Lori Osmond
- Canadian Blood Services; Ottawa Ontario Canada
| | - Vito Scalia
- Canadian Blood Services; Ottawa Ontario Canada
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O'Brien SF, Goldman M. Understanding iron depletion and overload in blood donors. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- S. F. O'Brien
- Canadian Blood Services; Ottawa ON Canada
- School of Epidemiology, Public Health and Preventive Medicine; University of Ottawa; Ottawa ON Canada
| | - M. Goldman
- Canadian Blood Services; Ottawa ON Canada
- Department of Pathology & Laboratory Medicine; University of Ottawa; Ottawa ON Canada
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Goldman M, Magnussen K, Gorlin J, Lozano M, Speedy J, Keller A, Pink J, Leung JNS, Chu CCY, Lee CK, Faed J, Chay J, Tan HH, Teo D, Djoudi R, Woimant G, Fillet AM, Castrén J, Miflin G, Vandewalle GC, Compernolle V, Cardenas JM, Infanti L, Holbro A, Buser A, van den Hurk K, Yahalom VJ, Gendelman V, Shinar E, Eder AF, Steele WR, O'Neill EM, Kamel H, Vassallo R, Delage G, Lebrun A, Robillard P, Germain M, Gandhi M, West KA, Klein HG. International Forum regarding practices related to donor haemoglobin and iron. Vox Sang 2016; 111:449-455. [DOI: 10.1111/vox.12431] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Goldman
- Medical Services and Innovation; Canadian Blood Services; Ottawa ON Canada
| | - K. Magnussen
- Clinical Immunology/Blood Centre; Copenhagen University Hospital; Hvidovre Denmark
| | - J. Gorlin
- Physician Services; Innovative Blood Centers; St. Paul MN USA
| | - M. Lozano
- Hospital Clinic; Department of Hemotherapy and Hemostasis; Barcelona Spain
| | - J. Speedy
- Australian Red Cross Blood Service; Adelaide South Australia Australia
| | - A. Keller
- Australian Red Cross; Perth Western Australia Australia
| | - J. Pink
- Australian Red Cross Blood Service; Stafford Queensland Australia
| | - J. N. S. Leung
- Blood Collection and Donor Recruitment Department; Hong Kong Red Cross Blood Transfusion Service; Kowloon Hong Kong
| | - C. C. Y. Chu
- Blood Collection and Donor Recruitment Department; Hong Kong Red Cross Blood Transfusion Service; Kowloon Hong Kong
| | - C.-K. Lee
- Blood Collection and Donor Recruitment Department; Hong Kong Red Cross Blood Transfusion Service; Kowloon Hong Kong
| | - J. Faed
- Otago Site, New Zealand Blood Service; Department of Haematology; University of Otago; Dunedin New Zealand
| | - J. Chay
- Blood Services Group; Health Sciences Authority; 11 Outram Road Singapore City 169078 Singapore
| | - H. H. Tan
- Blood Services Group; Health Sciences Authority; 11 Outram Road Singapore City 169078 Singapore
| | - D. Teo
- Centre for Transfusion Medicine; Singapore City Singapore
| | - R. Djoudi
- Qualification Biologique du Don; Etablissement Français du Sang; St. Denis France
| | - G. Woimant
- EFS, Médecine, la Recherche et l'Innovation; La Plaine Saint-Denis France
| | - A.-M. Fillet
- Medical Department; Etablisement Français du Sang; 20 Avenue du Stade de France La Plaine Saint-Denis 93218 France
| | - J. Castrén
- Medical Support in Blood Donation; Finnish Red Cross Blood Service; Kivihaantie 7 Helsinki FI-00310 Finland
| | - G. Miflin
- NHS Blood and Transplant; Watford UK
| | | | - V. Compernolle
- Blood Services; Belgian Red Cross; Ottergemsesteenweg 413 Ghent B-9000 Belgium
| | - J. M. Cardenas
- Tejidos Humanos; Centro Vasco de Transfusion y Tejidos Humanos; Labeaga s/n Galdakao 48960 Spain
| | - L. Infanti
- Blood Donation Center; Swiss Red Cross; Hebelstrasse 10 Basel CH-4031 Switzerland
| | - A. Holbro
- Blood Transfusion Centre; Swiss Red Cross; Hebelstrasse 10 Basel CH-4031 Switzerland
- Department of Hematology; University Hospital Basel; Basel Switzerland
| | - A. Buser
- Blood Transfusion Centre; Swiss Red Cross; Hebelstrasse 10 Basel CH-4031 Switzerland
- Department of Hematology; University Hospital Basel; Basel Switzerland
| | - K. van den Hurk
- Donor Studies; Sanquin Research; Plesmanlaan 125 Amsterdam 1066 CX The Netherlands
| | - V. J. Yahalom
- National Blood Services; Magen David Adom-National Blood Services; Ramat Gan 5262100 Israel
| | - V. Gendelman
- National Blood Services; Magen David Adom-National Blood Services; Ramat Gan 5262100 Israel
| | - E. Shinar
- National Blood Services; Magen David Adom-National Blood Services; Ramat Gan 5262100 Israel
| | - A. F. Eder
- Biomedical Headquarters; American Red Cross; 15601 Crabbs Branch Way Rockville MD 20855 USA
| | - W. R. Steele
- Transmissible Disease Department; American Red Cross; 15601 Crabbs Branch Way Rockville MD 20855 USA
| | - E. M. O'Neill
- National Headquarters; Biomedical Services; American Red Cross; 15601 Crabbs Branch Way Rockville MD 20855 USA
| | - H. Kamel
- Medical Affairs; Blood Systems, Inc.; 6210 E. Oak Street Scottsdale AZ 85257 USA
| | - R. Vassallo
- Blood Systems, Inc.; 6210 E. Oak Street Scottsdale AZ 85257 USA
| | - G. Delage
- Medical Affairs; Héma-Quebec; 4045 boul. Cote-Vertu, Ville Saint-Laurent Montreal QC Canada
| | - A. Lebrun
- Medical Affairs; Héma-Quebec; 4045 boul. Cote-Vertu, Ville Saint-Laurent Montreal QC Canada
| | - P. Robillard
- Medical Affairs; Héma-Quebec; 4045 boul. Cote-Vertu, Ville Saint-Laurent Montreal QC Canada
| | - M. Germain
- Medical Affairs; Héma-Quebec; 4045 boul. Cote-Vertu, Ville Saint-Laurent Montreal QC Canada
| | - M. Gandhi
- Laboratory of Medicine and Pathology; Mayo Clinic Minnesota; 200 1st Street SW Rochester MN 55905 USA
| | - K. A. West
- Department of Transfusion Medicine; National Institutes of Health Clinical Center; 10 Center Drive, Room 1N226 Bethesda MD 20892 USA
| | - H. G. Klein
- Department of Transfusion Medicine; National Institute of Health; Warren G. Magnuson Clinical Center; 10 Center Drive, Room IC711 Bethesda MD 20892 USA
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Goldman M, Uzicanin S, Scalia J, Scalia V, O'Brien SF. Impact of informing donors of low ferritin results. Transfusion 2016; 56:2193-8. [PMID: 27306595 DOI: 10.1111/trf.13691] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Informing donors of their ferritin status is one possible mitigating strategy to reduce iron deficiency in donors. STUDY DESIGN AND METHODS We evaluated the impact of informing donors of their ferritin status on their donation frequency, understanding of iron needs, and actions to improve iron intake 2 years after their inclusion in a prospective observational cohort study. RESULTS Informing donors of low ferritin results decreased return rate in first-time and repeat donors, and the median number of donations declined from three to two donations/year in returning donors with low ferritin on index donation compared to an increase from 1.5 to 2.5 donations/year in donors with normal ferritin. An electronic questionnaire demonstrated that approximately 60% of low ferritin donors saw their primary medical practitioner, and half of this group started iron. Qualitative interviews revealed suboptimal understanding of iron needs and poor compliance with iron supplementation. CONCLUSION Providing donors with results of ferritin testing may reduce return rates and donation frequency in the 2 years after testing. Simply providing donors with ferritin results and an information sheet is often inadequate to improve donors' understanding of iron needs and may not lead to a substantive increase in iron intake over time.
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Affiliation(s)
- Mindy Goldman
- Donor and Clinical Services, Canadian Blood Services, Ottawa, Ontario, Canada.
| | - Samra Uzicanin
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Jenna Scalia
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Vito Scalia
- National Testing Laboratory, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
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O'Brien SF. Donor iron policy: from research to practice. Transfusion 2016; 56:1496-8. [PMID: 27295024 DOI: 10.1111/trf.13555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Sheila F O'Brien
- Canadian Blood Services.,School of Epidemiology, Public Health and Preventive Medicine Canadian Blood Services, University of Ottawa, Ottawa, ON, Canada
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Low MSY, Speedy J, Styles CE, De-Regil LM, Pasricha SR. Daily iron supplementation for improving anaemia, iron status and health in menstruating women. Cochrane Database Syst Rev 2016; 4:CD009747. [PMID: 27087396 PMCID: PMC10182438 DOI: 10.1002/14651858.cd009747.pub2] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Iron-deficiency anaemia is highly prevalent among non-pregnant women of reproductive age (menstruating women) worldwide, although the prevalence is highest in lower-income settings. Iron-deficiency anaemia has been associated with a range of adverse health outcomes, which restitution of iron stores using iron supplementation has been considered likely to resolve. Although there have been many trials reporting effects of iron in non-pregnant women, these trials have never been synthesised in a systematic review. OBJECTIVES To establish the evidence for effects of daily supplementation with iron on anaemia and iron status, as well as on physical, psychological and neurocognitive health, in menstruating women. SEARCH METHODS In November 2015 we searched CENTRAL, Ovid MEDLINE, EMBASE, and nine other databases, as well as four digital thesis repositories. In addition, we searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and reference lists of relevant reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs comparing daily oral iron supplementation with or without a cointervention (folic acid or vitamin C), for at least five days per week at any dose, to control or placebo using either individual- or cluster-randomisation. Inclusion criteria were menstruating women (or women aged 12 to 50 years) reporting on predefined primary (anaemia, haemoglobin concentration, iron deficiency, iron-deficiency anaemia, all-cause mortality, adverse effects, and cognitive function) or secondary (iron status measured by iron indices, physical exercise performance, psychological health, adherence, anthropometric measures, serum/plasma zinc levels, vitamin A status, and red cell folate) outcomes. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures of Cochrane. MAIN RESULTS The search strategy identified 31,767 records; after screening, 90 full-text reports were assessed for eligibility. We included 67 trials (from 76 reports), recruiting 8506 women; the number of women included in analyses varied greatly between outcomes, with endpoint haemoglobin concentration being the outcome with the largest number of participants analysed (6861 women). Only 10 studies were considered at low overall risk of bias, with most studies presenting insufficient details about trial quality.Women receiving iron were significantly less likely to be anaemic at the end of intervention compared to women receiving control (risk ratio (RR) 0.39 (95% confidence interval (CI) 0.25 to 0.60, 10 studies, 3273 women, moderate quality evidence). Women receiving iron had a higher haemoglobin concentration at the end of intervention compared to women receiving control (mean difference (MD) 5.30, 95% CI 4.14 to 6.45, 51 studies, 6861 women, high quality evidence). Women receiving iron had a reduced risk of iron deficiency compared to women receiving control (RR 0.62, 95% CI 0.50 to 0.76, 7 studies, 1088 women, moderate quality evidence). Only one study (55 women) specifically reported iron-deficiency anaemia and no studies reported mortality. Seven trials recruiting 901 women reported on 'any side effect' and did not identify an overall increased prevalence of side effects from iron supplements (RR 2.14, 95% CI 0.94 to 4.86, low quality evidence). Five studies recruiting 521 women identified an increased prevalence of gastrointestinal side effects in women taking iron (RR 1.99, 95% CI 1.26 to 3.12, low quality evidence). Six studies recruiting 604 women identified an increased prevalence of loose stools/diarrhoea (RR 2.13, 95% CI 1.10, 4.11, high quality evidence); eight studies recruiting 1036 women identified an increased prevalence of hard stools/constipation (RR 2.07, 95% CI 1.35 to 3.17, high quality evidence). Seven studies recruiting 1190 women identified evidence of an increased prevalence of abdominal pain among women randomised to iron (RR 1.55, 95% CI 0.99 to 2.41, low quality evidence). Eight studies recruiting 1214 women did not find any evidence of an increased prevalence of nausea among women randomised to iron (RR 1.19, 95% CI 0.78 to 1.82). Evidence that iron supplementation improves cognitive performance in women is uncertain, as studies could not be meta-analysed and individual studies reported conflicting results. Iron supplementation improved maximal and submaximal exercise performance, and appears to reduce symptomatic fatigue. Although adherence could not be formally meta-analysed due to differences in reporting, there was no evident difference in adherence between women randomised to iron and control. AUTHORS' CONCLUSIONS Daily iron supplementation effectively reduces the prevalence of anaemia and iron deficiency, raises haemoglobin and iron stores, improves exercise performance and reduces symptomatic fatigue. These benefits come at the expense of increased gastrointestinal symptomatic side effects.
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Affiliation(s)
- Michael Sze Yuan Low
- Department of Immunology, Walter & Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Victoria, Australia, 3006
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Affiliation(s)
- M. Goldman
- Donor & Clinical Services; Canadian Blood Services; Ottawa ON Canada
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Cozon GJN. [Iron deficiency and digestive disorders]. Transfus Clin Biol 2014; 21:189-92. [PMID: 25282486 DOI: 10.1016/j.tracli.2014.08.135] [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: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 11/16/2022]
Abstract
Iron deficiency anemia still remains problematic worldwide. Iron deficiency without anemia is often undiagnosed. We reviewed, in this study, symptoms and syndromes associated with iron deficiency with or without anemia: fatigue, cognitive functions, restless legs syndrome, hair loss, and chronic heart failure. Iron is absorbed through the digestive tract. Hepcidin and ferroportin are the main proteins of iron regulation. Pathogenic micro-organisms or intestinal dysbiosis are suspected to influence iron absorption.
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Affiliation(s)
- G J N Cozon
- Pavillon F, hôpital E.-Herriot, place d'Arsonval, 69437 Lyon cedex 03, France; UFR Lyon-Est UCBL, domaine Rockefeller, 8, avenue Rockefeller, 69373 Lyon cedex 08, France.
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Moore C, Sambrook J, Walker M, Tolkien Z, Kaptoge S, Allen D, Mehenny S, Mant J, Di Angelantonio E, Thompson SG, Ouwehand W, Roberts DJ, Danesh J. The INTERVAL trial to determine whether intervals between blood donations can be safely and acceptably decreased to optimise blood supply: study protocol for a randomised controlled trial. Trials 2014; 15:363. [PMID: 25230735 PMCID: PMC4177700 DOI: 10.1186/1745-6215-15-363] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/28/2014] [Indexed: 12/04/2022] Open
Abstract
Background Ageing populations may demand more blood transfusions, but the blood supply could be limited by difficulties in attracting and retaining a decreasing pool of younger donors. One approach to increase blood supply is to collect blood more frequently from existing donors. If more donations could be safely collected in this manner at marginal cost, then it would be of considerable benefit to blood services. National Health Service (NHS) Blood and Transplant in England currently allows men to donate up to every 12 weeks and women to donate up to every 16 weeks. In contrast, some other European countries allow donations as frequently as every 8 weeks for men and every 10 weeks for women. The primary aim of the INTERVAL trial is to determine whether donation intervals can be safely and acceptably decreased to optimise blood supply whilst maintaining the health of donors. Methods/Design INTERVAL is a randomised trial of whole blood donors enrolled from all 25 static centres of NHS Blood and Transplant. Recruitment of about 50,000 male and female donors started in June 2012 and was completed in June 2014. Men have been randomly assigned to standard 12-week versus 10-week versus 8-week inter-donation intervals, while women have been assigned to standard 16-week versus 14-week versus 12-week inter-donation intervals. Sex-specific comparisons will be made by intention-to-treat analysis of outcomes assessed after two years of intervention. The primary outcome is the number of blood donations made. A key secondary outcome is donor quality of life, assessed using the Short Form Health Survey. Additional secondary endpoints include the number of ‘deferrals’ due to low haemoglobin (and other factors), iron status, cognitive function, physical activity, and donor attitudes. A comprehensive health economic analysis will be undertaken. Discussion The INTERVAL trial should yield novel information about the effect of inter-donation intervals on blood supply, acceptability, and donors’ physical and mental well-being. The study will generate scientific evidence to help formulate blood collection policies in England and elsewhere. Trial registration Current Controlled Trials ISRCTN24760606, 25 January 2012.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - John Danesh
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK.
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