1
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Crowder LA, Cable RG, Spencer BR. Validity of donor-reported iron supplementation practices obtained at the time of donation. Transfusion 2023; 63:470-475. [PMID: 36606513 DOI: 10.1111/trf.17235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Iron supplementation (IS) improves blood donors' iron stores and allows more frequent blood donation. Understanding the accuracy of self-reported IS is helpful for potential application of IS practices to donor eligibility or donation intervals. METHODS Successful whole blood and red cell apheresis donors completed a survey at donation on the use of select dietary supplements. Respondents reporting use of either iron pills (IP) or multivitamins (MV) were invited by email to complete a similar follow-up survey 6-8 weeks later and to provide the quantitative iron content of IS by referring the donor to the pill bottle label. Consistency between baseline and follow-up responses was assessed overall and by pill type and demographic variables. RESULTS Of 2444 donors answering the baseline survey, 40% (978) reported MV or IP at donation, 354 of whom completed the follow-up survey. A majority of survey respondents (56%-61%) reported taking iron across the two surveys, and 21%-24% took MV but were uncertain if their pills contained iron. Of 215 reporting IS at baseline, overall concordance at follow-up was 68% and was higher for donors who were female, ≥50-years old, and taking iron as an iron pill rather than in a multivitamin. CONCLUSION Consistency of donor responses may be insufficient for use in guiding donor eligibility. Referring donors to their pill bottles was unsuccessful in improving the high frequency of uncertain responses. Incorporating IS into donor eligibility determinations is a complex endeavor that will benefit from careful planning and from post-implementation monitoring.
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Affiliation(s)
- Lauren A Crowder
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
| | - Ritchard G Cable
- Scientific Affairs, American Red Cross, Farmington, Connecticut, USA
| | - Bryan R Spencer
- Scientific Affairs, American Red Cross, Dedham, Massachusetts, USA
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2
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Kim LG, Bolton T, Sweeting MJ, Bell S, Fahle S, McMahon A, Walker M, Ferguson E, Miflin G, Roberts DJ, Di Angelantonio E, Wood AM. Impact of a post-donation hemoglobin testing strategy on efficiency and safety of whole blood donation in England: A modeling study. Transfusion 2023; 63:541-551. [PMID: 36794597 PMCID: PMC10952564 DOI: 10.1111/trf.17277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Deferrals due to low hemoglobin are time-consuming and costly for blood donors and donation services. Furthermore, accepting donations from those with low hemoglobin could represent a significant safety issue. One approach to reduce them is to use hemoglobin concentration alongside donor characteristics to inform personalized inter-donation intervals. STUDY DESIGN AND METHODS We used data from 17,308 donors to inform a discrete event simulation model comparing personalized inter-donation intervals using "post-donation" testing (i.e., estimating current hemoglobin from that measured by a hematology analyzer at last donation) versus the current approach in England (i.e., pre-donation testing with fixed intervals of 12-weeks for men and 16-weeks for women). We reported the impact on total donations, low hemoglobin deferrals, inappropriate bleeds, and blood service costs. Personalized inter-donation intervals were defined using mixed-effects modeling to estimate hemoglobin trajectories and probability of crossing hemoglobin donation thresholds. RESULTS The model had generally good internal validation, with predicted events similar to those observed. Over 1 year, a personalized strategy requiring ≥90% probability of being over the hemoglobin threshold, minimized adverse events (low hemoglobin deferrals and inappropriate bleeds) in both sexes and costs in women. Donations per adverse event improved from 3.4 (95% uncertainty interval 2.8, 3.7) under the current strategy to 14.8 (11.6, 19.2) in women, and from 7.1 (6.1, 8.5) to 26.9 (20.8, 42.6) in men. In comparison, a strategy incorporating early returns for those with high certainty of being over the threshold maximized total donations in both men and women, but was less favorable in terms of adverse events, with 8.4 donations per adverse event in women (7.0, 10,1) and 14.8 (12.1, 21.0) in men. DISCUSSION Personalized inter-donation intervals using post-donation testing combined with modeling of hemoglobin trajectories can help reduce deferrals, inappropriate bleeds, and costs.
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Affiliation(s)
- Lois G. Kim
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Thomas Bolton
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
- BHF Data Science CentreHealth Data ResearchUK
| | | | - Steven Bell
- Dept of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
| | - Sarah Fahle
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Amy McMahon
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Matthew Walker
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Eamonn Ferguson
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- School of PsychologyUniversity of NottinghamNottinghamUK
| | | | - David J. Roberts
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- NHS Blood & TransplantJohn Radcliffe HospitalOxfordUK
- Radcliffe Dept of MedicineUniversity of OxfordOxfordUK
| | - Emanuele Di Angelantonio
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of CambridgeCambridgeUK
- Health Data Science Research CentreHuman TechnopoleMilanItaly
| | - Angela M. Wood
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of CambridgeCambridgeUK
- Cambridge Centre of Artificial Intelligence in MedicineCambridgeUK
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3
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Infanti L. Are we donating iron? Impact of apheresis on ferritin. Transfus Apher Sci 2023; 62:103668. [PMID: 36858832 DOI: 10.1016/j.transci.2023.103668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Laura Infanti
- Stiftung Blutspendezentrum SRK beider Basel, Hebelstrasse 10, CH-4031 Basel, Switzerland.
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4
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Spencer BR, White JL, Patel EU, Goel R, Bloch EM, Tobian AA. Eligibility Considerations for Female Whole Blood Donors: Hemoglobin Levels and Iron Status in a Nationally Representative Population. Transfus Med Rev 2023; 37:27-35. [PMID: 36528466 PMCID: PMC10787604 DOI: 10.1016/j.tmrv.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
Blood collection from minority populations improves the transfusion support of patients with sickle cell disease and thalassemia, but efforts are challenged by high deferral rates for hemoglobin (Hb) eligibility thresholds. This study sought to evaluate hemoglobin and iron status of a representative US female population to assess the suitability of 12.0 g/dL as minimum hemoglobin. Data were extracted from the National Health and Nutrition Examination Surveys (NHANES), 1999-2010. A national sample designed to reflect potential female blood donors (weight ≥110 lbs, not pregnant, no infectious marker reactivity, and no blood donation in past year) aged 16 to 49 years was analyzed for Hb and serum ferritin (SF) measures by race/ethnicity (N = 6937). Mean Hb and SF and the prevalence of iron deficiency ([ID] SF<12 ng/mL and SF<26 ng/mL) and low Hb (<12.5 g/dL and <12.0 g/dL) were estimated. Multivariable modified Poisson regression compared the prevalence for ID or low Hb at each cutoff by race/ethnicity. Mean SF values were higher and ID prevalence was lower in Non-Hispanic (NH) White (SF = 45.3 ng/mL, SF<12 ng/mL = 8.2%) than NH Black (SF = 39.6 ng/mL, SF<12 ng/mL = 14.2%) and Hispanic (SF = 36.5 ng/mL, SF<12 ng/mL = 12.7%) females. Compared to NH White females (13.7 g/dL), mean Hb was lower in NH Black (12.6 g/dL) and Hispanic females (13.4 g/dL). The percentage with Hb<12.5 g/dL was >4 times greater in NH Black (39.1%) and >2 times greater in Hispanic females (16.5%) compared to NH White (8.6%). Within 0.5 g/dL incremental categories of Hb, NH Black had higher mean SF levels and lower prevalence of SF<12 ng/mL or <26 ng/mL compared to NH White and Hispanic females. At Hb of 12.0 to 12.4g/dL, NH Black females had better measures of iron status (SF = 39.1 ng/mL, %SF<12 ng/mL = 12.0%) than NH White (SF = 33.6 ng/mL, %SF<12 ng/mL=15.8%) and Hispanic (SF = 30.4 ng/mL, %SF<12 ng/mL=15.5%) females whose Hb was 12.5 to 12.9 g/dL. Adjusting for age and Hb, the prevalence ratio for low SF was significantly lower in NH Black compared to NH White females at both SF<26 ng/mL (adjusted prevalence ratio [aPR] = 0.83, 95%CI = 0.76-0.92) and SF<12 ng/mL (aPR = 0.66, 95%CI = 0.52-0.83). NH Black females with Hb 12.0 to 12.4g/dL have better iron stores than NH White and Hispanic females whose Hb is 12.5 to 12.9 g/dL. The distribution of Hb and iron may support the safe collection of blood for female donors below the current Hb eligibility requirement of 12.5 g/dL.
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Affiliation(s)
| | - Jodie L White
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Eshan U Patel
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Aaron Ar Tobian
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
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5
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Abstract
PURPOSE OF REVIEW This review examines recent research on the prevalence and importance of iron deficiency in blood donors, and on efforts to mitigate it. RECENT FINDINGS Premenopausal females, teenagers, and high-frequency donors are at the highest risk for donation-induced iron deficiency, in both high-resource and low-resource settings. The physiology relating iron stores to hemoglobin levels and low hemoglobin deferral is well elucidated in blood donor populations, yet the clinical effects attributable to iron loss in the absence of anemia are challenging to identify. Expanded adoption of ferritin testing is improving donor management but may cause decreases in the blood supply from temporary donor loss. The potential for personalized donor management is emerging with development of computational models that predict individual interdonation intervals that aim to optimize blood collected from each donor while minimizing low hemoglobin deferrals. SUMMARY Measures to reduce iron deficiency are available that can be deployed on a standardized or, increasingly, personalized basis. Blood centers, regulators, and donors should continue to evaluate different tactics for addressing this problem, to obtain a balanced approach that is optimal for maintaining adequate collections while safeguarding donor health.
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Affiliation(s)
| | - Alan E. Mast
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI
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6
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Sadique Z, Willis S, Corte KD, Pennington M, Moore C, Kaptoge S, Angelantonio ED, Miflin G, Roberts DJ, Grieve R. Cost-effectiveness of alternative minimum recall intervals between whole blood donations. PLoS One 2022; 17:e0272854. [PMID: 35976959 PMCID: PMC9384981 DOI: 10.1371/journal.pone.0272854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The INTERVAL trial showed shorter inter-donation intervals could safely increase the frequency of whole-blood donation. We extended the INTERVAL trial to consider the relative cost-effectiveness of reduced inter-donation intervals. METHODS Our within-trial cost-effectiveness analysis (CEA) used data from 44,863 whole-blood donors randomly assigned to 12, 10 or 8 week (males), and 16, 14 or 12 week inter-donation intervals (females). The CEA analysed the number of whole-blood donations, deferrals including low- haemoglobin deferrals, and donors' health-related quality of life (QoL) to report costs and cost-effectiveness over two years. FINDINGS The mean number of blood donation visits over two years was higher for the reduced interval strategies, for males (7.76, 6.60 and 5.68 average donations in the 8-, 10- and 12- week arms) and for females (5.10, 4.60 and 4.01 donations in the 12-, 14- and 16- week arms). For males, the average rate of deferral for low haemoglobin per session attended, was 5.71% (8- week arm), 3.73% (10- week), and 2.55% (12- week), and for females the rates were: 7.92% (12-week), 6.63% (14- week), and 5.05% (16- week). Donors' QoL was similar across strategies, although self-reported symptoms were increased with shorter donation intervals. The shorter interval strategies increased average cost, with incremental cost-effectiveness ratios of £9.51 (95% CI 9.33 to 9.69) per additional whole-blood donation for the 8- versus 12- week interval for males, and £10.17 (95% CI 9.80 to 10.54) for the 12- versus 16- week interval arm for females. CONCLUSIONS Over two years, reducing the minimum donation interval could provide additional units of whole-blood at a small additional cost, including for those donor subgroups whose blood type is in relatively high demand. However, the significance of self-reported symptoms needs to be investigated further before these policies are expanded.
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Affiliation(s)
- Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Sarah Willis
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kaat De Corte
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Pennington
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Health Services and Population Research, King’s College London, London, United Kingdom
| | - Carmel Moore
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
- University of East Anglia, Norwich, United Kingdom
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Gail Miflin
- NHS Blood and Transplant, Liverpool, United Kingdom
| | - David J. Roberts
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
- NHS Blood and Transplant, Liverpool, United Kingdom
- Radcliffe Department of Medicine and BRC Biomedical Centre–Haematology Theme, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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7
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France JL, France CR, Rebosa M, Shaz BH, Kessler DA. Promoting awareness of donation-related iron depletion among high risk blood donors. Transfusion 2021; 61:3353-3360. [PMID: 34605554 DOI: 10.1111/trf.16694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The potential for iron deficiency is a known blood donor health concern and suggests the need to inform donors about the potential risks of low iron levels as well as strategies to address these risks. STUDY DESIGN AND METHODS Frequent (n = 904) and young (n = 629) donors were randomly assigned within risk group to either a control (n = 548) or an intervention (n = 985) group. The control group answered questions at baseline and 6-month follow-up regarding their awareness of the risk of donation-related iron depletion and whether they were taking actions to address their iron status. The intervention group answered the same questions at baseline and follow-up, but after completing the baseline survey, they received information regarding their risk of iron depletion and behaviors they could adopt to mitigate this risk. Intervention group participants were also offered the opportunity to develop an action plan to help them supplement their iron intake. RESULTS The intervention enhanced overall awareness of donation-related iron loss (OR = 1.5, 95% CI 1.171-1.864, p = .001), with no negative impact on retention. Reported iron health behaviors (iron supplementation, speaking with a doctor) showed significant increases when action planning was paired with the educational information. CONCLUSION These findings suggest that it is possible to increase awareness of donation-related risk for iron depletion without negatively influencing retention, and combining education with encouragement to develop an action plan may increase the likelihood of both retention and behavioral changes to promote healthy iron levels.
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Affiliation(s)
- Janis L France
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | | | - Mark Rebosa
- New York Blood Center, New York, New York, USA
| | - Beth H Shaz
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA
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8
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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.
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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
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9
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Spencer BR, Fox MP, Wise LA, Cable RG, Mast AE. Iron status and self-reported fatigue in blood donors. Transfusion 2020; 61:124-133. [PMID: 32974931 DOI: 10.1111/trf.16095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 12/21/2022]
Abstract
Fatigue is a reported symptom of iron depletion, but studies in blood donors show no conclusive link. We conducted an observational analysis of data from the STRIDE randomized trial to evaluate association of iron status with self-reported fatigue. STUDY DESIGN AND METHODS Three blood centers randomly assigned 692 frequent donors to education or iron supplementation treatments. Biomarkers for iron status were measured during 20 to 24 months of follow-up. A fatigue score was derived from an 11-item questionnaire at baseline and final visits, and associations between iron status and fatigue were assessed. RESULTS Final lab and questionnaire data were evaluable from 337 subjects. At baseline, female sex, older age, and anemia were associated with fatigue, but iron status was not. Mean (±SD) fatigue score change was 0.0 (±0.5). Mean (±SD) increase in iron stores was 1.0 (±3.5) mg/kg, but changes in body iron stores were not associated with fatigue score changes (0.01 per mg/kg; 95% CI, -0.01 to 0.02) or with fatigue (RR, 1.01; 95% CI, 0.99 to 1.04). The only factor associated with fatigue score changes was baseline fatigue (0.36; 95% CI, 0.25 to 0.48). CONCLUSION Among high-frequency donors, neither iron status at baseline nor changes in iron status predicted fatigue during follow-up, with improvements limited to those with higher levels of baseline fatigue. Assessment of the association between iron and fatigue in blood donors benefits from careful consideration of study design and the study population.
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Affiliation(s)
- Bryan R Spencer
- American Red Cross, Scientific Affairs, Dedham, Massachusetts, USA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.,Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ritchard G Cable
- American Red Cross, Scientific Affairs, Dedham, Massachusetts, USA
| | - Alan E Mast
- Blood Research Institute, Versiti, Milwaukee, Wisconsin, USA.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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10
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France JL, Hod EA, Caccappolo EA, Suhr JA, France CR, Kessler DA, Shaz BH. Examination of the relationship between iron status and cognitive function among healthy young women with and without a recent history of blood donation. Transfusion 2020; 60:2886-2895. [PMID: 32920826 DOI: 10.1111/trf.16069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND With growing awareness of the prevalence of nonanemic iron deficiency among blood donors, there is a need to explore the extent of potential negative consequences. This study examined the relationship between various measures of iron status, blood donation history, and neuropsychological and psychosocial functioning in healthy young women. STUDY DESIGN AND METHODS Using a cross-sectional design, 160 female undergraduates completed neuropsychology tests and measures of sleep, fatigue, quality of life, and depression before providing a blood sample. Correlational analyses examined the relationship between iron status (ferritin, iron, hemoglobin, and zinc protoporphyrin) and cognitive and psychosocial functioning. Performance on these measures was also examined as a function of recent blood donation history (zero, one, more than one donation in the past year). RESULTS Iron status (low ferritin, iron, or hemoglobin or high zinc protoporphyrin) was not associated with poorer performance on the cognitive tasks. Further, participants who reported donating once in the previous year performed better, rather than worse, than those with no recent donation history on several measures of executive function, even when controlling for ferritin levels. Although there was some evidence of greater fatigue among those who had donated more than once in the past year, this effect was not accounted for by ferritin levels. CONCLUSION The present findings are consistent with prior evidence that nonanemic iron deficiency is not associated with cognitive impairment or psychosocial dysfunction in healthy young females. Because these results are based on cross-sectional evidence, further study using longitudinal research is needed to confirm these findings.
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Affiliation(s)
- Janis L France
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Eldad A Hod
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Elise A Caccappolo
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Julie A Suhr
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Christopher R France
- Department of Psychology, Ohio University, Athens, Ohio, USA.,Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, Ohio, USA
| | | | - Beth H Shaz
- New York Blood Center Enterprises, New York, New York, USA
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11
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Oral iron and blood donation: cui bono? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:329-331. [PMID: 32931411 PMCID: PMC7592162 DOI: 10.2450/2020.0239-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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12
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Pagano MB, Allen ES, Chou ST, Dunbar NM, Gniadek T, Goel R, Harm SK, Hopkins CK, Jacobson J, Lokhandwala PM, Metcalf RA, Raval JS, Schwartz J, Shan H, Spinella PC, Storch E, Cohn CS. Current advances in transfusion medicine: a 2019 review of selected topics from the AABB Clinical Transfusion Medicine Committee. Transfusion 2020; 60:1614-1623. [PMID: 32472580 DOI: 10.1111/trf.15848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The AABB Clinical Transfusion Medicine Committee (CTMC) compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine (TM) for the board of director's review. This synopsis is now made available as a manuscript published in TRANSFUSION. STUDY DESIGN AND METHODS CTMC committee members review original manuscripts including TM-related topics published in different journals between late 2018 and 2019. The selection of topics and manuscripts are discussed at committee meetings and are chosen based on relevance and originality. After the topics and manuscripts are selected, committee members work in pairs to create a synopsis of the topics, which is then reviewed by two committee members. The first and senior authors of this manuscript assembled the final manuscript. Although this synopsis is comprehensive, it is not exhaustive, and some papers may have been excluded or missed. RESULTS The following topics are included: infectious risks to the blood supply, iron donor studies, pre-transfusion testing interference and genotyping, cold agglutinin disease (CAD), HLA alloimmunization in platelet transfusions, patient blood management, updates to TACO and TRALI definitions, pediatric TM, and advances in apheresis medicine. CONCLUSION This synopsis provides easy access to relevant topics and may be useful as an educational tool.
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Affiliation(s)
- Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Stella T Chou
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Ruchika Goel
- Transfusion Medicine Division, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Division of Hematology/Oncology, Simmons Cancer Institute at Southern Illinois University School of Medicine and Mississippi Valley Regional Blood Center, Springfield, Illinois, USA
| | - Sarah K Harm
- Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont
| | | | - Jessica Jacobson
- Department of Pathology, New York University Grossman School of Medicine, New York, New York
| | - Parvez M Lokhandwala
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan A Metcalf
- Clinical Pathology Division, Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Jay S Raval
- Transfusion Medicine Service, Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Joseph Schwartz
- Transfusion Medicine & Cellular Therapy, Department of Pathology & Cell Biology, Columbia University, New York, New York
| | - Hua Shan
- Department of Pathology, Stanford University, Stanford, California
| | - Philip C Spinella
- Division of Pediatric Critical Care, Washington University in St Louis, St Louis, Missouri, USA
| | - Emily Storch
- Office of Blood Research and Review, Food and Drug Administration, Silver Spring, Maryland
| | - Claudia S Cohn
- Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
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13
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Goldman M, Butler-Foster T, Lapierre D, O'Brien SF, Devor A. Trans people and blood donation. Transfusion 2020; 60:1084-1092. [PMID: 32343438 DOI: 10.1111/trf.15777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - Don Lapierre
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Sheila F O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Aaron Devor
- Sociology Department, University of Victoria, Victoria, British Columbia, Canada
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14
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Mast AE, Langer JC, Guo Y, Bialkowski W, Spencer BR, Lee TH, Kiss J, Cable RG, Brambilla D, Busch MP, Page GP. Genetic and behavioral modification of hemoglobin and iron status among first-time and high-intensity blood donors. Transfusion 2020; 60:747-758. [PMID: 32163187 DOI: 10.1111/trf.15743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Some people rapidly develop iron deficiency anemia following blood donation, while others can repeatedly donate without becoming anemic. METHODS Two cohorts of blood donors were studied. Participants (775) selected from a 2-year longitudinal study were classified into six analysis groups based on sex, donation intensity, and low hemoglobin deferral. Associations with iron supplement use, cigarette smoking, and four genetic variants of iron metabolism were examined at enrollment and with longitudinal regression models. An unbiased assessment of genetic variability and ability to repeatedly donate blood without experiencing low hemoglobin deferral was conducted on participants (13,403) in a cross-sectional study who were examined by genome wide association (GWA). RESULTS Behaviors and genetic variants were associated with differences in hemoglobin and ferritin change following repeated donation. At least weekly iron supplement use was associated with improved status in first-time donors, while daily use was associated with improved status in high-intensity donors. Cigarette smoking was associated with 0.5 g/dL increased hemoglobin in high-intensity donors. A736V in TMPRSS6 was associated with a rapid drop in hemoglobin and ferritin in first-time females following repeated donation. Conversely, the protective TMPRSS6 genotype was not enriched among high-intensity donors. H63D in HFE was associated with increased hemoglobin in female high-intensity donors. However, no differences in genotype between first-time and high-intensity donors were found in GWA analyses. CONCLUSION Behavioral and genetic modifiers contributed to first-time donor hemoglobin and iron status, while iron supplement use was more important than underlying genetics in high-intensity donors.
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Affiliation(s)
- Alan E Mast
- Blood Research Institute Versiti, Milwaukee, Wisconsin, USA.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Yuelong Guo
- RTI International, Durham, North Carolina, USA
| | | | - Bryan R Spencer
- American Red Cross Scientific Affairs, Dedham, Massachusetts, USA
| | - Tzong-Hae Lee
- Vitalant Research Institute, San Francisco, California, USA
| | - Joseph Kiss
- Vitalant Northeast Division, Pittsburgh, Pennsylvania, USA
| | - Ritchard G Cable
- American Red Cross Scientific Affairs, Farmington, Connecticut, USA
| | | | - Michael P Busch
- American Red Cross Scientific Affairs, Dedham, Massachusetts, USA
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15
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Spencer BR, Haynes JM, Notari EP, Stramer SL. Prevalence, risk factors, and ferritin testing to mitigate iron depletion in male plateletpheresis donors. Transfusion 2020; 60:759-768. [PMID: 32073674 DOI: 10.1111/trf.15729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/02/2020] [Accepted: 02/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most single-donor platelet (SDP) donors transition to plateletpheresis after prior red blood cell (RBC) donation. Recruitment may follow identification of a high platelet count, a marker associated with iron depletion (ID). SDP donors may have underrecognized risk for iron depletion. STUDY DESIGN AND METHODS To assess the prevalence of ID, we performed ferritin testing on male plateletpheresis donors with hemoglobin levels less than 13.5 g/dL. Multivariable logistic regression identified risk factors for low ferritin (LF; ferritin ≤26 ng/mL) and absent iron stores (AIS; ferritin <12 ng/mL). To assess the impact of notifying donors of LF results, we compared donation behavior of "Test" subjects before and after sending an LF notification letter to that of "Control" subjects before and after increasing the minimum hemoglobin for male donors. An electronic survey to Test donors inquired about iron supplementation practices. RESULTS Prevalence of LF was 50% and AIS was 23%, with increase in risk associated with more frequent SDP donation, both controlling for RBC donation and in donors with no recent RBC donations. Donation frequency after intervention declined less in 1272 Test donors (19%, from 13.9 to 11.2 annualized donations) than in 878 Control donors (49%, from 12.3 to 6.3 donations). Only 20% of Test donors reported taking supplemental iron when they received the LF letter; 64% of those not taking iron initiated iron supplementation following the letter. CONCLUSIONS Donors were responsive to notification of LF and attendant messaging on iron supplementation. Ferritin testing potentially benefits donor health and a stable platelet supply.
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Affiliation(s)
- Bryan R Spencer
- American Red Cross, Scientific Affairs, Dedham, Massachusetts
| | - James M Haynes
- American Red Cross, Scientific Affairs, Rockville, Maryland
| | | | - Susan L Stramer
- American Red Cross, Scientific Affairs, Gaithersburg, Maryland
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16
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Baart AM, van den Hurk K, de Kort WLAM, Huis In 't Veld EMJ. Impact of risk-dependent interventions on low haemoglobin deferral rates in whole blood donors. Vox Sang 2020; 115:171-181. [PMID: 31912518 DOI: 10.1111/vox.12885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Blood donors with a relatively low haemoglobin (Hb) level at their previous donation attempt have an increased risk of Hb deferral at the subsequent donation attempt. The aim of this study was to investigate whether the interventions prolongation of donation interval and/or a dietary advice decrease the Hb deferral rate. METHODS 11 897 whole blood donors with Hb levels from below to 0·2 mmol/l above the cut-off level for donation received either no intervention, a prolongation of the donation interval to six or twelve months, a dietary advice, or both. Deferral rates for low Hb levels at the subsequent donation attempt were compared in the different intervention groups. Additionally, the effects of the interventions on Hb deferral risk and donor return for a subsequent donation attempt were analysed using generalized estimating equations. RESULTS The Hb deferral rate was substantially lower in the group that received a prolongation of the donation interval to six months than in the Control Group (12·9% vs. 6·3% in men and 20·4% vs. 13·4% in women). However, the additional benefit of twelve over 6-month interval prolongation was small, and no benefit of a dietary advice showed up. On the other hand, receiving a dietary advice increased the likelihood of donor return for a subsequent donation attempt. CONCLUSION Implementation of a protocol for the prolongation of donation intervals to six months for donors with Hb levels from below to slightly above the cut-off level for donation may reduce the deferral rate for low Hb levels while keeping donor lapse at a minimum.
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Affiliation(s)
- A Mireille Baart
- Donor Medicine Research Group, Sanquin Research, Amsterdam, the Netherlands
| | - Katja van den Hurk
- Donor Medicine Research Group, Sanquin Research, Amsterdam, the Netherlands
| | - Wim L A M de Kort
- Donor Medicine Research Group, Sanquin Research, Amsterdam, the Netherlands
| | - Elisabeth M J Huis In 't Veld
- Donor Medicine Research Group, Sanquin Research, Amsterdam, the Netherlands.,Department of Cognitive Science & Artificial Intelligence, Tilburg University, Tilburg, the Netherlands
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17
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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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18
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To transfuse or not transfuse: an intensive appraisal of red blood cell transfusions in the ICU. Curr Opin Hematol 2019; 25:468-472. [PMID: 30281035 DOI: 10.1097/moh.0000000000000460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW This review is a critical appraisal of the current data comparing restrictive vs. liberal transfusion strategies for patients who are critically ill in ICUs. We focus on four subsets of critically ill patients: pediatric patients, patients with gastrointestinal bleeds, septic patients and patients undergoing cardiac surgery. RECENT FINDINGS Almost a decade after the TRICC trial, a randomized trial showing the safety of a restrictive transfusion threshold in critically ill patients, four large randomized controlled trials have shown that a restrictive transfusion strategy is safe in pediatric critically ill patients, patients with acute upper gastrointestinal bleeds, patients with septic shock and patients undergoing cardiac surgery. A large multicenter randomized trial is underway to determine the safety of a restrictive strategy in myocardial infarction. SUMMARY A restrictive transfusion threshold is recommended in nearly all critically ill patients. This is at least noninferior to more liberal transfusion practice; in addition, a restrictive threshold has shown improved outcomes in some patients and decreased chances of adverse events in patients. Judicious use of red cells improves patient outcome and protects the blood supply, a limited resource. More data are needed to determine appropriate transfusion threshold recommendations for patients with traumatic brain injury and acute coronary syndrome.
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19
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Spencer BR. Iron Depletion in Adult and Teenage Blood Donors: Prevalence, Clinical Impact, and Options for Mitigation. Hematol Oncol Clin North Am 2019; 33:781-796. [PMID: 31466604 DOI: 10.1016/j.hoc.2019.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Iron depletion is a known risk for adult blood donors, but recent studies indicate the prevalence of iron depletion is higher in teenage blood donors. Teenage donors account for more than 10% of the blood collected in the United States and are important for maintaining component availability. Evidence of harm from iron depletion has not been demonstrated, but the area would benefit from further scientific inquiry. Options to protect against iron depletion exist, but each has limitations including cost, logistics, and potential negative impact on blood supply. Blood centers should communicate with donors and make efforts to mitigate these risks.
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Affiliation(s)
- Bryan R Spencer
- Scientific Affairs, American Red Cross, 180 Rustcraft Road, Dedham, MA 02026, USA.
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20
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Spencer BR, Guo Y, Cable RG, Kiss JE, Busch MP, Page GP, Endres-Dighe SM, Kleinman S, Glynn SA, Mast AE. Iron status and risk factors for iron depletion in a racially/ethnically diverse blood donor population. Transfusion 2019; 59:3146-3156. [PMID: 31318071 DOI: 10.1111/trf.15448] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The optimal approach for reducing iron depletion (ID) in blood donors may vary depending on biologic or behavioral differences across donors. STUDY DESIGN AND METHODS More than 12,600 successful whole blood donors were enrolled from four US blood centers for ferritin testing. The study population was enriched for racial/ethnic minorities (1605 African American, 1616 Asian, 1023 Hispanic). Subjects completed questionnaires on ID risk factors. Logistic regression identified predictors of absent iron stores (AIS; ferritin <12 ng/mL) and low ferritin (LF; ferritin <26 ng/mL). RESULTS Across all subjects, 19% had AIS and 42% had LF, with a sharp increase in risk observed with increasing donation intensity and among women a large decrease in risk in those more than 50 years old. When other factors were controlled for, African American and Asian donors showed 20% to 25% decreased risk for AIS compared to non-Hispanic Caucasian donors, while Hispanic donors had 25% higher risk. Daily iron supplementation reduced risk for LF and AIS by 30% to 40%, respectively, while the benefit from less frequent use was lower (7%-19% protection). Regular antacid use was associated with at least 20% increment to risk. Use of oral contraceptives or estrogen in females reduced risk by 16% to 22%, while males who reported supplemental testosterone use had a 50% to 125% greater risk for LF and AIS. CONCLUSIONS This study confirms high prevalence of LF and AIS in US donors and the principal risk factors of age, sex, and donation frequency. Additional demographic and behavioral risk factors of secondary importance might allow for refinement of ID mitigation strategies.
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Affiliation(s)
- Bryan R Spencer
- American Red Cross Scientific Affairs, Dedham, Massachusetts
| | | | | | - Joseph E Kiss
- Vitalant Northeast Division (formerly The Institute for Transfusion Medicine), Pittsburgh, Pennsylvania
| | | | | | | | - Steven Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Simone A Glynn
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Alan E Mast
- Blood Research Institute, Versiti (formerly, Blood Center of Wisconsin), Milwaukee, Wisconsin.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
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21
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Cable RG, Spencer BR. Iron supplementation by blood donors: demographics, patterns of use, and motivation. Transfusion 2019; 59:2857-2864. [DOI: 10.1111/trf.15407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 01/06/2023]
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22
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Visagie M, Pearson KR, Purvis TE, Gehrie EA, Resar LMS, Frank SM. Greater anemia tolerance among hospitalized females compared to males. Transfusion 2019; 59:2551-2558. [PMID: 31063596 DOI: 10.1111/trf.15338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/22/2019] [Accepted: 04/23/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although females have a lower baseline hemoglobin (Hb) compared to males, it is unknown whether females have a greater tolerance for anemia when hospitalized. We tested the hypothesis that females tolerate severe anemia better than males, with decreased inpatient mortality in this setting. STUDY DESIGN AND METHODS We conducted a retrospective cohort study in 230,644 adult patients admitted to Johns Hopkins Hospital from January 2009 to June 2016. The relationships between nadir Hb and percentage change in Hb with inpatient mortality were assessed for nontransfused males and females. A multivariable logistic regression was used to determine risk-adjusted differences between males and females for the likelihood of inpatient mortality at nadir Hb levels of 5, 6, and 7 g/dL. RESULTS Males had increased mortality when nadir Hb was 6.0 g/dL or less (p < 0.05), whereas females did not. The risk-adjusted likelihood for inpatient mortality was greater for males compared to females at a nadir Hb of 6 g/dL or less (odds ratio, 1.84; 95% confidence interval, 1.09-3.16) (p = 0.02), but this sex-related difference was not significant at a nadir Hb of 5 or 7 g/dL or less. Inpatient mortality increased significantly in both males and females when the percentage decrease in Hb was greater than 50% from baseline (p < 0.05). CONCLUSIONS Compared to males, females tolerate a lower nadir Hb, but a similar percentage change in Hb, before an increase in inpatient mortality is recognized. The findings suggest that females may be "preconditioned" to tolerate anemia better than males.
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Affiliation(s)
- Mereze Visagie
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Eric A Gehrie
- Department of Pathology (Transfusion Medicine), Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Linda M S Resar
- Department of Medicine (Hematology), Department of Oncology, Department of Pathology, Institute for Cellular Engineering, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Steven M Frank
- Johns Hopkins Health System Blood Management Program, Department of Anesthesiology/Critical Care Medicine, Faculty, Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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23
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Spencer BR, Bialkowski W, Creel DV, Cable RG, Kiss JE, Stone M, McClure C, Kleinman S, Glynn SA, Mast AE. Elevated risk for iron depletion in high-school age blood donors. Transfusion 2019; 59:1706-1716. [PMID: 30633813 PMCID: PMC6499707 DOI: 10.1111/trf.15133] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND High school students 16 to 18 years-old contribute 10% of the US blood supply. Mitigating iron depletion in these donors is important because they continue to undergo physical and neurocognitive development. STUDY DESIGN AND METHODS Study objectives were to determine the prevalence of iron depletion in 16- to 18-year-old donors and whether their risk for iron depletion was greater than adult donors. Successful, age-eligible donors were enrolled from high school blood drives at two large US blood centers. Plasma ferritin testing was performed with ferritin less than 12 ng/mL as our primary measure of iron depletion and ferritin less than 26 ng/mL a secondary measure. Multivariable repeated-measures logistic regression models evaluated the role of age and other demographic/donation factors. RESULTS Ferritin was measured from 4265 enrollment donations September to November 2015 and 1954 follow-up donations through May 2016. At enrollment, prevalence of ferritin less than 12 ng/mL in teenagers was 1% in males and 18% in females making their first blood donation, and 8% in males and 33% in females with prior donations. Adjusted odds for ferritin less than 12 ng/mL were 2.1 to 2.8 times greater in 16- to 18-year-olds than in 19- to 49-year-olds, and for ferritin less than 26 ng/mL were 3.3- to 4.7-fold higher in 16- to 18-year-olds. Progression to hemoglobin deferral was twice as likely in 16- to 18-year-old versus 19- to 49-year-old females. CONCLUSION Age 16 to 18 years-old is an independent risk factor for iron deficiency in blood donors at any donation frequency. Blood centers should implement alternate eligibility criteria or additional safety measures to protect teenage donors from iron depletion.
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Affiliation(s)
- Bryan R. Spencer
- American Red Cross, Scientific Affairs, Dedham, MA, United States
| | - Walter Bialkowski
- Blood Research Institute, BloodCenter of Wisconsin Milwaukee, WI, United States
| | | | - Ritchard G. Cable
- American Red Cross, Scientific Affairs, Farmington, CT, United States
| | - Joseph E. Kiss
- Institute for Transfusion Medicine, Pittsburgh, PA, United States
| | - Mars Stone
- Blood Systems Research Institute, San Francisco, CA, United States
| | | | | | - Simone A. Glynn
- National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Alan E. Mast
- Blood Research Institute, BloodCenter of Wisconsin Milwaukee, WI, United States
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, United States
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24
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Goldman M, Yi Q, Steed T, O'Brien SF. Changes in minimum hemoglobin and interdonation interval: impact on donor hemoglobin and donation frequency. Transfusion 2019; 59:1734-1741. [DOI: 10.1111/trf.15155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Mindy Goldman
- Donor & Clinical ServicesCanadian Blood Services Ottawa Ontario Canada
| | - Qi‐Long Yi
- Donor & Clinical ServicesCanadian Blood Services Ottawa Ontario Canada
| | - Tony Steed
- Donor RelationsCanadian Blood Services Ottawa Ontario Canada
| | - Sheila F O'Brien
- Donor & Clinical ServicesCanadian Blood Services Ottawa Ontario Canada
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25
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Jansen P, Sümnig A, Esefeld M, Greffin K, Kaderali L, Greinacher A. Well-being and return rate of first-time whole blood donors. Vox Sang 2019; 114:154-161. [PMID: 30695836 DOI: 10.1111/vox.12752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/28/2018] [Accepted: 01/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous studies observed a transient increase in well-being in about one-third of regular donors after blood donation. In addition, personal contact with donors after donation seems to increase return rates. We were interested whether changes in well-being and/or personal contact after the first donation impact return rates of first-time donors (FTDs). MATERIALS AND METHODS First-time donors were randomized to a questionnaire group (QG), in which questionnaires assessing the well-being had to be filled in, or a control group (CG), which was not contacted with a questionnaire. The QG had to complete the same questionnaire three times at the day of the first donation and then four times over an 8-week period with reminding calls by the study coordinator. Return rates of participants were followed for 12 months. RESULTS A total of 102 FTDs participated in the QG and 115 in the CG. Changes in well-being after the first donation had minimal impact on the return rates. In contrast, contacting FTDs after their first donation had a significant impact on the return rate of male donors (89·2% in the QG vs. 58·3% in the CG; P = 0·001). Females showed no significant difference in return rates between both groups (P = 0·32). CONCLUSION The well-being of FTDs had no influence on their return rate. The intervention of regular contacts during a research project follow-up resulted in an increased return rate of male but not of female FTDs. The pronounced difference of the impact of this intervention between male and female donors requires further studies.
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Affiliation(s)
- Peer Jansen
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Ariane Sümnig
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Max Esefeld
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Klara Greffin
- Institut für Psychologie, Universität Greifswald, Greifswald, Germany
| | - Lars Kaderali
- Institut für Bioinformatik, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Andreas Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
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Grieve R, Willis S, De Corte K, Sadique MZ, Hawkins N, Perra S, Pennington M, Turner J, Moore C, Wickenden C, Koppitz C, Cho G, Roberts DJ, Miflin G, Cairns JA. Options for possible changes to the blood donation service: health economics modelling. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundEvidence is required on the cost-effectiveness of alternative changes to the blood collection service.Objectives(1) To estimate the cost-effectiveness of alternative minimum interdonation intervals between whole-blood donations. (2) To investigate donors’ frequency of whole-blood donation according to alternative changes to the blood collection service. (3) To estimate the cost-effectiveness of alternative strategies for maintaining the supply of whole blood.MethodsWe undertook a within-trial cost-effectiveness analysis (CEA) of the INTERVAL trial, stated preference (SP) surveys to elicit donor preferences and a CEA of different strategies for blood collection. The strategies considered were reduced minimum intervals between whole-blood donations, introduction of a donor health report and changes to appointment availability and opening times at blood collection venues. The within-trial CEA included 44,863 donors, with men randomly assigned to 12- versus 10- versus 8-week interdonation intervals, and women to 16- versus 14- versus 12-week interdonation intervals. We undertook a SP survey of non-INTERVAL donors (100,000 invitees). We asked donors to state the frequency with which they would be willing to donate blood, according to the service attribute and level. The CEA compared changes to the blood service with current practice by combining the survey estimates with information from the NHS Blood and Transpant database (PULSE) and cost data. The target population was existing whole-blood donors in England, of whom approximately 85% currently donate whole blood at mobile (temporary) blood collection venues, with the remainder donating at static (permanent) blood collection centres. We reported the effects of the alternative strategies on the number of whole-blood donations, costs and cost-effectiveness.ResultsThe reduced donation interval strategies had higher deferral rates caused by low haemoglobin (Hb), but increased frequency of successful donation. For men in the 8- versus 12-week arm of the INTERVAL trial [Di Angelantonio E, Thompson SG, Kaptoge S, Moore C, Walker M, Armitage J,et al.Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45 000 donors.Lancet2017;390:2360–71], the Hb-related deferral rate was 5.7% per session versus 2.6% per session, but the average number of donations over 2 years increased by 1.71 (95% confidence interval 1.60 to 1.80). A total of 25,187 (25%) donors responded to the SP survey. For static donor centres, extending appointment availability to weekday evenings or weekends, or reduced intervals between blood donations, increased stated donation frequency by, on average, 0.5 donations per year. The CEA found that reducing the minimum interval, extending opening times to weekday evenings and extending opening times to weekends in all static donor centres would provide additional whole blood at a cost per additional unit of £10, £23 and £29, respectively, with similar results for donors with high-demand blood types.LimitationsThe study did not consider the long-term rates at which donors will leave the donation register, for example following higher rates of Hb-related deferral.ConclusionsExtending opening hours for blood donation to weekday evenings or weekends for all static donor centres are cost-effective ways of increasing the supply of high-demand blood types.Future workTo monitor the effects of new strategies on long-term donation frequency.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Willis
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaat De Corte
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - M Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Neil Hawkins
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Silvia Perra
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Pennington
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Department of Health Services & Population Research, King’s College London, London, UK
| | - Jenny Turner
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Carmel Moore
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- INTERVAL Coordinating Centre, Department of Public Health and Primary Care, Cambridge, UK
| | | | | | - Gavin Cho
- NHS Blood and Transplant, London, UK
| | - David J Roberts
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant, London, UK
- Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | | | - John A Cairns
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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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
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Lynch R, Cohn S. Donor understandings of blood and the body in relation to more frequent donation. Vox Sang 2018; 113:350-356. [PMID: 29424121 DOI: 10.1111/vox.12641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The INTERVAL trial aimed to find the optimum frequency of blood donation to enhance blood supplies and maintain donor health. This not only requires biological knowledge, but also an appreciation of donor perspectives, and how their experiences and beliefs might be central if any changes are ever to be made. To address this, trial participants were interviewed about their ideas of blood and the body in relation to their experiences of increased donation frequency. MATERIALS AND METHODS Thirty in depth face-to-face interviews conducted with blood donors participating in the trial. RESULTS Three key themes emerged: ideas about how blood and iron reserves are replenished, and what people did to facilitate this; beliefs about physiological differences relating to age and gender; and practical issues that affected the experience of donation. Overall, participants interviewed welcomed more frequent donation, despite a range of pragmatic concerns. CONCLUSION Despite some practical obstacles, increased donation frequency aligned with participant's ideas about bodily replenishment, the value of donation, and their identity as enduring blood donors. They therefore supported the idea of increasing frequency of donation, independently of the biomedical evidence from the trial itself.
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Affiliation(s)
- R Lynch
- London School of Hygiene and Tropical Medicine, London, UK
| | - S Cohn
- London School of Hygiene and Tropical Medicine, London, UK
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29
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Di Angelantonio E, Thompson SG, Kaptoge S, Moore C, Walker M, Armitage J, Ouwehand WH, Roberts DJ, Danesh J. Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45 000 donors. Lancet 2017; 390:2360-2371. [PMID: 28941948 PMCID: PMC5714430 DOI: 10.1016/s0140-6736(17)31928-1] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/16/2017] [Accepted: 06/27/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Limits on the frequency of whole blood donation exist primarily to safeguard donor health. However, there is substantial variation across blood services in the maximum frequency of donations allowed. We compared standard practice in the UK with shorter inter-donation intervals used in other countries. METHODS In this parallel group, pragmatic, randomised trial, we recruited whole blood donors aged 18 years or older from 25 centres across England, UK. By use of a computer-based algorithm, men were randomly assigned (1:1:1) to 12-week (standard) versus 10-week versus 8-week inter-donation intervals, and women were randomly assigned (1:1:1) to 16-week (standard) versus 14-week versus 12-week intervals. Participants were not masked to their allocated intervention group. The primary outcome was the number of donations over 2 years. Secondary outcomes related to safety were quality of life, symptoms potentially related to donation, physical activity, cognitive function, haemoglobin and ferritin concentrations, and deferrals because of low haemoglobin. This trial is registered with ISRCTN, number ISRCTN24760606, and is ongoing but no longer recruiting participants. FINDINGS 45 263 whole blood donors (22 466 men, 22 797 women) were recruited between June 11, 2012, and June 15, 2014. Data were analysed for 45 042 (99·5%) participants. Men were randomly assigned to the 12-week (n=7452) versus 10-week (n=7449) versus 8-week (n=7456) groups; and women to the 16-week (n=7550) versus 14-week (n=7567) versus 12-week (n=7568) groups. In men, compared with the 12-week group, the mean amount of blood collected per donor over 2 years increased by 1·69 units (95% CI 1·59-1·80; approximately 795 mL) in the 8-week group and by 0·79 units (0·69-0·88; approximately 370 mL) in the 10-week group (p<0·0001 for both). In women, compared with the 16-week group, it increased by 0·84 units (95% CI 0·76-0·91; approximately 395 mL) in the 12-week group and by 0·46 units (0·39-0·53; approximately 215 mL) in the 14-week group (p<0·0001 for both). No significant differences were observed in quality of life, physical activity, or cognitive function across randomised groups. However, more frequent donation resulted in more donation-related symptoms (eg, tiredness, breathlessness, feeling faint, dizziness, and restless legs, especially among men [for all listed symptoms]), lower mean haemoglobin and ferritin concentrations, and more deferrals for low haemoglobin (p<0·0001 for each) than those observed in the standard frequency groups. INTERPRETATION Over 2 years, more frequent donation than is standard practice in the UK collected substantially more blood without having a major effect on donors' quality of life, physical activity, or cognitive function, but resulted in more donation-related symptoms, deferrals, and iron deficiency. FUNDING NHS Blood and Transplant, National Institute for Health Research, UK Medical Research Council, and British Heart Foundation.
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Affiliation(s)
- Emanuele Di Angelantonio
- NHS Blood and Transplant, Cambridge, UK; NHS Blood and Transplant, Oxford, UK; Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK
| | - Simon G Thompson
- Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK
| | - Carmel Moore
- Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK
| | - Matthew Walker
- Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK
| | - Jane Armitage
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, University of Oxford, Oxford, UK
| | - Willem H Ouwehand
- NHS Blood and Transplant, Cambridge, UK; NHS Blood and Transplant, Oxford, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - David J Roberts
- NHS Blood and Transplant, Cambridge, UK; NHS Blood and Transplant, Oxford, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NIHR Oxford Biomedical Research Centre-Haematology Theme and Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - John Danesh
- Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK.
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Cable RG, Birch RJ, Spencer BR, Wright DJ, Bialkowski W, Kiss JE, Rios J, Bryant BJ, Mast AE. The operational implications of donor behaviors following enrollment in STRIDE (Strategies to Reduce Iron Deficiency in blood donors). Transfusion 2017; 57:2440-2448. [PMID: 28703859 PMCID: PMC5612857 DOI: 10.1111/trf.14226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/18/2017] [Accepted: 05/22/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Donor behaviors in STRIDE (Strategies to Reduce Iron Deficiency), a trial to reduce iron deficiency, were examined. STUDY DESIGN AND METHODS Six hundred ninety-two frequent donors were randomized to receive either 19 or 38 mg iron for 60 days or an educational letter based on their predonation ferritin. Compliance with assigned pills, response to written recommendations, change in donation frequency, and future willingness to take iron supplements were examined. RESULTS Donors who were randomized to receive iron pills had increased red blood cell donations and decreased hemoglobin deferrals compared with controls or with pre-STRIDE donations. Donors who were randomized to receive educational letters had fewer hemoglobin deferrals compared with controls. Of those who received a letter advising of low ferritin levels with recommendations to take iron supplements or delay future donations, 57% reported that they initiated iron supplementation, which was five times as many as those who received letters lacking a specific recommendation. The proportion reporting delayed donation was not statistically different (32% vs. 20%). Of donors who were assigned pills, 58% reported taking them "frequently," and forgetting was the primary reason for non-compliance. Approximately 80% of participants indicated that they would take iron supplements if provided by the center. CONCLUSIONS Donors who were assigned iron pills had acceptable compliance, producing increased red blood cell donations and decreased low hemoglobin deferrals compared with controls or with pre-STRIDE rates. The majority of donors assigned to an educational letter took action after receiving a low ferritin result, with more donors choosing to take iron than delay donation. Providing donors with information on iron status with personalized recommendations was an effective alternative to directly providing iron supplements.
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Affiliation(s)
- Ritchard G. Cable
- New England Region, American Red Cross Blood Services, Dedham, Massachusetts
| | | | - Bryan R. Spencer
- New England Region, American Red Cross Blood Services, Dedham, Massachusetts
| | | | - Walter Bialkowski
- Blood Research and Medical Sciences Institutes, Blood Center of Wisconsin, Milwaukee, Wisconsin
| | - Joseph E. Kiss
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | - Jorge Rios
- New England Region, American Red Cross Blood Services, Dedham, Massachusetts
| | - Barbara J. Bryant
- Blood Research and Medical Sciences Institutes, Blood Center of Wisconsin, Milwaukee, Wisconsin
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | - Alan E. Mast
- Blood Research and Medical Sciences Institutes, Blood Center of Wisconsin, Milwaukee, Wisconsin
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
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31
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Suemnig A, Konerding U, Hron G, Lubenow N, Alpen U, Hoffmann W, Kohlmann T, Greinacher A. Motivational factors for blood donation in first-time donors and repeat donors: a cross-sectional study in West Pomerania. Transfus Med 2017; 27:413-420. [PMID: 28786224 DOI: 10.1111/tme.12450] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/29/2017] [Accepted: 07/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to analyse motivational factors for blood donation in different donor groups. BACKGROUND As the demographic change will result in a decrease of the population in age groups of blood donors, the risk of blood product shortage increases. METHODS During a 12-month period, every sixth blood donor presenting at the blood donation centre of the University Hospital was asked to complete a self-administered questionnaire assessing motivational factors for blood donation. Despite the formalised enrolment protocol, frequent donors were over-represented in the study cohort, which was adjusted by weighting donors with different numbers of donations per year in such a way that the distribution of numbers of donations per year was the same in the sample as in the donor population. RESULTS Of 2443 participants, 14·3% were first-time and 85·3% repeat donors. To "help other people" (>90%) and receiving "medical assessment of my blood values" (63-69%) were the strongest motivational factors in all donor groups. Receiving remuneration (49·2% vs 38·1%) was more important for repeat donors than for first-time donors, whereas it was the opposite for "being taken by a friend to the donor clinic" (47·0% vs 15·5%). A potentially important observation is that 33·9% of frequent donors reported feeling physically better after blood donation compared to infrequent donors (29·5%). CONCLUSION Identification of motivational factors can lead to the design of targeted motivation campaigns for blood donation. The underlying cause of the perceived well-being after blood donation requires further studies.
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Affiliation(s)
- A Suemnig
- Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald, Germany
| | - U Konerding
- Trimberg Research Academy, Otto-Friedrich-Universität Bamberg, Bamberg, Germany
| | - G Hron
- Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald, Germany
| | - N Lubenow
- Clinical Immunology and Transfusion Medicine, University Hospital, Uppsala, Sweden
| | - U Alpen
- Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald, Germany
| | - W Hoffmann
- Institut für Community Medicine, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany
| | - T Kohlmann
- Institut für Community Medicine, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany
| | - A Greinacher
- Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald, Germany
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