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Ekroos S, Karregat J, Toffol E, Castrén J, Arvas M, van den Hurk K. Menstrual blood loss is an independent determinant of hemoglobin and ferritin levels in premenopausal blood donors. Acta Obstet Gynecol Scand 2024; 103:1645-1656. [PMID: 38856303 PMCID: PMC11266725 DOI: 10.1111/aogs.14890] [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: 02/26/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION To prevent blood donors from developing iron deficiency (ferritin <15 μg/L) and subsequent anemia (hemoglobin <120 g/L), blood services rely on information about known risk factors, including the donor's sex and age. For example, while Finnish women are able to donate whole blood with a minimum donation interval of 91 days, women in the 18 to 25-year-old age group are recommended to donate no more than once per year. Menstrual blood loss is not accounted for in blood donation interval recommendations, despite being a known risk factor of iron deficiency. We aim to investigate to what extent menstrual bleeding is associated with ferritin and hemoglobin levels in female blood donors, and quantify the association of other menstruation-related variables not currently accounted for by blood services (i.e., use of hormonal contraception, heavy menstrual bleeding) with iron deficiency or anemia. MATERIAL AND METHODS The study population consisted of 473 premenopausal and 491 postmenopausal Dutch whole blood donors. Exclusion criteria were current pregnancy, BMI ≥50, ferritin ≥200, pictorial blood assessment chart (PBAC) ≥400, and age <18 or ≥70 years. Menstrual blood loss was quantified using a PBAC, a semiquantitative method to evaluate the number of used menstrual products and the degree of staining. We identified predictors of log(ferritin)/hemoglobin and iron deficiency/anemia using Bayesian linear and logistic regression models and quantified the average percentage of variance in log(ferritin) and hemoglobin explained by the covariates. RESULTS Menstrual blood loss accounted for most of the explained variance in hemoglobin (8%) and second only to the number of days since last donation for ferritin (8%). Heavy menstrual bleeding (PBAC ≥150, OR = 3.56 [1.45-8.85], prevalence 13%) was associated with anemia, and use of levonorgestrel-releasing intrauterine device was negatively associated with iron deficiency (OR = 0.06 [0.01-0.44]). After statistical control for menstrual blood loss, age was not associated with iron status. CONCLUSIONS Menstrual blood loss and blood donation were the most important determinants of iron status in premenopausal women. Thus, results suggest that accounting for menstrual blood loss in donation interval guidelines may benefit blood donors.
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Affiliation(s)
- Sofie Ekroos
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Jan Karregat
- Donor Studies, Department of Donor Medicine ResearchSanquin ResearchAmsterdamthe Netherlands
- Department of Public and Occupational HealthAmsterdam UMCAmsterdamthe Netherlands
| | - Elena Toffol
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Johanna Castrén
- Finnish Red Cross, Blood Service (FRCBS), Research and DevelopmentHelsinkiFinland
| | - Mikko Arvas
- Finnish Red Cross, Blood Service (FRCBS), Research and DevelopmentHelsinkiFinland
| | - Katja van den Hurk
- Donor Studies, Department of Donor Medicine ResearchSanquin ResearchAmsterdamthe Netherlands
- Department of Public and Occupational HealthAmsterdam UMCAmsterdamthe Netherlands
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Karregat JHM, Ekroos S, Castrén J, Arvas M, van den Hurk K. Iron status in Dutch and Finnish blood donor and general populations: A cross-cohort comparison study. Vox Sang 2024; 119:664-674. [PMID: 38622934 DOI: 10.1111/vox.13639] [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: 02/14/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND AND OBJECTIVES Blood donors are at risk of developing iron deficiency (ID) (ferritin <15 μg/L, World Health Organization definition). Blood services implement different strategies to mitigate this risk. Although in Finland risk group-based iron supplementation is in place, no iron supplementation is provided in the Netherlands. We aim to describe differences in ferritin levels and ID prevalence in donor and general populations in these countries. MATERIALS AND METHODS Six cohorts, stratified based on sex, and for women age, in the Netherlands and Finland were used to evaluate differences in ferritin levels and ID between donor populations (Donor InSight-III and FinDonor 10,000) and general populations (Prevention of Renal and Vascular End-Stage Disease [PREVEND], FinRisk 1997 and Health 2000) and newly registered Dutch donors. Multivariable logistic regression was used to quantify associations of various explanatory factors with ID. RESULTS In total, 13,443 Dutch and 13,933 Finnish subjects were included. Donors, except for women aged ≤50 years old in Finland, had lower median ferritin levels compared with the general population and new donors. Dutch regular blood donors had higher or similar prevalence of ID as compared with the Dutch general population, including new donors. In contrast, Finnish donors showed similar prevalence of ID compared with the general population, except for a markedly lower prevalence in ≤50-year-old women who routinely receive iron supplements when donating. CONCLUSION Iron status in blood donors differs from that in the general population. The Finnish blood service donor management policy, for example, iron supplementation for risk groups, seemingly protects young female blood donors from developing ID.
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Affiliation(s)
- Jan H M Karregat
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Public Health, Amsterdam Public Health (APH) Research Institute, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sofie Ekroos
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Castrén
- Finnish Red Cross Blood Service (FRCBS), Research and Development, Helsinki, Finland
| | - Mikko Arvas
- Finnish Red Cross Blood Service (FRCBS), Research and Development, Helsinki, Finland
| | - Katja van den Hurk
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Public Health, Amsterdam Public Health (APH) Research Institute, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
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Von Holle A, O'Brien KM, Janicek R, Weinberg CR. Development and validation of a prediction model for iron status in a large U.S. cohort of women. Sci Rep 2023; 13:17309. [PMID: 37828137 PMCID: PMC10570329 DOI: 10.1038/s41598-023-42993-3] [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: 12/06/2022] [Accepted: 09/18/2023] [Indexed: 10/14/2023] Open
Abstract
Serum iron levels can be important contributors to health outcomes, but it is not often feasible to rely on blood-based measures for a large epidemiologic study. Predictive models that use questionnaire-based factors such as diet, supplement use, recency of blood donation, and medical conditions could potentially provide a noninvasive alternative for studying health effects associated with iron status. We hypothesized that a model based on questionnaire data could predict blood-based measures of iron status biomarkers. Using iron (mcg/dL), ferritin (mcg/dL), and transferrin saturation (%) based on blood collected at study entry, in a subsample from the U.S.-wide Sister Study (n = 3171), we developed and validated a prediction model for iron with multivariable linear regression models. Model performance based on these cross-sectional data was weak, with R2 less than 0.10 for serum iron and transferrin saturation, but better for ferritin, with an R2 of 0.13 in premenopausal women and 0.19 in postmenopausal women. When menopause was included in the predictive model for the sample, the R2 was 0.31 for ferritin. Internal validation of the estimates indicated some optimism present in the observed prediction model, implying there would be worse performance when applied to new samples from the same population. Serum iron status is hard to assess based only on questionnaire data. Reducing measurement error in both the exposure and outcome may improve the prediction model performance, but environmental heterogeneity, temporal variation, and genetic heterogeneity in absorption and storage may contribute substantially to iron status.
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Affiliation(s)
- Ann Von Holle
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Robert Janicek
- Advanced Research and Diagnostic Laboratory, University of Minnesota, Minneapolis, MN, USA
| | - Clarice R Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Mail Drop A3-03, P.O. Box 12233, Durham, NC, 27709, USA.
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Turkulainen E, Ihalainen J, Arvas M. Simulated effects of ferritin screening on C-reactive protein levels in recruited blood donors. Vox Sang 2023; 118:901-905. [PMID: 37622476 DOI: 10.1111/vox.13515] [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: 03/23/2023] [Revised: 07/28/2023] [Accepted: 08/05/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Ferritin is commonly measured to evaluate iron stores in the body. Some countries have added or considered adding ferritin lower bounds to donor eligibility criteria. Ferritin is also elevated by inflammation. The main goal of this study is to estimate how different ferritin cut-offs would affect the proportion of donors with a C-reactive protein (CRP) level over 3 mg/L, which is the decision limit of the highest chronic cardiovascular risk. MATERIALS AND METHODS To simulate recruitment of new blood donors, we selected participants from two Finnish general population cohorts, namely FINRISK 1997 (n = 5369) and Health 2000 (n = 3278), that would likely fulfil the selection criteria of blood donation. We then calculated the proportion of individuals with high-sensitivity CRP values above 3 mg/L, over a range of ferritin values. RESULTS We found that for several ferritin cut-offs the proportion of potential donors with CRP > 3 mg/L would rise by a statistically significant amount. The trend was significant and similar for all subgroups but weaker for non-menstruating women as well as men. CONCLUSION Our results show that screening a population of potential blood donors with ferritin cut-offs raises the number of people with CRP > 3 mg/L within the blood donor population.
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Affiliation(s)
- Esa Turkulainen
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Jarkko Ihalainen
- 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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Cipek V, Ferenac Kiš M, Ratić D, Piškorjanac S, Samardžija M, Kralik K, Samardžija M. REASONS FOR DEFERRAL IN DEFERRED VOLUNTARY BLOOD DONORS IN EASTERN CROATIA. Acta Clin Croat 2023; 62:93-105. [PMID: 38304378 PMCID: PMC10829957 DOI: 10.20471/acc.2023.62.01.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2024] Open
Abstract
When choosing a voluntary blood donor (VBD), it is important to ensure the donor health, and at the same time to produce a quality and safe blood product. The donor selection process leads to donor rejection related to their current health condition. The aim of this study was to determine gender differences in VBDs, to examine the reasons for their rejection, and to determine the share of permanently and temporarily deferred VBD, especially due to low hemoglobin levels. The research was conducted in eastern Croatia in the 2014 to 2018 period. The study included 144,041 blood donations from a total of 80,418 VBDs, of which 83.3% of donations were from male VBDs and 16.7% from female VBDs. There were 11.46% of temporarily deferred and permanently rejected donors. Out of all temporarily deferred donors and possible reasons for deferral, the largest share of deferrals referred to a reduced hemoglobin level, which accounted for 54% in female VBD and 46% in male VBD. Female VBDs made up to one-third of total VBDs and account for one-sixth of total blood donations. Low hemoglobin was the most common reason for VBD deferral. Gender and age are related to blood hemoglobin levels in rejected and accepted donors. Female VBDs represent a potential reservoir for increasing the total number of VBDs.
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Affiliation(s)
- Vladimir Cipek
- Fresenius Kabi, EMEA Region, Bad Homburg, Germany
- University Hospital Centre Osijek, Department of Transfusion Medicine, Osijek, Croatia
| | - Marina Ferenac Kiš
- University Hospital Centre Osijek, Department of Transfusion Medicine, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Dalibor Ratić
- University Hospital Centre Osijek, Department of Transfusion Medicine, Osijek, Croatia
| | - Silvija Piškorjanac
- University Hospital Centre Osijek, Department of Transfusion Medicine, Osijek, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marko Samardžija
- Nord-Trøndelag Hospital Trust – Namsos Hospital, Department of Internal Medicine, Namsos, Norway
| | - Kristina Kralik
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marina Samardžija
- University Hospital Centre Osijek, Department of Transfusion Medicine, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Richard P, Fillet AM, Malard L, Leclerc C, Chanut C, Woimant G, Jacquot C, Leleu H, Morel P, Vimont A. Impact of donor ferritin testing on iron deficiency prevention and blood availability in France: A cohort simulation study. Vox Sang 2023; 118:24-32. [PMID: 36427060 DOI: 10.1111/vox.13377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Implementing a ferritin testing policy for whole blood (WB) donors may prevent iron deficiency (ID, ferritin <26 ng/mL) and anaemia, but may induce donation losses. As part of a national prevention plan in France, we aimed to estimate its impact on ID, anaemias and WB donations among donors at high risk of ID. MATERIALS AND METHODS A micro-simulation model was developed to evaluate different scenarios compared to the current situation without ferritin testing as a reference scenario. The following scenarios were simulated: a minimum scenario with a 6-month deferral for donors with absent iron store (AIS, ferritinemia <15 ng/ml), a main scenario with additional delayed invitations for donors with ferritinemia 15-25 ng/ml and a supplementation scenario with additional iron supplementation for 50% of the donors with AIS. RESULTS In the main scenario, 52,699 WB donations per year were estimated to be lost after 1 year (-8%), falling to 27,687 (-4.7%) after 5 years. IDs and anaemias were reduced by 13.6% and 29.3%, respectively, after 1 year. The supplementation scenario increased the number of prevented IDs and anaemias to 24.1% and 35.4%, respectively, after 1 year, and halved the number of anaemias at 5 years. The latter scenario also had the least impact on the number of donations (-3.2% after 5 years). CONCLUSION A ferritin testing policy resulting in delayed donations for ID donors is effective in reducing IDs and anaemias, but significantly impacts the number of donations, thereby posing a self-sufficiency challenge.
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Affiliation(s)
- Pascale Richard
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Anne-Marie Fillet
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Lucile Malard
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Carole Leclerc
- Blood Product Collection Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Claire Chanut
- Innovation and Projects Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Geneviève Woimant
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Chantal Jacquot
- Blood Product Collection Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | | | - Pascal Morel
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
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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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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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Vinkenoog M, de Groot R, Lakerveld J, Janssen M, van den Hurk K. Individual and environmental determinants of serum ferritin levels: A structural equation model. Transfus Med 2022; 33:113-122. [PMID: 37009681 DOI: 10.1111/tme.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/24/2022] [Accepted: 07/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Serum ferritin levels are increasingly being used to assess iron stores. Considerable variation in ferritin levels within and between individuals has been observed, but our current understanding of factors that explain this variation is far from complete. We aim to combine multiple potential determinants in an integrative model, and investigate their relative importance and potential interactions. METHODS We use ferritin measurements collected by Sanquin Blood Bank on both prospective (N = 59 596) and active blood donors (N = 78 318) to fit a structural equation model with three latent constructs (individual characteristics, donation history, and environmental factors). Parameters were estimated separately by sex and donor status. RESULTS The model explained 25% of ferritin variance in prospective donors, and 40% in active donors. Individual characteristics and donation history were the most important determinants of ferritin levels in active donors. The association between environmental factors and ferritin was smaller but still substantial; higher exposure to air pollution was associated with higher ferritin levels, and this association was considerably stronger for active blood donors than for prospective donors. DISCUSSION In active donors, individual characteristics explain 20% (17%) of ferritin variation, donation history explains 14% (25%) and environmental factors explain 5% (4%) for women (men). Our model presents known ferritin determinants in a broader perspective, allowing for comparison with other determinants as well as between new and active donors, or between men and women.
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Affiliation(s)
- Marieke Vinkenoog
- Transfusion Technology Assessment, Department of Donor Medicine Research Sanquin Research Amsterdam The Netherlands
- Leiden Institute of Advanced Computer Science Leiden University Leiden The Netherlands
| | - Rosa de Groot
- Donor Studies, Department of Donor Medicine Research Sanquin Research Amsterdam The Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC VU University Amsterdam The Netherlands
- Upstream Team, Amsterdam UMC VU University Amsterdam The Netherlands
| | - Mart Janssen
- Transfusion Technology Assessment, Department of Donor Medicine Research Sanquin Research Amsterdam The Netherlands
| | - Katja van den Hurk
- Donor Studies, Department of Donor Medicine Research Sanquin Research Amsterdam The Netherlands
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Lu G, Zhu Z, Lu Y, Shen J, Yu Q, Gao L, Chen W. The influence of blood donation before pregnancy on neonatal birth weight. PLoS One 2022; 17:e0269367. [PMID: 35749434 PMCID: PMC9231744 DOI: 10.1371/journal.pone.0269367] [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: 03/14/2021] [Accepted: 05/19/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the effect of blood donation before pregnancy on neonatal birth weight. Methods A total of 14996 women with singleton pregnancies at full-term in Ningbo Medical Center Lihuili Hospital and Ningbo Women’s and Children’s Hospital from November 2019 to November 2020 were enrolled in this study. Detailed records of whole blood donation before pregnancy were obtained through Alipay software. The records were classified into three groups: nondonors, low-frequency donors and high-frequency donors according to the total numbers of blood donations in the 3-year period before pregnancy. The demographics and clinical information of the enrolled participants and their fetuses were collected from electronic medical records (EMRs). The effect of blood donations in the 3-year period before pregnancy on neonatal birth weight was analyzed. Results There was no significant difference in neonatal birth weight among the three groups (P = 0.373). In line with this, there was no association between the number of blood donations in the 3-year period before pregnancy and neonatal birth weight (β = 14.5; 95% confidence interval [CI]: -3.9, 31.4; P = 0.094) in the bootstrapped multivariate linear regression analysis models, adjusted for maternal age, number of pregnancies, number of deliveries, gestational age, mode of delivery, years of education and blood type in pregnant women. Compared to the nondonors, the risk of fetal macrosomia was higher in both low-frequency donors and all donors (OR: 1.539, 95% CI: 1.058, 2.134, P = 0.016; OR: 1.454, 95% CI: 1.033, 1.952, P = 0.021, respectively), in the bootstrapped binary logistic regression analysis models after adjusting for the variables mentioned above. Conclusion Our study showed that maternal blood donation in the 3-year period before pregnancy may not lead to a reduction in neonatal birth weight, but may be associated with the incidence of fetal macrosomia.
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Affiliation(s)
- Genjie Lu
- Department of Blood Transfusion, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Zhe Zhu
- Department of Blood Transfusion, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Yangfang Lu
- Department of Radiotherapy, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Jun Shen
- Department of Obstetrics, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Qilin Yu
- Department of Blood Transfusion, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Li Gao
- Department of Blood Transfusion, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Wei Chen
- Department of Blood Transfusion, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
- * E-mail:
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Russell WA, Scheinker D, Custer B. Individualized risk trajectories for iron-related adverse outcomes in repeat blood donors. Transfusion 2021; 62:116-124. [PMID: 34783364 DOI: 10.1111/trf.16740] [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: 09/03/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Despite a fingerstick hemoglobin requirement and 56-day minimum donation interval, repeat blood donation continues to cause and exacerbate iron deficiency. STUDY DESIGN AND METHODS Using data from the REDS-II Donor Iron Status Evaluation study, we developed multiclass prediction models to estimate the competing risk of hemoglobin deferral and collecting blood from a donor with sufficient hemoglobin but low or absent underlying iron stores. We compared models developed with and without two biomarkers not routinely measured in most blood centers: ferritin and soluble transferrin receptor. We generated and analyzed "individual risk trajectories": estimates of how each donors' risk developed as a function of the time interval until their next donation attempt. RESULTS With standard biomarkers, the top model had a multiclass area under the receiver operator characteristic curve (AUC) of 77.6% (95% CI [77.3%-77.8%]). With extra biomarkers, multiclass AUC increased to 82.8% (95% CI [82.5%-83.1%]). In the extra biomarkers model, ferritin was the single most important variable, followed by the donation interval. We identified three risk archetypes: "fast recoverers" (<10% risk of any adverse outcome on post-donation day 56), "slow recoverers" (>60% adverse outcome risk on day 56 that declines to <35% by day 250), and "chronic high-risk" (>85% risk of the adverse outcome on day 250). DISCUSSION A longer donation interval reduced the estimated risk of iron-related adverse outcomesfor most donors, but risk remained high for some. Tailoring safeguards to individual risk estimates could reduce blood collections from donors with low or absent iron stores.
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Affiliation(s)
- W Alton Russell
- Department of Management Science and Engineering, Stanford University, Stanford, California, USA.,Epidemiology and Health Policy Science, Vitalant Research Institute, San Francisco, California, USA
| | - David Scheinker
- Department of Management Science and Engineering, Stanford University, Stanford, California, USA.,Systems Design and Collaborative Research, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA.,Pediatric Endocrinology, Stanford School of Medicine, Palo Alto, California, USA.,Clinical Excellence Research Center, Stanford School of Medicine, Palo Alto, California, USA
| | - Brian Custer
- Epidemiology and Health Policy Science, Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California, San Francisco, California, USA
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Palokangas E, Lobier M, Partanen J, Castrén J, Arvas M. Low ferritin levels appear to be associated with worsened health in male repeat blood donors. Vox Sang 2021; 116:1042-1050. [PMID: 33853204 DOI: 10.1111/vox.13104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Frequent blood donation depletes iron stores of blood donors. Iron depletion may lead to anaemia, but the health effects of iron depletion without anaemia in healthy blood donors are not well understood. We studied in the FinDonor cohort whether worsening of self-rated health of blood donors during the study period was associated with biomarkers for iron levels or other self-reported changes in lifestyle. MATERIALS AND METHODS We included 1416 participants from the cohort who answered an 89-item questionnaire on their health and lifestyle during their enrolment visit and again at the end of the study. We performed multivariate logistic regression to test if blood donation-related factors affected the probability of reporting worsened health. To set these findings into a more holistic context of health, we subsequently analysed all other questionnaire items with a data-driven exploratory analysis. RESULTS We found that donation frequency in men and post-menopausal women and ferritin level only in men was associated negatively with worsened health between questionnaires. In the exploratory analysis, stable physical condition was the only questionnaire item that was associated negatively with worsened health in both women and men. CONCLUSION Our results suggest that low ferritin level is associated with worsened health even in non-anaemic repeat donors, although we find that when health is analysed more holistically, ferritin and other factors primarily related to blood donation lose their importance.
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Affiliation(s)
| | - Muriel Lobier
- Finnish Red Cross Blood Service (FRCBS), Helsinki, Finland
| | - Jukka Partanen
- Finnish Red Cross Blood Service (FRCBS), Helsinki, Finland
| | | | - Mikko Arvas
- Finnish Red Cross Blood Service (FRCBS), Helsinki, Finland
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Lobier M, Niittymäki P, Nikiforow N, Palokangas E, Larjo A, Mattila P, Castrén J, Partanen J, Arvas M. FinDonor 10 000 study: a cohort to identify iron depletion and factors affecting it in Finnish blood donors. Vox Sang 2019; 115:36-46. [PMID: 31657023 PMCID: PMC7004091 DOI: 10.1111/vox.12856] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 09/16/2019] [Accepted: 10/01/2019] [Indexed: 12/14/2022]
Abstract
Background and Objectives There is increasing evidence that frequent blood donation depletes the iron stores of some blood donors. The FinDonor 10 000 study was set up to study iron status and factors affecting iron stores in Finnish blood donors. In Finland, iron supplementation for at‐risk groups has been in place since the 1980s. Material and Methods A total of 2584 blood donors (N = 8003 samples) were recruited into the study alongside standard donation at three donation sites in the capital region of Finland between 5/2015 and 12/2017. All participants were asked to fill out a questionnaire about their health and lifestyle. Blood samples were collected from the sample pouch of whole blood collection set, kept in cool temperature and processed centrally. Whole blood count, CRP, ferritin and sTFR were measured from the samples, and DNA was isolated for GWAS studies. Results Participant demographics, albeit in general similar to the general blood donor population in Finland, indicated some bias towards older and more frequent donors. Participation in the study increased median donation frequency of the donors. Analysis of the effect of time lag from the sampling to the analysis and the time of day when sample was drawn revealed small but significant time‐dependent changes. Conclusion The FinDonor cohort now provides us with tools to identify potential donor groups at increased risk of iron deficiency and factors explaining this risk. The increase in donation frequency during the study suggests that scientific projects can be used to increase the commitment of blood donors.
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Affiliation(s)
- Muriel Lobier
- Finnish Red Cross Blood Service, Research and Development, Helsinki, Finland
| | - Pia Niittymäki
- Finnish Red Cross Blood Service, Research and Development, Helsinki, Finland
| | - Nina Nikiforow
- Finnish Red Cross Blood Service, Research and Development, Helsinki, Finland
| | - Elina Palokangas
- Finnish Red Cross Blood Service, Research and Development, Helsinki, Finland
| | - Antti Larjo
- Finnish Red Cross Blood Service, Research and Development, Helsinki, Finland
| | - Pirkko Mattila
- Finnish Red Cross Blood Service, Research and Development, Helsinki, Finland
| | - Johanna Castrén
- Finnish Red Cross Blood Service, Research and Development, Helsinki, Finland
| | - Jukka Partanen
- Finnish Red Cross Blood Service, Research and Development, Helsinki, Finland
| | - Mikko Arvas
- Finnish Red Cross Blood Service, Research and Development, Helsinki, Finland
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