ImportanceBlood donors are at increased risk for iron deficiency. Current hemoglobin (Hb) monitoring policies are inadequate and new iron management strategies are warranted.ObjectiveTo determine the effects of ferritin-guided donation intervals for whole blood donors on Hb and ferritin levels, Hb deferral, iron deficiency (ferritin < 15 ng/mL) prevalence, donor return, and iron deficiency-related symptoms.DesignBetween November 2017 and November 2019 a ferritin-guided donation interval policy was gradually implemented nationwide and evaluated through a stepped-wedge cluster-randomized controlled trial.SettingAll blood collection centers in the Netherlands.Participants412,888 whole blood donors were included.InterventionsFerritin was measured in all new donors and at every 5thwhole blood donation. Subsequent donation intervals were extended to six months if ferritin is 15 ≤ 30 ng/mL and to twelve months if ferritin is <15 ng/mL (iron deficient).Main outcomes and MeasuresThe primary outcomes are ferritin and Hb levels, iron deficiency, Hb deferral, and donor return. Secondary outcomes are self-reported iron deficiency-related symptoms.ResultsWe measured 36,099 donors, median age 43 years and 52% female, making 37,621 donations during the study period. Ferritin-guided donation intervals increased log-transformed ferritin levels at all time points in the trial, up to 0.56 log-transformed ng/mL as compared to baseline (95% CI0.49 – 0.63, p <0.001). Hb increased as well, up to 0.39 g/dL (95% CI0.32 – 0.45, p <0.001). Decreased odds of 13% (95% CI8 – 22, p <0.001) for iron deficiency and 20% (95% CI6 – 47, p <0.001) for Hb deferral were reported compared to baseline. Odds of donor return decreased over the course of the trial, as low as 56% (95% CI48 – 66, p <0.001). We found no evidence for improved self-reported iron deficiency-related symptoms after implementation of the new policy.Conclusion and RelevanceFerritin-guided donation intervals significantly increased overall Hb and ferritin levels, thereby decreasing the prevalence of iron deficiency and Hb deferrals in whole blood donors. Ferritin-guided donation intervals seem beneficial for Hb levels and iron maintenance, but additional efforts are required to retain donors and to remedy self-reported iron deficiency-related symptoms.Trial RegistrationThis trial has been registered in the Dutch trial registry (NTR6738) on September 29th,, 2017 (https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6738).

Background and Objectives Blood banks use a haemoglobin (Hb) threshold before blood donation to minimize donors' risk of anaemia. Hb prediction models may guide decisions on which donors to invite, and should ideally also be generally applicable, thus in different countries and settings. In this paper, we compare the outcome of various prediction models in different settings and highlight differences and similarities. Materials and Methods Donation data of repeat donors from the past 5 years of Australia, Belgium, Finland, the Netherlands and South Africa were used to fit five identical prediction models: logistic regression, random forest, support vector machine, linear mixed model and dynamic linear mixed model. Only donors with five or more donation attempts were included to ensure having informative data from all donors. Analyses were performed for men and women separately and outcomes compared. Results Within countries and overall, different models perform similarly well. However, there are substantial differences in model performance between countries, and there is a positive association between the deferral rate in a country and the ability to predict donor deferral. Nonetheless, the importance of predictor variables across countries is similar and is highest for the previous Hb level. Conclusion The limited impact of model architecture and country indicates that all models show similar relationships between the predictor variables and donor deferral. Donor deferral is found to be better predictable in countries with high deferral rates. Therefore, such countries may benefit more from deferral prediction models than those with low deferral rates.

Objectives Previous studies suggest a positive association between coffee consumption and liver health, yet the evidence available is not unequivocal. Given the burden of liver disease, we studied the relationship of habitual coffee consumption with serum biomarkers of liver health and non-alcoholic fatty liver disease (NAFLD) incidence. Methods We included 209,575 participants from the UK Biobank cohort (mean age 56.1 and 68% women, median coffee consumption per day 1.00 cup [0.50, 3.00]), free of disease at baseline. Firstly, we studied cross-sectional associations of coffee consumption with serum concentrations of the liver enzymes alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GGT), and total bilirubin using multivariable linear regressions. Secondly, we analyzed associations with elevated enzyme concentrations according to clinical cutoffs to monitor liver damage, using logistic regressions. Lastly, in a longitudinal analysis, we assessed the association of coffee consumption and incident NAFLD in cox proportional hazard models. Models were adjusted for sociodemographic, lifestyle and health-related factors. Results are reported as β log transformed IU/L, odds ratio (OR) or hazard ratio (HR) with their 95% confidence intervals [95% CI] per one cup increase in coffee intake. Results Over a median follow up of 10.9 years, 2258 cases of incident NAFLD occurred in the population. Higher coffee consumption was associated with lower concentrations of log-transformed ALP (−0.005 [95% CI −0.006, −0.005]), ALT (−0.004 [−0.005, −0.003]), AST (−0.005 [−0.005, −0.004]), GGT (−0.008 [−0.009, −0.007]) and total bilirubin (−0.009 [−0.010, −0.008]). Secondly, higher coffee consumption was associated with lower odds of having elevated levels of all studied liver enzymes (OR from 0.91, [0.89, 0.92] for total bilirubin to 0.98 [0.97, 0.98] for GGT). Finally, higher coffee consumption was associated with lower risk of developing NAFLD (HR 0.98 [0.96, 0.99]). Conclusions In this large cohort we observed an inverse association between higher coffee consumption and serum concentrations of baseline liver enzymes and NAFLD risk. These findings suggest that habitual consumption of coffee may be protective of liver health. Funding Sources N/A.