Blood center practice and education for blood donors with anemia

Abstract

BACKGROUND Anemia is an early indicator of many diseases, yet blood donors with low hematocrit (Hct) often receive inadequate information about its medical importance. We sought to understand the types of information that are and should be provided to these donors. STUDY DESIGN AND METHODS Two companion studies were performed. The first investigated blood center practices for care of donors with low Hct including deferral length, information provided, and cutoff values used when referring donors for medical attention. The second was a randomized prospective pilot study comparing behavior of deferred donors receiving an “older” pamphlet providing a list of iron-rich foods or a “newer” pamphlet providing descriptions of common causes of anemia and advice for seeking medical attention. RESULTS More than 70% of centers defer donors for 1 day. Only 6% defer donors for more than 2 weeks. Most centers provide written and/or verbal information about low Hct. Only 35% have a cutoff value defining significant anemia that requires additional medical attention. In the study of donors with low Hct, significant disease was identified within 3 months after deferral in 2 of 104 subjects: metastatic lung cancer and acute lymphocytic leukemia. Only donors receiving the newer pamphlet reported that it “definitely improved” their ability to speak with their doctor about anemia. CONCLUSIONS The diagnosis of anemia in blood donors may be an indicator of significant undiagnosed disease. There are wide variations in how centers care for and educate donors with anemia. Donors with anemia should be provided improved and consistent educational information.

Low hemoglobin deferral in blood donors

“…Non-malignant diseases that have been specifically identified in donors with low hemoglobin include, occult gastrointestinal bleeding, vitamin B12 deficiency, hyperthyroidism with thyrotoxicosis, diabetes mellitus, and Raynaud’s syndrome [6]. Although anemia is not a sensitive indicator of malignant disease in blood donors with low hemoglobin deferral [36], previously unrecognized malignancies have been identified with published cases of essential thrombocythemia, acute lymphocytic leukemia and metastatic lung cancer identified in otherwise “healthy” individuals presenting to donate blood [6;10]. The many different causes for anemia identified in blood donors make it difficult to provide accurate, yet concise, information to the deferred donor.…”

“…Consequently, frequent blood donors, males and females, become iron deficient [7;8;16]. Donors are often advised to increase consumption of iron rich foods [10]. However, blood donation removes 200 to 250 mg of iron requiring the donor to absorb four to five mg of iron each day to replace that lost within the 56 day interdonation interval [13].…”

“…Donors deferred for low hemoglobin are also likely to benefit from iron supplementation [6;54]. While iron supplementation has been shown to be safe and effective, it may require careful medical assessment of some donors, particularly first-time and infrequent donors, so that the underlying cause of the anemia is identified and properly treated [10]. …”

“…Thus, a low hemoglobin deferral may represent a medically insignificant finding, iron deficiency anemia from frequent blood donation, or the initial sign of a previously unrecognized and life-threatening disease [10]. …”

Blood donor iron status

“…The importance of better donor education is underscored by a recent study by Delaney et al [32] who reviewed blood center management and blood donor understanding of low Hb deferrals. As much variability and confusion may exist regarding the discussion of anemia, less attention is paid to the donor iron stores.…”