Donor Deferral Due to Low Hemoglobin—An Updated Systematic Review

Abstract

Background/Objectives: 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. Materials/Methods: 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. Results: 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 inter-donation 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. Conclusion: 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.

Relationship of hemoglobin level and plasma coproporphyrin‐I concentrations as an endogenous probe for phenotyping OATP1B

“…Scatter plot matrix identified body weight, sex, and uric acid as factors associated with hemoglobin level. Previous meta‐analyses have reported female sex and low body weight as factors of low hemoglobin level, 45 , 46 supporting our results. Uric acid also correlated with body weight ( r = 0.48) and sex ( r = −0.51) in our study, suggesting that uric acid was a confounding factor of body weight and sex.…”

Examining knowledge translation in blood donor research: A review of vasovagal reaction literature

“…For example, in their initial review of factors that affect a donor's risk of a low hemoglobin deferral, Smith and colleagues 2 identified 55 studies published between 1980 and 2012. In their recently published updated review, they found an additional 76 studies published between 2012 and 2019 3 . This demonstrates an expansion at an increasing rate in the knowledge of blood donor recruitment, behavior, and health issues.…”

Effects of repeated blood donation on iron status of blood donors in Zimbabwe: A cross‐sectional study

“…This is made possible through voluntary or paid blood donation. 1 Consequently, the health and well‐being of blood donors are of paramount importance in transfusion medicine. Blood donor retention saves blood services institutions time and resources.…”

“… 1 Efforts to retain donors and get adequate blood for transfusion purposes are hampered by donor deferrals for various reasons: low hemoglobin being the major reason worldwide. 1 Deferrals have cost and health care implications to blood services and a negative effect on the donors to give blood in the future. 1 For this reason, blood services have a responsibility to protect blood donors against developing anemia.…”

“… 1 Deferrals have cost and health care implications to blood services and a negative effect on the donors to give blood in the future. 1 For this reason, blood services have a responsibility to protect blood donors against developing anemia. 2 …”