Iron Deficiency and Blood Donation: Links, Risks and Management

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.

Prevalence of Iron Deficiency, Anemia, and Associated Factors in a Blood Donor Population in Brazzaville, Congo

“…Tis prevention is based, on the one hand, on the postponement of donors whose Hb level is below a regulatory threshold and, on the other hand, on the prevention of iron defciency. Several measures can be used: the increase in the minimum interval between two total blood donations and/or the reduction in the maximum annual frequency of donations; the assay of serum ferritin measuring iron reserves and fnally donor iron supplementation [2,17,18,[20][21][22]. In France, after modeling diferent scenarios measuring the loss of donations, it was decided to opt for a ferritinemia strategy directed at groups at risk of iron defciency with postponement of 6 months if ferritinemia Anemia <15 ng/ml and spacing of donations if between 15 and 25 ng/ ml [17].…”

“…To prevent these risks and avoid inappropriate donations, a number of strategies are being implemented by some teams, including limiting the annual number of blood donations and predonation screening for iron defciency and anemia leading to deferral of blood donation below a certain threshold of eligibility for blood donation [2,5,6]. In Africa, its practice is not systematic, and several studies have shown that iron defciency and anemia in general are frequent and can afect, respectively, up to 63% and 36.5% of blood donors [7][8][9][10][11].…”

“…To reduce the infectious risk of transfusion, WHO recommends the use of voluntary but regular blood donors. Thus, they constitute a population at risk of iron deficiency and of anemia [ 1 , 2 ]. Blood donation results in a substantial loss of iron and a decrease of approximately 1 g/dL in hemoglobin (Hb) with each collection procedure, during which up to 425 to 475 ml of total blood is collected [ 3 , 4 ].…”

Effect of large volume red blood cell apheresis on cardiovascular functions in healthy donors

“…The advantages and cost‐effectiveness of RA have been discussed elsewhere, 7 the major concerns are fluid imbalance and iron depletion which could lead to serious donor reactions 8,9 . At present donating no more than two RBC units by single‐time apheresis seems to be safe and reasonable, 10 meanwhile, saline and iron supplement are recommended during apheresis in order to avoid aggravating iron deficiency 11,12 . The postdonation Hb and haematocrit (HCT) levels are inconsistent 13 due to different body weights and Hb levels, previous research showed the possibility of one‐time collecting more than two RBC units in autologous setting 14 .…”

“…8,9 At present donating no more than two RBC units by single-time apheresis seems to be safe and reasonable, 10 meanwhile, saline and iron supplement are recommended during apheresis in order to avoid aggravating iron deficiency. 11,12 The postdonation Hb and haematocrit (HCT) levels are inconsistent 13 due to different body weights and Hb levels, previous research showed the possibility of one-time collecting more than two RBC units in autologous setting. 14 Recently, we have proved the feasibility of donating large RBC volumes by apheresis at one single-time, 15 in this study, we aimed to investigate the impact of large volume RBC apheresis on the cardiovascular functions.…”