Iron depletion by whole‐blood donation harms menstruating females: The current whole‐blood‐collection paradigm needs to be changed

Abstract

ABBREVIATIONS: log(TfR/F) = mean log of the serum transferrin receptor factor/ferritin; sTfR = serum transferrin receptor. From the American Red Cross, Southeastern Michigan Region, Detroit, Michigan.Address reprint requests to: Bruce Newman, MD, American Red Cross, Southeastern Michigan Region-he collection of 450 or 500 mL of whole blood, plus an additional 30 to 50 mL for blood tests, results in 480 to 550 mL of blood loss per wholeblood donation. These losses leads to a 60-to 88-g loss of hemoglobin (Hb) per whole-blood donation in women, based on a Hb range of 12.5 to 16.0 g per dL, and 204 to 299 mg of iron loss, based on 3.4 mg of iron per gram of Hb. 1 This iron loss is 9 to 13 percent of the total body iron in an average woman (2300 mg), 2 and it is 66 to 97 percent of the total stored iron in an average menstruating woman (309 mg). 3 Therefore, whole-blood donation is an iron depletion event that causes significant iron loss in women.Menstruating women, even before blood donation, are at risk for iron depletion because of ongoing blood loss, recent pregnancies, and inadequate dietary iron. In Caucasian women, nonanemic iron deficiency is quantitatively defined as normal Hb concentration (≥12 g/dL), low ferritin (≤12 µg/L), and a second test that is consistent with iron deficiency. 4 Iron-deficiency anemia is defined as the same, except the Hb concentration is less than 12 g per dL. A number of studies have been performed, mainly on adult women, to determine the effect of iron-deficiency anemia or nonanemic iron deficiency on one's health. These studies have evaluated the effect of these two conditions on fatigue, 5-15 physical endurance and work capac-T ity, 16-28 restless leg syndrome, 29-37 adverse events related to pregnancy, 38-48 and cognitive changes. 12,13,14,15,[49][50][51][52][53][54][55][56] Many of these studies have shown harm from iron-deficiency anemia and nonanemic iron deficiency.The status of the current whole-blood-collection paradigm is to have a Hb cutoff that is slightly above the low end of normal in women and to not replace the iron that is lost during donation. This paradigm prevents severe anemia, but it does not prevent iron-deficiency anemia or nonanemic iron deficiency and their associated harms. A superior paradigm would be short-term iron replacement for menstruating women donors after successful wholeblood donation.The present commentary will review the topic of iron deficiency in women, iron deficiency induced by wholeblood donation, and the harmful effects of the present collection paradigm (no iron replacement) on female donor health. It will then review early and recent studies on the use of oral iron supplements to replace iron after whole-blood donation, discuss an iron-rich diet versus short-term oral iron supplements, review issues related to iron supplementation, and review the potential of iron supplementation coupled with slightly lower Hb acceptance standards for women to increase the whole-blood supply. IRON DEPLETION IN WOMENFortification of food with iron ha...

Study of Various Hematological Parameters and Iron Status among Voluntary Blood Donors

“…It has recently been recommended that short-term iron supplementation combined with adjustments of hemoglobin acceptance levels may reduce the rate of donor deferral for low hemoglobin. 15 The reason for iron deficiency in donors with repeated donations is that the iron demands increase with number of annual blood donations. Even though the absorption of nutritional iron among donors is much more efficient than non-donors, a donation frequency of 4-5 units per year cannot be compensated by iron absorption and results in an iron deficiency.…”

Female Gender Participation in the Blood Donation Process in Resource Poor Settings: Case study of Sokoto in North Western Nigeria

“…Among premenopausal female blood donors, 31.7% had depleted iron reserves and 3.3% iron deficiency anaemia [46]. Previous report indicates that whole blood donation can potentially harm menstruating females [47]. Other factors such as pregnancy and breastfeeding further restrict many women from donating blood in Sub-Saharan Africa.…”

Iron Supplements and Iron Status in Frequent Blood Donors

“…1,2,4,12 This study also showed the correlation between the frequently time of repeated donations every three months and hematological parameters and also the body iron stored. Because the blood loss that occurs during menstruation by females may affect the body iron, 13,14 only male donors were selected for studying. As only male donors were selected, the different ferritin and hematological parameters among the three groups were not dominant (normally iron depletion is mostly found in female rather than male donors).…”