Low hemoglobin deferral in blood donors

Abstract

Low hemoglobin deferral occurs in about 10% of attempted whole blood donations and commonly is a consequence of iron deficiency anemia. Pre-menopausal women often have iron deficiency anemia caused by menstruation and pregnancy and have low hemoglobin deferral on their first donation attempt. Frequent donors also develop iron deficiency and iron deficiency anemia because blood donation removes a large amount of iron from the donor and the 56-day minimum inter-donation interval for donors in the United States is not sufficient for recovery of hemoglobin and iron stores. Other causes for low hemoglobin deferral range from a medically insignificant deferral of a woman with hemoglobin between 12.0 and 12.4 g/dL, which is within the normal reference range but below the 12.5 g/dL needed to donate blood, to anemia caused by an unrecognized malignancy in a “healthy” individual attempting to donate blood. The diverse causes of anemia in blood donors make it difficult to provide accurate information to donors about the cause of their low hemoglobin deferral and complicate implementation of programs to prevent them by blood collecting agencies. This article reviews how hemoglobin is measured and the demographics and causes of low hemoglobin deferral in blood donors. It provides recommendations for how blood collection agencies can provide donors with accurate information about the cause of their deferral and discusses programs that can be implemented to decrease these deferrals in regular donors.

The donation interval of 56 days requires extension to 180 days for whole blood donors to recover from changes in iron metabolism

“…2,3 This interval is based on studies from the 1940s and 1950s, investigating recovery of (only) Hb, 4,5 but more recently, it was reported to be too short to prevent ID. 6,7 Because Hb falls short as a marker for nonanemic ID, 8,9 and to prevent blood donors from developing ID, there is a need for additional insights into the kinetics of red cell indices and iron parameters over time after blood donation. This may prove useful to assess the optimal donation interval and to select the parameter that is most suited to define personalized intervals.…”

Variations in hemoglobin measurement and eligibility criteria across blood donation services are associated with differing low‐hemoglobin deferral rates: a BEST Collaborative study

“…A potential benefit of iron monitoring is to identify donors with a high risk for low‐Hb deferral at the next donation. An extensive literature review suggested that studies performed so far have shown partially predictive value of iron monitoring . Studies investigating red blood cell parameters, zinc protoporphyrin, soluble transferrin receptor, and ferritin have not proven to be able to fully predict at‐risk donors and their subsequent low‐Hb deferrals.…”

“…An extensive literature review suggested that studies performed so far have shown partially predictive value of iron monitoring. 18 Studies investigating red blood cell parameters, [19][20][21] zinc protoporphyrin, 22 soluble transferrin receptor, 23 and ferritin 20,24 have not proven to be able to fully predict at-risk donors and their subsequent low-Hb deferrals. Our data also did not demonstrate lower low-Hb deferral rates among blood donation services which implemented iron monitoring.…”

Retrospective analysis of capillary hemoglobin recovery in nearly 1 200 000 blood donor returns

“…4,5 Studies have suggested that a portion of blood donors may become iron depleted or deficient. [6][7][8][9][10][11] Depending on populations and policies, 5% to 8% of presenting blood donors are deferred because of too low a level of hemoglobin, and for example, in the United States, 35% of frequent blood donors were found to be iron deficient. 8 Adverse health effects have been linked to iron deficiency and anemia, though the significance of iron deficiency without anemia in otherwise healthy individuals is still unclear.…”