Anaemia and iron deficiency in blood donors

Blood donation removes red cells and therefore iron. Donation is a known risk for developing iron deficiency.

Approximate iron loss by donation type

Maximum donation frequency
12 weekly
Volume whole blood loss, including samples (approximate)
500 mL
Iron loss (approximate)
220 mg
Maximum donation frequency
2 weekly
Volume whole blood loss, including samples (approximate)
80 mL
Iron loss (approximate)
35 mg
Maximum donation frequency
2 weekly
Volume whole blood loss, including samples (approximate)
40 mL
Iron loss (approximate)
18 mg
  • The iron loss associated with whole blood donation may represent up to almost 75% of a premenopausal female’s iron stores.
  • A plateletpheresis donor who donates every 2 weeks may almost equal the iron loss of a whole blood donor.
  • The introduction of saline replacement with plasmapheresis donation has resulted in minimal red blood cell loss in the lines, as the saline flushes these back to the donor. The 40mL loss is largely accounted for by samples.
  • Most iron-replete donors will have iron store recovery before their next donation. Those at particular risk of iron deficiency are young donors, premenopausal women and frequent donors.(1–3)
  • Poor oral iron intake or blood loss (eg, menstruation) may lead to inadequate iron replacement, culminating in iron deficiency long term.

More information about donation types can be found on donateblood.com.au.

References
  1. Simon TL, Garry PJ, Hooper EM. Iron stores in blood donors. JAMA 1981;245:2038–2043.
  2. Finch CA, Cook JD, Labbe RF, Culala M. Effect of blood donation on iron stores as evaluated by serum ferritin. Blood 1977;50:441–447.
  3. Cable RG, Glynn SA, Kiss JE, et al.: Iron deficiency in blood donors: the REDS-II donor Iron Status Evaluation (RISE) study. Transfusion 2012;52:702–711.

Donors with iron deficiency, with or without anaemia, should be medically assessed. If there is no other cause for iron deficiency the following interventions are possible:

  • Reduced donation frequency eg, annual donations for youth donors.
  • Transferring to plasmapheresis donation
  • Iron supplementation or 'replacement':
    • Studies of iron replacement in Australian donors are limited, however an eight-week course of 45 mg elemental iron (in the form of carbonyl iron) in premenopausal Australian donors, has been shown to be well-tolerated and effective in ameliorating iron loss due to blood donation.
    • A large study conducted in the US found a 60 day course of ferrous sulfate tablets well-tolerated and effective in increasing iron stores in blood donors.(1)

The Blood Service is conducting a study to determine the acceptability and operational feasibility of short and long-term iron replacement in female whole blood donors aged 18-45 years.

The Blood Service recommends that donors using post-donation iron replacement should do so in consultation with their general practitioner. As there is significant individual variability in iron requirements, monitoring of iron status is recommended to assess impact of replacement.

References
  1. Bryant BJ, Yau YY, Arceo SM, Daniel-Johnson J, Hopkins JA, Leitman SF. Iron replacement therapy in the routine management of blood donors. Transfusion 2012;52:1566–1575.

The Blood Service routinely screens each donor’s haemoglobin (Hb) level prior to every donation.

Acceptable Hb ranges

Whole blood
130–185
Apheresis
125–185
Whole blood
120–165
Apheresis
115–165

The Blood Service does not routinely screen for iron deficiency. It is therefore possible for a donor who meets the haemoglobin criteria to donate with depleted iron stores. See iron deficiency without anaemia.

Ferritin testing is performed in donors who have haemoglobin levels below the acceptable range for donation. Ferritin testing may also be performed if:

  • there is a >20 g/L drop in haemoglobin between successive donations or
  • annual full blood count testing of apheresis donors suggests iron deficiency.

The Blood Service reference ranges for ferritin are the same as the Royal College of Pathologists of Australasia (RCPA) adult ferritin reference range:

  • Male 30–300 μg/L
  • Female 15–200 μg/L

In an anaemic adult, ferritin <15 μg/L is diagnostic of iron deficiency for both males and females. Levels of 15-30 μg/L are highly suggestive. Iron deficiency may still be present with ferritin levels up to 100 μg/L as ferritin is an acute phase protein and may be elevated with co-existent illness.

The Blood Service manages donors with low haemoglobin and/or ferritin according to the following algorithm:

 
Haemoglobin Ferritin Action
Low or Normal Low

Deferred for 6 months

Referred to GP

Low Normal or High Referred to GP for investigation and management
Deferred until investigation and management complete
Underlying cause may impact on future eligibility

The Blood Service does not investigate or treat donors.

The assessment of blood donors with iron deficiency anaemia is not significantly different to that of the general population. It will depend on their age and gender, the likely contribution of blood donation to the iron deficiency, other potential causes, and the likelihood of underlying pathology.

These points should be taken into consideration:

  • a single blood donation in an at-risk individual can result in iron deficiency anaemia, however many donors are able to successfully donate on a regular basis without developing anaemia
  • causes of iron deficiency are often multifactorial
  • the Gastroenterological Society of Australia (GESA) cautions that even when an obvious cause of iron deficiency exists, the possibility of serious underlying cause must also be considered(1)
  • treatment of the iron deficiency and determination of the underlying cause should occur concurrently.
Reference
  1. Gastroenterological Society of Australia. Clinical update: Iron deficiency, First Edition. Sydney, Australia, Digestive Health Foundation, 2008. Available from: http://www.gesa.org.au.

 

 

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