ORIGINAL ARTICLE Iron deficiency in blood donors: a national cross-sectional study Hannah E. Salvin,1 Sant-Rayn Pasricha,1 Denese C. Marks,2 and Joanna Speedy1
BACKGROUND: Iron deficiency (ID) is an important consequence of blood donation. The epidemiology of this problem in the blood donor population was therefore studied to enable appropriate targeting of potential solutions to donor ID. STUDY DESIGN AND METHODS: A nationally representative, cluster-based cross-sectional study of Australian blood donors was performed. Donors were eligible for inclusion if they fulfilled criteria for blood donation or were deferred due to low or falling hemoglobin. Ferritin was measured and demographic and donation data were collected. RESULTS: A total of 3094 blood donors were recruited, of which samples were collected from 3049 donors; 1873 had exclusively donated whole blood (WB only), 242 had exclusively made apheresis donations, and 530 had not donated (“new” donors) in the previous 24 months. The prevalence of ID in new female donors was 12.0% compared with 1.3% in males. The prevalence of ID in female WB-only donors was 26.4%; it increased with donation frequency and decreased with age. The prevalence in male WB-only donors was 6.3% with no evident change with age or donation frequency. The prevalence of ID in apheresis-only donors (females 6.3%; males 2.2%) did not significantly exceed that of new donors nor did it change with donation frequency. Importantly, the risk of ID could not be satisfactorily predicted in an individual donor by his or her anemia status or with predictive modeling incorporating demographic and donation data. CONCLUSION: ID is especially prevalent in female, premenopausal, frequent WB donors. Strategies to combat ID should be implemented, specifically targeting this group.
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ron deficiency (ID) is an increasingly recognized consequence of blood donation. Each whole blood (WB) donation results in the loss of 200 to 250 mg of iron; mean body iron stores in adult US males and premenopausal women have been estimated as 752 and 297 mg, respectively.1 Progressive iron depletion can lead to iron-deficient erythropoiesis and, eventually, ID anemia.2 Blood donors with nonanemic ID making further donations are more likely to subsequently develop anemia.3 However, ID even in the absence of anemia may pose a significant health risk, potentially resulting in fatigue4 and impaired physical,5-8 work,9,10 and cognitive performance.11-14 ID has also been associated with adverse pregnancy outcomes including low birthweight, preterm delivery, and anemia and risk of transfusion at delivery.15 Finally, some,16,17 although not all,18 studies have reported associations between blood donation–induced ID and restless leg syndrome. Nonanemic ID is prevalent in blood donors, exceeding the background prevalence in the general population, especially in premenopausal females and frequent donors. For example, a US cross-sectional study identified ID (ferritin < 12 ng/mL) in 15% of donors, with a higher prevalence in female (19.1%) than male donors (10.7%).19 Frequent WB donors had a higher prevalence of ID (females, 27.1%; males, 16.4%) compared with first-time donors (females, 6.4%; males, 0%). A smaller Australian cross-sectional study in female premenopausal blood
ABBREVIATIONS: AUCROC = area under the receiver operating characteristic curve; ID = iron deficiency; WB = whole blood. From the 1Iron Taskforce and 2Research and Development, The Australian Red Cross Blood Service, Adelaide, SA, Australia. Address correspondence to: Joanna Speedy, Australian Red Cross Blood Service, Level 1, 301 Pirie Street, Adelaide, SA 5000, Australia; e-mail: [email protected]. This study was supported by a research grant from the Australian Red Cross Blood Service. Received for publication September 22, 2013; revision received February 3, 2014, and accepted February 3, 2014. doi: 10.1111/trf.12647 © 2014 The Australian Red Cross Blood Service. Transfusion © 2014 AABB TRANSFUSION **;**:**-**. Volume **, ** **
TRANSFUSION
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SALVIN ET AL.
donors found a similar prevalence of ID (22.6%) using a higher ferritin threshold (
BACKGROUND: Iron deficiency (ID) is an important consequence of blood donation. The epidemiology of this problem in the blood donor population was therefore studied to enable appropriate targeting of potential solutions to donor ID. STUDY DESIGN AND METHODS: A nationally representative, cluster-based cross-sectional study of Australian blood donors was performed. Donors were eligible for inclusion if they fulfilled criteria for blood donation or were deferred due to low or falling hemoglobin. Ferritin was measured and demographic and donation data were collected. RESULTS: A total of 3094 blood donors were recruited, of which samples were collected from 3049 donors; 1873 had exclusively donated whole blood (WB only), 242 had exclusively made apheresis donations, and 530 had not donated (“new” donors) in the previous 24 months. The prevalence of ID in new female donors was 12.0% compared with 1.3% in males. The prevalence of ID in female WB-only donors was 26.4%; it increased with donation frequency and decreased with age. The prevalence in male WB-only donors was 6.3% with no evident change with age or donation frequency. The prevalence of ID in apheresis-only donors (females 6.3%; males 2.2%) did not significantly exceed that of new donors nor did it change with donation frequency. Importantly, the risk of ID could not be satisfactorily predicted in an individual donor by his or her anemia status or with predictive modeling incorporating demographic and donation data. CONCLUSION: ID is especially prevalent in female, premenopausal, frequent WB donors. Strategies to combat ID should be implemented, specifically targeting this group.
I
ron deficiency (ID) is an increasingly recognized consequence of blood donation. Each whole blood (WB) donation results in the loss of 200 to 250 mg of iron; mean body iron stores in adult US males and premenopausal women have been estimated as 752 and 297 mg, respectively.1 Progressive iron depletion can lead to iron-deficient erythropoiesis and, eventually, ID anemia.2 Blood donors with nonanemic ID making further donations are more likely to subsequently develop anemia.3 However, ID even in the absence of anemia may pose a significant health risk, potentially resulting in fatigue4 and impaired physical,5-8 work,9,10 and cognitive performance.11-14 ID has also been associated with adverse pregnancy outcomes including low birthweight, preterm delivery, and anemia and risk of transfusion at delivery.15 Finally, some,16,17 although not all,18 studies have reported associations between blood donation–induced ID and restless leg syndrome. Nonanemic ID is prevalent in blood donors, exceeding the background prevalence in the general population, especially in premenopausal females and frequent donors. For example, a US cross-sectional study identified ID (ferritin < 12 ng/mL) in 15% of donors, with a higher prevalence in female (19.1%) than male donors (10.7%).19 Frequent WB donors had a higher prevalence of ID (females, 27.1%; males, 16.4%) compared with first-time donors (females, 6.4%; males, 0%). A smaller Australian cross-sectional study in female premenopausal blood
ABBREVIATIONS: AUCROC = area under the receiver operating characteristic curve; ID = iron deficiency; WB = whole blood. From the 1Iron Taskforce and 2Research and Development, The Australian Red Cross Blood Service, Adelaide, SA, Australia. Address correspondence to: Joanna Speedy, Australian Red Cross Blood Service, Level 1, 301 Pirie Street, Adelaide, SA 5000, Australia; e-mail: [email protected]. This study was supported by a research grant from the Australian Red Cross Blood Service. Received for publication September 22, 2013; revision received February 3, 2014, and accepted February 3, 2014. doi: 10.1111/trf.12647 © 2014 The Australian Red Cross Blood Service. Transfusion © 2014 AABB TRANSFUSION **;**:**-**. Volume **, ** **
TRANSFUSION
1
SALVIN ET AL.
donors found a similar prevalence of ID (22.6%) using a higher ferritin threshold (
