Status:
Ready to upload
Record number:
1978
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Danish Blood Donor Study (DBDS) results indicate that gender, number of previous blood donations, time from last donation, and menopausal status are the strongest predictors of iron deficiency. Loss of iron from a single donation (400-450 mL) is roughly 200-250 mg. Among frequent US blood donors, 27.1% of women and 16.4% of men have iron deficiency (ferritin level < 12ng/dL). In comparison, among high frequency DBDS donors, 39% of premenopausal women, 22% of postmenopausal women, and 9% of men have iron deficiency (ferritin level < 15 ng/mL).
Time to detection:
Ferritin is considered to be a good and well-studied single marker of iron stores in blood donors. Generally, a ferritin level less than 15 ng/mL is indicative of iron deficiency. The DBDS authors point out that levels between 30 ng/mL and 100 ng/mL should be interpreted with caution, since ferritin levels can rise during infection/inflammation. DBDS found that time since last donation was one of the strongest predictors of iron stores, indicating that adjusting the inter-donation interval may be a feasible approach for the prevention of iron deficiency among blood donors (DBDS did not expand on this time frame).
DBDS began ferritin measurements and targeted iron supplementation for blood donors in 2012. Types of iron included 100 mg elemental iron (JernC) or if abdominal discomfort, 25 mg elemental iron (Ferrochel). First-time donors were offered 20 iron tablets at future donations for ferritin levels between 30-60 ng/mL, 60 tablets for ferritin level < 30 ng/mL, and medical examination/referral to general practitioner for ferritin levels below the acceptable level. This program led to the discovery of blood donors with early stages of cancer, which could be viewed, according to the authors, as an extended medical donor care.
Alerting signals, symptoms, evidence of occurrence:
Iron deficiency may affect the innate and specific immune systems through decreased neutrophil function and bactericidal activity, depression of T-lymphocyte function, thymic atrophy, and impaired natural killer cell activity. However, clinically relevant immunological outcome has not yet been determined. DBDS did not find any association between low or declining hemoglobin level and the risk of infection. The authors highlight that iron is an important element for bacteria and depriving invading bacteria of iron is part of the innate host defense, which may explain the lack of association between low hemoglobin levels and the risks of subsequent infections.
DBDS concludes that guided iron supplementation is an effective strategy for avoiding iron depletion.
Demonstration of imputability or root cause:
Blood donation is associated with the loss of iron during full blood donations. The exact loss of iron associated with donation of 450-500 mL whole blood is dependent on the hemoglobin concentration of the blood donor and has been estimated to be in the range of 200-250 mg.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Suggest new keywords:
donor
iron deficiency
iron supplementation
ferritin
Reference attachment:
Suggest references:
Iron deficiency among blood donors: experience from the Danish Blood Donor Study and from the Copenhagen ferritin monitoring scheme. Transfus Med. 2017 Oct 10
Note:
I listed "other" as the Adverse Occurrence Type, but I'm not sure if that is correct. Iron deficiency, is the "harm" that the authors are trying to correct. Also, the potential consequences of iron deficiency are not really included on the list of " donors harms".
Expert comments for publication:
This article provides a high-level overview of the Danish Blood Donor Study and discusses some of the causes and consequences of iron deficiency, as well as ways to detect and possibly manage iron deficiency. This study does not assess the potential harms of iron deficiency on blood donors. DBDS presents a guided iron supplementation program as an effective strategy to manage and ultimately avoid iron depletion in blood donors.