Iron depletion in high-school age RBC donors

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Prevalence of low ferritin (<12 ng/mL) in teenage (16 to 18 year olds) first time blood donors was 1% in males & 18% in females; and 8% in males & 33% in females with previous donations. Adjusted odds for low ferritin was 2.1 to 2.8 times greater in teenagers than in adults (19 to 49 year olds). Progression to hemoglobin deferral was 2 times as likely in teenagers than adults. Being a high school-age blood donor is an independent risk factor for iron deficiency at any blood donation interval. However, the link between low iron and neurocognitive or physiologic impairment has not been definitively established and is not discussed in this manuscript.
Time to detection: 
Not applicable
Alerting signals, symptoms, evidence of occurrence: 
Low hemoglobin (<12.5 g/dL females, < 13 g/dL males) is considered to have poor sensitivity to detect nonanemic iron deficiency. Ferritin testing was performed on the date of donation, and a letter with the test results was sent to each participating donor. Low iron stores were defined as ferritin < 26 ng/mL; adequate as ferritin 26-550 ng/mL; and high as ferritin > 550 ng/mL for both genders.
Demonstration of imputability or root cause: 
The increased risk for iron depletion in high school-age RBC donors has been firmly established in this manuscript. However, the risk of harm or sequelae of low iron and ferritin is not discussed or definitively established.
Imputability grade: 
Not Assessable
Groups audience: 
Suggest new keywords: 
iron depletion
low ferritin
high-school blood donors
Reference attachment: 
Suggest references: 
Spencer BR, et al. Elevated risk for iron depletion in high‐school age blood donors. Transfusion. 2019 Jan 11. doi: 10.1111/trf.15133. [Epub ahead of print]
Expert comments for publication: 
The effect of iron deficiency and nonanemic iron deficiency on cognitive and physiologic function in teenagers is possible and suspected, but causation has not been firmly established.