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Low-dose iron supplementation improves hemoglobin recovery after blood donation
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Low-dose iron supplementation reduced the time to hemoglobin recovery among blood donors with normal baseline hemoglobin levels, according to study results.
Researchers observed the benefits of low-dose iron supplementation in all donors regardless of ferritin levels.
Joseph E. Kiss, MD, medical director of hemapheresis and blood services at the Institute for Transfusion Medicine of the University of Pittsburgh, and colleagues evaluated data from 215 blood donors who had not donated whole blood or red blood cells in the previous 4 months. The participants were aged 18 to 79 years, and 24% were aged older than 60 years. The majority (63%) were female. All participants donated 500 mL of whole blood.
Researchers classified participants as having low or high ferritin levels at baseline. Among those with low ferritin, the mean levels were 15.3 ng/mL for women and 14.7 ng/mL for men. Among those with high ferritin, the mean levels were 52.2 ng/mL for women and 63.5 ng/mL for men.
Researchers assigned 111 participants — 51 with low ferritin and 60 with high ferritin — to receive 37.5 mg ferrous gluconate daily for 168 days after blood donation. The other 104 participants — 50 with low ferritin and 54 with high ferritin — received no iron supplementation.
Mean hemoglobin levels among participants with low baseline ferritin dropped from 13.4 g/dL at baseline to 12 g/dL after blood donation. Participants in the high-ferritin cohort had mean hemoglobin levels of 14.2 g/dL at baseline and 12.9 g/dL after blood donation.
Time to 80% hemoglobin recovery served as the study’s primary endpoint.
In the low-ferritin cohort, the time to 80% hemoglobin recovery was 32 days (interquartile range [IQR], 30-34) among participants who received iron supplementation and 158 days (IQR, 126-˃168) among those who did not.
In the high-ferritin cohort, iron supplementation also was associated with shorter time to 80% hemoglobin recovery (31 days [IQR, 29-33] vs. 78 days [IQR, 66-95]).
The time to recovery of baseline ferritin levels also was improved among participants who received iron supplementation in the low-ferritin (21 days vs. ˃168 days) and high-ferritin (107 days vs. ˃168 days) cohorts.
About two-thirds (67%) of participants who did not receive iron supplementation did not recover their iron stores by 168 days post-blood donation.
Three participants in the iron supplementation arm experienced gastrointestinal adverse events. Two participants discontinued study treatment due to constipation and abdominal discomfort.
“Although the absolute amount of hemoglobin decrease was relatively small and of marginal clinical consequence after a single blood donation, donating blood is an iterative process that leads to progressive iron loss and anemia in some frequent blood donors, so it is important that the hemoglobin decrease after blood donation be recovered before the next blood donation,” Kiss and colleagues wrote. – by Alexandra Todak
Disclosure: One researcher reports grant support and honoraria from Novo Nordisk and Siemens.
Perspective
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Ralph Green, MD, PhD
Blood supply in the United States is precariously dependent on the donor base, which consists of approximately 9.2 million individuals who, in the aggregate, donated about 15.7 million units of red blood cells in 2011. Some donors are casual; however, most are regular donors. Donors are allowed to donate 500 mL of blood every 8 weeks, but what places a limit on the frequency with which the dedicated cadre of regular donors can be bled is deferral, more often than not resulting from not meeting a minimum required hemoglobin standard. This is most commonly caused by intercurrent iron deficiency. The debt incurred through donation of a unit of packed red blood cells is 230 mg iron. That — on top of the daily obligatory iron loss from the body of 1 mg daily in men or 2 mg in menstruating women — takes time to redress.The finding reported by Cable and colleagues a few years ago that a large proportion of both female and male frequent blood donors have iron depletion was therefore unsurprising. The fairly obvious conclusions from that study were that reducing the frequency of blood donation was likely to reduce the prevalence of iron deficiency among blood donors. However, that solution might seriously imperil the blood supply. Implementing routine iron supplementation for blood donors would constitute an alternative and more desirable approach.
On the strength of that more prudent approach, Kiss and colleagues embarked on their recently reported study in which they convincingly demonstrated the efficacy of a once-daily iron supplement of 37.5 mg ferrous gluconate in hastening the time to attaining eligibility for the next blood donation. Disappointingly, a report by Waldvogel and colleagues — designed to ameliorate possible symptoms, such as fatigue, in frequent blood donors with iron deficiency after a blood donation — demonstrated no clinical benefit from iron supplementation.
Despite the promising step forward in bolstering the supply side of the blood product equation, long-term solutions for red cells and other blood products still remain a holy grail. The development of blood substitutes together with promising new agents — such as the activin receptor fusion proteins reported last year at the ASH Annual Meeting that can enhance production of healthier blood cells and thus lower the need for regular blood transfusions in patients with disorders like myelodysplastic syndrome and thalassemia — will offer other approaches to this perennial problem.
References:
Cable RG, et al. Transfusion. 2011; doi:0.1111/j.1537-2995.2010.02865.x.
Piga AG, et al. Abstract 53. Presented at: ASH Annual Meeting and Exposition; Dec. 6-9, 2014; San Francisco.
Waldvogel S, et al. BMC Med. 2012;doi:10.1186/1741-7015-10-8.
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