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Teenagers, women at higher risk for iron deficiency after blood donations
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SAN DIEGO — An iron-rich diet between blood donations may not be adequate to help ferritin levels recover and prevent iron deficiencies, particularly among female and teenage donors, according to a presentation at ASH Annual Meeting and Exposition.
Because testing for iron deficiency is not performed before blood donations, frequent blood donors — many of whom are teenagers who participate in high school blood drives — can experience iron deficiencies accompanied by serious adverse events, according to Alan E. Mast, MD, PhD, associate professor in the department of cell biology, neurobiology and anatomy at Medical College of Wisconsin.
“I think we as blood centers owe our best donors ferritin testing to let them know when they are and if they are iron deficient,” Mast said during his presentation.
The risk is higher for women than men. On average, men have 1 gram of iron in their systems, whereas women have about one-quarter of a gram because of loss that occurs during their menstrual cycle or pregnancy.
A recent study on blood donation — the Recipient Epidemiology Donor Study, or REDS-III — showed that the average 56-day runoff between giving blood is not nearly enough time to recover the amount of iron lost during donation, Mast said. Each blood donation removes about 200 mg to 250 mg of iron from the donor, and it takes about 90 days for iron levels to recover.
However, most blood centers only test donors’ hemoglobin levels, so many people who donate blood routinely come in with low ferritin levels.
This can be particularly concerning for teenagers because iron assists in the physical and cognitive growth process that many of them are still experiencing, Mast said. This is especially concerning given that the Red Cross reported that 14% of all blood received through donations in the U.S. comes from high school blood drives.
Further, repeat donations among teenagers are permitted after 56 days if their hemoglobin levels reach the same cutoff used for adults — or 12.5 g/dL for women and 13 g/dL for men — despite having greater iron needs among young adults.
Mast and colleagues conducted a randomized study of 698 frequent donors to determine how long it takes to restore ferritin levels after giving blood. They defined frequent donors as those who give blood an average of eight times every 2 years.
Researchers randomly patients into three groups: The first group received 38 mg of elemental iron daily for 60 days, the second group received 19 mg of elemental iron daily for 60 days, and the third group received placebo for 60 days.
Donors with a ferritin level greater than 26 mg/L after giving blood received a letter recommending that they continue to give blood, whereas donors with a ferritin level of 26 mg/L or less received a letter recommending they take an iron supplement or delay their next donation.
Results showed that there was no difference in ferritin level recovery time between the group that received 19 mg of elemental iron and the group that received 38 mg of elemental iron. Patients taking placebo continued to get more iron deficient as they gave blood.
Further, eating an “iron-rich” diet did not have an effect on ferritin recovery, despite guidelines at many blood donation centers recommending it.
“If we can get donors to [take 19 mg of elemental iron every day for 60 days after donation], I think it would solve most of the problems with iron deficiencies in blood donors,” Mast said. – by John DeRosier
Reference:
Mast A. Blood donation and iron deficiency. Presented at: ASH Annual Meeting and Exposition; Dec. 1-4; San Diego.
Disclosure: Mast reports research funding from Novo Nordisk.