Iron deficiency among repeat blood donors does not affect quality of supply
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Iron-deficiency among frequent blood donors did not affect the quality of red blood cells for use in transfusions, according to results of a randomized, placebo-controlled study.
The findings, published in Blood, also revealed that volunteers who developed donation-induced iron deficiency did not experience lower quality of life or cognitive dysfunction.
“We are not harming these donors by drawing their blood, which is very comforting from a public health perspective,” Steven L. Spitalnik, MD, professor of pathology and cell biology and vice chairman of laboratory medicine at Columbia University’s Irving Medical Center, told Healio. “Although surprising, these results are very comforting for us to continue with business as usual.”
Background
Researchers have known for decades that the blood donation process left many donors iron deficient, according to Eldad A. Hod, MD, associate professor of pathology and cell biology at Irving Medical Center.
Additionally, much of the donated blood supply comes from a relatively small pool of typically repeat donors.
Hod’s group had concerns that use of blood from iron-depleted donors could affect the quality of the blood supplied as well as have a negative effect on the well-being of donors.
“We hypothesized that we would find some issues,” he told Healio. “Especially given that we had sone some previous animal studies suggesting that iron-deficient red blood cells don’t circulate as well.”
Methodology
The study included 79 frequent blood donors who were iron deficient (mean age, 34 years; interquartile range, 26-47; 68.4% women; 70.9% white) and had hematocrit levels meeting FDA donation criteria. Investigators defined iron deficiency as ferritin less than 15 g/L and zinc protoporphyrin greater than 60 Mol/mol heme.
Participants provided an initial blood donation for evaluation of red cell storage quality using a standard 51-chromium post-transfusion red blood cell recovery study. Within 30 days, investigators randomly assigned study donors in a 1:1 ratio to receive either IV iron repletion (1 g low-molecular-weight iron dextran; n = 39) or placebo (500 mL saline; n = 40).
Randomly selected participants provided another blood donation approximately 4 to 6 months later, followed by a second post-transfusion red blood cell recovery study.
Researchers administered quality-of-life surveys and assessments of cognitive function before both blood donations and after both post-transfusion recovery studies.
Within-subject change in post-transfusion recovery served as the study’s primary outcome measurement. Secondary outcomes included changes in quality-of-life self-assessments.
Hod and colleagues also reported primary outcomes of an ancillary study that assessed cognitive function using the National Institutes of Health Toolbox-derived uncorrected standard Cognition Fluid Composite Score.
Twenty-nine participants (74%) in the iron repletion group and 28 (70%) in the placebo group had both scheduled post-transfusion recovery studies completed for inclusion in the primary outcome analysis.
Key findings
Investigators reported a significant mean 1.4 g/dL (95% CI, 0.9-1.9) increase in hemoglobin levels in the iron repletion group compared with the placebo group from samples taken during the second donation.
Further analysis showed donated red blood cell units had a mean hemoglobin concentration of 18.7 g/dL (95% CI, 18.4-19.1) in the iron repletion group compared with 17.5 g/dL (95% CI, 17-18) in the placebo group.
Researchers observed no significant change in red cell storage quality after iron repletion, with a mean change in post-transfusion recovery among subjects randomized to iron repletion of 1.6% (95% CI, 0.5 to 3.8) compared with 0.4% (95% CI, 2 to 1.2) among those who received placebo. This resulted in a nonsignificant mean between-group difference of 2% (0.6 to 4.6).
Iron repletion had no effect on mean quality-of-life scores at any point during the study. Likewise, cognitive function assessments remained similar between the two groups throughout the study.
Clinical implications
Blood collection agencies should still feel free to recommend iron repletion to help prevent anemia and iron deficiency among donors, but the results of this study suggest no detrimental effects to donors or the supplied red blood cell units, Spitalnik said.
“We were pleasantly surprised to find no significant impact of iron depletion on the blood supply,” Hod told Healio. The results did show an approximate 5% decrease in red blood cell-circulating efficiency among premenopausal women who were iron deficient, he added.
“[These results are] good for the blood supply in that we don't have to change our current standard practice for blood donation,” Hod said.
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