Anaemia and iron deficiency in blood donors

Blood donation removes red cells and therefore iron.

All types of donation can be a risk factor for developing iron deficiency.

Approximate iron loss by donation type

 

Whole blood

Maximum donation frequency Every 12 weeks
Volume whole blood loss, including samples (approximate) 500 mL
Iron loss (approximate) 220 mg

 

Plateletpheresis

Maximum donation frequency Every 2 weeks
Volume whole blood loss, including samples (approximate) 80 mL
Iron loss (approximate) 35 mg

 

Plasmapheresis

Maximum donation frequency Every 2 weeks
Volume whole blood loss, including samples (approximate) 40 mL
Iron loss (approximate) 18 mg

 

The iron loss associated with whole blood donation may represent up to almost 75% of a premenopausal female’s iron stores.

Previously, a plateletpheresis donor who donated every 2 weeks could lose almost as much iron as that of a whole blood donor. The introduction of saline replacement with plasmapheresis donation has resulted in minimal red blood cell loss in the lines, as the saline flushes these back into the donor. Approximately 40 mL of blood loss is largely accounted for by mandatory testing samples.

Some donors like young adults, premenopausal women and frequent donors are at a higher risk of iron deficiency. Poor oral intake or ongoing blood loss (e.g. menstruation) may contribute to inadequate iron replacement, culminating in iron deficiency over time.

More information about donation types can be found here and more information about Iron health and blood donation can be found here.

Reducing the risk of iron deficiency in blood donors

To reduce the risk of iron deficiency in blood donors, consider:

  • Reduced frequency of whole blood donation.
  • Iron supplementation:
    • As women between the ages of 18-45 years are more susceptible to low iron, Lifeblood is recommending these donors take a short course of iron following each whole blood donation. Find out more about our recommendation here.
    • Other donors are advised to discuss the use of iron supplements with their doctor.
  • Donating plasma or platelets rather than whole blood.

Donors with iron deficiency, with or without anaemia, should be medically assessed.

Lifeblood haemoglobin screening

Lifeblood routinely screens each donor’s haemoglobin (Hb) level prior to every donation.

 

Acceptable Hb ranges

Male donor Hb (g/L)

Whole blood 130–185
Apheresis 125–185

 

Female donor Hb (g/L)

Whole blood 120–165
Apheresis 115–165

Assessment of iron status in blood donors

Lifeblood does not routinely screen for iron deficiency. It’s therefore possible for a donor who meets the haemoglobin criteria to donate with depleted iron stores. See iron deficiency without anaemia.

Ferritin testing is performed in donors who have haemoglobin levels below the acceptable range for donation. Ferritin testing may also be performed if:

  • there is a >20 g/L drop in haemoglobin between successive donations, and
  • annual full blood count testing of apheresis donors suggests iron deficiency.

Lifeblood reference ranges for ferritin are:

  • Male 30–300 μg/L
  • Female 15–200 μg/L

Management of donors with low haemoglobin

Lifeblood manages donors with low haemoglobin and/or ferritin according to the following algorithm:

 

Management of donors with low haemoglobin

Haemoglobin Ferritin Action
Low or normal Low

Deferred for 6 months. 

Referred to GP.

Low Normal or high

Referred to GP for investigation and management.

Deferred until investigation and management complete.

Underlying cause may impact on future eligibility.

Lifeblood does not investigate or treat donors.

Assessment of blood donors with iron deficiency anaemia in the community

The assessment of blood donors with iron deficiency anaemia is not significantly different to that of the general population. It will depend on their age and gender, the likely contribution of blood donation to the iron deficiency, other potential causes, and the likelihood of underlying pathology.

These points should be taken into consideration:

  • A single blood donation in an at-risk individual can result in iron deficiency anaemia, however many donors are able to successfully donate on a regular basis without developing anaemia.
  • Causes of iron deficiency are often multifactorial.
  • The Gastroenterological Society of Australia (GESA) cautions that even when an obvious cause of iron deficiency exists, the possibility of serious underlying cause must also be considered.
  • Treatment of the iron deficiency and determination of the underlying cause should occur concurrently.