A screening haemoglobin (Hb) test is performed using a point of care device prior to every donation. In most centres we use a capillary sample. If the result is outside our acceptable range, we then test on a venous sample. In some centres the test is performed on a venous sample in the first instance.
Table 1: Lifeblood acceptable haemoglobin ranges for donation
| Female | Male | |
|---|---|---|
| Whole blood | 120–165 g/L | 130–185 g/L |
| Apheresis | 115–165 g/L | 125–185 g/L |
| Hb range | |
|---|---|
Female <115 g/L Male <125 g/L | Donor is advised to see GP and deferred from all donation types for 6 months. Lifeblood does not conduct any further tests in this situation. Note: If the Hb is less than 100 g/L a Lifeblood Medical Officer speaks with the donor by phone whilst they are in the donor centre, to assess and discuss the urgency of making an appointment with their GP. |
| Female 115-119 g/L Male 125-129 g/L | Ferritin testing is performed if the donor attends to donate whole blood. The ferritin result is sent by post to the donor within 2 weeks of attendance. |
| Female >165 g/L Male >185 g/L | Donor is advised to see their GP and is deferred until cleared by their GP (via our Donor Safey Assessment Form). Note: If the Hb is ≥ 200 g/L a Lifeblood Medical Officer speaks with the donor by phone whilst they are in the donor centre, to assess and discuss the urgency of making an appointment with their GP. |
The screening haemoglobin is not a good predictor of iron deficiency in blood donors. Lifeblood research has shown that most donors presenting to donate who have iron deficiency, meet the Hb criteria to donate.1
The approximate iron loss associated with each type of donation is shown in Table 2. A donor’s ability to replenish iron stores (and therefore Hb) will depend on multiple factors including diet, menstrual loss, medical history, donation intervals, and use of iron supplements. Donors most at risk of iron deficiency are younger donors, female donors and frequent whole blood donors.1
Table 2: Donation intervals and iron loss by donation type
| Whole blood | Plasmapheresis | Plateletpheresis | |
|---|---|---|---|
| Minimum donation interval^ | 12 weeks | 2 weeks | 2 weeks |
| Iron loss | 250 mg | 10 mg | 48 mg |
^The minimum donation interval applies to donations of the same type. There are specific intervals between different donation types.
Current indications:
If a ferritin is indicated and the donor is donating on the day, the samples are collected at the beginning of the donation. Ferritin analysis is conducted in a Lifeblood laboratory. Lifeblood does not offer point of care ferritin testing.
All donors with a result outside of our reference range are referred to their GP. Donors will receive a notification letter by post within two weeks of the test with a recommendation to see their doctor. The letter will also explain if their result impacts their eligibility to donate blood.
Table 3: Lifeblood reference intervals for ferritin
| Female | 15-400 ug/L |
| Male | 30-500 ug/L |
Eligibility to donate depends on if the test was performed by Lifeblood or ordered by their doctor.
Table 4: Eligibility to donate based on Lifeblood ferritin result.
| Whole blood eligibility | Plasma/platelets eligibility | |
|---|---|---|
| Low ferritin <15 ug/L females <30 ug/L for males | Deferred for 6 months | * |
| High ferritin but <1000 | * | * |
| High ferritin >1000^ | Deferred until cleared by GP | Deferred until cleared by GP |
* Donors must still meet the Hb criteria at each attendance to be eligible to donate.
^If no significant pathology is identified, donors can return as a volunteer donor, or if haemochromatosis has been identified, as a therapeutic donor. Refer High ferritin | Lifeblood
Table 5: Eligibility to donate based on external ferritin result
Eligibility for whole blood and plasma/platelets | |
|---|---|
| Low ferritin | Deferred for 6 months |
| High ferritin | Deferred until cleared by GP |
Table 6: Prevalence (%) of iron deficiency in whole blood donors
Number of whole blood donations in previous 12 months | ||||||
|---|---|---|---|---|---|---|
| Age | New donor | 1 | 2 | 3 | 4 | |
| Females (Ferritin <15 ug/L) | 18-45 | 5.35% | 22.1% | 37.8% | 36.7% | 26.7% |
| 46+ | 0.74% | 8.7% | 21.7% | 28.1% | 27.1% | |
| Males (Ferritin <30 ug/L) | 18-45 | 2.32% | 13.6% | 21.1% | 41.3% | 42.9% |
| 46+ | 1.27% | 15.1% | 29.4% | 42.4% | 46.0% | |
New donor data is from 2023/24 and repeat donor data is from the 2012 Lifeblood Iron Deficiency Study
Donors with a high ferritin who are subsequently diagnosed with Hereditary Haemochromatosis may donate as a therapeutic donor if they meet our eligibility criteria. Refer High ferritin | Lifeblood.
Donors with a high ferritin who are investigated and found to have no significant underlying pathology can return as volunteer donors. Refer High ferritin | Lifeblood.
References:
1. Salvin, H.E., Pasricha, S.-R., Marks, D.C. and Speedy, J. (2014), Iron Stores in Blood Donors. Transfusion, 54: 2434-2444. https://doi.org/10.1111/trf.12647
2. Gastroenterological Society of Australia. Clinical Update for General Practitioners and Physicians. Iron Deficiency. Updated 2022. [Accessed 2/10/2024]. Available at: Clinical Practice Resources (gesa.org.au)