Optimizing donor health

A descriptive cross-sectional study was conducted at the University Hospital, General Sir John Kotelawala Defence University, Sri Lanka from September 2023 to April 2024. Two hundred first-time donors and frequent donors, who have donated at least once during the last two years were randomly selected. All donors passed the copper sulphate screening of haemoglobin. Basic demographic information, previous donation details, knowledge about iron depletion through donation and intake of regular iron supplements were obtained. Detailed dietary intake was analysed through a food frequency questionnaire and dietary iron intake was calculated. Height and weight were measured and Body Mass Index (BMI) was calculated; arm and waist circumferences were also obtained for anthropometric assessment.

Blood samples were collected for complete blood count and serum ferritin assessment. Haemoglobin (Hb) level, red cell indices such as mean red cell volume (MCV), mean red cell haemoglobin (MCH), mean cell haemoglobin concentration (MCHC), red cell distribution width (RDW), and serum ferritin were analysed in the first-time donors’ group (as the control group) and frequent blood donor group. After one year, a follow up study on same parameters will be conducted in the same donor groups to observe the changes with the blood donation.

Of the study group, overweight and obesity were more prevalent in frequent blood donors than in first time donors. The dietary analysis revealed that dhal and other pulses were the primary sources meeting daily iron requirements, followed by fish and other seafood. Although the donors’ daily iron intake was higher than the recommended daily allowance, the iron source mainly consisted of plant-based legumes such as lentils, which are considered to have a low bioavailability of iron. Over 90% of donors did not take iron supplements, and more than 75% were unaware that regular blood donation depletes iron stores.

The mean haemoglobin levels were slightly lower than 12.5 g/dl in female donors. Further, serum ferritin was below 15 ng/ml in about one fifth (22%) of the female donors and a small proportion (2%) of males. A decrease in the Hb and serum ferritin of donors with the number of donations was observed. In a small number of donors, iron-deficient erythropoiesis was evident, with normal haemoglobin levels masking reduced iron stores.

Haemoglobin levels do not necessarily reflect body iron levels. Increasing iron deficiency due to the regular donation lead to direct and indirect effects on the blood supply and blood services. Increasing donor deferral and discontinuation of regularity of blood donation disturb the blood stock management. Different blood services adopt various strategies to mitigate iron deficiency among regular donors.

1. Extending inter-donation interval and recommendation of maximum number of annual donations. Although after 8 weeks of donation physiological recovery happens, 3 months – 4 months delay of the next donation or ferritin guided adjustment of inter donation intervals 2. Two different haemoglobin cut off values for males and females (WHO recommends 12g/dl for females and 13 g/dl for males) 3. Pre-donation iron screening programs 4. Iron supplementation program NBTS has adopted prolongation of the inter donation interval and absolute deferral of four months is practised for whole blood donations.

Certain European countries practice routine iron screening and supplementation programs for regular donors7. But, at present, there is no consensus on the required serum ferritin levels for regular blood donors or on the dose and frequency of iron supplementation or monitoring of iron levels in donors. Therefore, these findings underscore the clear and essential need for standardized guidelines on iron management in blood donors. The ISBT donor and donation working party is planning to compile a set of guidelines for regular blood donors’ iron management across the ISBT member countries in 2026.

Additionally, education programs on nutrition factors, healthy life style, monitoring of body iron and appropriate iron supplementation should be organized by the blood services in parallel to the blood donor motivation programs.