Iron Replacement in Blood Donors

Iron is an essential element that is lost with each blood donation. In order for a donor to compensate for the iron lost in donating blood, iron is mobilized from the body's iron stores and absorption of iron from the diet is increased. However, this balance is often difficult to maintain in premenopausal women and regular blood donors since there is ongoing blood loss. Deficiency in iron results in reduced hemoglobin values, iron stores, and eventually iron deficiency anemia if not treated. Iron deficiency presents a problem in blood centers since the minimum allowable hemoglobin for blood donation is 12.5 g per dL. In the Department of Transfusion Medicine at the NIH, 14.6% of donors presenting for whole blood donation and 7.7% of donors presenting for apheresis platelet donation are deferred on at least one occasion per year due to low hemoglobin values. Overall, 7.9% of visits for whole blood donation and 2.1% of visits for apheresis platelet donation result in donor deferral due to low hemoglobin. Although the challenge of iron depletion in the blood donor population has been known for decades, little has been undertaken to resolve this issue. Several authors have reported data from successful short term projects demonstrating the safety and efficacy of iron replacement in donors, but larger long term studies have not been reported. The objectives of this protocol are to: (1) quantitate the prevalence of iron deficiency in first-time presumably healthy individuals who present for blood donation; (2) study the effects of long-term blood donation on donors' hemoglobin levels and iron stores; (3) evaluate the safety, practicality, and efficacy of distributing oral replacement iron to blood donors; (4) determine the effect of oral iron replacement therapy on the donor pool by monitoring deferral rates for low hemoglobin before and after the initiation of an iron replacement program. The goal of these objectives is to treat and prevent iron deficiency in prospective and regular blood donors, thereby expanding the eligible donor pool and leading to increased donor satisfaction and retention by decreasing deferral rates due to low hemoglobin.