“Eat your green veggies! Have a steak every now and then, for goodness’ sake!” We’ve been telling blood donors things like that for decades, but what if this advice isn’t really all that helpful? Dr. Jed Gorlin shows us the recent, troubling news on iron and blood donors.
In recent years, several excellent studies have demonstrated pretty clearly that blood donors have limited iron stores, and that the process of blood donation impacts those stores pretty dramatically. This is particularly true in several very well-defined groups of donors, including: Frequent whole blood donors (males donating more than three times in a year, females more than twice per year), premenopausal females, and young donors (especially teenagers) of both sexes. In the United States, donors may give blood every 8 weeks (up to 5 or 6 times per year), and up until 2016, males and females had the same qualifying hemoglobin (12.5 g/dL, or 125 g/L) to determine their eligibility (NOTE: The U.S. threshold was adjusted upward to 13.0 g/dL for males in 2016). Many other countries are more restrictive, and the topic of iron status of our blood donors is a very “hot” one right now!
So What do we Do?
This is an extremely important discussion, as blood centers everywhere are struggling with decreased collections. It is tempting to depend on donors in certain “easy to collect” groups, and those include donors at high risk outlined above! So, what to do? Dr. Gorlin has been heavily involved in these discussions, and he brings a unique perspective to this interview. He describes the relevant studies (linked in the “Further Reading” section below), and walks us through the steps that blood collectors (and donors) should take right away.
Dr. Jed Gorlin received his BS from Stanford and his MD from Yale. He is board-certified in pediatrics and blood banking/transfusion medicine. He is Medical Director and Vice President, Quality and Regulatory Affairs of Memorial Blood Centers and Nebraska Community Blood Bank, both divisions of Innovative Blood Resources. Dr. Gorlin has served in various leadership roles with AABB through his more than 20 years in transfusion medicine, including chair of the Standards Committee for the 20th and 21st editions of AABB Standards, and as an AABB board member. He is a chapter contributor to 16 published books and anthologies, and author or co-author of over 40 abstracts.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Gorlin nor I have any financial disclosures relevant to this discussion.
The images below are generously provided by Dr. Gorlin.
References Mentioned During this Episode:
- RISE Enrollment Data: Cable RG, Glynn SA, Kiss JE, et al. Iron Deficiency in Blood Donors: Analysis of Enrollment Data from the REDS-II Donor Iron Status Evaluation (RISE) Study. Transfusion. 2011;51(3):511-522.
- RISE Results: Cable RG, Glynn SA, Kiss JE, et al. Iron Deficiency in Blood Donors: The REDS-II Donor Iron Status Evaluation (RISE) Study. Transfusion. 2012;52(4):702-711.
- Study Showing Diet Alone is Insufficient for Frequent Blood Donors: Rigas A, Sorensen C, Pedersen O, et al. Predictors of iron levels in 14,737 Danish blood donors: results from the Danish blood study. Transfusion 2014;54:789-96
- HEIRS: Kiss JE, Brambilla D, Glynn SA et al for the National Heart, Lung, and Blood Institute (NHLBI) Recipient Epidemiology and Donor Evaluation Study–III (REDS-III). Oral iron supplementation after blood donation: A randomized clinical trial. JAMA. 2015;313(6):575-583
- HEIRS Analysis of Effect: Cable RG, Brambilla D, Glynn SA et al for the National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study-III (REDS-III). Effect of iron supplementation on iron stores and total body iron after whole blood donation. Transfusion, 56: 2005–2012.
- STRIDE: Mast AE, Bialkowski W, Bryant BJ et al. A randomized, blinded, placebo-controlled trial of education and iron supplementation for mitigation of iron deficiency in regular blood donors. Transfusion 2016;56:1588–1597.
- FDA Blood Products Advisory Committee: Discussion of iron management in blood donors, from November 2016
- FDA Blood Products Advisory Committee: Discussion of iron deficiency in teenage donors from November 2016
- AABB: Summary of BPAC Meeting (includes preliminary data on CHILL results at end of “Topic II” discussion).
- AABB: Public statement on iron management in blood donors, May 2017