Among blood donors with normal hemoglobin levels, low-dose oral iron supplementation, compared with no supplementation, reduced the time to recovery of the post-donation decrease in hemoglobin.

Hemoglobin level and iron status are getting renewed attention as a donor safety issue based on increasing evidence that iron depletion is associated with fatigue, decreased exercise capacity and neurocognitive changes.

Scientists at the Institute for Transfusion Medicine (Pittsburgh, PA, USA) and their colleagues from other institutions randomly assigned 215 eligible study participants, who had not donated whole blood or red blood cells within four months to receive one tablet of ferrous gluconate daily or no iron for 24 weeks after donating a 500 mL unit of whole blood. The study was conducted at four regional blood centers in the USA.

Ferritin and soluble transferrin receptor (sTfR), were measured with the ADVIA Centaur (Siemens Healthcare Diagnostics, Deerfield, IL, USA) and a complete blood cell count (CBC) done in a pre-donation sample. Laboratory testing was performed on pre-donation EDTA blood samples collected from a sampling pouch in line with tubing used to collect the whole blood unit and then on blood samples provided on seven occasions: days 3 through 8 and at 2, 4, 8, 12, 16, and 24 weeks after donation.

The primary outcomes for the study were time to recovery of 80% of the post donation decrease in hemoglobin and recovery of ferritin level which is an indicator of the amount of total iron stored in the body. The investigators found that compared with participants who did not receive iron supplementation; those who did had shortened time to 80% hemoglobin recovery in both the low-ferritin with an average of 32 days versus 158 days, and higher-ferritin groups with an average of 31 days versus 78 days. Recovery of iron stores in all participants who received supplements took a median of 76 days; for participants not taking iron, median recovery time was longer than 168 days. Without iron supplements, 67% of participants did not recover iron stores by 168 days.

The authors concluded that although the absolute amount of hemoglobin decrease was relatively small and of marginal clinical consequence after a single blood donation, donating blood is an iterative process that leads to progressive iron loss and anemia in some frequent blood donors, so it is important that the hemoglobin decrease after blood donation be recovered before the next blood donation. Among blood donors with normal hemoglobin levels, low-dose iron supplementation, compared with no supplementation, reduced time to 80% recovery of the post donation decrease in hemoglobin concentration in donors with low ferritin (≤26 ng/mL) or higher ferritin (>26 ng/mL). The study was published on February 10, 2015, in the Journal of the American Medical Association.

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