Long-term course of haemoglobin and ferritin values in high-frequency donors of whole blood and double erythrocyte apheresis

Background: High-intensity donation is a risk factor for iron deficiency in blood donors. Interdonation intervals for whole blood (WB) donation and double unit red blood cell apheresis (2RBC) vary among countries. We retrospectively evaluated the course of haemoglobin (Hb) and ferritin values in men regularly donating WB 4 times a year or 2RBC twice a year (i.e., maximal frequency) over a period of 48 months. Methods: Data of male donors with 16 WB or 8 2RBC consecutive donations were analysed. The minimum Hb levels for WB donation and 2RBC apheresis (collection of 360 mL RBC) were 135 and 140 g/L, respectively. There was no lower limit set for ferritin, and no iron was substituted. Results: We identified 294 WB (mean age 53 years, SD 11) and 151 2RBC donors (mean age 48 years, SD 9) who donated at a mean interval of 97 (SD 18) and 201 days (SD 32), respectively, between January 1, 2008, and December 31, 2013. At baseline, Hb and ferritin values were lower in WB donors compared to 2RBC donors, with a mean Hb of 153 g/L (SD 13) versus 159 g/L (SD 8) and a mean ferritin of 44 μg/L (SD 52) versus 73 μg/L (SD 56; p < 0.001 for both parameters), respectively. Ferritin was below 15 μg/L in 40 WB (14%) and in 4 (3%) 2RBC donors. In WB donors, the mean Hb levels at baseline versus last donation showed no significant difference (153 vs. 152g/L, p = 0.068), whereas the mean ferritin levels decreased significantly (44 vs. 35 μg/L, p < 0.001). The 2RBC donor group displayed a statistically different decrease in both the mean Hb levels (158 vs. 157 g/L; p < 0.05) and the mean ferritin levels (73 vs. 66 μg/L; p = 0.052). The lowest Hb was measured at the 11th WB donation (152 g/L; p < 0.05) and at the 4th 2RBC apheresis (157 g/L; p < 0.05). There was no deferral due to low Hb at any time. The lowest ferritin was shown at the 4th WB (37 μg/L) and at the 3rd 2RBC donation (60 μg/L), respectively. At the last visit, ferritin was below 15 μg/L in 23 WB donors (8%) and in 2 2RBC donors (1%). Conclusions: High-intensity male donors with an interdonation interval of 12 weeks for WB donation and 24 weeks for 2RBC apheresis maintain acceptable Hb levels and, after an initial decline,stable ferritin levels despite ongoing blood donation

Long-term course of hemoglobin and ferritin values in high-frequency blood donors donating whole blood or double erythrocyte apheresis

Background: Serum ferritin (SF) measurements in whole blood (WB) donors demonstrated that female sex and intensity of donation are major risk factors for iron deficiency. Approximately 200 mL red blood cells (RBC) and 200–240 mg iron are lost with WB donation. Double unit RBC (2RBC) collections of 360 mL (ca. 40 mL less than the RBC amount of two WB donations) lead to a loss of about 400 mg iron. In Switzerland, the maximal allowed donation frequency for male donors is once every 6 months for 2RBC and once every 3 months for WB donation. Aims: To describe and compare the course of hemoglobin (Hb) and SF in male subjects donating WB and 2RBC at our institution. Methods: We included 294 WB and 151 2RBC donors (n = 445) who donated with the maximal allowed donation frequency over 48 months between 2008 and 2013, yielding 4,704 WB and 1,208 2RBC donations. We excluded subjects with hyperferritinemia and known HFE mutations. Hb limits were 135 g/L for WB and 140 g/L for 2RBC donation. With 2RBC apheresis 360 mL RBC were collected. SF was measured on a predonation serum sample; Hb was determined from finger prick samples. The donors received no iron substitution. We used generalized estimating equation models for Hb and SF trajectories. Results: Mean age at the first blood donation was 53 (WB) and 48 years (2RBC), respectively. At the first donation, mean Hb was 153 g/L (SD 13) in WB and 159 g/L (SD 8) in 2RBC donors; mean SF was 44 (SD 52) and 73 lg/L (SD 56), respectively. On average, Hb and SF were higher in 2RBC donors (5.1 g/L and 26 lg/L, respectively; P 30 lg/L) and 40, respectively. In 2RBC donors, between the first and the last donation, mean Hb declined from 159 g/L to 157 g/L (P < 0.05) and mean SF from 73 lg/L to 66 lg/L (ns). In WB donors, mean Hb dropped from 153 g/L to 152 g/L (P < 0.05) and SF from 44 lg/L to 35 lg/L (P < 0.001). Similar results were found when adjusting for age and season. Hb values dropped from baseline until the 11th donation for WB donors and until the 4th donation for 2RBC donors with an upward trend thereafter. In both groups, no Hb value below the limits of blood donation and no anemia were observed. SF reached a nadir at the 4th donation in both WB and 2RBC donors (37 lg/L and 60 lg/L) and increased thereafter in 2RBC donors. In WB donors, SF followed a parabolic trend that peaked at the 10th donation, and then declined until the last donation. Summary/Conclusions: The maximal allowed blood donation frequency for WB and 2RBC male donors in Switzerland is not only protective for the development of anemia, but also for deferral of blood donors because of low Hb. This was observed even in subjects with low SF at baseline

Adverse events and retention of donors of double red cell units by apheresis

Safety of double-erythrocyte (2RBC) collection and reasons for ceasing 2RBC donation were retrospectively analysed in the blood donor population of Basel, Switzerland.; Donors with at least 1 2RBC apheresis were included in the study. Minimal requirements were Hb ≥140 g/L and body weight ≥70 kg; serum ferritin (SF) values were measured routinely, but were not part of the selection criteria. 2RBC collections were performed with ALYX devices at 6-month intervals. Adverse events (AEs) were systematically recorded and classified according to the ISBT EHN 2008 criteria. Data of procedures were retrieved from the ALYX software. Demographics, apheresis data and AEs were analysed with descriptive statistics.; Data of 4,377 2RBC aphereses performed in 793 donors (779 males) between 1(st) January 2003 and 31(st) May 2015 were evaluated. Mean donor age at first 2RBC donation was 44 years (standard deviation [SD] 21), median number of donations was 4 (interquartile range [IQR] 8); 32% of the donors underwent a single procedure. There were 161 AEs, mostly local haematomas (55%) and vasovagal reactions (20%); fatigue was reported in 6% of the cases and was more frequent than citrate toxicity. Two severe AEs were observed. The most frequent reasons for abandoning 2RBC donation were low SF levels and donor choice (both 11%), but most donors simply did not reply to invitations (16%). Overall, procedure-related causes (AEs, low SF levels, no time for apheresis, inadequate venous access) were observed in 14% of the cases. At the end of the observation period, 40% of the donors were still active blood donors, but only 20% were donating 2RBC.; 2RBC donation is overall safe. Donor retention was low over a period of 11 years. An important reason for abandoning 2RBC was the detection of low SF levels. The impact of fatigue on donor retention and the course of iron stores after repeated 6-monthly 2RBC apheresis require further investigation