“Just let me check your iron,” the nice phlebotomist says to the prospective blood donor as she reaches to do the fingerstick. If only!!
We do not in fact check anyone’s iron level; we check hemoglobin. While iron is necessary to produce hemoglobin, there is no direct relationship between the two. Even donors meeting our hemoglobin standard will, especially with repeated donation, have reduced iron stores. Low iron stores have been associated with fatigue, mental changes, and decreased exercise capacity. Last week, the Newsletter highlighted the Hemoglobin and Iron Recovery Study (HEIRS), which provided direct evidence that giving donors iron pills can reduce the time until hemoglobin level and iron stores are replaced. Should blood centers act on this and give our donors iron?
It would be helpful if we could measure iron at the point of donation to exclude donors who have acceptable hemoglobin but low iron stores. However, there is no available method for use in the donor room. We can collect samples for later testing and counseling, but few centers take this resource-intensive approach. Given the lack of technology to directly address the iron problem, other options can be considered.
AABB recommended adding more details about iron to our donor information materials, which most of us have done. However, the message is challenging. Participants in an evaluation of donor educational materials, sponsored by the Foundation for America’s Blood Centers, found information about iron confusing. If implementing iron supplementation, we would need to be extremely clear that donorsshouldtake a given type of iron at a given dose. But how many would do so?
The study shows that changing the interval between donations to ensure that donors maintain their iron stores without iron replacement would require a very long interval. Further, such a change would threaten blood availability, especially for type O negative. Raising the hemoglobin requirement would eliminate some with low iron stores, but would not address the iron replacement problem. Can we advise donors to eat better? Simply, no. No ordinary diet provides enough iron.
Among blood bankers, there seem to be two distinct philosophical views. One dictates that we are taking away a given amount of iron with each donation, and it is our “obligation” to replace it for donors. Another view holds that we should not try to turn our altruistic donors into hemoglobin factories for our own convenience. It seems clear that what we are doing now is not quite in the best interest of donors. It will take an iron will to find the right path forward.
Susan Rossmann, MD, PhD, Board President-elect; firstname.lastname@example.org