EFFECT OF FREQUENT BLOOD DONATIONS ON IRON STORES OF NON ANAEMIC MALE BLOOD DONORS
AbstractBackground: A healthy blood donor loses about 225 mg of iron per donation. This loss is made up very quickly by mobilizing the iron stores in form of ferritin, followed by replenishing the iron stores if diet is adequate. The situation, however, is different for donors with high frequency of blood donations. Their iron stores are under a constant pressure. In the absence of iron replacement this can lead to emptying of iron stores. We undertook this study to evaluate the effect of frequent blood donations on iron stores of regular male blood donors in Karachi. Methods: This study was carried out at Department of Physiology, BMSI, JPMC, Karachi. Our subjects were 8 groups each with 20 non-anaemic male donors, of 20–40 years age (total=160). The first group was ‘control group’ that comprised of first time donors, while the rest 7 groups comprised of donors who had donated 1–7 times in the last two years, the latest being at least 3 months back. The iron stores were measured by determining serum ferritin levels. Results: We found reduction in serum ferritin with increasing frequency of blood donations that became very significant in donors donating 4 or more times in the last two years. Finding of 40% and 50 % iron deficient subjects in the groups donating 6 and 7 times in two years respectively was a surprise for us, as this much high frequency has not been reported from elsewhere. We have tried to justify this extraordinary high frequency with the studies reporting low iron status of Pakistanis and Karachi population. Conclusions: Iron deficiency is very common in regular blood donors of Karachi, there is an immediate need to educate the donors about iron supplementation and yearly ferritin checking of so called ‘super donors’
Where to Donate/Receive Blood. American Association of Blood banks. (Monograph online). Available at URL: http://www.aabb.org/Locator/Locator.asp
Ali AM, McAvoy AT, Ali MA, Goldsmith CH, Blajchman MA. An approach to determine objectively minimum hemoglobin standards for blood donors. Transfusion 1985;25(3):286-288.
Ranney HM, Rapaport SI. The red blood cell. In: Best and Taylor’s Physiological basis of Medical practice. 12th ed., Baltimore: Williams & Wilkins; 1991. p.369-384
Huestis DW, Busch S. Selection of blood donors. In: Practical blood transfusion. 2nd ed. Boston: Little Brown and company; 1976. p.7-48.
Hewitt PE, Wagstaff W. ABC of transfusion. Br Med J 1989; 299: 1391-1394.
Simon TL, Garry PJ, Hooper EM. Iron stores in blood donors. JAMA 1981; 245: 2038-2043.
Hermosa V, Pastor JM, Muruzabal MJ, Ruiz-Tagle MA, Zuizarreta A. Iron deficiency in female blood donors. Sangre Barc 1990 ;35(5): 353-356.
Jacobs A, Kaltwasser JP, Crosby WH, Conrad ME, Nusbacher J. In International forum: The Hippocratian principle of ‘Primum nil nocere’ demands that the metabolic state of a donor should be normalized prior to subsequent donation of blood or plasma. How much blood, relative to his body weight, can a donor give over a certain period, without a continous deviation of iron metabolism in the direction of iron deficiency. Vox Sang 1981; 41(5-6): 336-343.
Roskams AJ, Connors JR. Iron, transferrin and ferritin in the rat brain during development and aging. J Neurochem 1994; 63(2): 709-716.
Finch CA, Huebers H. Perspective in iron metabolism. New Eng J Med 1982; 306: 1520-1528.
Milman N. Serum ferritin in Danes: studies of iron status from infancy to old age, during blood donation and pregnancy. Int J Hematol 1996; 63 (2): 103-135.
Lipschitz DA, Cook JD, Finch CA. A clinical evaluation of serum ferritin. New Eng J Med 1974; 290: 1213-1216.
Cook JD, Lipstchitz DA, Miles LEM, Finch CA. Serum ferritin as a measure of iron stores in normal subjects. Am J Clin Nutr 1974; 26: 681-686.
Jawad F. Iron in the human body. J Pak Med Assoc 1984; 34: 332-334.
Molla A, Khurshid M, Molla AM. Prevalence of iron deficiency anemia in children of the urban slums of Karachi. J Pak Med Assoc 1992; 42(5): 118-121.
Bridgen ML. Iron deficiency anemia. Every case is instructive. Postgrad Med 1993; 93(4): 181-182.
Siimes MA, Refino C, Dallman PR. Manifestation of iron deficiency at various levels of dietary intake. Am J clin Nutr 1980; 33: 570-574.
Massaro TF, widmayer P. the effect of iron deficiency on cognitive performance in the rat. Am J Clin Nutr 1981; 34: 864-870.
Webb TE, Oski FA. Behavioural status of young, adolescents with iron deficiency anaemia. J Spec Educ 1974; 8: 153-157.
Dillmann E, Gale C, Green W, Johnson DG, Mackler B, Finch C. Hypothermia in iron deficiency due to altered triiodothyronine metabolism. Am J Physiol 1980; 39: 377-381.
Skikne BS, Lynch S, Borek D, Cook J. Iron and blood donation. Clin Haematol 1984; 13: 271-287.
Agha F, Akhter P, Khan RA. Serum ferritin levels in apparently healthy subjects. J Pak Med Assoc 1987; 37: 63-66.
Zafar MN. Erythrocyte parameters using electronic hematology counter. J Pak Med Assoc 1989; 39: 118-119.
Brunvand L, Henriksen C, Larsson M, Sandberg AS. Iron Deficiency among pregnant Pakistanis in Norway and the content of phytic acid in their diet. Acta Obstet Gynnecol Scand 1995; 74(7) :520-525.
Ehrhardt P. Iron deficiency in young Bradford children from different ethnic groups. Br Med J 1986; 292: 90-93.
Mackintosh W, Jacobs P. Response in serum ferritin and haemoglobin to iron therapy in blood donors. Am J Hematol 1988; 27(1): 17-19.
Linpisarn S, Thanangkul O, Suwanraj C, Kaewvichit R, Kricka LJ, Whitehead TP. Iron deficiency in Northern Thai population: the effects of iron supplements studied by means of plasma ferritin estimations. Ann Clin Biochem 1984; 21(Pt4): 268-274.
Morse EE, Cable R, Pisciotto P, Kakaiya R, Kiraly T. Evaluation of iron status in women identified by copper sulphate screening as ineligible to donate blood. Transfusion 1987; 27(3): 238-241.
Guillemin C, Vigneron C, Streiff F. Serum and erythrocyte ferritin in regular blood donors. Nouv Rev Fr Hematol 1992; 34(3): 259-262.
Halvorsen R, Flesland O, Solheim BG, Borch-Iohnsen B, Leivestad T. Iron status in blood donors evaluated by serum ferritin. Tidsskr Nor Laegeforen 1990; 110(2): 189-191.
Milman N, Sondergaard M. iron stores in male blood donors evaluated by serum ferritin. Transfusion 1984; 24: 464-468.
Finch CA, Cook JD, Lobbe RF, Culala M. Effect of blood donation on iron stores as evaluated by serum ferritin. Blood 1977; 50: 441-447.
Monsen ER, Critchlow CW, Finch CA, Donhue DM. Iron balance in super donors. Transfusion 1983; 23: 221-225.
Alvarez-Ossario L, Kirchner H, Kluter H, Schleuke P. Low ferritin levels indicate the need for iron supplementation: strategy to minimize iron depletion in regular blood donors. Transfus Med 2001; 11(1): 59-60.
Concado RD, Chiattone CS, Alonso FF, Langhi DM Jr, Alves RD. Iron deficiency in blood donors. Sao Paulo Med J 2001; 119(4): 132-134.