Anaemia and iron deficiency in blood donors

A screening haemoglobin (Hb) test is performed using a point of care device prior to every donation. In most centres we use a capillary sample. If the result is outside our acceptable range, we then test on a venous sample. In some centres the test is performed on a venous sample in the first instance.

Table 1: Lifeblood acceptable haemoglobin ranges for donation

The screening haemoglobin is not a good predictor of iron deficiency in blood donors. Lifeblood research has shown that most donors presenting to donate who have iron deficiency, meet the Hb criteria to donate.¹

The approximate iron loss associated with each type of donation is shown in Table 2. A donor’s ability to replenish iron stores (and therefore Hb) will depend on multiple factors including diet, menstrual loss, medical history, donation intervals, and use of iron supplements. Donors most at risk of iron deficiency are younger donors, female donors and frequent whole blood donors.¹ 

Table 2: Donation intervals and iron loss by donation type 

^The minimum donation interval applies to donations of the same type. There are specific intervals between different donation types.

Current indications:

• First whole blood donation and every 10 donations thereafter (unless required earlier for an indication below).
• >20 g/L drop in Hb from the last visit, if the last visit was within 12 months.
• Hb 115-119 g/L for females and 125-129 g/L for males if presenting for whole blood donation.
• Full blood count finding suggestive of iron deficiency (FBC tested periodically in plasmapheresis donors and following each plateletpheresis collection).

If a ferritin is indicated and the donor is donating on the day, the samples are collected at the beginning of the donation. Ferritin analysis is conducted in a Lifeblood laboratory. Lifeblood does not offer point of care ferritin testing.

All donors with a result outside of our reference range are referred to their GP. Donors will receive a notification letter by post within two weeks of the test with a recommendation to see their doctor. The letter will also explain if their result impacts their eligibility to donate blood. 

Table 3: Lifeblood reference intervals for ferritin

Eligibility to donate depends on if the test was performed by Lifeblood or ordered by their doctor. 

Table 4: Eligibility to donate based on Lifeblood ferritin result.

	Whole blood eligibility	Plasma/platelets eligibility
Low ferritin <15 ug/L females <30 ug/L for males	Deferred for 6 months	Image *
High ferritin but <1000	Image *	Image *
High ferritin >1000^	Deferred until cleared by GP	Deferred until cleared by GP

* Donors must still meet the Hb criteria at each attendance to be eligible to donate.
^If no significant pathology is identified, donors can return as a volunteer donor, or if haemochromatosis has been identified, as a therapeutic donor. Refer High ferritin | Lifeblood

Table 5: Eligibility to donate based on external ferritin result

• Consider other causes of blood loss. The Gastroenterological Society of Australia (GESA) advises that even when an obvious cause of iron deficiency exists, the possibility of serious underlying cause must also be considered.²
• Consider the likely contribution of blood donation - ask about donation type and frequency and the use of iron supplements.
• The Lifeblood ferritin result reflects iron stores before the donation.
• A single blood donation in an at-risk person can result in iron deficiency or iron deficiency anaemia, or these states may develop after several donations depending on donation intervals and other donor factors.
• Prevalence rates for iron deficiency increase with whole blood donation frequency. Table 6 shows the prevalence of iron deficiency (based on Lifeblood reference ranges) in eligible whole blood donors who have a Hb in the acceptable range.

Table 6: Prevalence (%) of iron deficiency in whole blood donors

New donor data is from 2023/24 and repeat donor data is from the 2012 Lifeblood Iron Deficiency Study

• Donate plasma or platelets which has a much smaller red cell loss than whole blood; or
• Reduce the frequency of whole blood donation.
• Use of iron supplementation - the iron loss associated with a single whole blood donation may represent up to 75% of a premenopausal woman’s iron stores. Lifeblood currently recommends women aged 18-45 take a short course of iron supplements after each whole blood donation. We provide an information brochure on contraindications, suitable supplements and course length. For other groups it is recommended they discuss the suitability of iron supplements with their GP.
• Consider if external ferritin testing is required in addition to that provided periodically by Lifeblood.
• Reinforce that the Hb screening test prior to a donation does not measure iron stores.

Donors with a high ferritin who are subsequently diagnosed with Hereditary Haemochromatosis may donate as a therapeutic donor if they meet our eligibility criteria. Refer High ferritin | Lifeblood.

Donors with a high ferritin who are investigated and found to have no significant underlying pathology can return as volunteer donors. Refer High ferritin | Lifeblood.

References:
1.    Salvin, H.E., Pasricha, S.-R., Marks, D.C. and Speedy, J. (2014), Iron Stores in Blood Donors. Transfusion, 54: 2434-2444. https://doi.org/10.1111/trf.12647
2.    Gastroenterological Society of Australia. Clinical Update for General Practitioners and Physicians. Iron Deficiency. Updated 2022. [Accessed 2/10/2024]. Available at: Clinical Practice Resources (gesa.org.au)