Demographic correlates of low hemoglobin deferral among prospective whole blood donors
Alan E. Mast
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorKaren S. Schlumpf
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorDavid J. Wright
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorBrian Custer
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorBryan Spencer
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorEdward L. Murphy
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorToby L. Simon
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorfor the NHLBI Retrovirus Epidemiology Donor Study-II
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorAlan E. Mast
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorKaren S. Schlumpf
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorDavid J. Wright
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorBrian Custer
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorBryan Spencer
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorEdward L. Murphy
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorToby L. Simon
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorfor the NHLBI Retrovirus Epidemiology Donor Study-II
From the Blood Center of Wisconsin and the Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Westat Corp., Rockville, Maryland; the University of California, San Francisco and Blood Systems Research Institute, San Francisco, California; the New England Region, American Red Cross Blood Services, Dedham, Massachusetts; and CSL Plasma, Boca Raton, Florida.
Search for more papers by this authorThis work was supported by NHLBI Contracts N01-HB-47168, -47169, -47174, -47175, and -57181.
Abstract
BACKGROUND: Approximately 10% of attempted blood donations are not allowed because of low hemoglobin (Hb) deferral.
STUDY DESIGN AND METHODS: Low Hb deferrals were tracked in more 715,000 whole blood donors at six blood centers across the United States. A multivariable logistic regression model was developed to comprehensively assess demographic correlates for low Hb deferral.
RESULTS: Demographic factors significantly associated with low Hb deferral include female sex (11 times greater odds than males), increasing age in men (men over 80 have 29 times greater odds than men under 20), African American race (2-2.5 times greater odds than Caucasians), Hispanic ethnicity in women (1.29 times greater odds than Caucasian women), and weight in men (men under 124 pounds have 2.5 times greater odds than men over 200 pounds). Interestingly, increasing donation frequency is associated with decreased odds for low Hb deferral (women with one donation in the previous 12 months have two times greater odds than those with six donations).
CONCLUSIONS: Low Hb deferral is associated with female sex, older age, African American race/ethnicity, and lower body weight in men. An inverse association with donation frequency suggests a selection bias in favor of donors able to give more frequently. These data provide useful information that can be utilized to manage blood donors to limit low Hb deferrals and assist in policy decisions such as changing the Hb cutoff or permissible frequency of donation. They also generate hypotheses for new research of the causes of anemia in defined groups of donors.
REFERENCES
- 1 Newman B. Improving the US blood supply and blood donation safety for both women and men. Transfusion 2008; 48: 1032-5.
- 2 Custer B, Chinn A, Hirschler NV, Busch MP, Murphy EL. The consequences of temporary deferral on future whole blood donation. Transfusion 2007; 47: 1514-23.
- 3 Halperin D, Baetens J, Newman B. The effect of short-term, temporary deferral on future blood donation. Transfusion 1998; 38: 181-3.
- 4 Radtke H, Polat G, Kalus U, Salama A, Kiesewetter H. Hemoglobin screening in prospective blood donors: comparison of different blood samples and different quantitative methods. Transfus Apher Sci 2005; 33: 31-5.
- 5 Boulton F. Evidence-based criteria for the care and selection of blood donors, with some comments on the relationship to blood supply, and emphasis on the management of donation-induced iron depletion. Transfus Med 2008; 18: 13-27.
- 6 Simon TL, Garry PJ, Hooper EM. Iron stores in blood donors. JAMA 1981; 245: 2038-43.
- 7 Finch CA, Cook JD, Labbe RF, Culala M. Effect of blood donation on iron stores as evaluated by serum ferritin. Blood 1977; 50: 441-7.
- 8 Bhasin S, Woodhouse L, Casaburi R, Singh AB, Bhasin D, Berman N, Chen X, Yarasheski KE, Magliano L, Dzekov C, Dzekov J, Bross R, Phillips J, Sinha-Hikim I, Shen R, Storer TW. Testosterone dose-response relationships in healthy young men. Am J Physiol Endocrinol Metab 2001; 281: E1172-E1181.
- 9 Mast AE, Foster TM, Pinder HL, Beczkiewicz CA, Bellissimo DB, Murphy AT, Kovacevic S, Wroblewski VJ, Witcher DR. Behavioral, biochemical, and genetic analysis of iron metabolism in high-intensity blood donors. Transfusion 2008; 48: 2197-204.
- 10 Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood 2006; 107: 1747-50.
- 11 Rockey DC, Cello JP. Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia. N Engl J Med 1993; 329: 1691-5.
- 12 Niv E, Elis A, Zissin R, Naftali T, Novis B, Lishner M. Iron deficiency anemia in patients without gastrointestinal symptoms—a prospective study. Fam Pract 2005; 22: 58-61.
- 13 Beutler E, Larsh SE, Gurney CW. Iron therapy in chronically fatigued, nonanemic women: a double-blind study. Ann Intern Med 1960; 52: 378-94.
- 14 Brownlie T, Utermohlen V, Hinton PS, Haas JD. Tissue iron deficiency without anemia impairs adaptation in endurance capacity after aerobic training in previously untrained women. Am J Clin Nutr 2004; 79: 437-43.
- 15 Kettaneh A, Eclache V, Fain O, Sontag C, Uzan M, Carbillon L, Stirnemann J, Thomas M. Pica and food craving in patients with iron-deficiency anemia: a case-control study in France. Am J Med 2005; 118: 185-8.
- 16 Silber MH, Richardson JW. Multiple blood donations associated with iron deficiency in patients with restless legs syndrome. Mayo Clin Proc 2003; 78: 52-4.
- 17 Murray-Kolb LE, Beard JL. Iron treatment normalizes cognitive functioning in young women. Am J Clin Nutr 2007; 85: 778-87.
- 18 Bruner AB, Joffe A, Duggan AK, Casella JF, Brandt J. Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls. Lancet 1996; 348: 992-6.
- 19 Steinberg L. Cognitive and affective development in adolescence. Trends Cogn Sci 2005; 9: 69-74.
- 20 Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood 2004; 104: 2263-8.
- 21 Guralnik JM, Ershler WB, Schrier SL, Picozzi VJ. Anemia in the elderly: a public health crisis in hematology. Hematology Am Soc Hematol Educ Program 2005; 528-32.
- 22 Nilsson-Ehle H, Jagenburg R, Landahl S, Svanborg A, Westin J. Haematological abnormalities and reference intervals in the elderly. A cross-sectional comparative study of three urban Swedish population samples aged 70, 75 and 81 years. Acta Med Scand 1988; 224: 595-604.
- 23 Cusick SE, Mei Z, Freedman DS, Looker AC, Ogden CL, Gunter E, Cogswell ME. Unexplained decline in the prevalence of anemia among US children and women between 1988-1994 and 1999-2002. Am J Clin Nutr 2008; 88: 1611-7.
- 24 Faerstein E, Szklo M, Rosenshein N. Risk factors for uterine leiomyoma: a practice-based case-control study. I. African-American heritage, reproductive history, body size, and smoking. Am J Epidemiol 2001; 153: 1-10.
- 25 Harlow SD, Campbell B. Ethnic differences in the duration and amount of menstrual bleeding during the postmenarcheal period. Am J Epidemiol 1996; 144: 980-8.
- 26 Beutler E, West C. Hematologic differences between African-Americans and whites: the roles of iron deficiency and alpha-thalassemia on hemoglobin levels and mean corpuscular volume. Blood 2005; 106: 740-5.
- 27 Benyamin B, Ferreira MA, Willemsen G, Gordon S, Middelberg RP, McEvoy BP, Hottenga JJ, Henders AK, Campbell MJ, Wallace L, Frazer IH, Heath AC, De Geus EJ, Nyholt DR, Visscher PM, Penninx BW, Boomsma DI, Martin NG, Montgomery GW, Whitfield JB. Common variants in TMPRSS6 are associated with iron status and erythrocyte volume. Nat Genet 2009; 41: 1173-5.
- 28 Chambers JC, Zhang W, Li Y, Sehmi J, Wass MN, Zabaneh D, Hoggart C, Bayele H, McCarthy MI, Peltonen L, Freimer NB, Srai SK, Maxwell PH, Sternberg MJ, Ruokonen A, Abecasis G, Jarvelin MR, Scott J, Elliott P, Kooner JS. Genome-wide association study identifies variants in TMPRSS6 associated with hemoglobin levels. Nat Genet 2009; 41: 1170-2.
- 29 Tanaka T, Roy CN, Yao W, Matteini A, Semba RD, Arking D, Walston JD, Fried LP, Singleton A, Guralnik J, Abecasis GR, Bandinelli S, Longo DL, Ferrucci L. A genome-wide association analysis of serum iron concentrations. Blood 2010; 115: 94-6.
- 30 Newman B. Iron depletion by whole-blood donation harms menstruating females: the current whole-blood-collection paradigm needs to be changed. Transfusion 2006; 46: 1667-81.
- 31 Garry PJ, Koehler KM, Simon TL. Iron stores and iron absorption: effects of repeated blood donations. Am J Clin Nutr 1995; 62: 611-20.
- 32 Boulton F, Collis D, Inskip H, Paes H, Garlick M. A study of the iron and HFE status of blood donors, including a group who failed the initial screen for anaemia. Br J Haematology 2000; 108: 434-9.
- 33 Nicolas G, Bennoun M, Devaux I, Beaumont C, Grandchamp B, Kahn A, Vaulont S. Lack of hepcidin gene expression and severe tissue iron overload in upstream stimulatory factor 2 (USF2) knockout mice. Proc Natl Acad Sci USA 2001; 98: 8780-5.
- 34 Lee P, Gelbart T, West C, Halloran C, Beutler E. Seeking candidate mutations that affect iron homeostasis. Blood Cells 2002; 29: 471-87.
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