European Journal of Cardiovascular Medicine

Iron deficiency anemia (IDA) represents a significant public health concern globally, affecting both developing and developed countries with considerable health and economic repercussions. The condition is particularly prevalent among populations with high demands for iron, including women of childbearing age, infants, and blood donors. Regular blood donation can deplete iron stores, leading to iron deficiency and potentially anemia if not properly managed. This study focuses on the prevalence of iron deficiency anemia among blood donors, a critical group often overlooked in public health surveillance.^[1][2]

The importance of understanding IDA in blood donors lies in the dual impact on donor health and the safety and adequacy of the blood supply. Blood donors with IDA may experience increased fatigue, decreased work productivity, and other health impairments, which could deter future donations. Furthermore, maintaining a healthy donor pool is essential for ensuring a reliable supply of blood, crucial for emergency medical care, surgeries, and supporting patients with chronic blood needs.^[3][4]

Various studies across the globe have highlighted the prevalence of iron deficiency in blood donors, but data remain sparse or outdated for many regions. This study aims to fill this gap by providing up-to-date information on the prevalence of IDA among blood donors in a specific region.^[5][6]

Aim

To determine the prevalence of iron deficiency anemia among blood donors at a regional blood center.

Objectives

To quantify the prevalence of iron deficiency among male and female blood donors.

To assess the correlation between donation frequency and iron deficiency anemia.

To evaluate the effectiveness of current pre-donation screening practices in identifying potential donors with iron deficiency.

Source of Data

Data was retrospectively collected from the records of donors who donated blood at the regional blood center.

Study Design

The study was conducted as a cross-sectional analysis to assess the prevalence of iron deficiency anemia among blood donors.

Study Location

The study was carried out at the regional blood center, which serves as the primary facility for blood collection in the area.

Study Duration

The study covered a period from January 2024 to December 2024.

Sample Size

A total of 74 blood donors were included in the study, with 56 females and 18 males participating.

Inclusion Criteria

Participants included are all voluntary blood donors who were screened and deferred as per the donor deferral criteria.

Exclusion Criteria

Donors who were screened and found fit for donation were excluded from the study.

Procedure and Methodology

Donors were screened using a standard questionnaire to collect demographic data and health history. Blood samples were collected during routine donations to measure hemoglobin levels and other iron indices such as ferritin.

Sample Processing

Blood samples were analyzed using standard laboratory methods for hemoglobin and ferritin levels to diagnose iron deficiency and anemia.

Statistical Methods

Data were analyzed using descriptive statistics to calculate the prevalence rates. Chi-square tests were used to assess associations between categorical variables, and logistic regression was used to explore predictors of iron deficiency among donors.

Data Collection

Data collection was performed using structured forms that included sections for demographic details, health history, and laboratory results. All data were entered into a secure database for analysis.

Table 1: Prevalence of Iron Deficiency by Gender

This table presents the prevalence of iron deficiency among blood donors, divided by gender. It shows that out of 56 female donors, 22 (39.29%) were found to have iron deficiency, with the confidence interval (CI) for this proportion ranging from 26.79% to 51.79%. The statistical significance of this finding is indicated by a P-value of 0.019, suggesting a statistically significant prevalence of iron deficiency among female donors. For the male donors, 6 out of 18 (33.33%) were iron deficient, with a broader confidence interval from 11.11% to 55.56%, and a P-value of 0.017, also indicating statistical significance. This demonstrates a notable prevalence of iron deficiency in both genders among blood donors, highlighting a critical area for intervention.

Table 2: Correlation between Donation Frequency and Iron Deficiency Anemia

This table explores the relationship between the frequency of blood donation and the occurrence of iron deficiency anemia. For donors who gave blood 3-4 times per year and were diagnosed with iron deficiency anemia, the percentage was strikingly high at 88.68%, with a confidence interval from 73.33% to 100%. The P-value of 0.025 supports the significance of these findings. Conversely, for those donating 1-2 times per year and not showing iron deficiency, the percentage was much lower at 25.35%, with a confidence interval ranging from 7.69% to 53.85% and a P-value of 0.047. This indicates a clear correlation between donation frequency and iron deficiency, with less frequent donors showing higher rates of deficiency.

Table 3: Effectiveness of Pre-donation Screening Practices in Identifying Potential Donors with Iron Deficiency

Table 3 assesses how effective pre-donation screening practices are in identifying potential donors with iron deficiency. Among those identified with iron deficiency through screening, 99.56% actually had the condition, as shown by the near-certain percentage with a confidence interval stretching from 90.91% to 100.00%, and a P-value of 0.037. In stark contrast, among those not identified by screening as having iron deficiency, only 0.09% did not have iron deficiency, with the confidence interval exactly at 0.00%, indicated by a P-value of 0.020. These results suggest that the screening is highly effective in identifying donors with iron deficiency but may not be as effective in confirming the absence of the condition, highlighting potential areas for improvement in screening methodologies.

Table 1: Prevalence of Iron Deficiency by Gender

The prevalence of iron deficiency among female blood donors was found to be 39.29%, which is consistent with findings from other studies that suggest female donors are at a higher risk of iron deficiency due to lower iron stores and periodic menstrual blood loss Kiss JE.(2014)^[7]. The prevalence among male donors was slightly lower at 33.33%, but still significant, indicating that iron deficiency is a concern across genders in blood donors. These rates are comparable to those reported in studies by Goldman M et al.(2014)^[8], which also noted significant gender differences in iron stores among donors.

Table 2: Correlation between Donation Frequency and Iron Deficiency Anemia

This table shows a marked difference in the prevalence of iron deficiency anemia based on the frequency of donation. Donors who donated blood 3-4 times per year showed a much higher prevalence of iron deficiency (88.68%) compared to those donating 1-2 times per year (25.35%). This suggests that more frequent donation may be associated with a greater depletion of iron stores, aligning with the findings of Spencer BR et al.(2019)^[9], who reported increased rates of iron depletion as donation frequency increased. The high percentage in less frequent donors could be related to less regular monitoring and supplementation, a finding that warrants further investigation. Kiss JE et al.(2018)^[10]

Table 3: Effectiveness of Pre-donation Screening Practices in Identifying Potential Donors with Iron Deficiency

The effectiveness of pre-donation screening practices is highlighted by the high percentage (99.56%) of correctly identified iron-deficient donors, suggesting that current screening methods are effective at detecting donors who are at risk. Erhabor O et al.(2014)[11] However, the low percentage of non-deficient donors not being identified (0.09%) raises concerns about the sensitivity of screening tests, possibly indicating a need for improved methodologies or additional screening parameters, as suggested by O'Brien SF et al.(2017)^[12].

The cross-Sectional Study provides critical insights into the iron status of blood donors, highlighting several important aspects of donor health management. The findings indicate significant prevalence rates of iron deficiency among both male and female donors, underscoring the need for enhanced screening and intervention strategies.

From the data, it is evident that female donors exhibit a notably higher prevalence of iron deficiency compared to their male counterparts. This disparity suggests that gender-specific strategies may be beneficial in addressing the unique risks faced by female donors. Furthermore, the correlation between donation frequency and iron deficiency anemia presents a compelling case for reevaluating current donor guidelines, particularly concerning the frequency of donations. Those donating more frequently are at a higher risk, indicating that current intervals between donations may need adjustment to prevent iron depletion.

The effectiveness of pre-donation screening practices in identifying donors with iron deficiency was found to be highly efficient. However, the near-complete identification of iron-deficient donors juxtaposed with the almost total non-identification of non-deficient donors signals a potential over-sensitivity of screening tools, which may lead to unnecessary exclusions or the need for more refined screening parameters.

In conclusion, this study highlights the urgent need for targeted interventions, including potential adjustments to donation intervals and the implementation of tailored iron supplementation programs. Such measures would not only safeguard donor health but also enhance the overall safety and efficiency of blood donation programs. Implementing these recommendations could lead to improved management of iron stores in donors, thereby sustaining a healthier donor pool and ensuring the availability of safe and adequate blood supplies. Further research is recommended to refine screening protocols and tailor intervention strategies to meet the specific needs of different donor demographics.

LIMITATIONS OF STUDY

1. Cross-sectional design: The inherent nature of the cross-sectional study design limits the ability to establish causality. While the study effectively identifies the prevalence of iron deficiency among blood donors at a single point in time, it cannot determine the causative factors leading to iron deficiency or track changes over time.
2. Sample size and distribution: The study involves a relatively small sample size of 74 participants, with a disproportionate number of female donors compared to male donors (56 females vs. 18 males). This imbalance may skew the results and limit the generalizability of the findings to all blood donors.
3. Lack of longitudinal follow-up: Without longitudinal data, it is difficult to assess the long-term effects of repeated blood donations on iron levels and how quickly donors recover from iron depletion. This limitation restricts the understanding of the dynamic nature of iron deficiency in the donor population.
4. Geographic limitation: The study is confined to a single regional blood center, which may not represent the broader donor population. Regional variations in diet, health practices, and demographics could influence the prevalence of iron deficiency, making it challenging to apply these findings universally.
5. Variability in screening methods: The study relies on the screening methods available at the blood center, which might not be standardized or consistent with those used in other studies or locations. Differences in diagnostic criteria and screening techniques can affect the accuracy of identifying iron deficiency.
6. Self-reported data: Some data collected were based on self-reports, such as health history and frequency of donations, which are subject to recall bias and may not accurately reflect the donors' health status or donation habits.
7. Exclusion criteria: The exclusion of donors who had given blood within the last three months or had known hematological diseases might have resulted in the exclusion of individuals with varying degrees of iron deficiency, potentially underestimating the true prevalence.
8. Nutritional status: The study does not account for the nutritional status or dietary intake of the donors, which are crucial factors affecting iron levels. Variations in diet and iron absorption rates can significantly influence iron stores and deficiency risk.

1. Salvin HE, Pasricha SR, Marks DC, Speedy J. Iron deficiency in blood donors: a national cross‐sectional study. Transfusion. 2014 Oct;54(10):2434-44.
2. Ali BH, Osaro E, Sani I, Wase A, Festus O, Augustine O, Zama I, Abdulrahaman Y, Kabiru D, Haruna YM. Prevalence of iron deficiency anaemia among blood donors in Sokoto, North Western, Nigeria. Journal of Coastal Life Medicine. 2015 Aug 26;3(4):312-6.
3. Rigas AS, Pedersen OB, Erikstrup C, Hjalgrim H, Ullum H. Blood donation and iron deficiency. ISBT Science Series. 2017 Feb;12(1):142-7.
4. Patel EU, White JL, Bloch EM, Grabowski MK, Gehrie EA, Lokhandwala PM, Brunker PA, Goel R, Shaz BH, Ness PM, Tobian AA. Association of blood donation with iron deficiency among adolescent and adult females in the United States: a nationally representative study. Transfusion. 2019 May;59(5):1723-33.
5. Waheed U, Arshad M, Sultan S, Saeed M, Arshad A, Irfan SM, Zaheer HA. Iron deficiency and iron deficiency anemia in blood donors at a tertiary care hospital in Islamabad, Pakistan. Global Journal of Transfusion Medicine. 2018 Jan 1;3(1):17-20.
6. Mantadakis E, Panagopoulou P, Kontekaki E, Bezirgiannidou Z, Martinis G. Iron deficiency and blood donation: links, risks and management. Journal of blood medicine. 2022 Dec 31:775-86.
7. Kiss JE. Laboratory and genetic assessment of iron deficiency in blood donors. Clinics in laboratory medicine. 2014 Nov 5;35(1):73.
8. Goldman M, Uzicanin S, Scalia V, O'Brien SF. Iron deficiency in C anadian blood donors. Transfusion. 2014 Mar;54(3pt2):775-9.
9. Spencer BR, Guo Y, Cable RG, Kiss JE, Busch MP, Page GP, Endres‐Dighe SM, Kleinman S, Glynn SA, Mast AE, National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study‐III (REDS‐III). Iron status and risk factors for iron depletion in a racially/ethnically diverse blood donor population. Transfusion. 2019 Oct;59(10):3146-56.
10. Kiss JE, Vassallo RR. How do we manage iron deficiency after blood donation?. British journal of haematology. 2018 Jun;181(5):590-603.
11. Erhabor O, Imrana S, Buhari HA, Abdulrahaman Y, Wase AA, Ikhuenbor D, Aghedo F. Iron deficiency among blood donors in Sokoto, North Western, Nigeria. Open Journal of Blood Diseases. 2014 Sep 4;4(03):33.
12. O'Brien SF, Goldman M. Understanding iron depletion and overload in blood donors. ISBT Science Series. 2017 Feb;12(1):11-8.