Blood donation removes red cells and therefore iron. Donation is a known risk for developing iron deficiency.
Approximate iron loss by donation type
- The iron loss associated with whole blood donation may represent up to almost 75% of a premenopausal female’s iron stores.
- A plateletpheresis donor who donates every 2 weeks may almost equal the iron loss of a whole blood donor.
- The introduction of saline replacement with plasmapheresis donation has resulted in minimal red blood cell loss in the lines, as the saline flushes these back to the donor. The 40mL loss is largely accounted for by samples.
- Most iron-replete donors will have iron store recovery before their next donation. Those at particular risk of iron deficiency are young donors, premenopausal women and frequent donors.(1–3)
- Poor oral iron intake or blood loss (eg, menstruation) may lead to inadequate iron replacement, culminating in iron deficiency long term.
More information about donation types can be found on donateblood.com.au.
- Simon TL, Garry PJ, Hooper EM. Iron stores in blood donors. JAMA 1981;245:2038–2043.
- Finch CA, Cook JD, Labbe RF, Culala M. Effect of blood donation on iron stores as evaluated by serum ferritin. Blood 1977;50:441–447.
- Cable RG, Glynn SA, Kiss JE, et al.: Iron deficiency in blood donors: the REDS-II donor Iron Status Evaluation (RISE) study. Transfusion 2012;52:702–711.
To reduce the risk of iron deficiency in blood donors, consider:
- Reduced whole blood donation frequency
- Iron supplementation:
- As women 18-45 are more susceptible to low iron, the Blood Service is recommending these donors take a short course of iron following each whole blood donation. Find out more about our recommendation here.
- Other donors are advised to discuss the use of iron supplements with their doctor.
- Donating plasma rather than whole blood.
Donors with iron deficiency, with or without anaemia, should be medically assessed.
Bryant BJ, Yau YY, Arceo SM, Daniel-Johnson J, Hopkins JA, Leitman SF. Iron replacement therapy in the routine management of blood donors. Transfusion 2012;52:1566–1575.
Marks D, Speedy J, Robinson K, Brama T, Capper H, Mondy P, Keller A. An 8-week course of 45 mg of carbonyl iron daily reduces iron deficiency in female whole blood donors aged 18 to 45 years: results of a prospective randomized controlled trial. Transfusion 2013;54:780-788.
Pasricha S, Marks D, Salvin H, Brama T, Keller A, Pink J, Speedy, J. Postdonation iron replacement for maintaining iron stores in female whole blood donors in routine donor practice: results of two feasibility studies in Australia. Transfusion 2017;57:1922-1929.
The Blood Service does not routinely screen for iron deficiency. It is therefore possible for a donor who meets the haemoglobin criteria to donate with depleted iron stores. See iron deficiency without anaemia.
Ferritin testing is performed in donors who have haemoglobin levels below the acceptable range for donation. Ferritin testing may also be performed if:
- there is a >20 g/L drop in haemoglobin between successive donations or
- annual full blood count testing of apheresis donors suggests iron deficiency.
The Blood Service reference ranges for ferritin are:
- Male 30–300 μg/L
- Female 15–200 μg/L
In an anaemic adult, ferritin <15 μg/L is diagnostic of iron deficiency for both males and females. Levels of 15-30 μg/L are highly suggestive. Iron deficiency may still be present with ferritin levels up to 100 μg/L as ferritin is an acute phase protein and may be elevated with co-existent illness.
The Blood Service manages donors with low haemoglobin and/or ferritin according to the following algorithm:
|Low or Normal||Low||
Deferred for 6 months
Referred to GP
|Low||Normal or High||Referred to GP for investigation and management
Deferred until investigation and management complete
Underlying cause may impact on future eligibility
The Blood Service does not investigate or treat donors.
The assessment of blood donors with iron deficiency anaemia is not significantly different to that of the general population. It will depend on their age and gender, the likely contribution of blood donation to the iron deficiency, other potential causes, and the likelihood of underlying pathology.
These points should be taken into consideration:
- a single blood donation in an at-risk individual can result in iron deficiency anaemia, however many donors are able to successfully donate on a regular basis without developing anaemia
- causes of iron deficiency are often multifactorial
- the Gastroenterological Society of Australia (GESA) cautions that even when an obvious cause of iron deficiency exists, the possibility of serious underlying cause must also be considered(1)
- treatment of the iron deficiency and determination of the underlying cause should occur concurrently.
- Gastroenterological Society of Australia. Clinical update: Iron deficiency, First Edition. Sydney, Australia, Digestive Health Foundation, 2008. Available from: http://www.gesa.org.au.