Bryan Spencer

Iron Stores and Vascular Function in Voluntary Blood Donors

Background—Iron is a pro-oxidant cofactor that may be linked to atherosclerosis progression. Reduction of body iron stores secondary to blood donation has been hypothesized to reduce coronary risk, but retrospective studies have yielded inconsistent findings. We sought to assess the effects of blood donation frequency on body iron stores and physiological and biochemical biomarkers of vascular function associated with atherosclerosis progression. Methods and Results—Forty high-frequency voluntary blood donors (≥8 donations in past 2 years) and 42 low-frequency blood donors (1 to 2 donations in past 2 years) aged 50 to 75 years were randomly selected from American Red Cross of Connecticut blood donor records. Flow-mediated dilation in the brachial artery, serum markers of iron stores, vascular inflammation and oxidative stress, and cardiac risk factors were assessed in all subjects. Serum ferritin was significantly decreased in high-frequency blood donors when compared with low-frequency blood donors (median values 17 versus 52 ng/mL; P<0.001), but hematocrit did not differ between groups. Flow-mediated dilation in the brachial artery was significantly greater in high-frequency donors when compared with low-frequency donors in univariate analysis (5.5±2.6% versus 3.8±1.6%; P=0.0003) and in multivariate analysis adjusting for cardiac risk factors and other potential confounders. Serum biomarkers of vascular inflammation did not differ between groups but 3-nitrotyrosine, a marker of oxidative stress, was decreased in high-frequency donors when compared with low-frequency donors. Conclusions—High-frequency blood donors had evidence of decreased body iron stores, decreased oxidative stress, and enhanced vascular function when compared with low-frequency donors. These findings support a potential link between blood donation and reduced cardiovascular risk that warrants further investigation in prospective outcome studies.

Demographic correlates of low hemoglobin deferral among prospective whole blood donors

BACKGROUND: Approximately 10% of attempted blood donations are not allowed because of low hemoglobin (Hb) deferral.

Seroprevalence of Babesia microti in blood donors from Babesia-endemic areas of the northeastern United States: 2000 through 2007.

BACKGROUND: Current estimates of 70 cases of transfusion‐transmitted Babesia microti, with 12 associated deaths, suggest that Babesia is a growing blood safety concern. The extent of Babesia infections among blood donors has not been well defined. To determine how common exposure to B. microti is among blood donors, a seroprevalence study was undertaken in the American Red Cross Northeast Division.

Oral Iron Supplementation After Blood Donation: A Randomized Clinical Trial

IMPORTANCEnAlthough blood donation is allowed every 8 weeks in the United States, recovery of hemoglobin to the currently accepted standard (12.5 g/dL) is frequently delayed, and some donors become anemic.nnnOBJECTIVEnTo determine the effect of oral iron supplementation on hemoglobin recovery time (days to recovery of 80% of hemoglobin removed) and recovery of iron stores in iron-depleted (low ferritin, ≤26 ng/mL) and iron-replete (higher ferritin, >26 ng/mL) blood donors.nnnDESIGN, SETTING, AND PARTICIPANTSnRandomized, nonblinded clinical trial of blood donors stratified by ferritin level, sex, and age conducted in 4 regional blood centers in the United States in 2012. Included were 215 eligible participants aged 18 to 79 years who had not donated whole blood or red blood cells within 4 months.nnnINTERVENTIONSnOne tablet of ferrous gluconate (37.5 mg of elemental iron) daily or no iron for 24 weeks (168 days) after donating a unit of whole blood (500 mL).nnnMAIN OUTCOMES AND MEASURESnTime to recovery of 80% of the postdonation decrease in hemoglobin and recovery of ferritin level to baseline as a measure of iron stores.nnnRESULTSnThe mean baseline hemoglobin levels were comparable in the iron and no-iron groups and declined from a mean (SD) of 13.4 (1.1) g/dL to 12.0 (1.2) g/dL after donation in the low-ferritin group and from 14.2 (1.1) g/dL to 12.9 (1.2) g/dL in the higher-ferritin group. Compared with participants who did not receive iron supplementation, those who received iron supplementation had shortened time to 80% hemoglobin recovery in both the low-ferritin (mean, 32 days, interquartile range [IQR], 30-34, vs 158 days, IQR, 126->168) and higher-ferritin groups (31 days, IQR, 29-33, vs 78 days, IQR, 66-95). Median time to recovery to baseline ferritin levels in the low-ferritin group taking iron was 21 days (IQR, 12-84). For participants not taking iron, recovery to baseline was longer than 168 days (IQR, 128->168). Median time to recovery to baseline in the higher-ferritin group taking iron was 107 days (IQR, 75-141), and for participants not taking iron, recovery to baseline was longer than 168 days (IQR, >168->168). Recovery of iron stores in all participants who received supplements took a median of 76 days (IQR, 20-126); for participants not taking iron, median recovery time was longer than 168 days (IQR, 147->168 days; Pu2009<u2009.001). Without iron supplements, 67% of participants did not recover iron stores by 168 days.nnnCONCLUSIONS AND RELEVANCEnAmong blood donors with normal hemoglobin levels, low-dose iron supplementation, compared with no supplementation, reduced time to 80% recovery of the postdonation decrease in hemoglobin concentration in donors with low ferritin (≤26 ng/mL) or higher ferritin (>26 ng/mL).nnnTRIAL REGISTRATIONnclinicaltrials.gov Identifier: NCT01555060.

Restless legs syndrome, pica, and iron status in blood donors

The association of blood donation–related iron deficiency with pica or restless legs syndrome (RLS) remains poorly elucidated. This study evaluated the prevalence of RLS and pica in blood donors completing the REDS‐II Iron Status Evaluation (RISE) study.

The potential impact of selective donor deferrals based on estimated blood volume on vasovagal reactions and donor deferral rates

BACKGROUND: Whole blood donation in the United States is restricted in volume to 10.5u2003mL/kg or less in an effort to prevent hypovolemic reactions, but still may exceed more than 15% of a donors estimated blood volume (EBV). We analyzed the association of EBV with prefaint and systemic vasovagal reactions (SVRs) among whole blood donors and the potential impact of an EBV‐based deferral policy.

Risk for malaria in United States donors deferred for travel to malaria-endemic areas

BACKGROUND: Deferral for travel to malaria‐endemic areas excludes many blood donors in the United States. Most transfusion‐transmitted malaria is associated with lengthy residence in malaria‐endemic areas rather than routine travel. This study compares the impact of existing deferral requirements to the risk that a presenting donor with malaria travel history harbors malaria parasites under current and hypothetical alternate regulations.

Demographics of successful, unsuccessful and deferral visits at six blood centers over a 4-year period

BACKGROUND: Descriptions of donor demographics are of value in formulating recruitment and retention strategies. The demographics of successful (SV), unsuccessful (UV; meaning a nonuseable unit), and deferred (DV) donor visits over a 4‐year period were investigated using Retrovirus Epidemiology Donor Study (REDS)‐II databases.

Prevalence of selected viral infections among blood donors deferred for potential risk to blood safety

BACKGROUND: Health history questions identify blood donors believed to pose a higher risk of transmission of infectious diseases. This study assesses the current impact of some of these questions on blood safety as reflected by infectious disease markers.

A randomized, blinded, placebo-controlled trial of education and iron supplementation for mitigation of iron deficiency in regular blood donors.

The historical approach of offering dietary advice to donors with low hemoglobin (Hb) is ineffective for preventing iron deficiency in frequent donors. Alternative approaches to maintaining donor iron status were explored.