Iron status of blood donors.

Blood donation is associated with decreased iron stores in blood donors which may affect the development of physiological functions and overall health. Previous studies reported a wide variation in the prevalence of iron deficiency in this population (1% to 62%). So, we want to establish the prevalence of iron deficiency in blood donors from a systematic review of the literature. Exhaustive and reproducible search of literature in 7 databases, based in a protocol for searching in 4 languages between 2001 to 2011 with inclusion and exclusion criteria and information extraction. The analysis was based on the calculation of frequencies and specific prevalence by sex and number of previous donations, with their respective confidence intervals in Excel and Epidat (3.0). A total of 16.979 donors, 5.096 regular, with 59% men. The prevalence of iron deficiency found was 13% (IC 95%: 12,4 to 13,4) with a range between 1% and 62%. Prevalence statistically higher was observed in women (19,56%) and repetitive donors (20,36%). We obtained iron deficiency prevalence in blood donors over higher risk groups like children, being higher in female and repetitive donors. That suggests the need to encouraged blood banks in the application of protocols designed to preserve healthy donors and this will result in an adequate blood supply.

This study was undertaken to investigate body iron stores in so-called remunerated blood donors as well as to evaluate the sensitivity of hemoglobin determination in detecting iron deficiency in two populations of blood donors. The authors studied 522 male donors who were divided into three groups: Group I, first-time volunteer donors with hemoglobin levels greater than or equal to 13 g per dl; Group II, remunerated donors with hemoglobin levels greater than or equal to 13 g per dl; and Group III, remunerated donors rejected because their hemoglobin levels were less than 13 g per dl. Iron stores were evaluated with an enzyme-linked immunosorbent assay for plasma ferritin. In Group I, 4.5 percent were iron-deficient with a mean ferritin value of 55.3 ng per ml; in Group II, 59.7 percent were iron deficient with a mean ferritin level of 17.4 ng per ml, and in Group III, 82.5 percent were iron-deficient and the mean ferritin level was 8.4 ng per ml. The last values represent the highest percentage of iron deficiency and the lowest mean ferritin value thus far reported. In Group I, hemoglobin determination had a sensitivity of 95 percent in detecting iron deficiency, but in Group II had only 40 percent sensitivity. These results indicate that a more accurate and reliable test, such as a plasma or serum ferritin determination, may be necessary to detect iron deficiency in blood donors when they donate more than five times per year, particularly those who are remunerated.

Iron deficiency anaemia is an important limiting factor for the number of donations in regular donors. Limited data is available on the iron status in Iranian donors. This study was conducted to evaluate the prevalence of iron deficiency and its related factors in blood donors at Yazd blood transfusion centre, Iran. In this descriptive study, 337 persons accepted for donation in 2003 were selected randomly. Haemoglobin, serum iron, total iron-binding capacity and ferritin concentrations were measured. Results showed that the prevalence of reduction in iron stores increased with an increase in the number of donations (P = 0.0001), such that reduction in iron stores was seen in all regular female donors (100%) and 48% of regular male blood donors. The prevalence of iron deficiency in female and male regular donors was 78 and 28%, whereas 55.6 and 16% of these donors had iron deficiency anaemia. Just one blood donation resulted in a significant increase in the prevalence of iron deficiency in women (P < 0.05), but in men, a significant increase was seen only in regular donors (P < 0.05). It is therefore recommended that blood donors should be educated about iron deficiency, and research studies should be performed to determine the best method of iron supplementation with minimal complications for all regular blood donors and women of childbearing age on their first donation.

Bone Marrow Iron in CKD: Correlation With Functional Iron Deficiency

See article on page 1471–1478, in this issue

Iron deficiency (ID) is the most common nutritional deficiency, and iron metabolism becomes further deteriorated in the presence of certain conditions, such as heart failure (HF). Atrial fibrillation (AF) has many similarities to HF, including a chronic inflammatory pathophysiology; however, the prevalence of ID and other hematinic deficiencies in AF patients have not been determined. In this study, the prevalence of iron (serum ferritin <100 µg/L or ferritin 100-299 µg/L with transferrin saturation <20%), vitamin B12 (<200 pg/mL), and folate deficiency (<4.0 ng/mL) was evaluated in 101 patients with non-valvular AF with preserved left ventricular ejection fraction and no signs of HF, and the results were compared with 35 age- and gender-matched controls. Anemia was detected in 26% of the patients. A total of 48 (47.6%) patients had ID, 10 (9.9%) had a vitamin B12 deficiency, and 13 (12.9%) had a folate deficiency. The prevalence of ID was similar in the controls and the paroxysmal AF patients, but increased gradually in persistent and permanent AF. Univariate logistic regression analysis demonstrated that permanent vs. paroxysmal AF [Odds ratio (OR): 2.17; 95% confidence interval (CI): 0.82-5.69; p=0.011], high sensitive C-reactive protein (OR: 1.47; 95% CI: 0.93-2.36; p=0.019), N-terminal pro b-type natriuretic peptide (OR: 1.24; 95% CI: 0.96-1.71; p=0.034), and white blood cell count (OR: 1.21; 95% CI: 0.95-1.58; p=0.041) were associated with ID. In multivariable analysis, permanent AF remained as an independent clinical associate of ID (OR: 4.30; 95% CI: 0.83-12.07; p=0.039). ID is common in permanent AF, as in HF. Inflammation and neurohormonal activation seem to contribute to its development.

The prevalence of iron deficiency varies widely according to how it is defined. To compare the prevalence of iron deficiency among women using 3 different definitions. The cross-sectional Hemochromatosis and Iron Overload Screening Study (HEIRS; 2000-2006) evaluated the prevalence, determinants, and outcomes of hemochromatosis and other iron-related disorders. Multiethnic, primary care-based screening (2001-2003) was performed at 5 field centers (4 in the US and 1 in Canada). Volunteer women aged 25 years and older were recruited at primary care venues associated with the field centers. Data were analyzed from June to December 2023. Measures included transferrin saturation, serum ferritin level, and self-reported age, pregnancy, and race and ethnicity. Three iron deficiency definitions were studied: (1) combined transferrin saturation less than 10% and serum ferritin less than 15 ng/mL (HEIRS), (2) serum ferritin less than 15 ng/mL (World Health Organization [WHO]), and (3) serum ferritin less than 25 ng/mL (a threshold for iron-deficient erythropoiesis [IDE]). Among 62 685 women (mean [SD] age, 49.58 [14.27] years), 1957 women (3.12%) had iron deficiency according to the HEIRS definition, 4659 women (7.43%) had iron deficiency according to the WHO definition, and 9611 women (15.33%) had iron deficiency according to the IDE definition. Among 40 381 women aged 25 to 54 years, 1801 women (4.46%) had iron deficiency according to HEIRS, 4267 women (10.57%) had iron deficiency according to WHO, and 8573 women (21.23%) had iron deficiency according to IDE. Prevalence rates of iron deficiency among 2039 women aged 25 to 44 years who reported pregnancy were 5.44% (111 women) according to HEIRS, 18.05% (368 women) according to WHO, and 36.10% (736 women) according to IDE. Iron deficiency prevalence by the 3 respective definitions increased significantly in each racial and ethnic group and was significantly higher among Black and Hispanic participants than Asian and White participants. The relative iron deficiency prevalence among the 62 685 women increased 2.4-fold (95% CI, 2.3-2.5; P < .001) using the WHO definition and increased 4.9-fold (95% CI, 4.7-5.2; P < .001) using the IDE definition. Three definitions of iron deficiency were associated with significantly different prevalence of iron deficiency in women, regardless of self-reported age, pregnancy, or race and ethnicity. Using higher serum ferritin thresholds to define iron deficiency could lead to diagnosis and treatment of more women with iron deficiency and greater reduction of related morbidity.

Prevalencia y características de la anemia y ferropenia en pacientes hospitalizados por enfermedades digestivas en España.

In 2009, the Ministry of Health of Kyrgyzstan launched a national Infant and Young Child Nutrition (IYCN) program which included point-of-use fortification of foods with micronutrient powders (MNP) containing iron, vitamin A, and other micronutrients. Caretakers of children aged 6-23 months were given 30 sachets of MNP every 2 months. Micronutrient surveys were conducted in 2009 and 2013. The objective of the study was to compare the prevalence of anemia and deficiencies of iron and vitamin A among children aged 6-29 months prior to the MNP program (2009) with those after full implementation (2013). Cross-sectional national surveys were conducted in 2009 (n = 666) and 2013 (n = 2150). Capillary blood samples were collected to measure hemoglobin, iron (ferritin and soluble transferrin receptor [sTfR]) and vitamin A (retinol binding protein [RBP]) status, and inflammation status (C-reactive protein [CRP] and α-1-acid glycoprotein [AGP]). Ferritin, sTfR, and RBP were adjusted for inflammation; hemoglobin was adjusted for altitude. The prevalence of anemia was non-significantly lower in 2013 compared to 2009 (32.7% vs. 39.0%, p = 0.076). Prevalence of inflammation-adjusted iron deficiency (54.8% vs. 74.2%, p<0.001) and iron deficiency anemia (IDA, 25.5% vs. 35.1%, p = 0.003) were lower and the prevalence of inflammation-adjusted vitamin A deficiency was higher (4.3% vs. 2.0%, p = 0.013) in 2013 compared to 2009. Four years after the initiation of a national Infant and Young Child Nutrition program including the introduction of point-of-use fortification with MNP, the prevalence of iron deficiency and IDA is lower, but the prevalence of vitamin A deficiency is higher.

Iron deficiency is prevalent among pregnant women because of the increased maternal iron requirements. Uncorrected maternal iron deficiency can lead to adverse neurodevelopmental outcomes in neonates. Therefore, the aim of this study was to assess serum ferritin concentration and prevalence of iron deficiency among pregnant women in Jiangsu, China. Within a cohort study, pregnant women were followed up from 2nd trimester of pregnancy until their labour. They were assessed for iron status in 2nd and 3rd trimesters using serum ferritin. In addition, neonatal APGAR score and birth weight were assessed in order to determine if maternal iron deficiency was associated with these neonatal outcomes. A total of 1688 pregnant women were followed up until their labour. The mean age of participants was 29 ± 4 years and 54.0% of them were multigravidas. Mean serum ferritin concentration in 2nd trimester was significantly higher than 3rd trimester (59.9 vs. 22.2 ng/mL) (P < 0.001). The prevalence of iron deficiency using serum ferritin concentration cut-off of < 15 ng/mL in 2nd and 3rd trimesters was 11.9% and 37.4%, respectively (P < 0.05). Maternal iron deficiency as assessed by serum ferritin concentration in 2nd and 3rd trimesters of pregnancy was not associated with neonatal outcomes (all P > 0.05). Our study reported that increased prevalence of maternal iron deficiency in 3rd trimester, suggesting that screening and supplementation of at-risk pregnancies can be used as a preventive strategy to tackle the issue. Consideration should be given to ensure adequate maternal iron status through pregnancy.

Seroprevalence of Kaposi's Sarcoma-Associated Herpesvirus Infection among Blood Donors from Texas

Laboratory and Genetic Assessment of Iron Deficiency in Blood Donors

Background: Iron deficiency (ID) is a major heart failure comorbidity associated with increased mortality, worse symptoms and a poorer quality of life, irrespective of anaemia. In Nepal, limited data are available to permit an estimation of the spectrum and prevalence of ID associated with heart failure, which the present study aimed to find. Methods: A single-centre, cross-sectional, observational study was conducted at a tertiary care hospital in Kathmandu, Nepal. Patients meeting validated clinical criteria of heart failure were included and assessed for their iron status. Absolute ID was defined as serum ferritin &lt;100 μg/l and functional ID was defined as normal ferritin (100–300 μg/l), with low transferrin saturation &lt;20%. Data were analysed using SPSS (version 23). A logistic regression model was used to calculate the OR, with p-values &lt;0.05 and 95% CIs. Results: A total of 400 patients were studied. Anaemia was present in 244. ID was present in 314 (78.5%) patients, out of which absolute deficiency was present in 181 (57.6%) and functional deficiency was present in 133 (42.4%) patients. ID with anaemia was present in 222 patients. Female sex (OR 1.93; 95% CI [1.18–3.18]), New York Heart Association class III/IV (OR 2.46; 95% CI [1.48–4.07]), age &gt;65 years (OR 1.97; 95% CI [1.21–3.21]) and anaemia (OR 7.01; 95% CI [4.08–12.06]) were significantly associated with ID. ID without anaemia was present in 29% of patients. Conclusion: The present study showed a high prevalence of ID in heart failure patients, which was significantly associated with older age, female sex and higher New York Heart Association class. It also showed that a significant number of patients who were non-anaemic had ID. Therefore, iron profiling and treatment should be a part of the routine assessment of patients with heart failure.

Approximately half of pregnant women in India are anemic, representing over 7.5 million women. Few studies have assessed the relationship between multiple micronutrient deficiencies and anemia during pregnancy or the trajectory of hemoglobin (Hb) during pregnancy in low‐resource settings. We enrolled 200 pregnant women from the Maternal and Newborn Health (MNH) registry, a population‐based pregnancy and birth registry in Eastern Maharashtra, India to address these gaps. The women provided capillary (finger‐prick) and venous blood specimens at enrollment (<15 weeks), and a second capillary specimen in the 3rd trimester (>27 weeks). Capillary specimens were analyzed at the time of collection with a HemoCue Hb 201+; venous specimens were shipped on dry ice to a laboratory for cyanmethemoglobin assessment. In the 1st trimester, mean Hb concentration and anemia (Hb<11.0 g/dL) prevalence using capillary specimens were 10.9 ± 1.5 g/dL and 51.1%; mean Hb concentration using venous blood specimens was estimated to be 11.3 ± 1.3 g/dL and anemia prevalence was 37.5%. The prevalence of iron, vitamin B12 and folate deficiencies were 40%, 30% and 0%, respectively. Among women with anemia in the 1st trimester (venous blood), 56% had concurrent iron deficiency (inflammation‐adjusted serum ferritin <15 µg/L) indicating that their anemia may be amenable to iron supplementation. In total, 21% of women had ID and anemia, 19% ID in the absence of anemia, 16.5% anemia in the absence of ID and 43.5% had neither. By the 3rd trimester, mean Hb from capillary specimens had declined to 10.1 ± 1.35 g/dL and anemia prevalence increased to 70.7%, despite 99.4% mothers reporting receipt of iron‐folic acid (IFA) supplements during her current pregnancy, and 83.9% reporting IFA consumption the previous day. Significant predictors of anemia in the 1st trimester (both venous and capillary) included the number of weeks gestation at the time of Hb assessment and inflammation‐adjusted serum ferritin. For 3rd trimester anemia, significant predictors included 1st trimester height, BMI and IFA consumption during the 3rd trimester (but not 1st trimester micronutrient biomarkers), indicating that IFA supplementation over the course of pregnancy may have influenced micronutrient status and anemia risk. Our findings highlight the severity of the burden of anemia and micronutrient deficiencies in Eastern Maharashtra, but also highlight that in many cases, ID and anemia affect different individuals. Preventing and managing anemia in pregnancy in India will require strengthening both clinical and community‐based strategies targeting iron deficiency, as well as other causes of anemia.

Prevalence of iron deficiency in male elite athletes Study aim: To assess the prevalence of iron deficiency in competitive male athletes. Material and methods: In total, 90 elite athletes practicing judo, rowing, pentathlon, volleyball, kayaking and biathlon, aged 16-33 years, were studied. Blood morphology indices: haemoglobin concentration (Hb), hematocrit (Hct), red blood cell count (RBC), leucocyte count (WBC), mean corpuscular haemoglobin concentration (MCHC), mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) were determined. The concentrations of ferritin, soluble transferrin receptor (sTfR) and iron, as well as total iron binding capacity (TIBC), were determined in serum. Additionally, erythropoietin (EPO) was assayed in subjects with elevated sTfR levels. Results: In no case iron-deficiency anaemia was found, but in 43% of subjects iron deficiency was detected. This included first stage of iron deficiency (iron depletion; ID) in 13% of subjects (ferritin &lt;20 μg/L), and iron-deficient erythropoiesis (IDE) in 30% of subjects (ferritin &lt;16 μg/L and sTfR&gt; 2.75 mg/L). In all subjects with IDE, the concentrations of EPO were within normal range. The haematological indices remained unaffected in iron-depleted subjects, but in iron-deficient erythropoiesis subgroups the mean values of haemoglobin concentration and hematocrit were significantly lower than in subjects with normal iron stores (NIS). Conclusion: Despite the lack of anaemia among studied athletes, the incidence of latent iron deficiencies (iron depletion and iron-deficient erythropoiesis) was very high. The increasing incidence of iron deficiency, together with apparent decreases of haematological indices in subjects with iron-deficient erythropoiesis, markedly augments the risk of anaemia in young, competitive male athletes. Therefore, that category of subjects should be periodically screened for iron deficiency.