Oral Supplementation After Blood Donation: The Hemoglobin and Iron Recovery Study (HEIRS)

Justin Kyei-Frimpong, PharmD candidate 2015, Mercer University College of Pharmacy

Blood donors are allowed to donate 500ml of whole blood every 8 weeks in the United States. The Food and Drug Administration (FDA) has set the minimum blood count or hematocrit level for blood donation to be 38%. This level serves as a precaution that donors have enough blood to give and have available iron stores to make more blood after donation. Low hemoglobin levels (<12.5g/dl) are another indicator that red blood cell count is low.1 It is estimated that 25 to 35% of blood donors become iron depleted from regular blood donation.2

Table 1. 3

Primary Outcome MeasureTime to recovery of 80% of the post-donational decrease in hemoglobin and recovery of ferritin level to baseline as a measure of iron stores.

Title: Oral Supplementation After Blood Donation: A randomized clinical trial
Design Randomized, non-blinded, multicenter clinical trial
Objective To determine the hemoglobin recovery time in iron depleted donors on iron supplementation compared to unsupplemented iron depleted controls
Study groups A total of 334 participants enrolled; out of this, 215 eligible participants were randomized into two groups. One group received iron supplements (n=111) and the other did not receive iron supplements (n=104).
Methods Participants were randomized to receive oral ferrous gluconate
325 mg once a day for 24 weeks, or no supplementation.
Participants were also restricted to taking only supplements provided and required not to donate blood.
Duration 24 weeks
Baseline Characteristics Participants aged 18 to 79 years who had not donated whole blood or red blood cells within 4 months, 60% female, 40% male, individuals 60 years old and over (20%), ferritin levels <300 ng/ml
Results Median time to recovery to all patients taking iron was 76 days (IQR, 20-126 days, P<0.001). For participants not taking iron median time to recovery was longer than 168 days (IQR, 147 to more than 168 days, P<0.001). In addition, 67% of participants not taking iron did not reach their baseline ferritin by 168 days.
Adverse Events Common Adverse Events: Gastrointestinal effects – 0.14%, constipation and abdominal discomfort – 0.009%
Serious Adverse Events: None Reported
Percentage that Discontinued due to Adverse Events: 0.009%
Study Author Conclusions Among blood donors with normal hemoglobin levels, low-dose iron supplementation, compared with no supplementation, reduced time to 80% recovery of the post donation decrease in hemoglobin concentration in donors with low ferritin (≤26 ng/mL) or higher ferritin (>26 ng/mL).

According to this study, iron supplementation after blood donation aids in the recovery of hemoglobin levels in blood donors. The study also suggests hemoglobin and iron recovery in blood donors can be delayed when they do not receive necessary iron supplementation. This delay may lead to longer intervals before blood donors can make further donations. Due to low iron levels, blood donors may also be in danger of developing anemia, so it could be recommended that regular blood donors take iron supplements to help prevent this.

References:

1. Baart AM, van Noord PAH, Vergouwe Y, et al. High prevalence of subclinical iron deficiency in whole blood donors not deferred for low hemoglobin. Transfusion. 2013;53(8):1670-1677.
2. Cable RG, Glynn SA, Kiss JE, et al; NHLBI Retrovirus Epidemiology Donor Study-II (REDS-II).Iron deficiency in blood donors: the REDS-II Donor Iron Status Evaluation (RISE) study. Transfusion.2012;52(4):702-711.
3. Kiss JE, Brambilla D, Glynn SA, et al. Oral iron supplementation after blood donation: a randomized clinical trial. JAMA. 2015;313(6):575-83.

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