April 18, 2019
3 min read

Female blood donors at risk for iron deficiency anemia

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Photo of Aaron Tobian
Aaron Tobian

Female blood donors demonstrated an increased risk for iron deficiency anemia compared with the general population, according to study results published in Transfusion.

Researchers observed the risk among both female adolescents and adults.

Aaron Tobian, MD, PhD, director of transfusion medicine at Johns Hopkins Hospital, and colleagues conducted a cross-sectional analysis using data from the 1999 to 2010 National Health and Nutrition Examination Surveys (NHANES).

The analysis included 9,647 females aged 16 to 49 years who reported their blood donation history in the prior year and had serum ferritin measurements. The study population included 2,419 adolescents aged 16 to 19 years.

Results showed mean serum ferritin levels for blood donors were significantly lower than for nonblood donors among both adults and adolescents. Rates of iron deficiency anemia were 9.5% among adolescent donors, 7.9% among adult donors and 6.1% among nondonors.

“This research sounds an alarm bell that it is time to act and make sure that we protect these young blood donors,” Tobian told HemOnc Today. “We are proposing that there should be accreditation standards or FDA regulations to make sure that we protect these young women.”

HemOnc Today spoke with Tobian about the study and the potential implications of the results.


Question: What prompted this study?

Answer: Prior research suggested that iron deficiency is a problem among young female adolescent blood donors. However, these findings were not evaluated on a national level, nor had they thoroughly compared blood donors to nonblood donors. We conducted our study using the National Health and Nutrition Examination Survey database, which is representative of the entire United States. This allowed us to evaluate donors and nondonors.


Q: How did you conduct the study?

A: We incorporated the NHANES data provided by CDC and evaluated the years between 1999 and 2010, when we had available data of ferritin and hemoglobin levels. Participants also answered questionnaires about whether they had donated blood in the past 12 months, and how recently the donation occurred. We then incorporated the ferritin and hemoglobin data with the questionnaire data to evaluate for possible associations.


Q: What did you find?

A: Serum ferritin levels were significantly lower among blood donors than nondonors, and this was accentuated among female adolescent blood donors. The geometric main serum ferritin level was 21 ng/mL for blood donors vs. 32 ng/mL for nondonors. We also found that blood donors had significantly higher rates of absent iron stores and iron deficiency anemia, which was defined by serum ferritin levels less than 26 ng/mL. Low hemoglobin levels were defined as less than 12 g. Among young female blood donors, there is a significant concern for iron deficiency anemia. This study adds to the prior research in that it evaluated blood donors across the entire nation and was not limited to a small study population. It also clearly compares blood donors with nondonors.


Q: What is the impact of these results on blood donations?

A: Adolescents provide a substantial contribution to society by donating blood. The concern is whether we are causing harm to these individuals, and it is critical that individuals who are providing blood on an altruistic basis are protected and not harmed by their selfless act. Currently, there are weight and hemoglobin requirements, but there is no testing for iron deficiency. There are three main options to reduce the risk for iron deficiency caused by blood donation. One is to increase the interval between donations. Another is to test for iron deficiency and inform donors who may be iron deficient. The third is to provide blood donors with iron supplementation if they are at critically low levels.


Q: Can you elaborate on why female donors appear to be at greater risk than men?

A: The NHANES study only had serum ferritin levels available for women, but young women are at a much greater risk for iron deficiency for two main reasons. The first is that young women usually are smaller than young men. When you donate a unit of red cells and take 200 mg to 250 mg of iron from these individuals, it's a much higher amount proportionately. The second reason is young women already have some blood loss due to menstruation.


Q: Do you plan to conduct further research in this area?

A: We are beginning to investigate iron supplementation levels and their impact on young blood donors. More importantly, I think the data are very clear and warrant a call to action for the AABB or FDA to draft accreditation standards or regulations. – by Joe Gramigna

For more information:

Aaron Tobian, MD, PhD, can be reached at Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287; email: atobian1@jhmi.edu.


Patel EU, et al. Transfusion. 2018;doi:10.1111/trf.15179.

Disclosure: Tobian reports no relevant financial disclosures.