AABB23: A Closer Look at Ferritin Testing to Identify Iron Deficiency Risk in Blood Donors

Strategies to mitigate the risk of iron deficiency among blood donors – particularly those that donate frequently – are important to ensure donors’ optimal health and maintain a sustainable donor pool.

At a Monday morning session, Aditi Khandelwal, MD, MSc, medical officer at Canadian Blood Services, spoke about strategies to help identify and address the risk of iron deficiency among blood donors. She said ferritin testing can play a role in identifying donors with iron deficiency who may be at risk of becoming anemic. Once identified, interventions to inform donors about the risk for anemia and strategies to improve iron levels could benefit donors’ overall health and allow them to continue to donate.

A low hemoglobin level – a marker of iron deficiency – is the most common reason for donation deferrals. Low hemoglobin levels are seen more frequently among female donors and among those who donate frequently. Khandelwal explained that Canadian Blood Services has implemented several mitigation strategies to help reduce the risk of iron deficiency among blood donors. These include longer inter-donation intervals for female donors and a higher hemoglobin threshold for male donors.

In January 2023, Canadian Blood Services also implemented selective ferritin testing. To begin with, ferritin testing was conducted for every tenth female donor. Donors with low ferritin (defined as less than 300 mcg/L) were informed of their iron levels through personalized messaging. “Those with low ferritin were asked to pause donation for six months and consider iron supplementation,” Khandelwal said.

During the first six weeks following implementation of selective ferritin testing, the median ferritin of those tested was 43 mcg/L. A total of 632 donors were identified as having low ferritin and received personalized messaging.

Khandelwal said the goal of the personalized messaging is to “proactively reduce hemoglobin deferrals by empowering donors to improve their iron stores.” She said that research is ongoing and more data is needed to better assess the correlation between the personalized messaging and the percentage of donors who return to successfully donate blood again later.