Iron supplementation is one of the most talked-about topics in the field of transfusion medicine these days. So it’s no surprise that the Tuesday morning session on this issue included a variety of strong opinions and thought-provoking data. The session, “Iron Supplementation in Blood Donors: Who, What Why and How?,” featured four experts – Ritchard Cable, MD; Bryan Spencer, PhD; Dan Waxman, MD; and Louis Katz, MD – all of whom have studied and worked on issues regarding iron supplementation for many years.
Cable highlighted some of the data regarding self-administration of iron supplementation among blood donors. He noted that the REDS-II RISE study, conducted between in 2007 and 2009, demonstrated that 32% of male and 52% of female frequent donors took self-initiated supplemental iron. Following the results of that study, the Red Cross began recommending iron supplements for frequent donors.
Cable also shared results of a new survey he worked on, the results of which indicate that self-initiated iron supplementation was more common among women and older donors. It was also more common among frequent donors and among those who donate plateletpheresis. “The benefits of iron supplementation have already been recognized by a minority of donors,” he concluded. “But there is considerable opportunity to increase iron supplementation in blood donors with blood center-initiated education efforts.”
Spencer discussed data examining donors’ responses to blood center promotion of iron supplementation. He focused on two studies from Australia and one from Canada. The first Australian study, the READ trial, examined the effect of iron education on iron supplementation in donors. The second, the DIRECT trial, examined pill distribution. The Canadian study examined the efficacy of sending a letter to donors with low iron levels, informing them of their iron levels and encouraging them to see a doctor, consider iron supplementation, or wait six months to donate again. The results of all three studies suggest that many donors are receptive to iron supplementation and that those who begin a regimen of iron supplementation show good compliance. However, the results also indicate that the level of awareness regarding iron depletion is very low among the general donor population.
Katz was the final speaker at the session. He acknowledged that iron supplementation for blood donors remains a challenging issue for the blood community, but said he believes blood centers should probably be providing iron supplements to donors. “Giving iron directly to donors is probably most appropriate,” he said.
However, as Katz noted, there are multiple legal, logistical and medical issues to consider. For example, which donors should receive iron supplements? Populations to consider include teens, young adults, women of childbearing age and frequent donors – and some say all donors should be considered for iron supplements.
Katz noted that AABB’s Working Group on Iron Management in Blood Donors is using a risk-based decision-making framework to examine the issue and available data, and expects to have recommendations by the end of 2017.