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Blood donors, iron deficiency and supplementation options – Will clinical trials help moving forward?

      Frequent whole blood donors have an acknowledged increased risk of developing iron deficiency [
      • Vassallo R.R.
      Donor iron depletion in context.
      ,
      • Prinsze F.J.
      • de Groot R.
      • Timmer T.C.
      • Zalpuri S.
      • van den Hurk K.
      Donation-induced iron depletion is significantly associated with low hemoglobin at subsequent donations.
      ,
      • Spencer B.R.
      • Fox M.P.
      • Wise L.A.
      • Cable R.G.
      • Mast A.E.
      Iron status and self-reported fatigue in blood donors.
      ]; recent evidence has made clear that iron deficiency may exist despite donors presenting with a hemoglobin pre-donation test within the commonly accepted values. Not only female donors [
      • Patel E.U.
      • White J.L.
      • Bloch E.M.
      • Grabowski M.K.
      • Gehrie E.A.
      • Lokhandwala P.M.
      • et al.
      Association of blood donation with iron deficiency among adolescent and adult females in the United States: a nationally representative study.
      ,
      • Fillet A.M.
      • Martinaud C.
      • Malard L.
      • Le Cam S.
      • Hejl C.
      • Chenus F.
      • et al.
      Iron deficiency among French whole-blood donors: first assessment and identification of predictive factors.
      ,
      • France J.L.
      • Hod E.A.
      • Caccappolo E.A.
      • Suhr J.A.
      • France C.R.
      • Kessler D.A.
      • et al.
      Examination of the relationship between iron status and cognitive function among healthy young women with and without a recent history of blood donation.
      ] but also male blood donors are exposed to this risk [
      • Russell W.A.
      • Scheinker D.
      • Custer B.
      Individualized risk trajectories for iron-related adverse outcomes in repeat blood donors.
      ]. Further, not only whole blood and erythrocyte apheresis donors are subjected to it [
      • Pehlic V.
      • Volken T.
      • Holbro A.
      • Jirout Z.
      • Drexler B.
      • Buser A.
      • et al.
      Long-term course of haemoglobin and ferritin values in high-frequency donors of whole blood and double erythrocyte apheresis.
      ], but also frequent platelet and plasma donors [
      • Pfeiffer H.
      • Hechler J.
      • Zimmermann R.
      • Hackstein H.
      • Achenbach S.
      Iron store of repeat plasma and platelet apheresis donors.
      ,
      • Spencer B.R.
      • Haynes J.M.
      • Notari 4th, E.P.
      • Stramer S.L.
      Prevalence, risk factors, and ferritin testing to mitigate iron depletion in male plateletpheresis donors.
      ,
      • Chinigi Sab P.
      • Kaur G.
      • Kaur P.
      • Tahlan A.
      • Bedi R.K.
      • Mittal K.
      • et al.
      Assessment of serum iron stores in regular plateletpheresis donors.
      ]. This is calling for further definitions in the transfusion medicine glossary, to implement “iron deficiency” in addition to anemia, and to precisely define what “frequent donation” is.
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