1. Compared to no supplementation, low-dose iron supplementation reduced time to 80% recovery of pre-donation hemoglobin concentration in blood donors.
2. This effect was seen regardless of sex or low or high levels of pre-donation ferritin.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Blood donors experience a drop in hemoglobin levels upon donation. While the current literature suggests that iron supplementation may improve hemoglobin and iron levels, these studies have largely examined blood donor deferral rather than physiologic end points such as blood hemoglobin or iron levels. The authors of this study conducted a randomized controlled trial to assess the effects of daily oral iron supplementation on hemoglobin recovery and iron replenishment for 24 weeks after blood donation. Participants who received iron supplements had a shorter time of recovery to 80% of pre-donation hemoglobin concentration compared to participants who did not receive iron supplements. Iron supplementation reduced the time to 80% hemoglobin recovery rapidly regardless of baseline ferritin level and equally in both sexes.
The major strengths of this study were its design as a multi-center, randomized control trial and its inclusion of participants of varying donation frequency. However, participants may have been motivated to strictly adhere to the daily oral iron supplementation as a result of participating in a clinical trial and/or receiving compensation. Similar rates of compliance may not be observed in ordinary clinical settings. Overall, this study raises questions as to whether the current 8-week donation interval in the U.S. and Canada is sufficient and suggests that iron supplementation may be beneficial to hemoglobin recovery rates.
In-Depth [randomized controlled trial]: This study included 215 blood donors from four U.S. blood centers. Participants were stratified by ferritin level (high >26ng/mL or low ≤26ng/mL) and then randomized to receive daily oral iron supplements or no treatment for 24 weeks. The primary outcomes were time to recovery of 80% of pre-donation hemoglobin levels and recovery of ferritin levels to baseline as a measure of iron stores. Compared to participants with low-ferritin who did not receive supplements, participants in the low-ferritin group who received supplements had a more rapid time to 80% hemoglobin recovery (mean 32 days, IQR 30 to 34, vs 158 days, IQR 126 to >168). Similarly, participants in the high-ferritin group who received supplements experienced rapid time to 80% hemoglobin recovery (mean 31 days, IQR 29 to 33, vs 78 days, IQR 66 to 95). Time to recovery of baseline ferritin levels was quickest in the low-ferritin group that received iron (median 21 days, IQR 12 to 84). Participants with high-ferritin levels and received iron had a median recovery of 107 days (IQR 75 to 141). Among the group who did not receive iron, both participants with low- or high-ferritin required a median of longer than 168 days (low-ferritin IQR 128 to >168; high-ferritin >168 to >168).
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