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Abstract

Blood Center/Blood Hospital-Based Donor Center

Oral Abstract - Blood Donor Issues

OA3-AM24-ST-17 - Ferritin Testing of Adult Donors with a Prior Low Hemoglobin (Hb) Deferral

Saturday, October 19, 2024

11:15 AM - 12:15 PM

Location: 372

CE: Zero

Presenting Author(s)

Ralph R. Vassallo, MD FACP

EVP / Chief Medical & Scientific Officer
Vitalant
Scottsdale, Arizona, United States

Disclosure(s): Cerus Corp.: Consultant/Advisory Board (Ongoing); Fresenius Kabi: Consultant/Advisory Board (Ongoing); Hemanext: Consultant/Advisory Board (Ongoing)

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Disclosure(s):

Ralph R. Vassallo, MD FACP: Cerus Corp.: Consultant/Advisory Board (Ongoing); Fresenius Kabi: Consultant/Advisory Board (Ongoing); Hemanext: Consultant/Advisory Board (Ongoing)

Background/Case Studies: Since Jan 2020, donors age ≥19 with a low Hb deferral (LHD; < 13.0 g/dL male/ < 12.5 g/dL female) were ferritin (F) tested on their next successful donation. Those with WHO-defined iron deficiency (ID, F < 15 ng/mL) were not deferred, but notified by letter encouraging healthcare provider discussion and use of 18-28 mg elemental iron for 60 days(d) after donation. Compared to a control group of non-notified donors with F 15-25, their next-presentation rate was not different and the LHD rate only slightly higher than all donors at first presentation after the original LHD. However, over 14 mo. follow-up, they presented slightly less often (3.6 vs. 4.0 per person-year (PPY)), with fewer successful donations (2.7 vs. 3.2 PPY). To better understand the impact of ID notification, the pilot was extended.

Study

Design/Methods:

We followed CY 2022 allogeneic presenting donors with LHD through Jun 2023, characterizing the first presentation (P1) Hb ± F after index LHD, as well as their next-presentation (P2) Hb after P1 F testing. For P1 and P2, we describe donor return rates and mean inter-presentation intervals (mIPI) across Hb & F values. F results included notified/ID ( < 15), non-notified low F (15-25) and iron replete (IR, ≥26 ng/mL). A subset (~½) of donors were asked about iron intake for another ongoing study.

Results/Findings:

Of 32,992 donors with a first LHD in 2022, 58% returned [Table 1] by Jun 2023 with mIPI of 80d. 77% of returnees had adequate Hb (mIPI = 86d). The mIPI of returning donors with a second LHD was shorter at 60d. The mIPI of donors with Hb < 1 g/dL above cutoff was 72d vs. 103d at ≥1 g/dL higher.

Of those returning (P1) with acceptable Hb, 14,619 were tested for F. From these, 27% had ID and were notified (group 1, G1)[Table 1]. Donors with F 15-25 ng/mL (G2) or F 26-450 (G3) were not notified. The ID rate at P1 was higher (36%) for donors with Hb < 1 g/dL above cutoff vs. those ≥1 g/dL higher (16%). Compared to G2 who had a 77% P2 return rate and 18% LHD rate, G1 had a lower 73% P2 return rate, and higher 28% LHD rate. G1-3 donors returned at mIPI of 91-99d.

G1 returned 2.3x PPY of follow-up compared with G2’s 3.8x (p < 0.0001). Similarly, G1 had 2.0 successful donations PPY while G2 had 3.3 (p < 0.0001). At P1, 20% of G1 donors were taking iron, while only 9% more reported iron intake at P2. G2 remained unchanged from 29% at P1 vs. 26% at P2 (p=0.152).

Conclusions: After LHD, longer mIPIs were associated with higher Hb and lower rates of subsequent LHD. Lower returning Hb was associated with higher ID rates. F testing and notification of LHD donors with ID encouraged little additional iron use and quite significantly decreased subsequent presentation and donation rates. This strategy did not appear to promote donor health or increase successful donation after LHD.