Blood Donors, Physicians Support Blood Bank Iron Supplementation Policy

Findings from a recent study are providing clinicians with an overview of the knowledge and perception of individuals involved in blood donation regarding donation-induced iron loss and iron supplementation as a service policy.

Insight provided by donors, collection staff, and physicians during focus group discussions revealed donor lack of awareness regarding iron loss and positive attitudes toward iron supplementation, although collection staff participants expressed skepticism towards its ethicality and effectiveness if implemented as a policy.¹

“Qualitative research on the awareness of donation-induced iron depletion and perceptions on iron supplementation as an iron store management strategy amongst individuals involved in blood donation is limited,” wrote investigators.¹ “However, this approach is important for the detection of potential barriers and facilitators to the successful implementation of an iron supplementation policy.”

Millions of people need blood transfusions each year, all requiring blood from a donor. Most healthy adults can donate a pint of blood safely with no health risks.² According to the American Red Cross, someone in the US needs blood every 2 seconds. An estimated 6.8 million people donate blood and 13.6 million units of whole blood and red blood cells are collected in the US each year.³ Misconceptions and a general lack of knowledge about blood donation may prevent eligible patients from participating.

To provide a comprehensive overview of the knowledge and perceptions regarding donation-induced iron loss and iron supplementation, Jan Karregat, MSc, of the department of donor medicine research at Sanquin Research, and a team of investigators conducted focus group discussions with whole blood donors, collection staff, and physicians from blood collection centers in the Netherlands between February and July 2021. To be included in the study, donors were required to have donated at least 5 times and be fluent in Dutch. Staff and physicians were recruited through an internal Sanquin employee newsletter.¹

Investigators selected 200 donors from the Sanquin Blood Bank database and invited them to participate in the study, 16 of whom accepted. Internal staff and physician recruiting yielded a low response rate, which investigators noted limited the number of focus groups with staff and physician participation. In total, 28 individuals participated in this study, with this cohort comprised of 11 donors (43.8% female), 8 collection staff members (87.5% female), and 4 physicians (100% female).¹

Investigators pointed out in-person focus group sessions were not possible due to COVID-19 restrictions at the time of the study. Instead, discussions were carried out online using Zoom Video Communications and Microsoft Teams and were conducted by a facilitator who presented open-ended questions in a slideshow to guide discussion. Each focus group discussion lasted until no new information was shared, and all focus group recordings were manually transcribed for analysis.¹

Investigators used a grounded theory approach to design a final codebook with main themes and separate sub-themes based on the transcripts of each focus group discussion. The 4 main themes identified were donor health, donation-induced iron loss, iron supplements, and iron supplementation as an iron management policy. Sub-themes included donation-related health effects, ferritin-guided deferral, iron store recovery, awareness and experience regarding supplements, and perceptions, concerns, and expectations about supplements as a service policy.¹

Upon analysis, most individuals involved in blood donation indicated they were aware of donation-related health effects, with donors frequently mentioning decreased ferritin levels. Less than half of the donors involved in the study said they had been informed about low ferritin levels in the past. Some indicated the focus group was the first time they became aware of the increased risk of iron deficiency through donation.¹

Donors indicated they felt donation was a non-time-consuming and simple altruistic act for them, also describing how potential disadvantageous health effects did not affect their willingness to donate because of the positive feeling it gave them. Most donors said they were aware of the ferritin-guided deferral policy and some had been deferred due to low ferritin levels at least once. Among those who had been previously deferred, many expressed their disappointment about not being able to donate for an extended period. Additionally, some donors who had been deferred indicated this made them more cautious about the effect of donation on their health.¹

All included donors were aware of iron as a dietary supplement and its availability at drug stores, but only a few donors had ever used it or considered using iron supplements. Most donors said they had not felt the need to start using iron supplements because they never experienced any health complaints related to low iron stores. All donors who had used iron supplements in the past indicated that these were prescribed by their general physician. Despite the low use of iron supplements, most donors indicated they felt iron supplementation as a policy would be a convenient way to be able to continue to donate since it is so important to them.¹

Donors were positive about blood banks prioritizing donor health by providing iron supplements, but participants also pointed out providing iron supplements could be perceived as benefiting blood banks by making sure donors can donate more often. Of note, most collection staff members cited ethical concerns regarding iron supplementation as a blood bank policy, calling attention to the voluntary nature of blood donation and suggesting the necessity of iron supplementation may take away from it. However, physicians were predominantly positive about iron supplementation as a blood bank policy and did not see it as an ethical dilemma.¹

Freedom of choice of the donor was widely cited as an important factor in implementing iron supplementation as a policy. Donors expected information about donation-induced iron deficiency and guidance regarding iron supplementation would be provided prior to receiving iron supplements, while physicians indicated they expect to be responsible for informing the donors.¹

“Individuals involved in blood donation, both donors and staff, were predominantly positive towards iron supplementation as a blood bank policy on a voluntary basis,” concluded investigators.¹ “Important conditions for successful implementation of iron supplementation are sufficient training of the collection staff, as well as the provision of sufficient information, guidance and iron status monitoring to donors by physicians.”

References:

1. Karregat JHM, Blokhuis D, Quee FA, van den Hurk K. Iron supplementation: A qualitative study on the perception of blood donors, blood collection staff and donor physicians [published online ahead of print, 2023 Oct 20]. Vox Sang. 2023;10.1111/vox.13547. doi:10.1111/vox.13547
2. Mayo Clinic. Blood Donation. Tests & Procedures. Accessed October 23, 2023. https://www.mayoclinic.org/tests-procedures/blood-donation/about/pac-20385144
3. American Red Cross. Why Blood Donation is Important – and Who Benefits. May 19, 2021. Accessed October 23, 2023. https://www.redcrossblood.org/local-homepage/news/article/blood-donation-importance.html