A non-invasive strategy for haemoglobin screening of blood donors

Assessing blood-donor haemoglobin (Hb) is a worldwide screening requirement against inappropriate donation. The pre-donation Hb (which should be at least 12.5 g/dL in women and 13.5 g/dL in men) is usually determined in capillary blood from a finger prick, using a spectrophotometer which reveals the absorbance of blood haemolysed in a microcuvette. New non-invasive methods of measuring Hb are now available.

In the first semester of 3 consecutive years three different strategies were employed to screen donors for anaemia at the moment of donation. In 2011 all whole-blood donors underwent the finger-prick method using azide-methaemoglobin: the test's negative predictive value (NPV) was determined by comparison with the sub-threshold Hb values ascertained by haemocytometry of test-tube blood drawn at the start of the donation. In 2012 the donor evaluation was based on NBM 200 occlusion spectrophotometry. The same approach was kept in 2013, but a haemocytometry test was added on a pre-donation venous sample drawn from donors who, though fit to donate, had previous critical Hb values in their clinical records.

In 2011, the NPV (in 3,856 donors) was 86% for women and 95% for men; in 2012 (3,966 donors), the values were 85% and 95%, respectively, and in 2013 (3,995 donors) they were 91% and 97%, respectively. Fisher's test for contingency tables revealed no statistically significant differences between 2011 and 2012, but the 2013 results were a significant improvement.

Measuring Hb by finger prick is not wholly satisfactory since, above all in women, the result of this screening may subsequently be belied by the haemocytometry finding of an unacceptable Hb value. Using a non-invasive method does not diminish the selective efficiency. In women, in particular, adding a haemocytometric test on a venous sample significantly improves donor selection and avoids the risk of inappropriate donation or blood-letting.