An approach to determine objectively minimum hemoglobin standards for blood donors

Area of Science:

• Hematology
• Transfusion Medicine
• Public Health

Background:

• Current North American blood donor hemoglobin standards are 13.5 g/dL for males and 12.5 g/dL for females.
• Donors are deferred if their hemoglobin levels do not meet these criteria.
• The iron status of these deferred donors is often not assessed.

Purpose of the Study:

• To evaluate the iron status of blood donors deferred due to low hemoglobin levels.
• To determine if current hemoglobin screening criteria accurately identify iron deficiency.
• To propose evidence-based, objective minimum hemoglobin standards for blood donation.

Main Methods:

• Prospective study involving deferred blood donors.
• Measurement of hemoglobin, mean corpuscular volume, ferritin, and free erythrocyte protoporphyrin.
• Utilized Receiver Operating Characteristic (ROC) curves to establish optimal hemoglobin thresholds.

Main Results:

• A significant majority of deferred donors were not iron deficient (85% of males, 83% of females).
• ROC curve analysis indicated that lower hemoglobin levels could be used while still excluding most iron-deficient donors.
• Proposed new minimum hemoglobin levels: 12.5 g/dL for males and 12.0 g/dL for females.

Conclusions:

• Current hemoglobin screening for blood donation may be overly stringent, leading to the deferral of many non-iron-deficient individuals.
• Objective minimum hemoglobin standards, informed by ROC analysis, can balance donor inclusion with the exclusion of iron deficiency.
• Revised hemoglobin criteria could potentially increase the donor pool without compromising donor safety.