Assessment of implementation of ferritin testing on donor return

One mitigation strategy for donor iron deficiency is to implement ferritin testing and encourage donors with low ferritin to pause donation and increase iron intake. We evaluated positive outcomes (reduced hemoglobin deferrals) and negative outcomes (donor nonreturn) in a 2-year observation period after implementing ferritin testing of female donors at each 10th donation.

Donors with ferritin below 25 ug/L were advised to pause donation for 6 months and see their health care practitioner about increasing iron intake but were not deferred. Ferritin results for donors screened in the first 6 months of the program (Jan-June 2023), hemoglobin on return and time to return in the 2 years following testing were calculated for low ferritin and normal/high ferritin donors.

Twenty five percent of 8613 tested donors had low ferritin, associated with younger age, high donation frequency, and previous hemoglobin deferral. About one third of low ferritin donors returned to donate less than 6 months after testing, and had a hemoglobin deferral rate of 16%, compared to 4.4% in those who waited 6 months or more and 5.2% in donors with normal ferritin. After 2 years, 77.5% of low ferritin compared to 88.5% of normal/high ferritin donors returned to donate.

Iron deficiency was common. Low ferritin donors who paused donation and returned to donate had hemoglobin deferral rates similar to normal ferritin donors. However, many returned early and had high failure rates. Two years after testing, an 11% difference in return rates remained between low and normal/high ferritin donors.