Donor Deferral Due to Low Hemoglobin—An Updated Systematic Review

Andrew Browne, Sheila A. Fisher*, Katya Masconi, Graham Smith, Carolyn Doree, Ryan Chung, Mana Rahimzadeh, Akshay Shah, Silvia Alonso Rodriguez, Thomas Bolton, Stephen Kaptoge, Angela Wood, Michael Sweeting, David J. Roberts

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

3 Citations (Scopus)

Abstract

Blood donors attending a donation session may be deferred from donating blood due to a failure to meet low hemoglobin (Hb) thresholds. This costs the blood donor service and donors valuable time and resources. In addition, donors who are deferred may have more symptoms, and as a direct and/or indirect effect of their experience, return rates of donors deferred for low Hb are reduced, even in repeat donors. It is therefore vital that low Hb deferral (LHD) is minimized. The aim of this updated systematic review is to expand the evidence base for factors which affect a donor's risk of deferral due to low Hb. Studies were identified by searching MEDLINE, Embase, The Cochrane Library, and the WHO International Clinical Trials Registry to March 2019. Demographic data, donor history, hematological/biological factors, and the primary outcome of deferral due to low Hb were extracted. Our primary outcome was deferral due to low Hb. Analyses were descriptive and quantitative; pooled odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by meta-analysis using random-effects models. A total of 116 studies met the inclusion criteria. Meta-analysis showed a significantly greater risk of LHD in females compared with males in studies applying universal Hb thresholds for males and females (OR 14.62 95% CI 12.43-17.19) and in those which used sex-specific thresholds (OR 5.73, 95% CI 4.36-7.53). Higher rates of LHD were also associated with increasing age in men, low body weight, shorter interdonation interval, donors of Hispanic or African descent, higher ambient temperature, donors with low ferritin levels, and donation in a fixed donor center. There was conflicting evidence on the effect of new and repeat donor status, and blood group. This work has strengthened the evidence of the previous review in identifying factors that should be considered in studies of donor deferral and highlighting areas in need of further study, including ABO and Rh blood groups, previous platelet donation, diet, smoking, time of day, and genetic data. These factors may lead to individually tailored donation criteria for safe and efficient donation in the future.

Original languageEnglish
Pages (from-to)10-22
Number of pages13
JournalTransfusion Medicine Reviews
Volume34
Issue number1
DOIs
Publication statusPublished - Jan 2020
Externally publishedYes

Bibliographical note

Funding Information:
We thank Prof Michael F Murphy for helpful comments on an early draft of the manuscript. This research is supported by core funding from NHS Blood and Transplant, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre Programme (SF, CD), the UK Medical Research Council (MR/L003120/1), the British Heart Foundation (RG/13/13/30194; RG/18/13/33946), and the National Institute for Health Research [Cambridge Biomedical Research Centre at the Cambridge University Hospitals NHS Foundation Trust]. AB, TB, and KM are funded by the NIHR Blood and Transplant Research Unit in Donor Health and Genomics (NIHR BTRU-2014-10024). SAR is funded by the National Institute for Health Research [Cambridge Biomedical Research Centre at the Cambridge University Hospitals NHS Foundation Trust]. The views expressed herein are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. Prof David Roberts is joint principal investigator of the INTERVAL study. There are no other conflicts of interest.

Funding Information:
We thank Prof Michael F Murphy for helpful comments on an early draft of the manuscript. This research is supported by core funding from NHS Blood and Transplant , the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre Programme (SF, CD), the UK Medical Research Council ( MR/L003120/1 ), the British Heart Foundation ( RG/13/13/30194 ; RG/18/13/33946 ), and the National Institute for Health Research [Cambridge Biomedical Research Centre at the Cambridge University Hospitals NHS Foundation Trust]. AB, TB, and KM are funded by the NIHR Blood and Transplant Research Unit in Donor Health and Genomics ( NIHR BTRU-2014-10024 ). SAR is funded by the National Institute for Health Research [Cambridge Biomedical Research Centre at the Cambridge University Hospitals NHS Foundation Trust]. The views expressed herein are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

Publisher Copyright:
© 2019 Elsevier Inc.

Keywords

  • Anemia
  • Blood donation
  • Blood donors
  • Deferral
  • Hemoglobin

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