Skip to content
Join our Newsletter

Frequent blood donors put themselves at risk, study shows

In her health care job, Jackie Hannaford is well aware of the need for blood donations and willingly rolls up her sleeve to donate 500 millilitres four or five times a year.
11081879.jpg
Jackie Hannaford of Vancouver is a frequent blood donor who became iron deficient.

In her health care job, Jackie Hannaford is well aware of the need for blood donations and willingly rolls up her sleeve to donate 500 millilitres four or five times a year.

But last fall she had to take a break when she discovered her altruistic act was making her sick.

“I went to my doctor and told her I had been feeling tired, that I wasn’t feeling so hot. I was getting short of breath just going up the stairs,” said the Vancouver occupational therapist. “She did some tests and she found out my ferritin was at eight and it’s supposed to be 100. She was quite concerned about it.”

Ferritin, which measures iron stores and isn’t tested at blood clinics, is a blood-cell protein that contains iron. Low ferritin levels indicate an iron deficiency, a precursor to anemia. Hemoglobin, measured before donors give blood, is a red blood count and a low level indicates anemia.

Hannaford had just recently given blood and assumed because the blood clinic told her her hemoglobin levels were high enough to donate, that her blood was fine.

“I wasn’t really aware of the ferritin numbers, I thought it was all about the hemoglobin,” said Hannaford, 29. “That was new information for me. I was quite surprised.”

She’s not alone.

Women who donate blood more than two or three times a year are twice as likely as those who don’t donate to be iron deficient. That is, one-in-three women have low ferritin levels, and frequent donors have a two-in-three chance of low ferritin.

And men, who in the general population have virtually no iron deficiencies, have a one-in-three chance of suffering low ferritin levels if they donate more than three times a year.

That’s according to a study done by Canadian Blood Services, which took over English Canada’s blood collection duties from the Canadian Red Cross Society after the blood scandal that rocked the Red Cross in the 1980s and 1990s.

A national inquiry discovered the Red Cross had been negligent because it took three years after HIV was first reported in Canada to start screening for it and that it had also failed to properly screen blood for hepatitis C.

The CBS has known for years of the link between frequent donations and low ferritin levels, associated with fatigue, poor effort tolerance, cognitive changes, as well as restless leg syndrome and pica, a craving for unusual items like ice or dirt.

“I think we’ve known for a while iron deficiency is a problem for frequent donors,” said Dr. Mindy Goldman, author of the report and medical director for donor and clinical services.

In September of 2012, the AABB, an international association representing blood collection agencies, including CBS, urged its members to “take action(s) to monitor, limit or prevent iron deficiency in blood donors,” such as testing donors’ ferritin levels, providing replacement iron or recommending donors take supplements, and restricting the number of yearly donations.

“(After a 2011 AABB workshop), there was a clear focus on the impact of blood donation on body iron stores and its disproportionate effect on the health of menstruating women,” said an AABB bulletin to its members.

It recommended its members list adverse affects, risks and consequences of iron deficiency for donors.

Dr. Graham Sher, CEO of CBS and past president of the AABB, didn’t return a request for comment.

Almost three years after that recommendation, CBS has begun randomly sampling ferritin levels of 12,000 to 15,000 donors across Canada after a pilot study of 550 donors in Ottawa showed high iron deficiency rates among frequent donors, said Goldman.

Donors with low levels are sent a letter recommending they see their doctor and consider iron supplements, and then receive a followup call, she said.

Goldman said donors are already provided with adequate information about possible iron deficiencies and they’re aware of the link.

But the CBS website contains little information about iron or ferritin and doesn’t include iron levels in a long list of topics on its “ABCs of eligibility” page, which lists acupuncture, asthma, colds and flu, Ebola, surgery, travel and tattoos.

Goldman’s report isn’t found on the website, nor is a 2014 PowerPoint presentation done by a CBS resident doctor called “Blood Donation: How much is too much?”

Goldman said the information from the larger survey will be used to see if better education is needed on iron for donors and family physicians and to look at whether or not the number of allowable donations should be changed, she said.

But she said she’s also responsible for maintaining a sufficient blood supply as well as educating donors.

“We cannot make a big change in criteria without being aware of the effect it would have on the blood supply,” she said.

A 2013 Italian study showed that Canada and the U.S. are the only two countries that allow donations up to six times a year, once every 56 days, for women. Six other countries allow men to donate up to six times yearly but women are limited to two-to-four times a year.

“I think 56 days is too frequent for women,” said Cheryl Garrison of the Iron Disorders Institute in the U.S.

She also urges more people to ask for ferritin tests because “that’s not a test most people would know about.”

Hannaford, like several other female frequent donors interviewed by The Province, said they wish they had been given better and clearer information on ferritin.

Hannaford has been buying her own iron supplements to get her levels back up so she can start donating again.

“It would have been better if I had known about that before so I could have been careful not to let my levels get so low,” she said.

 

Blood Facts:

How much blood donated a year in Canada: 950,000 units (500 ml each).

Number of Canadian donors: 600,000.

Percentage of blood from repeat donors: 90.

Percentage of the population who donate: 2.

Percentage of female donors in Canada: 51.

Percentage of Canadians eligible to donate: 50

Number yearly donations allowed for women in Canada and the U.S.: 6

Other countries: 2-4.