Targeted use of iron supplementation at groups or individuals at greater risk of iron deficiency is suggested to reduce or prevent donation deferrals due to low Hb.
A Cochrane review [Abstract] 1 included 30 RCTs with a total of 4704 participants to assess the efficacy and safety of iron supplementation to reduce deferral, iron deficiency and/or anaemia in blood donors. Studies comparing iron supplementation versus placebo or control, oral versus parenteral iron supplementation, iron supplementation versus iron-rich food supplements, and different doses, treatment durations and preparations of iron supplementation in healthy blood donors were included.
The results of supplementation versus no supplementation are summarized in Table 1. Rates of donor deferral due to low haemoglobin were considerably less in those taking iron supplements compared with those without iron supplementation, both at the first donation visit and at subsequent donation.
| Outcome | Relative risk | Number of participants (studies) | Assumed risk (control) | Corresponding risk (iron supplementation) |
|---|---|---|---|---|
| Deferral (low Hb at first visit) | RR 0.34 (0.21 to 0.55) | 1194(4 studies) | 105 per 1000 | 36 per 1000(22 to 58) |
| Deferral (low Hb after multiple visits) | RR 0.25 (0.15 to 0.41) | 793(3 studies) | 199 per 1000 | 50 per 1000(30 to 81) |
| Hb level (g/l) before further donation | 847(8 studies) | 135.2 g/l | 2.36 higher(0.06 to 4.66 higher) | |
| Hb level (g/l) after donation | 406(3 studies) | 127.8 g/l | 6.37 higher(2.36 to 10.39 higher) | |
| Any adverse effect | RR 1.6 (1.23 to 2.07) | 1748(4 studies) | 171 per 1000 | 274 per 1000(210 to 354) |
Adverse effects included constipation, diarrhoea, nausea, vomiting and taste disturbances, and some participants stopped treatment due to side effects.
In the comparison of ferrous sulphate with ferrous fumarate, one study showed a significant increase in overall adverse effects associated with ferrous sulphate (RR 1.40; 95% CI 1.04 to 1.88; n = 131). However, there were no significant differences observed in individual studies, or from meta-analysis of the frequencies of specific adverse effects, which included constipation, diarrhoea, nausea/vomiting and abdominal pain and/or cramps.
There was no evidence for a difference in the overall frequency of adverse effects between ferrous sulphate and carbonyl iron from a meta-analysis of two studies (RR 0.89; 95% CI 0.75 to 1.06 n = 96), or in the frequency of specific adverse effects which included constipation, diarrhoea, nausea/vomiting, abdominal pain and/or cramps, gastric/epigastric pain and headache.
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