Ispitivanje statusa željeza u dobrovoljnih davatelja krvi u Republici Hrvatskoj [Investigation of iron status in Croatian blood donors]

Vuk, Tomislav (2017) Ispitivanje statusa željeza u dobrovoljnih davatelja krvi u Republici Hrvatskoj [Investigation of iron status in Croatian blood donors]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Introduction: With each donation of whole blood, healthy blood donor loses 200 – 250 mg of iron. This loss is compensated by the mobilization of stored iron. Several studies showed that blood donors may be at risk of iron deficiency/depletion and the development of anemia. This risk is particularly pronounced in female donors of childbearing age and frequent blood donors. Therefore, implementation of numerous measures are considered in order to prevent iron deficiency and improve the safety of blood donors. Aim: The aim of this study was to evaluate the iron status of voluntary blood donors in Croatia, primarily by measuring ferritin level in donors with different donation freqency, to assess the diagnostic value of RBC parameters, as well as combined cell index (CCI) in detecting reduced iron stores, to evaluate the blood donor safety in relation to the iron stores using current selection criteria and to consider the implementation of measures to prevent iron deficiency, particularly the introduction of ferritin testing in blood donors. Methods: The study involved 1,084 male and 792 female whole blood donors, accepted for blood donation. In addition to the short questionnaire about general data and lifestyle, two additional samples were collected: one for the determination of complete blood count (CBC) and one for the determination of ferritin, serum iron, UIBC/TIBC. Statistical analysis was performed using the MedCalc software and Excel 2016. Results: In male donors, linear drop of serum ferritin was demonstrated with increasing frequency of blood donations:from the median of 129 μg/L in the control group to 43 μg/L in those with 7 – 8 donations in two years. In control group of female donors, the median value of ferritin was 33 μg/L, while in test groups the median ferritin was within a narrow range between 22 μg/L and 29 μg/L, and in correlation with the menstrual status. Depleted iron stores (ferritin ˂12 μg/L) were found in males with the frequency of 0% in the control group and 1.95% in those with 1 – 8 donations in two years. Depleted iron stores were found in 6.7% females of the control group and in 17.2% of female donors with 1 – 6 donations in two years. Combined Cell Index (CCI) showed satisfactory diagnostic value in the assessment of depleted iron stores in both sexes. Conclusion: In addition to more intense education of blood donors on the importance of iron and its loss during the blood donation, we propose the implementation of quantitative method for haemoglobin determination, along with the gradual introduction of ferritin test.

Abstract in Croatian

Uvod: Svakom donacijom pune krvi zdravi davatelj izgubi 200 – 250 mg željeza. Ovaj gubitak organizam nadoknađuje mobilizacijom željeza iz zaliha. Brojnim studijama dokazan je rizik manjka/deplecije zaliha željeza i nastanka anemije u davatelja, osobito žena generativne dobi i frekventnih davatelja. Zbog toga se razmatra potreba implementacije mjera kojima bi se prevenirao deficit željeza i unaprijedila sigurnost davatelja krvi. Cilj: Cilj rada bio je ispitati status željeza u dobrovoljnih davatelja krvi u RH, prije svega mjerenjem feritina u davatelja različitih učestalosti donacija, procijeniti dijagnostičku vrijednost parametara CKS - crvene krvne slike, kao i kombiniranog indeksa CCI (Combined Cell Index) u detekciji smanjenih zaliha željeza, procijeniti sigurnost davatelja u odnosu na zalihe željeza primjenom trenutno važećih kriterija odabira te razmotriti implementaciju mjera prevencije deficita željeza, osobito uvođenja feritina u testiranje davatelja. Metode: U studiju je uključeno 1.084 muškaraca i 792 žene, koji su udovoljili svim zahtjevima za davanje pune krvi. Uz informirani pristanak i kratki upitnik o općim podacima i životnim navikama, uzeta su dva dodatna uzorka: jedan za ispitivanje KKS i jedan za određivanje feritina, serumskog željeza, UIBC/TIBC. Statistička analiza podataka rađena je primjenom MedCalc software-a i Excell 2016. Rezultati: Kod muškaraca je dokazano linearno smanjenje koncentracije feritina u ovisnosti o frekvenciji davanja krvi, od medijana 129 μg/L kod kontrolne skupine na 43 μg/L u onih sa 7 – 8 donacija u dvije godine. Kod žena kontrolne skupine početna koncentracija feritina bila je 33 μg/L (medijan), a u ispitanim grupama medijan feritina kretao se u uskom rasponu od 22 μg/L do 29 μg/L i u značajnoj je korelaciji sa statusom menstruacije. Deplecija zaliha željeza (feritin ˂12 μg/L) nije nađena kod muškaraca iz kontrolne skupine, a u onih s 1 – 8 donacija u 2 godine nađena je s frekvencijom od 1,95%. Kod žena je 6,7% imalo depleciju željeza u kontrolnoj skupini i 17,2% u žena s 1 – 6 donacija u 2 godine. Indeks CCI pokazao je zadovoljavajuću dijagnostičku vrijednost u procjeni depletiranih zaliha željeza kod oba spola. Zaključak: Uz intenzivnije mjere edukacije davatelja o značaju željeza i njegovog gubitka tijekom donacija krvi, predlaže se implementacija kvantitativne metode određivanja hemoglobina, uz postepeno uvođenje određivanja feritina.

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