ROLE OF ESTIMATING SERUM FERRITIN LEVELS IN A REPEATED VOLUNTARY BLOOD DONOR –HAEMOVIGILANCE Dr. Nishi Jaswal Assistant Professor Department of Immunohematology and blood transfusion DYSPGMC Nahan HP

BACKGROUND A lot of money is being spent for the screening of donors for protection of recipients but very little attention is given to the health status of donors. The main reason is the fear of losing the donor in a time when the demand of blood is soaring all over the world and the donors are becoming scarce. It is seen that repeated blood donations can cause iron deficient anaemia in the voluntary blood donors. To recruit and retain regular voluntary blood donors, the iron status of the donors needs to be identified. A study was conducted to estimate the serum ferritin levels among voluntary blood donors with different frequency of donations and compared with haemoglobin and haematocrit levels.

METHODS A cross-sectional study was conducted in 435 donors in the department of Blood transfusion in collaboration with department of Biochemistry over the period of three years . A questionnaire was designed and specific questions regarding age , number of donations per year in the last three years , date of last donation , total number of donations in the past etc were asked . The control group comprised of donors who donated blood the first time and the study group had donors who donated once, twice, thrice or four times in a year. The red cell parameters were measured by automatic cell count and estimation of serum ferritin was done by ELISA method ( Bio -detect human ferritin )

RESULTS  There were 86.20 % males and 13.79 % females. All the donors with haemoglobin more that 12.5 g % and age group 18 years to 65 years were included in the study , though there were only 2 donors (0.45%) donors with age more than 54 years . Age wise distribution was done in four groups ( 18 -30 years 31-42 years 43-54 years and more than 54 years ) and it was seen that maximum donors were in the age group 18 to 30 years followed by 31 to 42 years as shown in the Table no . 1

Table1 Age wise distribution was in four groups ( 18 -30 years 31-42 years , 43-54 years and more than 54 years ) Age 18-30 yrs Age 31- 42 Age 43-54 yrs Age >54 230 (52.87%) 153(35.17%) 50(11.49) 2(0.45%)

RESULTS According to the frequency of donations i.e number of donations per year over the period of three years the following observations were made .  The first time donors (controls) were 50.57 percent. The study groups were donors who donated once (28.5 %), twice (11.59%), thrice (6.43%) and four times (2.52%) in a year marked as group A to D . Serum ferritin was markedly reduced in donors who donated > 20 times and last donation was within 3-5 months.

Frequency wise distribution of the donors 1st time donors Once a yr donors Twice a yr donation Thrice a yr donation Four times donation / yr total 220 (50.57%) 124 (28.5%) 52 (11.95%) 28 (6.43%) 11 (2.52%) 435

RESULTS A statistically significant correlation was seen between frequency of donation and serum ferritin levels. Distribution on the basis of number of donations per year and serum ferritin <15 ng/ml in the donors were 4.54 % in first time, 16.12% in once a year, 19.23 % in twice a year 28.57% in thrice year and 36.36 % in four times a year donations .

1st time donors Once a yr donors Twice a yr donation Thrice a yr donation Four times donation / yr total Donors 220 (50.57%) 124 (28.5%) 52 (11.95%) 28 (6.43%) 11 (2.52%) 435 Low ferritin 4.54 % 16.12% 19.23 % 28.57% 36.36 %

CONCLUSION In our study, there was a definite correlation between serum ferritin levels and the frequency of blood donation in voluntary blood donors. Our study suggests that estimation of serum ferritin level is a mandatory tool for haemovigilance in the donors. Although several studies have indicated that repeated blood donation induces iron depletion and iron deficiency, all blood centers still test only hemoglobin as an indicator for selecting the donors. (Mittal R et al )

… Iron supplements were given to the donors who had low ferritin levels. We recommend iron supplementation and donor health education programme based on balanced nutritious diet for all donors Measurements of serum ferritin regularly can detect iron overload. If iron overload is present, it will be considered malpractice to provide iron supplementation. In our country, the iron stores in females are low especially in the reproductive age group. Hence, serum ferritin evaluation needs to be included in the testing of first time female donors for donor safety. It is also logical to include serum ferritin measurement in the assessment of regular blood donors to secure adequate iron reserves in the donor population in order to maintain adequate donor recruitment .

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