Reticulocyte hemoglobin content allows early and reliable detection of functional iron deficiency in blood donors

Frequent blood donations may lead to a depletion of body iron stores resulting in manifest anemia. Reticulocyte hemoglobin content (CHr) – a marker for impaired hemoglobinisation (IH) caused by functional iron deficiency (FID) – was investigated regarding its value as a routine screening parameter in frequent whole blood donors. In a prospective study, 917 frequent blood donors and 688 first time or reactivated donors were tested for iron status and red blood cell count, including CHr. The ferritin index as a marker to indicate absent iron stores (AIS) was calculated. Depending on the number of donations during the preceding 12months, AIS were detected in up to 21.4% of male and 27.8% of female donors, respectively. IH was present in up to 6.4% male and 16.7% female donors with 2 and 4 preceding donations, respectively. The defined CHr cut-off value was 28.0pg to detect IH in frequent whole blood donors with AIS, leading to a test specificity of 98.2% (positive predictive value, PPV: 57.7%) in male and of 97.8% (PPV: 82.9%) in female donors. Determination of CHr is feasible to detect FID resulting in IH in frequent blood donors. It may help to prevent the development of anemia in frequent blood donors and also can help to decide whether donor deferral or even iron substitution need to be recommended. ► Frequent blood donations lead to iron deficiency and impaired hemoglobinisation. ► Reticulocyte hemoglobin content is a marker for functional iron deficiency. ► Functional iron deficiency results in impaired hemoglobinisation. ► Impaired hemoglobinisation may lead to donor deferral or iron substitution.