Iron Deficiency (Anaemia)

Acceptability at Recruitment

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Acceptability at CT / Work-Up

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Individual at Risk

Donor / Recipient

Guidance

Females with iron deficiency anaemia or non-anaemic iron deficiency

Iron deficiency is common in women of menstruating age due to chronic blood loss. Females diagnosed with iron deficiency anaemia at workup should be advised to supplement iron (200mg ferrous sulfate once a day for six weeks - to be obtained from a pharmacy), and may donate once the haemoglobin has risen to normal level.

Ensure appropriate GP follow-up is in place.

Males with non-anaemic iron deficiency

Male donors where diet or regular blood donation is the cause of low ferritin with or without low MCV, but with normal HB may donate.

In males who are omnivores and not blood donors, conduct a thorough medical review. Specifically, ask them:

• Have you previously had low iron levels or anaemia?

• How many times a week (or month) do you eat red meat?

• Have you had any of the following symptoms: difficulty swallowing food or liquid, heartburn or reflux symptoms, abdominal pain, change in bowel habit, change in appetite, unexplained tiredness, diarrhoea, bloating, unintentional weight loss, dark stool, or blood in the stool?

• Are there bowel problems or cancers in your family?

• Is there any history of low iron or anaemia in your family?

• Have you had any previous operations (e.g. gastric bypasses)?

• Have you noticed any bleeding (e.g. nosebleeds, blood in the urine, blood in the stool etc)?

• Have you noticed any excessive bruising?

If the donor reports red flag symptoms of a GI cancer (dysphagia, change in appetite, change in bowel habit, unintentional weight loss, unexplained fatigue, blood in the stool or dark stool), the donation process should be deferred with an urgent 2ww referral via their GP. In people with a family history of GI malignancy, referral for further investigation should also be undertaken.

Symptoms suggestive of IBD should also result in deferral and investigation.

If the donor reports visible haematuria, the donation process should be deferred with a 2ww referral to renal/urology (depending on donor age) via their GP.

If the donor answers "yes" to any of the other questions and a non-malignant and non-inflammatory cause for the iron deficiency is identified, this should be followed up appropriately (e.g. dietary advice if insufficient red meat intake, coagulation screen/FBC if reports of bruising, coagulation screen/FBC then post-donation GP review for nosebleeds). As long as remaining blood tests are normal (such as coagulation screens), the donor can be cleared. Iron supplementation should be advised (200mg ferrous sulfate once a day for six weeks). A letter should also be written to the donor's GP to inform them of the finding and advise consideration of a coeliac screen.

If there is no obvious cause of iron deficiency AND there are no red flag symptoms AND no family history of bowel problems, conduct a FIT test (which can be posted to the donor's address). If this is negative, the donor can be cleared to donate. As above, iron supplementation should be advised and their GP informed.

Males with iron deficiency anaemia

Male donors who are anaemic with no clear cause should be deferred for investigation.

Bone marrow donation

If ferritin level is below 50, iron supplementation (with 200mg ferrous sulphate to be taken daily in the lead up to the bone marrow collection procedure) should be advised to all donors.

See also Anaemia

Version

Version 1, Edition 3

Date of Last Update

16 May 2024