Difference between revisions of "Iron Deficiency (Anaemia)"
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==Explanation of Condition== | ==Explanation of Condition== | ||
| + | In donors with iron deficiency or iron deficiency anaemia, there are two factors to consider. The first is whether their haemoglobin is at a level which is clearable. The second is the cause of the underlying iron deficiency. A thorough history is required to elucidate the cause. Some causes are benign and have no effect on clearance (e.g. blood donation, vegetarian diet) while some causes can affect clearance (such as symptoms suggesting an underlying gastrointestinal malignancy or IBD). | ||
==Guidance== | ==Guidance== | ||
| − | + | <b> Females with iron deficiency anaemia or non-anaemic iron deficiency </b> | |
| + | 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 an acceptable level (>110) | ||
| − | + | Ensure appropriate GP follow-up is in place. | |
| − | Male donors who are | + | |
| + | |||
| + | <b> Males with non-anaemic iron deficiency </b> | ||
| + | |||
| + | 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 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, consideration of 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. | ||
| + | |||
| + | |||
| + | <b> Males with iron deficiency anaemia </b> | ||
| + | |||
| + | Male donors who are anaemic with no clear cause should be deferred for investigation. | ||
| + | |||
| + | |||
| + | <b> Bone marrow donation </b> | ||
| + | |||
| + | 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. | ||
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==Version== | ==Version== | ||
| − | Version 1, Edition | + | Version 1, Edition 3 |
====Date of Last Update==== | ====Date of Last Update==== | ||
| − | + | 16 May 2024 | |
Latest revision as of 13:28, 5 June 2024
Contents
Acceptability at Recruitment
QUALIFIED
Acceptability at CT / Work-Up
QUALIFIED
Individual at Risk
Donor / Recipient
Explanation of Condition
In donors with iron deficiency or iron deficiency anaemia, there are two factors to consider. The first is whether their haemoglobin is at a level which is clearable. The second is the cause of the underlying iron deficiency. A thorough history is required to elucidate the cause. Some causes are benign and have no effect on clearance (e.g. blood donation, vegetarian diet) while some causes can affect clearance (such as symptoms suggesting an underlying gastrointestinal malignancy or IBD).
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 an acceptable level (>110)
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 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, consideration of 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
Pseudonyms or Related Conditions
Version
Version 1, Edition 3
Date of Last Update
16 May 2024
