Iron and blood donation- an under-recognised safety issue.

A growing body of evidence suggests that iron status is frequently affected by blood donation. Iron deficiency may be assessed through iron storage depletion measured by serum ferritin. These measurements indicate a high incidence of iron deficiency in repeat donors. This is not ameliorated through increasing pre-donation haemoglobin cut-offs. Depletion of tissue--rather then storage--iron, may be assessed by measurement of the serum transferrin receptor; such measurements in repeat donors indicate tissue iron depletion, but to a much lesser extent than storage iron depletion. A fuller understanding on how repeat donation affects donor health will allow better haematological criteria for donor selection to be developed. Blood agencies and standard-setting authorities need to accord the issue of donor iron and donation status as high a priority as that of any blood safety issue involving patient safety, if the safety and supply of the blood system is to be maintained.