Transfusion Medicine, 2010, 20, 22–29
ORIGINAL ARTICLE
Study of iron stores in regular plateletpheresis donors
E. A. Page,1 J. E. Coppock2 & J. F. Harrison3
and 3 Colindale, UK
Received 07 May 2009; accepted for publication 16 October 2009
summary. Plateletpheresis donors will lose up to
100 mL of blood at each donation, leading to con-
cern that they may become iron deficient, particu-
larly if donating at the maximum allowed frequency
under National Blood Service policy of every 2 weeks.
The serum ferritin levels of 508 regular plateletphere-
sis donors and 101 non-donors were measured to
indicate the level of their iron stores. About 33·9%
(156/460) of platelet donors had depleted iron stores
compared with 3·1% (3/97) non-donors. Results for
male and post-menopausal female donors were similar
with 36·2% (131/362) of males and 37·7% (20/53) of
post-menopausal females showing iron depletion. There
was clear correlation with donation frequency in males
with 63·9% (46/72) of males donating at 2 weekly
At the time of this study in England and Wales,
plateletpheresis donors could donate at a minimum
interval of 2 weeks but no more than 24 times a year.
Blood loss within the harness (Gambro BCT, 2004) and
at sampling on the Trima Accel cell separator is between
80 and 100 mL resulting in an annual blood loss of
up to 2400 mL in someone donating at the maximum
frequency. This is the equivalent of four to five whole
blood donations per annum.
In order to understand the effect of regular platelet-
pheresis on donor iron stores, a three-centre study
was conducted to determine whether regular platelet
donors become iron depleted. In addition, the rela-
tionship between donor iron status and lifetime num-
ber of donations, donation frequency, gender and other
factors such as diet or pre-menopausal status was
examined.
Correspondence: Dr Elizabeth Anne Page, National Blood Service
NBS Tooting, 75 Cranmer Terrace, London, United Kingdom.
Tel.: 0208 258 8300; Fax: 0208 258 8491;
e-mail: lizanne.page@nbs.nhs.uk
22
doi: 10.1111/j.1365-3148.2009.00979.
1 National Blood Service, Tooting, London, UK, 2 Birmingham, UK,
intervals found to be iron depleted. The percentage of
iron depleted male subjects decreased as donation inter-
vals increased. Correlation with lifetime donations of
platelets was not demonstrated, although no donor who
had given fewer than 14 blood and/or platelet donations
was found to be iron depleted. In males there was a
clear correlation between iron depletion and frequency
of donation. There appeared to be no correlation with
lifetime number of platelet donations. As a result of this
study, we have advised that volunteers should not donate
platelets more than 15 times per year, so that red cell
loss is no more than the equivalent of three whole blood
donations (1500 mL).
Key words: donation, iron stores, plateletpheresis donor,
serum ferritin.
MATERIALS AND METHODS
Study design
The National Blood Service (NBS) collects platelets
by apheresis at 24 static sites. Donors were selected
to participate in this study from three of the largest
static sites – Brentwood, Birmingham and Tooting: 508
(402 males, 106 females) platelet donors participated
in this study and 101 controls (46 males, 51 females).
All of the platelet donors had previously donated whole
blood prior to joining the plateletpheresis programme
on which they donate platelets only and refrain from
blood donation, and the control subjects had never
donated platelets or blood. Donors were selected in
two equally sized groups: 256 donors (203 males, 53
females) had donated platelets for more than 3 years
and 252 donors (199 males, 53 females) had donated
for less than 3 years. Donors were selected at random
and reflected a range of donation frequencies from those
who donated at 2 weekly intervals to those who donated
at 8 or even 12 weekly intervals. The iron stores of
both participating donors and controls were assessed
by measuring serum ferritin, which is recognized as
© 2009 The Authors
Journal compilation © 2009 British Blood Transfusion Society

having a high degree of correlation with the amount of
storage iron (Walters et al ., 1973) in healthy subjects.
Venous blood samples for serum ferritin and a full
blood count were taken immediately prior to a platelet
donation.
Individuals entering the study were given an infor-
mation sheet explaining the aims of the study and the
process they would undergo, and written consent was
obtained. Subjects who were found to have a serum
ferritin level below the normal reference range were
advised to consult their General Practitioner (GP) who
was given details of the results. Such individuals were
advised to refrain from donation for a period of up to
6 months, whilst investigation and treatment was deter-
mined by their GP.
All those participating in the study were required to
complete a questionnaire giving information on diet,
iron supplementation and whether they had any con-
dition possibly causing blood loss such as haemor-
rhoids or symptoms of gastritis. Additionally, females
were asked to confirm whether they were pre- or
post-menopausal and whether they had heavy periods.
Those who responded positively were excluded from the
study.
All participants in the study, both donors and non-
donors, were selected according to the standard criteria
for whole blood and component donors as outlined
in the Guidelines for the Blood Transfusion Services
in the UK and the Donor Selection Guidelines (The
Stationary Office, 2005). A minimum haemoglobin level
of 135 g L−1 for males and 125 g L−1 for females is
required for donation in the UK. Prior to acceptance
on to the study, all participants were tested using a
gravimetric method with CuSO4 solution to determine
that they satisfied these criteria. Donors who failed to
achieve this standard using the CuSO4 solution test had
a further test on a venous sample using a haemoglobin
photometer (Hemocue) which was required to show the
desired haemoglobin level in order to allow them to
proceed to donation.
Samples
One native 10 ml blood sample and one 5 ml sample
in ethylenediaminetetraacetic acid (EDTA) were col-
lected into plastic tubes immediately prior to dona-
tion. The native sample was transported to the Whit-
tington Hospital laboratory for serum ferritin analysis
where samples were stored unseparated at 4 ◦ C. Sam-
ples were then centrifuged at room temperature prior to
assay.
The EDTA samples were stored at room temperature
overnight before being analysed for full blood count at
NBS testing laboratories.
© 2009 The Authors
Journal compilation © 2009 British Blood Transfusion Society, Transfusion Medicine, 20, 22–29
Iron stores in plateletpheresis donors 23
Equipment and assays
Plateletpheresis was performed on the Trima Accel
Automated Blood Collection System, version 5·1
(Caridian BCT, Inc, Lakewood, CO, USA). Hb was
determined by using a Coulter LH 500 haematology
analyser (Beckman Coulter, Inc, Fullerton, CA, USA)
using diluent and reagents from Beckman Coulter.
Reference values were supplied by Beckman Coulter.
The reference range for males was Hb 130–170 g L−1
and for females was Hb 120–160 g L−1 .
Ferritin was determined by using a Hitachi Modular E
floor model analyser and reagents from Roche Diagnos-
tics (Mannheim, Germany). Reference values for ferritin
were established to 95% confidence (two standard devi-
ations). The reference ranges for ferritin were males
30–400 ng/mL, females age 14 years up to 50 years
13–200 ng/mL and females older than 50 years of age
30–400 ng/mL.
RESULTS
The results in Table 1 show that 40% (70/175) of
males donating regularly by plateletpheresis for less than
3 years and 32·6% (61/187) of males donating regularly
by plateletpheresis for more than 3 years had low iron
stores as indicated by having serum ferritin below the
normal range of 30–400 ng/mL. It can clearly be seen
in both cohorts that the number of donors with low
iron stores is related to the frequency of donation. The
number of donors showing iron depletion is greater in
the group donating for less than 3 years than in the group
who have donated for more than 3 years. No donor who
donated at intervals of more than 8 weeks had deficient
iron stores.
In the cohort of male donors who had donated by
plateletpheresis for less than 3 years, five donors had a
haemoglobin beneath the acceptance level for donation
which requires a male donor to have a haemoglobin of
135 g L−1 or above. All five subjects had a serum ferritin
concentration below the normal range. Four donors had
a haemoglobin between 130 and 135 g L−1 and one had
a haemoglobin of 115 g L−1 . This was a 48-year-old
man who had given 27 platelet donations at 6 weekly
intervals and who had a serum ferritin of 25 ng mL−1 .
In the cohort of male donors who had donated by
plateletpheresis for more than 3 years, three donors had
haemoglobin levels between 132 and 134 g L−1 .
Table 2 shows the results for female donors. As
expected, the percentage of post-menopausal female
donors with serum ferritin below range is similar
to those found in the male donors. Notably, only
11·1% (5/45) of pre-menopausal female plateletphere-
sis donors had a serum ferritin below the normal range
24 E. A. Page et al.
Table 1. Number and percentage of male platelet donors with serum ferritin below normal reference range of 30 ng/mL∗
Donation Male plt donors Number with serum
frequency donated <3 years ferritin <30 ng/mL
Total donors (all 175 70 (40%)
frequencies)
2 weekly 34 21 (61·8%)
3 weekly 38 18 (47·4%)
4 weekly 69 23 (33·3%)
5–6 weekly 20 6 (30%)
8 weekly 8 2 (25%)
9–16 weekly 6 0
Plt, platelet.
∗ Serum ferritin range for males = 30 − 400 ng/mL.
for pre-menopausal women (13–200 ng/mL). There is
no correlation with frequency of donation though this
may reflect the small number of iron depleted subjects
studied.
Of the non-donors sampled, 3·2% (3/101) – one male
and two pre-menopausal females – were found to have
a serum ferritin below the normal range.
Results were considered in terms of the lifetime num-
ber of plateletpheresis donations made. Table 3 shows
little correlation between the number of plateletpheresis
procedures and donor iron stores in the male donors.
In order to ascertain the influence of previous whole
blood and plasmapheresis as well as platelet donations
in the donor’s lifetime, data were analysed according
to the donor’s credited numbers of donations on the
NBS computer system. Prior to 1992, donation type is
not itemized so there is no way of identifying whether
the donations given were of whole blood, plasma or
platelets. The total number of donations (whether whole
blood, plasma or platelets) credited by the computer has
been listed in Table 4.
The minimum number of donations before any subject
showed depleted iron stores was 14, the donor having
given 11 blood donations prior to three plateletpheresis
donations. Otherwise, as shown in Table 4, there is little
correlation between deficient iron stores and the lifetime
number of donations either in males or females.
Of the 460 donors on the study, 11 (2·4%) were
vegetarian, whilst all other donors ate red meat at least
once a week. Of the 10 males who were vegetarian,
40% (4/10) were iron deficient though not anaemic, a
similar percentage to the whole study population. Two
of the iron depleted vegetarian donors donate at 2 weekly
intervals and two at 4 weekly intervals. The one female
donor who was a vegetarian was iron depleted. Three
of the 101 (2·97%) non-donors were vegetarian and
a further two ate no red meat whatsoever. These five
Journal compilation © 2009 British Blood Transfusion Society, Transfusion Medicine, 20, 22–29
Male plt donors Number with serum
donated >3 years ferritin <30 ng/mL
187 61 (32·6%)
38 25 (65·8%)
49 18 (36·7%)
64 14 (21·9%)
23 4 (17·4%)
7 0
6 0
donors all had normal iron stores as indicated by ferritin
levels within the normal range.
Donors were questioned as to whether they were
currently taking iron supplementation. Of the 362 male
plateletpheresis donors, 15 (4·1%) admitted to taking
iron. Of the 15 donors taking iron supplementation,
two (13·3%) had a serum ferritin level below the
normal range. One donated at 2 weekly intervals, the
other at 3 weekly intervals and both donors had a
normal haemoglobin level of 141 g L−1 and 159 g L−1 ,
respectively. Four female donors, all post-menopausal,
admitted to taking iron supplementation. Two (50%) of
these had serum ferritin levels below the normal range
and both donated at 3 weekly intervals. No non-donor
reported taking iron supplementation.
DISCUSSION
It has been appreciated that regular blood donors will
become iron depleted, particularly if they donate at
the maximum frequency allowed under NBS, England
and Wales (NBS) policy. The development of ferritin
assays (Cook et al ., 1976) in the 1970s led to a
greater understanding of the effects of regular donation
with studies showing that regular blood donation is
accompanied by progressive decline of serum ferritin
concentration (Finch et al ., 1977; Simon et al ., 1981;
Milman et al ., 1998). A blood donor donating at the
maximum frequency allowed under NBS policy of
three or four times in a year will lose 1500–2000 mL
of blood per annum. A study (Taylor & Harrison,
2000) by the NBS showed 83% of a sample of 41
regular male blood donors who had donated a lifetime
average of 74 units including eight times within the past
2 years had a serum ferritin below the normal range.
In contrast, 22% of 18 male donors with a lifetime
average of 14 donations, up to three donations in the
past 2 years and no donation in the past 6 months had
© 2009 The Authors
 Iron stores in plateletpheresis donors 25

the past 6 months had a serum ferritin below the normal

<30 ng/mL
Se ferritin

9 (42·9%)
4 (30·1%)
20 (37·7%)
2 (40%)
5 (50%)
range.

0
0
The daily iron requirement for an adult male is
1·0 mg and for an adult menstruating female 1·5–2 mg
menopausal (Harrison, 2008). A blood donation of 470 mL plus
30 mL samples (500 mL blood loss in total) contains
Post-

approximately 250 mg of iron, so that a donor will need

53

10
21
13
5

2
2
to absorb 0·7 mg of iron daily (250/365) for each unit
donated per year. A person eating a western diet can
expect to absorb between 1 and 4 mg of iron per day.
<13 n g/mL
Se ferritin

5 (11·1%)

1 (11·1%)
Thus, anyone who donates blood three to four times
2 (40%)

2 (10%)
0

0
0 per annum may have difficulty maintaining adequate or
normal iron stores.
At the time of this study in England and Wales,
menopausal

plateletpheresis donors were invited to donate at a

minimum interval of 2 weeks but no more than 24
Pre-

45
5
4
20
9
4
3

times a year. Blood loss within the harness (Gam-

bro BCT, 2004) and at sampling on the Trima Accel
cell separator is between 80 and 100 mL resulting in
(post-men) <13 ng/mL
Se ferritin <30 ng/mL

an annual blood loss of up to 2400 mL in some-

Table 2. Number and percentage of female platelet donors with serum ferritin below normal reference range∗

∗ Serum ferritin range for pre-menopausal females = 13 − 200 ng/mL and for post-menopausal females = 30 − 400 ng/mL.

one donating at the maximum frequency. This is the

7 (30·4%)
3 (23·1%)
(pre-men)

equivalent of four to five whole blood donations per

3 (50%)
3 (50%)
16 (32%)

annum. Studies in repeat apheresis donors have shown

0
0

serum ferritin levels decreasing in a donation-frequency

dependent manner, with females showing significantly
decreased ferritin levels with over 21 donations (Furuta
et al ., 1999).
Whilst some authors have questioned the relevance
>3 years
Donated

of iron depletion short of anaemia (Verloop, 1970),

50
6
6
23
13
1
1

others have demonstrated adverse clinical effects in

some situations. There is evidence of reduced intellec-
tual capacity in non-anaemic iron deficient children and
(post-men) <13 ng/mL
Se ferritin <30 ng/mL

adolescents (Gordon, 2003). A joint study from South

Plt, platelet; post-men, post-menopausal; pre-men, pre-menopausal; Se, serum.

Africa and the United States in 2003 (Beard et al ., 2003)

9 (18·8%)

4 (22·2%)
2 (22·2%)
(pre-men)

showed a significant correlation between iron status and

1 (25%)
2 (25%)

impaired cognitive functioning, depression, anxiety and

0
0

anger, in women with iron-deficiency anaemia, and in

iron depleted but non-anaemic women. Furthermore, a
recent case report (Page et al ., 2008) described a regular
plateletpheresis donor who donated at 2 weekly intervals
and who developed an impairment of anterograde mem-
<3 years
Donated

ory coupled with moderate depression in the presence

48

18
4
8

9
5
4

of a non-anaemic iron depletion. Following iron therapy

and a return of his iron stores to normal levels, there was
a marked improvement in his memory testing scores and
Total donors (all frequencies)

a recovery from his depression.

The results from the study reported here show that
33·9% (156/460) of plateletpheresis donors had serum
ferritin concentrations below the normal range, with
those who had donated for less than 3 years showing
12–16 weekly
8–10 weekly
5–6 weekly

similar or even greater levels of iron depletion to those

frequency
Donation

2 weekly
3 weekly
4 weekly

who had been donating for more than 3 years. About

23·8% (5/21) of donors who had given only one to
four platelet donations were iron depleted. However, it
© 2009 The Authors
Journal compilation © 2009 British Blood Transfusion Society, Transfusion Medicine, 20, 22–29
 26 E. A. Page et al.

Table 3. Number and percentage of platelet donors with serum ferritin below normal reference range according to lifetime number of platelet donations∗

No. platelet Se ferritin <30 ng/mL Se ferritin Pre-men Se ferritin Post-men Se ferritin
donations All donors male Males <30 ng/mL females <13 ng/mL females <30 ng/mL

Total donors 460 156 (33·9%) 362 131 (36·2%) 46 6 (13%) 52 19 (35·5%)
1–4 21 5 (23·8%) 17 5 (29·4%) 3 0 1 0
5–9 31 8 (25·8%) 18 5 (27·8%) 9 1 (11%) 4 2 (50%)
10–14 56 15 (26·8%) 43 14 (32·6%) 5 0 8 1 (12·5%)
15–19 52 15 (28·8%) 38 12 (31·6%) 9 0 5 3 (60%)
20–24 38 17 (44·7%) 30 14 (46·7%) 3 1 (33·3%) 5 2 (40%)
25–29 27 9 (33·3%) 24 8 (33·3%) 1 0 2 1 (50%)
30–39 42 17 (40·5%) 38 17 (44·7%) 2 0 2 0
40–49 32 9 (28·1%) 23 7 (30·4%) 2 0 7 2 (28·6%)
50–74 51 15 (29·4%) 41 10 (24·4%) 4 2 (50%) 6 3 (50%)
75–99 42 23 (54·8%) 33 20 (60·6%) 6 2 (33·3%) 3 1 (33·3%)
100–149 41 11 (26·8%) 33 8 (24·2%) 2 0 6 3 (50%)
150–199 19 8 (42·1%) 16 7 (43·8%) – – 3 1 (33·3%)
200–285 8 4 (50%) 8 4 (50%) – – – –

Plt, platelet; post-menopausal; pre-men, pre-menopausal; Se, serum; post-men.

∗
Serum ferritin range for pre-menopausal females = 13 − 200 ng/mL and for males and post-menopausal females = 30 − 400 ng/mL.

Journal compilation © 2009 British Blood Transfusion Society, Transfusion Medicine, 20, 22–29
© 2009 The Authors
© 2009 The Authors
Table 4. Number and percentage of platelet donors with serum ferritin below normal reference range according to lifetime number of total whole blood and pheresis
donations∗

No. platelet + whole Se ferritin<normal Se ferritin Pre-men Se ferritin Post-men Se ferritin

blood donations All donors range Males <30 ng/mL females <13 ng/mL females <30 ng/mL

Total donors 460 156 (33·9%) 362 131 (36·2%) 46 6 (13%) 52 19 (35·5%)
1–9 12 0 4 0 7 0 1 0
10–24 53 12 (22·6%) 39 10 (25·6%) 8 0 6 2 (33·3%)
25–49 103 36 (35%) 79 29 (36·7%) 10 1 (10%) 14 6 (42·9%)
50–74 95 28 (29·5%) 78 26 (33·3%) 7 0 10 2 (20%)
75–99 40 15 (37·5%) 31 12 (38·7%) 5 2 (40%) 4 1 (25%)
100–149 58 25 (43·1%) 50 21 (42%) 3 1 (33·3%) 5 3 (60%)
150–199 38 17 (44·7%) 33 15 (45·5%) 0 0 5 2 (40%)
200–249 12 6 (50%) 7 4 (57·1%) 5 2 (40%) 0 0
250–299 9 3 (29·4%) 9 3 (24·4%) 0 0 0 0
300–349 10 1 (10%) 7 0 0 0 3 1(33·3%)
350–399 3 2 (66·7%) 3 2 (66·7%) 0 0 0 0
400–499 13 4 (30·1%) 8 2 (25%) 1 0 4 2 (50%)

Journal compilation © 2009 British Blood Transfusion Society, Transfusion Medicine, 20, 22–29
500–699 14 7 (50%) 14 7 (50%) – – – –

Plt, platelet; post-men, post-menopausal; pre-men, pre-menopausal; Se, serum.

∗
Serum ferritin range for pre-menopausal females = 13 − 200 ng/mL and for males and post-menopausal females = 30 − 400 ng/mL.
Iron stores in plateletpheresis donors
27
28 E. A. Page et al.
was notable that no donor who had donated a total of
less than 14 blood and/or platelet donations was iron
depleted suggesting the relevance of previous whole
blood donations. Thereafter, there was no correlation
between lifetime number of donations and iron status. A
study evaluating the iron status of new plateletpheresis
recruits may provide valuable information as to whether
donors are already iron depleted at the point of entry on
to the platelet programme and indicate whether sampling
of all new platelet recruits to determine their ferritin
concentration would be of benefit.
The results showed a strong correlation between fre-
quency of plateletpheresis and iron depletion with 63·9%
(46/172) of male donors donating at 2 weekly inter-
vals having serum ferritin concentrations below normal
range. No donor who donated at more than 8 weekly
intervals was found to be iron depleted.
Of the 362 male donors on the stud,y only 1 (0·3%)
was found to be anaemic. None of the female cohort
was found to be anaemic. This compares with a report
of iron-deficiency anaemia as affecting around 3% of
males and 8% of females under the age of 65 years
in the general population (Falaschetti et al ., 2002).
The low incidence of anaemia in our plateletphere-
sis donors as compared with the general population
may be explained by the fact that only donors who
passed haemoglobin screening were accepted on to the
study.
Of the 362 male donors, 231 (63·8%) were not iron
depleted. The range of serum ferritin for this group
was 30–488 ng/mL with a mean of 65·3 ng/mL. In the
female (menopausal and pre-menopausal) cohort, 74·5%
(73/97) had serum ferritin within normal range with a
range of 14–137 ng/mL and a mean of 43 ng/mL. Of
the 94 (male and female) non-donors, 96·9% (94/97)
had a serum ferritin within normal range with a range
of 13·4–330 ng/mL and a mean of 83·4 ng/mL which
is consistent with other reported figures (Vetpillai, S).
It is notable that the mean serum ferritin of non-iron
depleted male and female donors is significantly below
that of non-donors.
Due to the small number of females on this study (98),
it is not easy to draw sound conclusions. The results for
post-menopausal females were of a similar order to the
male donors. However, it is notable that pre-menopausal
females showed considerably less iron depletion than
the other groups with only 13% (6/46) having serum
ferritin levels below the normal range. Previous studies
have found that healthy pre-menopausal women are able
to absorb more iron than males (Hadley et al ., 2006).
Further studies on pre-menopausal females would seem
justified.
The NBS has considered iron supplementation of
regular donors but there are concerns about possible
Journal compilation © 2009 British Blood Transfusion Society, Transfusion Medicine, 20, 22–29
side effects and donor compliance (Radtke et al ., 2004;
Boulton, 2008).
As a result of this study, we have advised that
volunteers should not donate platelets more than 15
times per year, so that red cell loss is no more than the
equivalent of three whole blood donations (1500 mL).
In 2008, the NBS changed its policy to reflect this
recommendation.
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