SISTRA Liviana Catalano

Blood donation
Nutrition, protection of blood
donors’ health, lifestyles
Giuliano Grazzini
Director, National Blood Centre
Istituto Superiore di Sanità
Rome, Italy
GAINING HEALTH
Strategy to
avoid premature death and significantly reduce the
disease burden from noncommunicable diseases,
improving quality of life and making healthy life
expectancy more equitable.
2006
Objectives:
- integrated action
on risk factors and
their underlying
determinants,
EUROPEAN ACTION PLAN
FOR FOOD AND NUTRITION POLICY
GLOBAL STRATEGY ON DIET,
PHYSICAL ACTIVITY, AND HEALTH
- prevention and
control of
noncommunicable
diseases.
http://www.euro.who.int/__data/assets/pdf_file/0008/76526/E89306.pdf
ITALIAN PROGRAM
WHY IS PROPER NUTRITION IMPORTANT?
Proper nutrition is a cornerstone of good health.
Basic rules to follow for proper
nutrition :
From http://www.safefood.eu/Healthy-Eating/What-is-a-balanced-diet/The-FoodPyramid.aspx
-
to pay attention to individual
foods or nutrients of food;
-
to ensure that intake is
proportionate to the caloric
energy expenditure;
-
to ensure a varied and balanced
diet.
Nutrition not only serves to replace energy reserves but also to feed most of
the strategic regulatory systems of the organism
(e.g. the nervous, immune, endocrine system …)
From Ministero della salute. “Guadagnare salute” - Rendere facili le scelte salutari.
http://www.salute.gov.it/imgs/C_17_pubblicazioni_605_allegato.pdf
NUTRITION AND BLOOD DONATION: WHICH LINK?
NUTRITION
BLOOD
DONATION
Only subjects in good health and in good nutritional conditions are suitable
for blood and blood component donation
Optimal nutrition habits (part of a correct lifestyle) favor eligibility to blood
and blood component donation
NUTRITION AND BLOOD DONATION: WHICH LINK?
NUTRITION
BLOOD
DONATION
Only subjects in good health and in good nutritional conditions are suitable
for blood and blood component donation
Optimal nutrition habits (part of a correct lifestyle) favor eligibility to blood
and blood component donation
Fratres, Banco Alimentare Toscana, Aic Toscana. Il cibo è vita. Dal sè all'altro. Alimentazione, salute,
solidarietà. Alimentazione, il teatro e la scrittura per il benessere psichico, salute, solidarietà.
A cura di Anna Garante e Leda Spagnuolo.
Briciole. Trimestrale del Cesvot - Centro Servizi Volontariato Toscana n. 36, aprile 2013.
BLOOD DONORS SELECTION CRITERIA
DECRETO 3 marzo 2005
Protocolli
per l'accertamento della idoneita' del donatore di sangue
e di emocomponenti. (GU n. 85 del 13-4-2005)
Art. 6.
Valutazione delle condizioni generali di salute del donatore
1. Mira ad evidenziare le condizioni generali di salute del
candidato donatore con particolare attenzione a stati quali
debilitazione, iponutrizione, edemi, anemia, ittero, cianosi,
dispnea, instabilita' mentale, intossicazione alcolica, uso di
stupefacenti ed abuso di farmaci.
For the protection of donors’ health
Allegato 7
C) Esami per il donatore periodico.
Il donatore periodico, oltre agli esami indicati ai precedenti
punti A e B, ogni anno e' sottoposto ai seguenti esami:
creatininemia;
glicemia;
proteinemia ed elettroforesi sieroproteica colesterolemia;
trigliceridemia;
ferritinemia.
BODY MASS INDEX (BMI) AND OBESITY
A moderately high prevalence of obesity among healthy blood
donors has been reported in some studies, with demographic
associations comparable to those seen in population-based
studies.
STUDY
Edward L Murphy, Karen Schlumpf, David J Wright,
Ritchard Cable,Ronald Sacher, and Michael P Busch for
the NHLBI Retrovirus Epidemiology Donor Study II. BMI
and obesity in US blood donors: a potential public health
role for the blood centre Public Health Nutr2012 June ;
15(6): 964–971.
KEY POINT
We found a moderately high prevalence of obesity among otherwise
healthy US blood donors, with demographic associations comparable
to those seen in population-based studies. As some blood centres
move towards measurement of cholesterol and glycosylated Hb as a
service to donors, the combination of these indices with BMI could lead
to useful health education measures and even interventions to induce
health-conscious blood donors to maintain healthier diet and lifestyles.
Cássia da Silva Faria, Clovis Botelho, Regina Maria Veras In our study, BMI and other indicators of abdominal adiposity is
Gonçalves da Silva, Márcia Gonçalves Ferreira. Smoking associated with smoking, regardless of alcohol consumption and other
and abdominal fat in blood donors. J Bras Pneumol. confounders.
2012;38(3):356-363
Cruz del Castillo AH, García Fierro R, Hess Moreno MI, Of the 726 donors, 85.1% were male, according to the ATPIII criteria,
Vigil Pérez CA, Córdova Fernández JA, Chuck Santiago MP, 54.8% (398) had a GAA, 63.2% (458) had hypertriglyceridemia, almost
Domínguez Moreno R. Metabolic syndrome prevalence 17% (121) presented HDL hypocholesterolemia, 44.1% (320) were
and clinical features in blood donors. Rev Fac Cien Med overweight by BMI, the prevalence of metabolic syndrome was 54.4%,
Univ Nac Cordoba. 2012;69(3):144-9.
in comparison by gender, men had a statistically significant difference
compared to women, showing an OR = 2.27 (p = 0.0001, 95% CI 1.443.60).
CARDIOVASCULAR RISK FACTORS (CVR) (I)
Although blood donation targets healthy individuals, data suggest
that a relevant percentage of blood donors could have at least one
cardiovascular risk factor, some at critical levels as defined by
National Heart, Lung, and Blood Institute (NHLBI):










High blood pressure
High blood cholesterol
Diabetes and prediabetes
Smoking
Being overweight or obese
Being physically inactive
Having a family history of early heart disease
Having a history of preeclampsia during pregnancy
Unhealthy diet
Age
National Heart, Lung, and Blood Institute (NHLBI). Screening for Cardiovascular Risk Factors.
Available at http://www.nhlbi.nih.gov/
CVR ASSESMENT STUDIES ON BLOOD DONORS
STUDY
Debra A. Kessler, Caroline Ortiz, Kathleen Grima, David
Vlahov, Vijay Nandi, Robert Jones, Christopher D. Hillyer, and
Beth H. Shaz. Cardiovascular disease risk assessment and
prevention in blood donors. TRANSFUSION 2012;52:2174-2182.
KEY POINT
Although blood donation targets healthy individuals, more than 85% of the
participants had at least one risk factor, some at critical levels.
In this study 61% of the health screening participants reported being motivated to
very motivated to change their lifestyle behaviors including diet, exercise, and/or
smoking.
Femke Atsma and Femmie de Vegt. The healthy donor effect: a A major topic in donor health research is the protective effect of blood
matter of selection bias and confounding. TRANSFUSION donation against cardiovascular disease.
2011;51:1883-1885.
Debra A. Kessler, Kathleen M. Grima, Jay E. Valinsky, Caroline In this study blood donors are healthier than the general population, but many still
Ortiz, Christopher D. Hillyer, Vijay Nandi, Robert L. Jones, Beth have CVD risk factors, particularly obesity.
H. Shaz. The integration of high-throughput testing of blood
donors for cardiovascular disease risk assessment and
prevention. Transfusion and Apheresis Science 49 (2013) 263–
267.
Marcella Longo, Carla Lucci, Maurizio Marconi, Giovanna Although most of the blood donors belonged to the group with low CVR, it
Cremonesi. Cross-sectional epidemiological study to evaluate was nevertheless possible to identify a group of donors with high CVR.
the cardiovascular profile of a cohort of blood donors. Blood
Transfus 2007; 5: 153-157.
Müller M, Ruf E, Weinauer F, Martin S, Becker C, Illig T, Döring With the exception of type 2 diabetes, the prevalence of the investigated
A, Wichmann HE, Rapp S. The BSD Health Study: a pilot study diseases was lower in blood donors than in the general population.
to examine the comparability of Bavarian blood donors with
the Bavarian general population by a comparison with KORA
S4. Gesundheitswesen. 2009 Aug;71(8-9):481-8.
Cruz del Castillo AH, García Fierro R, Hess Moreno MI, Vigil Metabolic syndrome is highly prevalent in blood donors population, which
Pérez CA, Córdova Fernández JA, Chuck Santiago MP, involves implementing preventive measures, changes in lifestyles and identify risk
Domínguez Moreno R. Metabolic syndrome prevalence and factors, to be free from diseases like diabetes, hypertension, obesity and MS itself.
clinical features in blood donors. Rev Fac Cien Med Univ Nac
Cordoba. 2012;69(3):144-9.
VITAMIN DEFICIENCY
Although the finding of vitamin deficiency in blood donors in
developed countries is an infrequent event, some studies showed
that this group of apparently healthy adults may be at risk for
nutritional deficiency.
 Christine K Booth, Therese Clark, and Anne Fenn. Folic acid, riboflavin,
thiamine, and vitamin B-6 status of a group of first-time blood donors. Am J Clin
Nutr 1998;68:1075–80.
 Havivi E, Manny N, Dacosta-Stupp Y, Reshef A. Nutritional status of a
population assessed on the basis of a group of blood donors. Isr J Med Sci
1985 Jun;21(6):499-503.
 Cafolla A, Dragoni F, Girelli G, Tosti ME, Costante A, Pastorelli D, Bedogni G,
Scott S. Folate status in Italian blood donors: relation to gender and smoking.
Haematologica 2000 Jul;85(7):694-8.
AIS (Absent Iron Stores)
Plasma ferritin < 12 ng/mL
This cutoff is a highly specific
indicator of iron deficiency that
reflects absent tissue and
marrow iron store, but lacks
sensitivity
IDE (Iron Deficient Erythropoiesis)
Identified by Log of the ratio: soluble
Transferrin Receptor / Ferritin.
The use of the two reciprocally regulated
measurements seems to provide excellent
discrimination of clinical iron deficiency
anemia and experience in blood donors
suggests high sensitivity in the detection
of iron-deficient erytrhopoiesis (IDE)
IRON DEFICIENCY
AIS: absent iron stores
IDE: iron deficient erythropoiesis
1. Deferral for low Hb is the most common cause of presenting donor loss [RISE
study: 9.9% of all donation attempts (17.7% females, 1.6% males) end in a deferral for
low Hb or Ht]
2. Based on currently accepted Hb reference ranges for all adults*, some female
donors with values within the reference range are deferred, and some male donors
who are below the reference range are eligible to donate
3. An analysis of NHANES II** data for adults shown to have adequate iron stores also
shows that 12.5 g/dL is not an appropriate lower limit for blood donation to prevent
iron depletion […]
4. In most cases there are “non protective” changes in donor Hb in frequent donors as
a function of prior donation intensity
**)
*)
5. The Hb screen is a poor assessment of the iron status of blood donors **
6. Previous donation intensity and gender are the most important predictors of iron
deficiency and iron deficient erythropoiesis (IDE)
7. Other independent predictors : age, weight, smoking, iron supplementation, HFE
genotype, menstrual and pregnancy status
8. Optimizing the safety of blood donation for volunteer donors requires significant
attention and specific committment
9. To what extent the current donor standards can prevent and detect significant
adverse donor sequelae related to iron depletion?
**)
**)
Hemoglobin & Ferritin
general data from 6 Italian Regions
86,518 blood donors
86% repeat donors (median age 42)
14% first-time donors (median age 34)
19,833 female
66,685 male
Hb (g/dL)
Ferritin (ng/mL)
Female donors: 13.3
Male donors: 15.1
FT donors:
All 14.5
F 13.4
M 15.3
RR donors:
All 14.8
F 13.3
M 15.2
Reference range:
Min 15-20 / Max 260-300
FT donors:
> lower limit: 82%
< lower limit: 15%
> upper limit: 3%
RR donors:
> lower limit: 80%;
< lower limit: 19.5%;
> upper limit: 0.5%
p < 0.05
Hemoglobin & Ferritin
data from 2 Italian Regional Blood Centres
24,535 blood donors
RBC 1: 54% / RBC 2: 46%
7,360 FT donors (30%) - median age 40
17,175 RR donors (70%) - median age 46
29% female
71% male
113,040 WB/RBC donations
Average WB/RBC donation frequency:
Male 1.3/year
Female 1.1/year
Hb (g/dL)
Ferritin (ng/mL)
FT donors:
F 13.8
M 15.3
RR donors:
F 13.7
M 15.1
Female donors: 33
Male donors: 86
FT donors:
F 34
M 95
RR donors:
F 29
M 46
Reg. BC 1 Reg. BC 2
p < 0.05
Hemoglobin & Ferritin
data from 2 Italian Regional Blood Centres
Critical ferritin values (< 12 ng/mL)
among F and M blood donors donating
only WB/RBC
Females: 20%
Males: 3.3%
Thanks for your
attention