Blood donation Nutrition, protection of blood

donors’ health, lifestyles

Giuliano Grazzini Director, National Blood Centre

Istituto Superiore di Sanità Rome, Italy

GAINING HEALTH

Objectives:

- integrated action

on risk factors and

their underlying

determinants,

- prevention and

control of

noncommunicable

diseases.

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.

EUROPEAN ACTION PLAN

FOR FOOD AND NUTRITION POLICY

GLOBAL STRATEGY ON DIET,

PHYSICAL ACTIVITY, AND HEALTH

2006

http://www.euro.who.int/__data/assets/pdf_file/0008/76526/E89306.pdf

ITALIAN PROGRAM

Basic rules to follow for proper

nutrition :

- 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.

WHY IS PROPER NUTRITION IMPORTANT?

Proper nutrition is a cornerstone of good health.

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

From http://www.safefood.eu/Healthy-Eating/What-is-a-balanced-diet/The-Food-

Pyramid.aspx

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.

Allegato 7

For the protection of donors’ health

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

STUDY KEY POINT

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.

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

Gonçalves da Silva, Márcia Gonçalves Ferreira. Smoking

and abdominal fat in blood donors. J Bras Pneumol.

2012;38(3):356-363

In our study, BMI and other indicators of abdominal adiposity is

associated with smoking, regardless of alcohol consumption and other

confounders.

Cruz del Castillo AH, García Fierro R, Hess Moreno MI,

Vigil Pérez CA, Córdova Fernández JA, Chuck Santiago MP,

Domínguez Moreno R. Metabolic syndrome prevalence

and clinical features in blood donors. Rev Fac Cien Med

Univ Nac Cordoba. 2012;69(3):144-9.

Of the 726 donors, 85.1% were male, according to the ATPIII criteria,

54.8% (398) had a GAA, 63.2% (458) had hypertriglyceridemia, almost

17% (121) presented HDL hypocholesterolemia, 44.1% (320) were

overweight by BMI, the prevalence of metabolic syndrome was 54.4%,

in comparison by gender, men had a statistically significant difference

compared to women, showing an OR = 2.27 (p = 0.0001, 95% CI 1.44-

3.60).

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.

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 KEY POINT

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.

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

matter of selection bias and confounding. TRANSFUSION

2011;51:1883-1885.

A major topic in donor health research is the protective effect of blood

donation against cardiovascular disease.

Debra A. Kessler, Kathleen M. Grima, Jay E. Valinsky, Caroline

Ortiz, Christopher D. Hillyer, Vijay Nandi, Robert L. Jones, Beth

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.

In this study blood donors are healthier than the general population, but many still

have CVD risk factors, particularly obesity.

Marcella Longo, Carla Lucci, Maurizio Marconi, Giovanna

Cremonesi. Cross-sectional epidemiological study to evaluate

the cardiovascular profile of a cohort of blood donors. Blood

Transfus 2007; 5: 153-157.

Although most of the blood donors belonged to the group with low CVR, it

was nevertheless possible to identify a group of donors with high CVR.

Müller M, Ruf E, Weinauer F, Martin S, Becker C, Illig T, Döring

A, Wichmann HE, Rapp S. The BSD Health Study: a pilot study

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.

With the exception of type 2 diabetes, the prevalence of the investigated

diseases was lower in blood donors than in the general population.

Cruz del Castillo AH, García Fierro R, Hess Moreno MI, Vigil

Pérez CA, Córdova Fernández JA, Chuck Santiago MP,

Domínguez Moreno R. Metabolic syndrome prevalence and

clinical features in blood donors. Rev Fac Cien Med Univ Nac

Cordoba. 2012;69(3):144-9.

Metabolic syndrome is highly prevalent in blood donors population, which

involves implementing preventive measures, changes in lifestyles and identify risk

factors, to be free from diseases like diabetes, hypertension, obesity and MS itself.

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?

**) **)

86,518 blood donors 86% repeat donors (median age 42)

14% first-time donors (median age 34)

19,833 female

66,685 male

Hemoglobin & Ferritin general data from 6 Italian Regions

Hb (g/dL)

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

Ferritin (ng/mL)

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

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

Hemoglobin & Ferritin data from 2 Italian Regional Blood Centres

Hb (g/dL)

FT donors:

F 13.8

M 15.3

RR donors:

F 13.7

M 15.1

Ferritin (ng/mL)

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

Critical ferritin values (< 12 ng/mL)

among F and M blood donors donating

only WB/RBC

Females: 20%

Males: 3.3%

Hemoglobin & Ferritin data from 2 Italian Regional Blood Centres

Thanks for your attention