Individualized risk trajectories for iron-related adverse outcomes in repeat blood donors

BackgroundDespite a fingerstick hemoglobin requirement and 56-day minimum donation interval, repeat blood donation continues to cause and exacerbate iron deficiency. Study design and methodsUsing data from the REDS-II Donor Iron Status Evaluation study, we developed multiclass prediction models to estimate the competing risk of hemoglobin deferral and collecting blood from a donor with sufficient hemoglobin but low or absent underlying iron stores. We compared models developed with and without two biomarkers not routinely measured in most blood centers: ferritin and soluble transferrin receptor. We generated and analyzed individual risk trajectories: estimates of how each donors risk developed as a function of the time interval until their next donation attempt. ResultsWith standard biomarkers, the top model had a multiclass area under the receiver operator characteristic curve (AUC) of 77.6% (95% CI 77.3% - 77.8%). With extra biomarkers, multiclass AUC increased to 82.8% (95% CI 82.5% - 83.1%). In the extra biomarkers model, ferritin was the single most important variable, followed by the donation interval. We identified three risk archetypes: fast recoverers (<10% risk of any adverse outcome on post-donation day 56), slow recoverers (>60% adverse outcome risk on day 56 that declines to <35% by day 250), and chronic high-risk (>85% risk of adverse outcome on day 250). DiscussionA longer donation interval reduced estimated risk of iron-related adverse events for most donors, but risk remained high for some. Tailoring safeguards to individual risk estimates could reduce blood collections from donors with low or absent iron stores.