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| LETTER TO EDITOR |
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| Year : 2022 | Volume
: 7
| Issue : 2 | Page : 217-218 |
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Can we tweak the golden number of 12.5 gm% hemoglobin for blood donation?
Abhishekh Basavarajegowda1, Saptarshi Mandal2
1 Department of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
2 Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| Date of Submission | 12-Sep-2022 |
| Date of Decision | 31-Oct-2022 |
| Date of Acceptance | 31-Oct-2022 |
| Date of Web Publication | 5-Nov-2022 |
Correspondence Address:
Abhishekh Basavarajegowda
Department of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/gjtm.gjtm_70_22
How to cite this article:
Basavarajegowda A, Mandal S. Can we tweak the golden number of 12.5 gm% hemoglobin for blood donation?. Glob J Transfus Med 2022;7:217-8 |
Sir,
The minimum hemoglobin (Hb) threshold for blood donation is intended to prevent blood collection from donors with anemia and leave the donor himself anemic postdonation. The Hb of a blood donor drops by 1–1.5 g/dL after donating a single unit of whole blood, depending on the volume donated (350 ml or 450 ml).[1] With a current Hb, “one size fits all” cutoff of 12.5 gm% for blood donation in India and widely followed elsewhere if a donor has a Hb between 12.5 and 13 gm%, it leaves the donor at about Hb% of 11–11.5 postdonation. After donating 450 mL of whole blood, the average fall in Hb from the baseline is 7% immediately and 5% in about 2 weeks, with complete recovery to predonation levels within about 4–6 weeks.[2] If the donation is smaller, say 100 ml or 200 ml, the Hb fall also would be lesser. Hence, if a donor with Hb of 12 gm% donates 200 ml or one with 11.5 donates 100 ml, still, the donor's postdonation Hb would be between 11 and 11.5 gm/dl.
The donation criteria for Hb cutoff in different countries are slightly different but generally hover around 12.5 gm%.[3] A Hb level of not <12.0 g/dl for females and not <13.0 g/dl for males is the threshold for donation, as per the WHO. Japanese Red Cross Society cutoff has been set at 12 and 12.5 g/dL for 200 and 400 mL donations, respectively, for females, and 12.5 and 13 g/dL, for 200 and 400 mL donations, respectively, for males. Hong Kong Red Cross Blood Transfusion Service seems to accept 11.5 g/dL for female donors.[3] Altering the cutoff by 0.5 gm% has increased the donations by up to 5% in various modeling studies. Whereas a single deferral due to lower Hb can lead to a 5%–15% reduction in future rates of return for a donation.
A smaller volume of the pedigreed collection, say 100ml or 200 ml of whole blood as needed, may be allowed at the blood donation physician's discretion. This will be helpful for the recipients who require small-volume transfusions such as pediatric age group patients and adult patients with circulatory overload or failure to raise their hematocrit and supplement the inventory. Two such smaller units can also be given to adults akin to RDPs, mainly if they belong to uncommon phenotypes.
Often, the whole unit opened for transfusion in pediatric patients in an open system becomes unusable due to a lapse of 24 h due to the nonavailability of a similar suitable recipient within the specified time. There also have been practices wherein the whole unit is issued to a pediatric patient wherein the physician transfuses the required amount and discards off the leftover unit.
Donations of a lesser volume can be beneficial, especially in pediatric patients, without compromising the donor. Given that many hospitals or blood banks/centers cater only to pediatric patients, these alternative strategies would go a long way in improving donations and inventory in a country like India. This donation seems relatively safe even for a person of borderline fitness.[4] Studies have not noted any significant side effects of these more minor falls in Hb levels.[5] It would also do less or no harm to the donors' health in terms of their body iron stores. The embarrassment of a deferral to the donor can also be avoided. In India, wherein the female donation is <10%, we note that many young enthusiastic female donors, especially in colleges, would miss out due to borderline Hb, and they feel dejected, and enthusiasm soon dies off if they do not succeed to improve their Hb in an attempt or two. These deferrals are sizeable, sometimes as much as 30% of the total donation.[6] If these donors are allowed to donate a smaller volume would be a massive bonus to many of our inventories, especially those who treat many pediatric patients and act as a motivating factor to this sizeable donor base.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Chaudhary R, Dubey A, Sonker A. Techniques used for the screening of hemoglobin levels in blood donors: Current insights and future directions. J Blood Med 2017;8:75-88.  |
| 2. | Ziegler AK, Grand J, Stangerup I, Nielsen HJ, Dela F, Magnussen K, et al. Time course for the recovery of physical performance, blood hemoglobin, and ferritin content after blood donation. Transfusion 2015;55:898-905. |
| 3. | Karp JK, King KE. International variation in volunteer whole blood donor eligibility criteria. Transfusion 2010;50:507-13. |
| 4. | Das K, Raturi M, Agrawal N, Kala M, Kusum A. Indian blood donor selection guidelines: Review in the context of the ongoing COVID-19 pandemic. Transfus Clin Biol 2021;28:213-6. |
| 5. | Gandhi MJ, Duffy K, Benike M, Jenkins S, Stubbs JR. Effect of increasing hemoglobin cutoff in male donors and increasing interdonation interval in whole blood donors at a hospital-based blood donor center. Transfusion 2012;52:1880-8. |
| 6. | Bruhin A, Goette L, Haenni S, Jiang L, Markovic A, Roethlisberger A, et al. The sting of rejection: Deferring blood donors due to low hemoglobin values reduces future returns. Transfus Med Hemother 2020;47:119-28. |
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