Can a patient with a ferritin level of 57 continue with blood donation?

Blood Donation with Ferritin Level of 57: Recommendation

A patient with a ferritin level of 57 ng/mL should not continue with blood donation at this time, as this value indicates borderline iron stores that could lead to iron deficiency with further blood donation. 1

Understanding Ferritin Levels and Blood Donation

Current Ferritin Status

• A ferritin level of 57 ng/mL falls within the lower range of normal but is at the borderline of what is considered adequate iron stores for blood donors 1
• Clinical guidelines for hemochromatosis treatment consider a ferritin level between 50-100 μg/L (equivalent to ng/mL) as the target range indicating adequate but not excessive iron stores 1
• Regular blood donation causes significant decreases in ferritin levels, with studies showing up to 45% reduction in ferritin values with repeated donations 2

Risk Assessment

• Blood donation removes approximately 200-250 mg of iron with each unit of blood donated 1
• Donors with borderline ferritin levels (50-100 ng/mL) are at high risk of developing iron deficiency with continued donations 3
• Studies show that 11.2% of regular donors develop iron deficiency erythropoiesis even when their hemoglobin levels remain within acceptable ranges for donation 2

Evidence-Based Approach to Blood Donation

Recommended Ferritin Thresholds

• European Association for the Study of the Liver (EASL) guidelines recommend maintaining ferritin levels between 50-100 μg/L to avoid iron deficiency 1
• American Association for the Study of Liver Diseases (AASLD) guidelines similarly suggest that ferritin levels between 50-100 μg/L indicate adequate iron stores 1
• When ferritin falls below these levels, iron deficiency becomes increasingly likely, even if hemoglobin remains normal 4

Monitoring Recommendations

• Ferritin should be measured periodically in regular blood donors who donate more than twice per year 5
• Donors with low-normal ferritin (50-100 ng/mL) should have their levels checked before subsequent donations 3
• Hemoglobin alone is an inadequate measure to detect iron deficiency in blood donors 2

Management Algorithm for Blood Donors with Borderline Ferritin

1. For ferritin <50 ng/mL:

   • Temporarily defer blood donation 1
   • Consider oral iron supplementation 5
   • Recheck ferritin after 3 months of supplementation 1

2. For ferritin 50-100 ng/mL (like this patient at 57):

   • Consider temporary deferral from donation, especially if:
     • The donor has donated recently (within past 3-4 months) 2
     • The donor is female (higher risk of iron deficiency) 2
     • The donor has symptoms of iron deficiency 1
   • Recommend iron supplementation before next donation 3
   • Recheck ferritin before next donation 5

3. For ferritin >100 ng/mL:

   • Safe to proceed with blood donation 3
   • Continue routine monitoring 1

Common Pitfalls and Caveats

• Hemoglobin levels can remain normal despite depleted iron stores, making it an unreliable sole indicator for iron status in blood donors 2
• Transient elevations in ferritin can occur due to inflammation or infection, potentially masking underlying iron deficiency 6
• A ferritin level >50 μg/L does not automatically exclude iron deficiency, especially in the presence of inflammatory conditions 4
• Regular donors are at particularly high risk of developing iron deficiency even when meeting standard hemoglobin criteria for donation 3

Conclusion for This Patient

Given the patient's ferritin level of 57 ng/mL, which is just above the lower threshold of 50 ng/mL recommended by guidelines, temporary deferral from blood donation is advised until iron stores can be replenished. Iron supplementation should be considered, with a follow-up ferritin test in 2-3 months to ensure levels have increased to >100 ng/mL before resuming blood donation 1, 3.