ArticleAnnals of hematology2026
Latent iron deficiency as a silent driver of donor attrition in high-frequency plateletpheresis donors: a longitudinal cohort study.
Article in Annals of hematology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
High-frequency plateletpheresis is crucial for meeting transfusion demands but poses a significant risk of cumulative iron depletion in donors. Current screening protocols relying solely on hemoglobin (Hb) fail to detect latent iron deficiency (LID), a condition where depleted iron stores coexist with normal Hb levels. This study investigated the longitudinal trajectory of iron parameters in high-frequency plateletpheresis donors and quantified the impact of LID on donor deferral and attrition. A retrospective longitudinal cohort study was conducted on 538 eligible plateletpheresis donors at a regional blood center in China from January 2021 to December 2024. Donors were stratified into high-frequency (≥ 10 donations/year) and low-frequency (< 10 donations/year) groups. Longitudinal changes in serum ferritin and Hb were modeled using Generalized Estimating Equations (GEE), adjusting for time-varying inflammation (WBC) and demographics. The association between baseline LID (ferritin < 30 ng/mL) and temporary Hb deferral was assessed using a multivariable modified Poisson regression. Predictors of donor attrition (lapse > 12 months) were identified using a time-dependent Cox proportional hazards model. High-frequency donors exhibited a precipitous decline in serum ferritin over four years (β = -0.42, p < 0.001), with a significant time-by-frequency interaction (β = -0.15, p < 0.001), while Hb levels remained stable. Baseline LID was a potent predictor of future temporary deferral (Adjusted Relative Risk = 3.8, 95% CI: 2.6–5.5). Survival analysis revealed that both the experience of a deferral event (Hazard Ratio [HR] = 2.42, 95% CI: 1.85–3.16) and baseline LID (HR = 1.58, 95% CI: 1.21–2.06) were independent predictors of donor attrition. Subgroup analyses confirmed these risks were consistent across sex, age, and residence status. High-frequency plateletpheresis induces progressive LID that is masked by stable Hb levels. LID serves as a silent precursor to both operational deferral and long-term donor attrition through physiological and psychological pathways. Integrating routine ferritin monitoring and personalized donation intervals into donor management strategies is essential to safeguard donor health and ensure a sustainable platelet supply.
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