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Abstract：
BACKGROUND: To prevent blood donors from developing iron deficiency (ferritin <15 μg/L) and subsequent anemia (hemoglobin <120 g/L), blood services rely on information about known risk factors, including the donor\'s sex and age. For example, while Finnish women are able to donate whole blood with a minimum donation interval of 91 days, women in the 18 to 25-year-old age group are recommended to donate no more than once per year. Menstrual blood loss is not accounted for in blood donation interval recommendations, despite being a known risk factor of iron deficiency. We aim to investigate to what extent menstrual bleeding is associated with ferritin and hemoglobin levels in female blood donors, and quantify the association of other menstruation-related variables not currently accounted for by blood services (i.e., use of hormonal contraception, heavy menstrual bleeding) with iron deficiency or anemia.
METHODS: The study population consisted of 473 premenopausal and 491 postmenopausal Dutch whole blood donors. Exclusion criteria were current pregnancy, BMI ≥50, ferritin ≥200, pictorial blood assessment chart (PBAC) ≥400, and age <18 or ≥70 years. Menstrual blood loss was quantified using a PBAC, a semiquantitative method to evaluate the number of used menstrual products and the degree of staining. We identified predictors of log(ferritin)/hemoglobin and iron deficiency/anemia using Bayesian linear and logistic regression models and quantified the average percentage of variance in log(ferritin) and hemoglobin explained by the covariates.
RESULTS: Menstrual blood loss accounted for most of the explained variance in hemoglobin (8%) and second only to the number of days since last donation for ferritin (8%). Heavy menstrual bleeding (PBAC ≥150, OR = 3.56 [1.45-8.85], prevalence 13%) was associated with anemia, and use of levonorgestrel-releasing intrauterine device was negatively associated with iron deficiency (OR = 0.06 [0.01-0.44]). After statistical control for menstrual blood loss, age was not associated with iron status.
CONCLUSIONS: Menstrual blood loss and blood donation were the most important determinants of iron status in premenopausal women. Thus, results suggest that accounting for menstrual blood loss in donation interval guidelines may benefit blood donors.
METHODS: The study population consisted of 473 premenopausal and 491 postmenopausal Dutch whole blood donors. Exclusion criteria were current pregnancy, BMI ≥50, ferritin ≥200, pictorial blood assessment chart (PBAC) ≥400, and age <18 or ≥70 years. Menstrual blood loss was quantified using a PBAC, a semiquantitative method to evaluate the number of used menstrual products and the degree of staining. We identified predictors of log(ferritin)/hemoglobin and iron deficiency/anemia using Bayesian linear and logistic regression models and quantified the average percentage of variance in log(ferritin) and hemoglobin explained by the covariates.
RESULTS: Menstrual blood loss accounted for most of the explained variance in hemoglobin (8%) and second only to the number of days since last donation for ferritin (8%). Heavy menstrual bleeding (PBAC ≥150, OR = 3.56 [1.45-8.85], prevalence 13%) was associated with anemia, and use of levonorgestrel-releasing intrauterine device was negatively associated with iron deficiency (OR = 0.06 [0.01-0.44]). After statistical control for menstrual blood loss, age was not associated with iron status.
CONCLUSIONS: Menstrual blood loss and blood donation were the most important determinants of iron status in premenopausal women. Thus, results suggest that accounting for menstrual blood loss in donation interval guidelines may benefit blood donors.
摘要：
背景：为了防止献血者发生缺铁（铁蛋白<15μg/L）和随后的贫血（血红蛋白<120g/L），血液服务依赖于已知危险因素的信息，包括捐赠者的性别和年龄.例如,虽然芬兰妇女能够以最少91天的捐献间隔捐献全血，建议18至25岁年龄组的妇女每年捐赠不超过一次。建议献血间隔中不考虑月经失血，尽管是铁缺乏的已知危险因素。我们的目的是调查女性献血者月经出血与铁蛋白和血红蛋白水平有多大的关联。并量化目前未被血液服务考虑的其他月经相关变量的关联(即，使用荷尔蒙避孕，大量月经出血）缺铁或贫血。
方法：研究人群包括473名绝经前和491名绝经后的荷兰全血献血者。排除标准是当前怀孕，BMI≥50，铁蛋白≥200，图示血液评估图（PBAC）≥400，年龄<18或≥70岁。月经失血量用PBAC定量,一种半定量方法，用于评估使用过的月经产品的数量和染色程度。我们使用贝叶斯线性和逻辑回归模型确定了log（铁蛋白）/血红蛋白和铁缺乏/贫血的预测因子，并量化了由协变量解释的log（铁蛋白）和血红蛋白的平均方差百分比。
结果：月经失血占血红蛋白变化的大部分（8％），仅次于自上次捐献铁蛋白以来的天数（8％）。月经大量出血（PBAC≥150，OR=3.56[1.45-8.85]，患病率13%)与贫血相关，使用释放左炔诺孕酮的宫内节育器与铁缺乏呈负相关（OR=0.06[0.01-0.44]）。经血量统计控制后，年龄与铁状态无关.
结论：月经失血和献血是绝经前妇女铁状态的最重要决定因素。因此，结果表明，在献血间隔指南中考虑月经失血可能会使献血者受益。
方法：研究人群包括473名绝经前和491名绝经后的荷兰全血献血者。排除标准是当前怀孕，BMI≥50，铁蛋白≥200，图示血液评估图（PBAC）≥400，年龄<18或≥70岁。月经失血量用PBAC定量,一种半定量方法，用于评估使用过的月经产品的数量和染色程度。我们使用贝叶斯线性和逻辑回归模型确定了log（铁蛋白）/血红蛋白和铁缺乏/贫血的预测因子，并量化了由协变量解释的log（铁蛋白）和血红蛋白的平均方差百分比。
结果：月经失血占血红蛋白变化的大部分（8％），仅次于自上次捐献铁蛋白以来的天数（8％）。月经大量出血（PBAC≥150，OR=3.56[1.45-8.85]，患病率13%)与贫血相关，使用释放左炔诺孕酮的宫内节育器与铁缺乏呈负相关（OR=0.06[0.01-0.44]）。经血量统计控制后，年龄与铁状态无关.
结论：月经失血和献血是绝经前妇女铁状态的最重要决定因素。因此，结果表明，在献血间隔指南中考虑月经失血可能会使献血者受益。
