The impact of intensive serial plasmapheresis and iron supplementation on iron metabolism and Hb concentration in menstruating women: a prospective randomized placebo-controlled double-blind study.
BACKGROUND
Iron (Fe) depletion is common among regular whole-blood donors, but can be prevented through regular oral Fe supplementation. Little is known, however, about the Fe metabolism of donors undergoing intensive plasmapheresis. These donors lose considerable amounts of blood drawn for laboratory analyses and remaining in the disposable plastic sets.


METHODS
Menstruating women were enrolled in a prospective placebo- controlled double-blind study. One hundred women were randomly allocated to receive either 100 mg of elemental Fe per day or placebo over 24 weeks and asked to donate plasma at 1-week intervals. Hb was determined before each plasmapheresis. Ferritin, transferrin, and Fe concentration and reticulocyte count were measured every 4 weeks.


RESULTS
Thirty donors in the placebo group and 29 receiving Fe completed the study. The total mean blood loss was 526 mL in the placebo group and 546 mL in the Fe arm (p=0.271). The number of donations with Hb values lower than 12.5 g per dL requiring prolongation of the time interval until the next plasmapheresis was significantly greater in the placebo arm. In the placebo group (n=30), ferritin levels began to decline significantly 4 weeks after entry. When the study was completed, Hb concentration and reticulocyte count also were found to be significantly lower in the placebo group than in the Fe study arm (p=0.028 and p=0.036, respectively). Hb, ferritin, and transferrin levels and reticulocyte counts did not change significantly in the Fe group during the observation period.


CONCLUSIONS
Menstruating women undergoing regular plasmapheresis at short intervals are prone to develop Fe depletion. This can be prevented by regular Fe intake. Laboratory analyses in product plasma instead of serum gained from whole-blood samples could be an alternative to reduce blood loss.
Bier-Ulrich
Anne-Marie
AM
Institute of Hemostaseology and transfusion Medicine, Academic City Hospital, Ludwigshafen, Germany.
Haubelt
Hannelore
H
Anders
Christof
C
Nagel
Dietmar
D
Schneider
Steffen
S
Siegler
Karl E
KE
Seiler
Dieter
D
Hellstern
Peter
P
D000328:Adult; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007501:Iron / Q000097:blood / Q000378:metabolism*; D019266:Iron, Dietary / Q000008:administration & dosage*; D008598:Menstruation; D010919:Placebos; D010956:Plasmapheresis / Q000009:adverse effects*; D011446:Prospective Studies; D017701:Reticulocyte Count; D014168:Transferrin / Q000032:analysis
D006454:Hemoglobins; D019266:Iron, Dietary; D010919:Placebos; D014168:Transferrin; D005293:Ferritins; D007501:Iron