Donor wellness and Iron: Ferritin Testing

Ferritin testing provides information about an individual’s iron stores. This is different from the hemoglobin test performed at the start of each donation (finger prick). Iron is vital for making the red part of the blood called hemoglobin, which carries oxygen throughout the body. If ferritin is low, it reliably indicates low iron stores and is a good predictor of who may develop low hemoglobin (anemia).

We care about donor wellness. It’s important to their experience as a donor and enables them to continue helping patients.

Whole blood donations result in some iron loss. Blood operators around the world, including Canadian Blood Services, are making efforts to address iron stores in blood donors.

In 2015, Canadian Blood Services made the first step by lengthening the blood donation cycle for donors registered as female, from every 56 days to every 84 days; and in 2017, increasing the acceptable minimum hemoglobin levels for donors registered as males, from 125 g/L to 130 g/L.

In January 2023, Canadian Blood Services will take the next step of selectively testing blood donors’ ferritin levels. Our regulator, Health Canada, does not require ferritin testing of donors. Our intent is to enhance donor experience by taking proactive steps to prevent low iron in donors.

Samples taken from donated blood will be tested at our testing facilities, where we normally perform our tests. The first phase will selectively test donors registered as female because of their higher risk of having low iron. Testing may eventually increase in frequency for donors registered as female and expand to testing donors registered as male.

We are testing ferritin levels of select donors. In the first phase, we will select, and test donors registered as female at every 10th donation. We are starting to test donors who may have a higher risk of having low iron stores. However, all donors are recommended to discuss their iron levels with their healthcare provider to maintain their iron stores.

Over time, testing may eventually increase in frequency and be expanded to more donors, including donors registered as male.

The first phase will selectively test donations of those donors registered as female as they are more likely to develop low iron stores. This is due to higher iron requirements from menstruation, prior pregnancies or lactation, and insufficient iron intake.  Eventually we may expand to testing donors registered as male.

We don’t test iron, but we do test hemoglobin. Before donating, everyone must pass a finger prick hemoglobin test which measures if a donor has sufficient levels of hemoglobin to donate blood. However, one can have normal hemoglobin, despite low iron stores.  

If the results show the donor has low or high levels of ferritin, they will be notified and encouraged to follow up with their healthcare provider. Donors may receive an email or mailed letter, depending on their communication preferences we have on file. They can also check their test results on their donor file on the Give Blood app or web portal. 

Only donors who were selectively tested and had low or high levels will receive notification by email or letter. All donors who are tested will be able to access their results on the Give Blood app or web portal.

All donors are recommended to discuss their ferritin levels with their healthcare provider and maintain iron stores. 

If the results show the donor has low or high levels of ferritin, they will be notified and encouraged to follow up with their healthcare provider. 

If ferritin is low, it reliably indicates low iron stores and is a good predictor of who may develop anemia (low hemoglobin). Donors with low levels will be encouraged to pause whole blood donation for six months to allow iron stores to replenish. An iron-rich diet is recommended, but it is difficult to replenish the iron lost in donation by diet alone, particularly for donors who already have low ferritin. Donors should see their healthcare provider about further iron supplementation. Although low iron may be due to due inadequate intake of iron and loss of iron in donation and menses, it may also be related to other medical conditions. Donors should also check with their healthcare provider if iron stores (ferritin) should be retested before they come back to donate. Donors can find more information about iron on our website. Donors with low iron stores will also be asked to cancel any upcoming whole blood appointments within the next six months.

Elevated ferritin may be caused by a hereditary condition called hemochromatosis or other causes. More information about hemochromatosis can be found on our website. Donors with elevated levels can continue donating if they meet eligibility criteria but are encouraged to consult with their healthcare provider for further assessment. 

We are grateful to our dedicated donors. For those who may need to temporarily pause their donations, we empathize with the disappointment and frustration you may feel and appreciate your understanding and co-operation.

We recommend donors who have low ferritin test results wait six months before their next donation as this is the time it takes for donors with low ferritin to replenish their iron stores. An iron-rich diet is recommended, but it is difficult to replenish the iron lost in donation by diet alone, even in a 6-month period, particularly for donors who already have low ferritin. Donors should see their healthcare provider about further iron supplementation. Donors with low iron stores will also be asked to cancel any upcoming whole blood appointments within the next six months. 

Although you are encouraged to pause your whole blood donation for six months, you are welcome to donate in other ways while you wait, such as plasma, platelets, register as an organ donor or give a financial donation. You could also consider recruiting another blood donor to fill the need. 

While there is always a way to support Canada’s Lifeline, we empathize with the disappointment anyone who wants to donate feels when they learn they cannot do so in the way that is most meaningful to them.

No, low or high ferritin levels do not prevent a donor from donating whole blood. We are proactively notifying donors with high or low ferritin levels and recommend they speak with a healthcare provider about next steps. 

No, we will test for ferritin using the routine samples taken during your donation.

Regular, long-term whole blood donation may contribute to low iron stores. There are other causes of low iron as well, including a diet low in iron, trouble absorbing iron, prior pregnancies or lactation, menstruation or gradual blood loss.   

Iron stores may be replenished with an iron rich diet and supplementation under the supervision of a healthcare provider.   

Donors with elevated levels can continue donating if they meet eligibility criteria but are encouraged to consult with their healthcare provider for further assessment.  

We recommend that donors with low levels of ferritin refrain from donating whole blood for six months to allow for iron stores to replenish. We do not prevent donors with low ferritin from donating, so it is up to the donor to take appropriate action to manage their iron stores. If a donor decides to go ahead and continue donating before six months, they may continue to experience low levels of ferritin and eventually their hemoglobin could begin to decrease.

Iron stores may be replenished with an iron rich diet and supplementation under the supervision of a healthcare provider.