铁蛋白缺乏的单采血小板捐献者红细胞参数变化以及献血间隔对体内铁蛋白水平的影响

Effect of red blood cell parameters and blood donation interval on ferritin level in apheresis platelet donors with ferritin deficiency

目的研究铁蛋白缺乏的单采血小板捐献者红细胞参数变化和献血间隔对体内铁蛋白水平的影响,为制定更加细致的献血者关爱策略提供实验依据。方法 2020年4月选取本站单采血小板男性固定献血者100人,检测铁蛋白及红细胞参数。献血员按年度献血频率分为310、1115、1624次3组,分析铁缺乏率的组间差异。按照铁蛋白检测值分为铁缺乏组和铁蛋白(SF)正常组,比较分析2组的血红蛋白(Hb)、平均红细胞容积(MCV)、平均红细胞血红蛋白量(MCH)、平均红细胞血红蛋白浓度(MCHC)数值变化。对铁缺乏献血员献血期间按不同时间段分为2019年1月3月组、2019年4月6月组、2019年7月9月组、2019年10月12月组与2020年1月4月组,比较分析组间Hb、MCV、MCH数值变化。其中继续献血的铁缺乏献血员按照献血间隔分为延长组(最低献血间隔30 d)和未延长组(最低献血间隔14 d),干预观察2020年5月12月的献血情况,2020年12月再次对铁缺乏献血员进行血清铁蛋白检测,分析2组间的SF变化。结果 3组献血频率的铁缺乏率分别为7.5%、22.5%、40.0%,组间比较PSymbol|@@0.05。铁缺乏组与SF正常组比较,Hb (g/L)为144.15±9.37 vs 151.72±8.81、MCV(fl)为87.21±4.02 vs 89.38±2.96、MCH(pg)为29.91±2.13 vs 31.01±1.25、MCHC(g/L)为345.85±9.08 vs 346.48±9.18,P值均<0.05。铁缺乏献血员不同献血时间段内的Hb、MCV、MCH数值比较,在Hb均值的两两比较中,除了2020年1月4月组与2019年1月3月组比较(PSymbol|@@0.05),其余各组均不具有统计学差异。MCV均值组间比较P<0.05,2020年1月4月组分别于2019年1月3月组、2019年4月6月组、2019年7月9月组两两比较,P值均Symbol|@@0.05。2019年10月12月组与2019年1月3月组,PSymbol|@@0.05。MCH均值组间比较P<0.05,2020年1月4月组分别与2019年1月3月组、2019年4月6月组,P值均Symbol|@@0.05。2019年10月12月组与2019年1月3月组比较,PSymbol|@@0.05。铁缺乏组和SF正常组20192020年度采前检测Hb、MCV、MCH离散度比较,Hb离散度为0.030±0.008 vs 0.025±0.004,MCV离散度为0.011±0.006 vs 0.007±0.002,MCH离散度为0.019±0.008 vs 0.013±0.005,P值均<0.05;HbSymbol|@@130g/L的铁缺乏献血员高频献血Hb、MCV、MCH值下降明显;铁缺乏献血员献血间隔未延长组原SF(μg/L)=13.89±4.66,现SF(μg/L)=12.27±5.17,P>0.05,献血间隔延长组原SF(μg/L)=24.80±4.43,现SF(μg/L)=35.92±5.20,P<0.05。结论单采血小板捐献者铁缺乏率随献血频率的增加而增加,铁缺乏的单采血小板捐献者Hb、MCV、MCH、MCHC值降低,采前检测Hb、MCV、MCH离散度增加,MCV、MCH优于Hb更早反映献血员体内的红细胞代谢状态。HbSymbol|@@130 g/L的铁缺乏单采血小板捐献者易减少献血频次。延长献血间隔能够增加铁缺乏的单采血小板捐献者SF水平。建议血站对铁蛋白及相关红细胞参数进行动态监测,个性化定制献血间隔。

Objective To study the effect of changes in red blood cell parameters and blood donation interval on ferritin level in platelet donors with ferritin deficiency, so as to provide experimental evidence for formulating targeted blood donor care strategies. Methods 100 regular male platelet apheresis donors in April 2020 were selected to test the ferritin and red blood cell parameters. Blood donors were classified according to the annual blood donation numbers: 3~10, 11~15, and 16~24,and the difference of iron deficiency rate among groups was analyzed. They also were classified according to the detection value of ferritin: iron deficiency donors versus SF normal donors, and the changes of Hb, MCV, MCH and MCHC values of them were compared. The iron deficiency donors were stratified by donation time: January to March 2019, April to June 2019, July to September 2019, October to December 2019 and January to April 2020, so as to compare the changes of Hb, MCV and MCH values among each group. The iron deficiency donors, continued the donation afterwards, were divided into interval-extended donors(minimum donation interval of 30 days) and normal ones(minimum donation interval of 14 days), and blood donation from May to December 2020 was intervened and observed. In December 2020, serum ferritin was tested again for iron deficiency donors to analyze the changes in SF between two groups. Results The incidence of iron deficiency in three groups with different donation frequency was 7.5%, 22.5% and 40.0%, respectively(P<0.05). The Hb(g/L)(144.15±9.37 vs 151.72±8.81), MCV(fl)( 87.21±4.02 vs 89.38±2.96), MCH(pg)(29.91±2.13 vs 31.01± 1.25), and MCHC(g/L)(345.85±9.08 vs 346.48±9.18) of iron deficiency donors were significantly lower than those of SF normal ones(P<0.05). The paired-comparison of Hb of iron deficiency donors was not statistically different by donation periods, except for January-April 2020 versus January-March 2019(P<0.05). MCV mean values were statistically different by donation periods, especially January-April 2020 versus January-March/April-June/July-September 2019 and October-December 2019 versus January-March 2019(P<0.05).MCH mean values were statistically different by donation periods,especially January-April 2020 versus January-March/April-June and October-December 2019 versus January-March 2019(P<0.05). The pre-collection distribution of Hb, MCV, and MCH in iron deficiency donors and SF normal donors during 2019 and 2020 were 0.030±0.008 vs 0.025±0.004, 0.011±0.006 vs 0.007±0.002, and 0.019±0.008 vs 0.013±0.005, respectively(P<0.05)..The Hb, MCV, and MCH values of high-frequency blood donors with Hb less than 130 g/L decreased significantly. The original SF(μg/L) of iron-deficiency donors without extended interval was 13.89±4.66, and the current 12.27±5.17(P>0.05), and original 13.89±4.66 vs current 35.92±5.20 in the extended ones(P<0.05). Conclusion The incidence of iron deficiency in apheresis platelet donors increased as blood donation frequency elevated. The Hb, MCV, MCH and MCHC value of iron deficiency donors decreased while the dispersion of pre-collection Hb, MCV and MCH decreased. MCV and MCH are superior to Hb in early-reflection of metabolism status of red blood cell. It is recommended that iron deficiency donors with Hb less than 130 g/L should reduce the frequency of donation. Extending the donation interval can increase the SF level of iron deficiency donors.Dynamic monitoring of ferritin and related red blood cell parameters should be carried out by blood banks to customize the donation interval.