Impact of allogeneic 2-RBC apheresis on iron stores of Brazilian blood donors Alfredo Mendrone Jr. a, * , Cyntia Araújo Arrais a , César Almeida Neto a , Sandra de Fátima Menocci Gualandro b , Pedro Enrique Dorlhiac-Llacer a,b , Dalton de Alencar Fischer Chamone a,b , Ester Cerdeira Sabino a,b a Fundação Pró-Sangue/Hemocentro de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 155 – 1° andar, Cerqueira Cesar, 05403-000 São Paulo, SP, Brazil b Hematology Department, University of São Paulo, São Paulo, SP, Brazil article info Keywords: 2-RBC collection Multicomponent collection Apheresis Iron depletion abstract One limiting factor for automated two-red blood cells collections (2-RBC) is its potential iron depletion. We analyzed hematological parameters and iron balance before, two and four months after 2-RBC of 96 non-supplemented male donors. Four months after 2-RBC, ferritin level was significantly lower (P < 0.01) than baseline levels and the number of donors who presented ferritin <30 ng/ml increased from 18 to 47. We concluded that four months was not sufficient for iron recuperation in the population studied. In an attempt to avoid iron depletion after 2-RBC, we recommend augmentation in the interval between blood donations and pre-donation ferritin measurement. Ó 2009 Published by Elsevier Ltd. 1. Introduction The collection of the equivalent of two allogeneic red blood cells (2-RBC) by apheresis during a single donation has been available since 1997 when the Haemonetics MCS + device was approved by the USA Food and Drug Administration (FDA) for this procedure. According to re- cent data, 8–9% of allogeneic RBC used in the USA is de- rived from apheresis and this number is growing [1]. Benefits of 2-RBC collection by apheresis include optimiza- tion of the donor visit to the blood center; reduction of ad- verse effects related to whole-blood donation; decreased opportunity for errors associated with donor history, com- ponent preparations and infectious disease testing and col- lection of more standardized blood components. Recently, a study referred that shifting from whole blood to 2-RBC collection can led to a substantial gain in available RBCs even with policies that adversely affect the quantity of RBCs in the supply as European travel deferral [2]. From the perspective of the patient, apheresis RBC offers a high quality product which provides greater predictability of the transfusion outcome [3]. Although studies have indicated that collection of 2- RBC by apheresis is safer for the donors than whole-blood collections [4–8], the requirements for 2-RBC are more stringent than for blood donation due to higher red blood cell loss. The main risk of this procedure is its impact on iron stores, especially in donors who are going to donate double red cells frequently. FDA approved the collection of 2-RBC from healthy blood donors based on a nomogram that takes into account the donor’s sex, hematocrit, weight and height [9]. In Brazil, the Ministry of Health has limited 2-RBC by apheresis only for donors weighting at least 132 lbs (60 kg) and hemoglobin level of 130 g/l or hematocrit of 39%, or greater [10]. The minimal interval between two 2-RBC donations must be twice that of whole-blood dona- tion: four months for men and six months for women. As there were no studies evaluating the impact of 2-RBC on iron stores in Brazilian donors, these requirements were based on American and Europeans rules. 1473-0502/$ - see front matter Ó 2009 Published by Elsevier Ltd. doi:10.1016/j.transci.2009.05.002 * Corresponding author. Tel.: +55 11 3061 5544x343; fax: +55 11 3088 8317. E-mail address: alfredo.mendrone@usp.br (A. Mendrone). Transfusion and Apheresis Science 41 (2009) 13–17 Contents lists available at ScienceDirect Transfusion and Apheresis Science journal homepage: www.elsevier.com/locate/transci