What you need to know about anemia, iron and hemochromatosis

Anemia is the medical term used when an individual has low hemoglobin.

Every person has a different personalized range of hemoglobin.

To appropriately test for anemia, it is important to consult with your healthcare practitioner. Low hemoglobin or anemia occurs for many different reasons. Iron deficiency is the most common cause of anemia. Other causes include vitamin B12 deficiency, blood breakdown (hemolysis), altered function of vital organs, various types of cancers, etc. As donation leads to removal of blood it can cause and worsen anemia.

Anemia can lead to symptoms such as fatigue, difficulty breathing, lowered exercise tolerance, light-headedness and difficulty concentrating.

If you have anemia, please return to donate once the cause of anemia has been treated and hemoglobin improves.  

When people donate whole blood, red cells that have hemoglobin and iron are removed.  

Each whole blood donation reduces hemoglobin levels by approximately 10 g/L and reduces the body’s iron stores.  

Donors produce new blood to replenish the donation. Iron is an essential building block of blood. If your iron levels are low, your body may have more difficulty replenishing blood, hemoglobin does not return to prior levels and anemia can develop.  

Anemia from blood donation usually occurs due to depletion of the iron stores. All donors should consider iron supplements under medical supervision to help replenish their iron stores.

We recommend that you see your healthcare provider to check your hemoglobin and iron stores (ferritin). Your healthcare provider will investigate reasons why your hemoglobin may be low and may suggest taking iron supplementation.

Iron requirements change with age and changes in body functions. Requirements are higher:

• For blood donors to help replenish donated blood
• During puberty
• For those who menstruate to replenish iron stores and restore blood levels
• while pregnant to ensure brain and blood development of the fetus
• while lactating (breast/chestfeeding) to meet the needs of the baby
• For those who are consuming a low iron diet

Iron stores in the body can be estimated by measuring ferritin levels. Low ferritin levels imply depletion of iron stores. High ferritin levels can occur for multiple reasons, including due to a condition called hemochromatosis.  

Other tests can also be used to assess iron levels and these are performed under the supervision of a healthcare professional.  

Fingerstick testing performed at the time of donation assesses hemoglobin levels. Hemoglobin levels can be normal even if the iron stores are low.  

Iron comes in two forms:  

• Heme iron - which is more easily absorbed by the body and found in foods with heme iron. For example: beef, lamb, pork, liver, veal, chicken, turkey (the dark meat has more iron), fish and seafood.
• Non-heme iron - which is less easily absorbed by the body and found in foods with non-heme iron. For example: breakfast cereals (fortified with iron), breads and pasta (whole grain and enriched), lentils, dried peas and beans, tofu, seeds and nuts (pumpkin, sesame or peanut), dried fruit (raisins or apricots), dark green, leafy vegetables, and eggs.

People who have a low iron diet, drink tea or coffee with meals, may not be getting sufficient iron from diet alone. 

If you think your iron is low, please see your healthcare professional to determine if you need any tests done and advise about iron supplements.

If you donate blood, you may require iron supplementation in addition to the iron in their regular diet to help replenish iron stores and prevent anemia (low hemoglobin).

Individuals who have been diagnosed with hemochromatosis are not recommended additional iron supplementation.

We suggest you discuss taking iron supplements with your healthcare provider.

Yes. Hemochromatosis is an inherited condition where too much iron is absorbed from the diet and stored in the body. Eventually, the excess iron accumulates in tissues and can compromise the function of vital organs such as the liver, pancreas and heart.

Hemochromatosis is an inherited condition that leads to too much iron in the body. Eventually, the excess iron can compromise the function of vital organs such as the liver, pancreas and heart.

Often, hemochromatosis is identified before vital organ function is affected. Those with preserved organ function and hemochromatosis are eligible to donate, provided they meet all the other donation criteria.

Treatment of hemochromatosis usually includes reducing iron intake and removing excess iron from the body.

People with hemochromatosis reduce iron intake by avoiding iron-rich foods, as well as multivitamins with iron or iron supplements.

Removal of blood, called phlebotomy, is the main way to decrease iron levels and prevent iron accumulation. Phlebotomies for treatment purposes are performed under the supervision of a prescribing health practitioner at medical facilities.

People with hemochromatosis can donate blood, provided they meet all Canadian Blood Services donor criteria. Donor criteria includes an extensive medical eligibility questionnaire as well as wellness check at the collection centre.

Donor eligibility screening helps ensure that the phlebotomy will not harm the donor, nor impact the safety of the blood product or the safety of recipient. For this reason, people with complications of organ dysfunction are not eligible to donate. Many people have improvement of organ function after regular phlebotomies. It is possible that even if not initially eligible to donate, those who have recovery of their organ function can subsequently become eligible to donate whole blood.

All whole blood donors, including those with hemochromatosis, can donate blood every 56 days if they are registered as male and every 84 days if they are registered as female.  

Individuals may have phlebotomies in between donations, providing there is at least a 1-week gap. between an outpatient phlebotomy and their next Canadian Blood Services donation.