BACKGROUND: Determination of blood donor hemoglobin (Hb) levels is a pre-requisite to ensure donor safety and blood product quality. We aimed to identify Hb measurement practices across blood donation services and to what extent differences associate with low-Hb deferral rates. METHODS: An online survey was performed among Biomedical Excellence for Safer Transfusion (BEST) Collaborative members, extended with published data. Multivariable negative-binomial regression models were built to estimate adjusted associations of minimum donation intervals, Hb cut-offs (high, ≥13.5 g/dL in men or ≥ 12.5 g/dL in women, vs. lower values), iron monitoring (yes/no), providing or prescribing iron supplementation (yes/no), post-versus pre-donation Hb measurement and geographical location (Asian vs. rest), with low-Hb deferral rates. RESULTS: Data were included from 38 blood services. Low-Hb deferral rates varied from 0.11% to 8.81% among men and 0.84% to 31.85% among women. Services with longer minimum donation intervals had significantly lower deferral rates among both women (rate ratio, RR 0.53, 95%CI 0.33-0.84) and men (RR 0.53, 95%CI 0.31-0.90). In women, iron supplementation was associated with lower Hb deferral rates (RR 0.47, 95%CI 0.23-0.94). Finally, being located in Asia was associated with higher low-Hb deferral rates; RR 9.10 (95%CI 3.89-21.27) for women and 6.76 (95%CI 2.45-18.68) for men. CONCLUSION: Differences in Hb measurement and eligibility criteria, particularly longer donation intervals and iron supplementation in women, are associated with variations in low-Hb deferral rates. These insights could help improve both blood donation service efficiency and donor care.

American Red Cross Washington D C Washington

Australian Red Cross Blood Service Adelaide South Australia Australia

Blood Assurance Inc Chattanooga Tennessee

Blood Centre and Laboratory Medicine Innlandet Hospital Lillehammer Oppland Norway

Carter BloodCare Bedford Texas

Centro Vasco de Transfusion y Tejidos Humanos Galdakao Biscay Spain

Community Blood Center of the Carolinas Charlotte North Carolina

Department of Public Health and Primary Care University of Cambridge Cambridge United Kingdom

Division of Transfusion Medicine Mayo Clinic Rochester New York

Donor Studies Department of Donor Medicine Research Sanquin Research Amsterdam The Netherlands

Établissement Français du Sang Paris Île de France France

Finnish Red Cross Blood Service Helsinki Finland

German Red Cross Springe Lower Saxony Germany

Health Sciences Authority Blood Services Group Singapore Singapore

Hong Kong Red Cross Blood Transfusion Service Kowloon Hong Kong SAR China

Hospital Israelita Albert Einstein Sao Paulo Brazil

Hospital Sirio Libanes Blood Bank São Paulo Brazil

LifeShare Blood Centers Shreveport Louisiana

Medical Affairs and Innovation Héma Québec Quebec City Canada

Medical Services and Innovation Canadian Blood Services Ottawa Ontario Canada

Michigan Blood Saginaw Michigan

Military University Hospital Prague Czech Republic Prague Bohemia

National Institutes of Health Clinical Center Bethesda Maryland

New Zealand Blood Service Auckland New Zealand

Physician Services Innovative Blood Centers St Paul Minnesota

Red Cross Flanders Ghent East Flanders Belgium

Regional Blood Transfusion Service Swiss Red Cross Basel Switzerland

Safety Vigilance Department Technical Department Blood Service Headquarters Japanese Red Cross Society Tokyo Japan

Shepeard Community Blood Center Augusta Georgia

Stanford Blood Center Stanford California

Vitalant Scottsdale Arizona

Welsh Blood Service Wales United Kingdom

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