Authors: (including presenting author): :
Kong SY (1), Chu CY (1), Lee CK (1)
Affiliation: :
(1) Hong Kong Red Cross Blood Transfusion Service, 15 King’s Park Rise, Kowloon, Hong Kong
Keyword 1: :
Blood donation
Keyword 2: :
Pre-donation haemoglobin
Keyword 3: :
Iron deficiency
Introduction: :
Hong Kong Red Cross Blood Transfusion Service (BTS) has adopted 11.5 g/dL as the pre-donation haemoglobin (Hb) cutoff for female donors for over 50 years. Though thalassaemia trait is not uncommon locally, BTS prepared to uplift the pre-donation Hb for female donors from 11.5 to 12 g/dL as a worldwide trend and mitigation measure of iron deficiency related to blood donation.
Objectives: :
This article aims to discuss the strategies for implementation and review the impact to the whole blood (WB) collection of the change in pre-donation Hb cutoff for female donors.
Methodology: :
WB collection statistics, deferral rate and donation history were retrieved from the blood bank data management information system and reviewed. The total number of WB donations from male and female and the deferral rate of low Hb for female WB donors were compared between Jun to Sep 2024 (11.5 g/dL as cutoff) and Jun to Sep 2025 (12 g/dL as cutoff). Details of female WB donors with Hb 11.5-11.9 g/dL from 1 Jun to 30 Sep 2025 were analysed.
Result & Outcome: :
Preparation phase: Years of effort was paid at multiple levels of governance and operation to overcome the barriers of uplifting pre-donation Hb threshold for female donors
1) Various governing bodies of HKRCBTS endorsed the initiative to raise the pre-donation Hb cutoff for female donors but the blood inventory was deeply affected by the local societal change since 2010s and global COVID-pandemics.
2) The dilemma was tackled with the iron program for blood donors. Universal oral iron supplementation and ferritin testing in selected risk groups were implemented since 2010s. Territory-wide promotional campaigns to enhance dietary iron intake and iron health awareness were conducted in Hong Kong.
3) A gradual improvement in deferral rate of low Hb for female donors (12.0% in 2019 to 9.1% in 2021 to 7.2% in 2023) was observed. Together with a manageable daily loss of 20 donors estimated from previous collection data, it paved the way for HKRCBTS to raise the Hb cutoff for female donor from 11.5 to 12 g/dL on 27 May 2025 while maintain a stable blood supply. Post-implementation review: From 1 Jun to 30 Sep 2025, there were 29606 female donors and 1985 (6.7%) of them were deferred for Hb level of 11.5-11.9 g/dL. The mean deferral rate of low Hb for female WB donors from Jun to Sep 2024 and from Jun to Sep 2025 were 8% and 11.47% respectively (p < 0.05). Although there was a daily loss of 16 donors on average due to uplift of pre-donation Hb cutoff for female donors, the total number of WB collection was not significantly affected (16095-18910 units from Jun to Sep 2024 vs. 14437-17018 units from Jun to Sep 2025, p = 0.61).
