Prospective Blood Donors Deferred by Hemoglobin Estimation Methodology

Blood transfusion is an essential part of health care and permits increasingly complex medical and surgical interventions and dramatically increases the life expectancy and quality of life of patients with a variety of acute and chronic conditions.

In developing countries, it is believed that a large majority of donor deferral could be due to a temporal and correctable cause such as anemia which is a condition of less than normal levels of healthy red blood cells circulating in the blood stream and the severity of anemia is measured by a person’s hemoglobin level.


Medical laboratory scientists at the University of Ghana (Accra) determined anemia in prospective blood donors deferred by the copper sulphate technique of hemoglobin estimation. Venous blood samples were collected into anticoagulant tubes from the subjects who were consenting potential blood donors but failed to meet the requirement for donation due to low hemoglobin level using the copper sulphate technique. The hemoglobin levels and red cell indices were measured using an automatic hematology analyzer. A thin blood film was prepared and stained using Leishman stain and then observed under the light microscope.

A total number of 1,263 prospective blood donors presented to donate blood during the period of this study. Out of these, 1,120 (88.68%) were males and 143 (11.32%) females. A total of 538 (42.6%) involving 444 males and 94 females were deferred due to varied reasons and 114 (21.2%) of these were due to low hemoglobin (Hb) level. These were assessed for anemia using Hb and red cell indices from a Sysmex 2000i hematology autoanalyzer (Sysmex Corporation; Kobe, Japan) and morphology. Those with Hb less than 13.5 g/dL for males and Hb less than 12.0 g/dL for females were termed as anemic.

Ninety two of the 114 (80.7%) were eventually diagnosed with various forms of anemia using the standard methods of full blood count and morphology. This represented 17.1% of the total number (538) deferred and 7.3% of the total (1,263) prospective donors. Twenty two or 19.3% of those who failed the copper sulphate test were found not to be anemic. Four different types of anemia based on the red cell indices and morphology studies were found in the participants who were diagnosed with anemia. These were normocytic normochromic, normocytic hypochromic, microcytic normochromic and microcytic hypochromic.

The authors concluded that there was a high prevalence of deferral of prospective blood donors and a significant proportion of these deferred donors were as a result of low Hb levels and subsequently anemia. They suggest that people who fail the copper sulphate procedure of Hb testing should not be just sent way as deferred donors but rather be assessed for anemia and be offered advice and treatment so that if their anemia can be corrected, they are encouraged to come back to donate. The study was published on October 22, 2015, in the journal BMC Hematology.

Related Links:
University of Ghana 
Sysmex Corporation