Ironing out blood donation Perspectives, predictions and policies for blood donor iron management

Iron loss during blood donation puts donors at risk of iron deficiency and anemia. To prevent this, blood establishments can apply various iron management strategies, such as deferring donations based on biomarker measurements like hemoglobin and ferritin. However, deferral may demoralize donors and reduce return rates, threatening the sustainability of the blood supply. This thesis aimed to optimize iron management by integrating donor perspectives, data-driven policy development, and evaluation of new policies through experimental studies. We showed that donor acceptance of interventions depends more on trust and prior experiences than on knowledge, that current Hb-based deferral may be improved by incorporating measurement variability, and that ferritin-guided deferral strategies and iron supplementation can effectively improve donor iron status, though with different impacts on donor return. The optimal strategy for donor iron management therefore depends on context, policy, and donor experiences. Incorporating donor perspectives remains essential for the success and sustainability of the blood supply.