ABSTRACT
Background and Aim
Anemia in general and iron deficiency constitute a public health problem, particularly about blood donation. Blood donation can lead to anemia, particularly deficiency anemia under certain conditions. This study therefore aims to determine the prevalence of anemia and iron deficiency anemia in blood donors and identify associated factors.
Methods
We conducted an analytical cross‐sectional study over 4 months. Blood donors were recruited at the blood bank of the Bafoussam Regional Hospital. Blood samples were collected in EDTA and dry tubes for biological tests, among which full blood counts, serum ferritin level, and serum iron following standard assay protocols (flow cytometry, sandwich Elisa, and spectrophotometric). The results obtained were analyzed using R software version 4.3.2. The significance threshold for analyses was set at p value < 0.05.
Results
In total, 210 blood donors were included in the study. The sex ratio was 5.3 in favor of men. The mean age was 29.69 ± 7.98 years. The most common type of donation was paid donation (38.6%); 70% of the donations were sporadic. Out of the 210 donors, 63 (30%) had anemia, and 45 (21.4%) had iron deficiency. The mean hemoglobin level was 10.81 ± 0.89 g/dL in anemic donors (AD), and 12.84 ± 1.18 g/dL in non‐anemic donors (NAD) (p < 0.001). The mean red blood cell count was 4.67 ± 0.55 T/L in AD and 5.21 ± 0.62 T/L in NAD (p < 0.001). The mean hemoglobin levels were 10.8 ± 0.87 g/dL in AD, and 12.9 ± 1.17 g/dL in NAD (p < 0.001). Serum iron level differed in AD compared to NAD with respective means of 305 ± 128 µg/dL in AD and 386.00 ± 207 µg/dL in NAD (p < 0.001). Macroplateletosis was identified as a predictive factor of iron deficiency anemia during blood donation (OR = 2.93; 95% CI = [1.00; 8.59]; p = 0.054).
Conclusion
This study reports a high frequency of iron deficiency anemia in blood donors. This suggests a systematic exploration of anemia and iron deficiency anemia in blood donors is useful to preserve donor safety and ensure the efficacy of blood transfusion.
Keywords: anemia, associated factors, blood donation, iron deficiency anemia
1. Introduction
Anemia is a condition characterized by a decrease in the number of red blood cells or hemoglobin in the blood [1, 2]. Current recommendations for blood hemoglobin thresholds range from 13 to 14.2 g/dL in men and 11.6 and 12.3 g/dL in women [3]. The World Health Organization estimates that approximately one‐quarter of the world's population suffers from anemia [4]. It can be caused by various factors, such as deficiencies in essential nutrients, chronic diseases, bleeding, or genetic abnormalities [5, 6, 7]. Iron deficiency anemia is a form of anemia caused by a deficiency of iron, which is essential for the production of hemoglobin. It is the most common nutritional deficiency worldwide and the leading cause of anemia [8]. Cameroon is a Central African country where anemia and iron deficiency anemia are major public health problems. According to the World Health Organization (WHO), anemia affects more than 40% of the Cameroonian population, particularly women of childbearing age, those aged 15 to 49 years, and children aged 6 to 59 months [3]. According to WHO, iron deficiency anemia is the most common form of anemia globally, affecting approximately 2 billion people or 30% of the world's population [4].
Blood donors are a group of people particularly vulnerable to anemia and iron deficiency anemia due to blood loss caused by donations [9]. In addition, blood donors may be exposed to health risks such as infection, allergy, anemia, etc [10].
Iron deficiency anemia is a global public health problem affecting both developing and developed countries, with major consequences for human health and socio‐economic development [11]. Iron deficiency is the leading cause of anemia in Cameroon [3]. Every year, vast amounts of funding are devoted to recipient safety, but the importance of blood donor health is poorly addressed by hemovigilance systems [12]. The occurrence of adverse events attributable to blood donation is 1% [10]. Generally, donor care surveys have focused on immediate complications and iron balance in the body. Iron balance in donors is an influential safety issue [2]. Red blood cell (RBC) loss and plasma dilution result in decreased hemoglobin (Hb) levels early after donation, by 0.5–1.0 g/dL [13]. With continued depletion of iron stores, the body adapts to reduced iron concentrations or develops iron deficiency and anemia [13]. Studies have shown that the prevalence of iron deficiency in blood donors is higher than in the general population. In Europe, the prevalence of iron deficiency in blood donors can vary between 5% and 15%, in the United States, the prevalence is estimated at 10% [14, 15]. Sub‐Saharan Africa varies by region and study; in Nigeria, studies have shown that up to 40% of blood donors were iron deficient [16, 17].
In Cameroon, iron deficiency is a common public health problem. Thus, it is well known that iron deficiency anemia is the final stage of iron deficiency. The latter, in the absence of anemia, can also have negative consequences, including a reduction in physical capacities and intellectual performance, and reduced resistance to infections and disturbances during pregnancy. This leads to pushing the action of anemia prevention towards prevention against iron deficiency [18]. Iron deficiency and anemia in blood donors exist; however, they remain underestimated and thus present a transfusion risk for the recipient. Moreover, in Cameroon, screening for iron deficiency is not systematic among blood donors, although it should be. In this context, the main objective of this study was to determine the prevalence of anemia and iron deficiency anemia in blood donors in Cameroon and to identify the factors associated with these disorders. This would allow the development of effective prevention and management strategies to ensure transfusion safety, patient health, and donor protection.
2. Materials and Methods
2.1. Study Design, Study Location and Medical Selection of the Donor
We carried out a cross‐sectionnal and analytical study over 4 months in 2024 at the Blood Bank of the Bafoussam Regional Hospital (HRB). According to the health pyramid of Cameroon, HRB is reference hospitals responsible for collecting blood on a daily basis in order to supply the clinical services of the hospital and the surrounding health facilities. This blood bank regularly receives blood donors of all categories, including occasional, first‐time, volunteer, repeat, autologous and directed donors. First‐time blood donors were defined as those who had never donated blood in the past. Occasional donors were defined as those who had already donated blood, regardless of the time elapsed between donations and/or since the last donation. Repeat donors were defined as those who had already have donated 2 times in an interval of less than 12 months. Autologous donor was defined as one who donates blood that will be transfused later.
Furthermore, according to the recommendations of the Cameroon National Blood Transfusion Center (NBTC) and in line with WHO recommendations, the maximum authorized frequencies for blood donation are 6 times/year for men and 4 times/year for women. It is also important to respect a minimum of 8 weeks between each donation to guarantee the health and safety of donors. After being informed and sensitized, the blood donor was selected during a medical interview based on a questionnaire, a physical examination and screening of anemia using an hemoglobinometer.
For general examination, patients included were those with a body mass index (kg/m2) whose reference values were greater than or equal to 18.5 and less than or equal to 30; and blood pressure whose reference values were 140/90 mmHg. The interview aimed to assess the donor's tolerance to donation. Also, the questionnaire was administrated prior to donation to screen for previous illnesses, history of transfusions, conditions causing iron mal‐absorption, alcohol intake, and current medication. We excluded all the donor having chronic condition, signs and symptoms of anemia or apparently sick, past history of transfusion or recent severe bleeding episode. Samples were taken only from subjects with no medical contraindications to blood donation. Pregnant women and donors on iron supplementation were not included in this study. The donations made were exclusively whole blood donations.
2.2. Procedure for Data Collection and Biological Analysis of Samples
Data collection was initiated by collecting blood samples. It was done by taking samples from the elbow crease in 2 EDTA and dry tubes for the realization of haematological analyses on the one hand and biochemical analyses on the other hand. Concerning haematological analyses, they consisted of exploring blood cells, in particular determining a hemogram using a haematology machine (MINDRAY BC 2800) whose cell counting principle is flow cytometry. Then, a blood smear was taken on the one hand for observing cellular quality under the microscope after staining with May Grünwald Giemsa and on the other hand, brilliant cresyl blue staining allowed the reticulocyte count to be carried out. These 02 protocols were done according to the procedures and the principle described by Rovanowsky [19]. The slides were read using an optical microscope model: Olympus CX23.
On the other hand, concerning the biochemical analyses, they consisted in the evaluation of the iron status of the donors. It was done from the biochemical dosage by spectrophotometry of serum iron from the protocol of the reagent defined by FerroZine by colorimetric method. Then, the determination of serum ferritin level was done by indirect ELISA method according to the protocol defined by reagent ‘Fortress Diagnostics’ of the batch number BX0892 on semi‐automated Mini Vidas (BioMérieux).
2.3. Data Management and Statistical Analysis
The data obtained were entered into a Microsoft Excel 2016 spreadsheet and analyzed using the R statistical tool version 4.3.2. The variables analyzed included quantitative variables: serum iron, MCHC, MPV, serum ferritin level, platelet, hemoglobin level, red blood cells, white blood cells, platelets, reticulocytosis, MCHC MCV; qualitative variables: age groups, sex, BMI, clinicobiological data, characteristics of the donation including type of donor, nature of the donation. Quantitative variables were categorized as ‘low, normal, high’ according to the reference values defined by the manufacturer or WHO where applicable. For this study, anemia was defined as hemoglobin values < 12 g/dL in women and 13 g/dL in men. Iron deficiency was defined as serum ferritin level< 30 ng/mL in men and < 15 ng/mL in women [10]. Iron deficiency anemia was defined as patients with both anemia and iron deficiency [14].
A normality test was performed to ensure the normal distribution of values. The results were presented as mean and standard deviation for quantitative variables and frequencies for qualitative variables. The “Student test” was used to compare quantitative variables while the Pearson chi2 test allowed the comparison of proportions. A 95% confidence interval whenever necessary. Logistic regression analyses will be done via the univariate model allowed us to identify the factors associated with anemia and deficiency anemia. The significance threshold will be set for values of p < 0.05.
2.4. Ethical Considerations
The conduct of this study obtained approval from the competent authorities, including authorization for collection and analysis from the Regional Hospital of Bafoussam (No. 663/L/MINSANTE/SG/DRSPO/HRB/D); and on the other hand an ethical clearance from the Université des Montagnes (No. 2024/212/UdM/PR/CEAQ). For the selection of participants, the principle of confidentiality was rigorous, on the one hand in the context of the selection of the donor for blood donation and on the other hand the confidentiality of the information obtained as stated in the Helsinki Declaration relating to scientific and medical research [20]. Participants in this study were informed of the aim, risks, and benefits through a detailed questionnaire. Acceptance for participation was obtained through free and informed consent by affixed signature.
3. Results
3.1. Distribution of Donors According to Sociodemographic, Anthropometric Characteristics, and Characteristics Related to the Donation
In total 210 blood donors were included in this study. It appears that 63 donors (30%) presented anemia. The average age of the donors was 29.6 ± 7.95 years. Table 1 below describes the socio‐demographic characteristics and anthropometric data of donors, the type of donations and characteristics related to the donation according to anemia:
Table 1.
Sociodemographic and anthropometric characteristics of donors according to anemia.
| Parameters | AD (n = 63)n (%) | NAD (n = 147)n (%) | TD (n = 210)n (%) | p value | |
|---|---|---|---|---|---|
| Sex | |||||
| F | 9 (14.3) | 24 (16.3) | 33 (15.7) | 0.87a | |
| M | 54 (85.7) | 123 (83.7) | 177 (84.3) | ||
| Age (M ± Sd) | 31.9 ± 8.66 | 28.7 ± 7.45 | 29.6 ± 7.95 | 0.01b, * | |
| Age range | |||||
| < 20 | 3 (4.76) | 12 (8.16) | 15 (7.14) | 0.06 | |
| [20;30] | 30 (47.6) | 78 (53.1) | 108 (51.4) | ||
| [30;40] | 18 (28.6) | 45 (30.6) | 63 (30.0) | ||
| [40;50] | 9 (14.3) | 12 (8.16) | 21 (10.0) | ||
| > 50 | 3 (4.76) | 0 (0.00) | 3 (1.43) | ||
| BMI (M ± Sd) | 27.7 ± 3.00 | 27.7 ± 3.42 | 27.7 ± 3.29 | 0.99a | |
| BMI | |||||
| Normal | 12 (19.0) | 45 (30.6) | 57 (27.1) | 0.16a | |
| Obese | 15 (23.8) | 24 (16.3) | 39 (18.6) | ||
| Overweight | 36 (57.1) | 78 (53.1) | 114 (54.3) | ||
| Type of donation | |||||
| Voluntary | 30 (47.6) | 42 (28.6) | 72 (34.3) | 0.001a, * | |
| Family/replacement | 21 (33.3) | 36 (24.5) | 57 (27.1) | ||
| Paid | 12 (19.0) | 69 (46.9) | 81 (38.6) | ||
| Type of donor | |||||
| Sporadic donor | 27 (42.9) | 66 (44.9) | 93(44,29) | ||
| Repeat donor | 15 (23.8) | 48 (32.7) | 63(30) | ||
| First‐time | 21 (33.3) | 33 (22.4) | 54(21,71) | ||
Note: M ± SD, mean ± standard deviation.
Abbreviations: AD, anemic donor; BMI, body mass index; F, female; M, male; NAD, non‐anemic donor; TD, total donors.
Chi2 test.
Student's test.
p < 0.05.
From Table 1 above, the most represented donor age group is that of [20–30] (51.4%). The mean age of the study population was 29.6 ± 7.95 years. 177 (84.3) donors were male (84.3%) and 33 (15.7) females for a sex ratio of 5.3. Furthermore, sex does not differ significantly in anemic and non‐anemic donors (p = 0.83). Anthropometric parameters did not significantly differ according to anemia. Furthermore, all the donors included had no history of blood transfusion. And the donation made was a whole blood donation. The donors included had an average donation history of 3 ± 2 donations with a minimum of 1 and a maximum of 5. Donors were mainly paid donors (38.6%). 44.29% of donations were sporadic but did not differentiate according to the presence or absence of anemia.
3.2. Distribution of Donors According to Biological Data
3.2.1. Blood Count Profile in Donors
3.2.1.1. Red Lineage Profile, Anemia and Biological Characterization
Table 2 below describes the red lineage profile and biological characterization of anemia in blood donors:
Table 2.
Red lineage profile and biological characterization of anemia in donors.
| Parameters | AD (n = 63)n (%) | NAD (n = 147)n (%) | TD (n = 210)n (%) | p value | |
|---|---|---|---|---|---|
| RBC (T/L) (M ± Sd) | 4.67 ± 0.55 | 5.21 ± 0.62 | 5.05 ± 0.65 | < 0.001a | |
| RBC | |||||
| Low | 6 (9.52) | 0 (0.00) | 6 (2.86) | 0.001a, b | |
| Normal | 57 (90.5) | 147 (100) | 204 (97.1) | ||
| HB(g/dL) (M ± Sd) | 10.8 ± 0.87 | 12.9 ± 1.17 | 12.3 ± 1.46 | < 0.001b, * | |
| HB | |||||
| Low | 63 (100) | 0 (0.00) | 63 (30.0) | < 0.001b, * | |
| Normal | 0 (0.00) | 147 (100) | 147 (70.0) | ||
| MCV (M ± Sd) | 88.0 ± 6.05 | 91.7 ± 3.28 | 90.6 ± 4.62 | < 0.001b, * | |
| MCV (fL) | |||||
| Low | 6 (9.52) | 0 (0.00) | 6 (2.86) | 0.001b, * | |
| Normal | 57 (90.5) | 147 (100) | 204 (97.1) | ||
| MCHC (M ± Sd) | 25.8 ± 1.13 | 26.9 ± 0.93 | 26.6 ± 1.13 | < 0.001b, * | |
| MCHC (g/dL) | |||||
| Low | 63 (100) | 147 (100) | 210 (100) | < 0.001b, * | |
| MCH (M ± Sd) | 22.7 ± 2.35 | 24.9 ± 1.39 | 24.2 ± 1.99 | < 0.001b, * | |
| MCH (pg) | |||||
| Low | 63 (100) | 138 (93.9) | 201 (95.7) | 0.06b, * | |
| Normal | 0 (0.00) | 9 (6.12) | 9 (4.29) | ||
| Hematocrit (M ± Sd) | 41.0 ± 4.29 | 47.4 ± 5.85 | 45.5 ± 6.16 | < 0.001a, * | |
| Hematocrit (%) | |||||
| Low | 12 (19.0) | 0 (0.00) | 12 (5.71) | < 0.001a, * | |
| Normal | 51 (81.0) | 147 (100) | 198 (94.3) | ||
| Rt (G/L) (M ± Sd) | 169 ± 55 | 100 ± 26.5 | 166 ± 56 | < 0.001a, * | |
Note: M ± SD= mean ± standard deviation.
Abbreviations: AD, anemic donors; HB, hemoglobin; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; MCV, mean cell volume; NAD, non‐anemic donors; RBC, red blood cells; Rt, reticulocytes; TD, total donors.
: Student's test.
: Chi2 test.
= p‐value < 0.05; ‐ not available.
The results show a mean red blood cell count of 5.05 ± 0.65 T/L in the total population including 4.67 ± 0.55 T/L in anemic donors (DA) and 5.21 ± 0.62 T/L in non‐anemic donors (DNA) (p < 0.001) for 9.52% erythrocytopenia in anemic donors. Hemoglobin levels show a mean of 10.8 ± 0.87 g/dL in DA, and 12.9 ± 1.17 g/dL in DNA (p < 0.001). The MCV showed a significant difference in anemic donors compared to non‐anemic donors (p < 0.001) with a mean of 88.0 ± 6.05 fL in DA and 91.7 ± 3.28 in DNA (p < 0.001) including 9.52% microcytosis in DA versus none in DNA (p < 0.001). Hypochromia was significantly higher (p < 0.001) in DA compared to DNA. The mean reticulocyte count in DA was 169 ± 55 G/L and 100 ± 26.5 G/L in DNA (p < 0.001) characterizing a greater generation in DA (p < 0.001).
3.2.1.2. White Blood Cell and Platelet Profile
Table 3 below describes the white blood cell and platelet profile in donors:
Table 3.
White blood cell and platelet profile in donors.
| Parameters | AD (n = 63)n (%) | NAD (n = 147) n (%) | TD (n = 210)n (%) | p value | |
|---|---|---|---|---|---|
| WBC (G/L) (M ± Sd) | 3.7 ± 1.5 | 4.01 ± 1.2 | 3.9 ± 1.3 | 0.22a | |
| WBC (G/L) | |||||
| Normal | 45 (71.4) | 69 (46.9) | 114 (54.3) | 0.002b | |
| Low | 18 (28.6) | 78 (53.1) | 96 (45.7) | ||
| Lymphocyte (M ± Sd) | 1.4 ± 0.5 | 1.3 ± 0.5 | 1.3 ± 0.5 | 0.44a | |
| Lymphocyte (G/L) | |||||
| Low | 12 (19.0) | 42 (28.6) | 54 (25.7) | 0.55b | |
| Normal | 51 (81.0) | 105 (71.4) | 156 (74.3) | ||
| Monocyte (M ± Sd) | 0.3 ± 0.1 | 0.3 ± 0.1 | 0.3 ± 0.1 | 0.23a | |
| Monocyte (G/L) | |||||
| Low | 3 (4.76) | 3 (2.04) | 6 (2.86) | 0.367b | |
| Normal | 60 (95.2) | 144 (98.0) | 204 (97.1) | ||
| Granulocytes (M ± Sd) | 1.9 ± 1.2 | 2.2 ± 1.01 | 2.1 ± 1.1 | 0.072a | |
| Granulocytes (G/L) | |||||
| Low | 57 (90.5) | 123 (83.7) | 180 (85.7) | 0.37b, * | |
| Normal | 6 (9.52) | 24 (16.3) | 30 (14.3) | ||
| Platelets (G/L) (M ± Sd) | 284 ± 103 | 268 ± 59.0 | 273 ± 75.0 | 0.269a, * | |
| Platelets (G/L) | |||||
| Normal | 57 (90.5) | 147 (100) | 204 (97.1) | 0.001b | |
| Low | 3 (4.76) | 0 (0.00) | 3 (1.43) | ||
| High | 3 (4.76) | 0 (0.00) | 3 (1.43) | ||
| MPV (M ± Sd) | 10.5 ± 0.87 | 10.2 ± 0.81 | 10.3 ± 0.84 | 0.021 a | |
| MPV (fL) | |||||
| High | 24 (38.1) | 51 (34.7) | 75 (35.7) | 0.753b | |
| Normal | 39 (61.9) | 96 (65.3) | 135 (64.3) | ||
Note: M ± SD, mean ± standard deviation.
Abbreviations: AD, anemic donor; MPV, mean platelet volume; NAD, non‐anemic donor; TD, total donors; WBC, Whyte blood cell.
Student's test.
Chi2 test.
= p‐value < 0.05; ‐ not available.
From the Table 3 above it is clear that 45.7% of patients had leukopenia. 85.7% had granulocytopenia and 35.7% had macroplateletosis.
3.2.2. Frequency of Iron Deficiency and Iron Deficiency Anemia, Iron Parameters in Donors and Associated Factors
3.2.2.1. Frequency of Iron Deficiency and Iron Deficiency Anemia
At the end of the study, 45 (21.4%) donors presented iron deficiency but it did not differ according to the presence of anemia. Of these, 15 (7.14%) presented iron deficiency anemia. Table 4 below shows the distribution of the population according to iron parameters and iron deficiency in the population according to anemia.
Table 4.
Iron parameters and iron deficiency in donors.
| Parameters | AD (n = 63) n (%) | NAD (n = 147) n (%) | TD (n = 210) n (%) | p value | |
|---|---|---|---|---|---|
| Serum ferritin level (ng/mL) (M ± SD) | 120 ± 107 | 104 ± 103 | 109 ± 104 | 0.328a | |
| Serum ferritin level (ng/mL) | |||||
| Low | 15 (23.8) | 30 (20.4) | 45 (21.4) | 0.295b | |
| High | 15 (23.8) | 24 (16.3) | 39 (18.6) | ||
| Normal | 33 (52.4) | 93 (63.3) | 126 (60.0) | ||
| Serum iron (µg/dL) (M ± SD) | 305 ± 128 | 386 ± 207 | 362 ± 191 | < 0.001a | |
| Serum iron (µd/dL) | |||||
| Low | 0 (0.00) | 3 (2.04) | 3 (1.43) | 0.093a, * | |
| High | 54 (85.7) | 135 (91.8) | 189 (90.0) | ||
| Normal | 9 (14.3) | 9 (6.12) | 18 (8.57) | ||
Note: M ± SD, mean ± standard deviation.
Abbreviations: AD, anemic donor; NAD, non‐anemic donor; TD, total donors.
Student's test.
Chi2 test.
= p‐value < 0.05.
Table 4 above reports a significant decrease in serum iron in anemic donors compared to non‐anemic donors (p < 0.001). It reports a decrease in ferritin in blood although not different according to the presence of anemia (p = 0.295).
3.2.3. Factors Associated With Anemia
3.2.3.1. Factors Associated With Anemia in Donors During This Study
The following Table 5 describes the factors associated with anemia in donors:
Table 5.
Factors associated with anemia in donors during this study.
| Parameters | Yes n = 63 | No n = 147 | OR [IC 95%] | p‐value |
|---|---|---|---|---|
| Sex | ||||
| F | 9 (14.3) | 24 (16.3) | Ref. | Ref. |
| M | 54 (85.7) | 123 (83.7) | 1.17 [0.51;2.69] | 0.728 |
| Age range | ||||
| < 20 | 3 (4.76) | 12 (8.16) | Ref. | Ref. |
| [20;30] | 30 (47.6) | 78 (53.1) | 1.54 [0.41;5.84] | 0.559 |
| [30;40] | 18 (28.6) | 45 (30.6) | 1.60 [0.40;6.35] | 0.535 |
| [40;50] | 9 (14.3) | 12 (8.16) | 3.00 [0.65;13.9] | 0.175 |
| > 50 | 3 (4.76) | 0 (0.00) | — | 0.025 |
| BMI | ||||
| Normal | 12 (19.0) | 45 (30.6) | Ref. | Ref. |
| Obese | 15 (23.8) | 24 (16.3) | 2.34 [0.95;5.80] | 0.070 |
| Overweight | 36 (57.1) | 78 (53.1) | 1.73 [0.82;3.66] | 0.152 |
| Type de donor | ||||
| Volunteers | 30 (47.6) | 42 (28.6) | Ref. | Ref. |
| Family | 21 (33.3) | 36 (24.5) | 1.22 [0.60;2.50] | 0.585 |
| Paid | 12 (19.0) | 69 (46.9) | 4.11 [1.90;8.88] | < 0.001 |
| Type of donation | ||||
| Sporadic | 27 (42.9) | 66 (44.9) | Ref. | Ref. |
| Repeat | 15 (23.8) | 48 (32.7) | 1.31 [0.63;2.72] | 0.480 |
| New | 21 (33.3) | 33 (22.4) | 0.64 [0.32;1.30] | 0.228 |
| Ferritin | ||||
| Low | 15 (23.8) | 30 (20.4) | 0.71 [0.34;1.48] | 0.368 |
| High | 15 (23.8) | 24 (16.3) | 0.57 [0.27;1.21] | 0.152 |
| Normal | 33 (52.4) | 93 (63.3) | Ref. | Ref. |
| Serum Iron | ||||
| Low | 0 (0.00) | 3 (2.04) | 2.50 [0.94;6.64] | 0.075 |
| High | 54 (85.7) | 135 (91.8) | — | 0.165 |
| Normal | 9 (14.3) | 9 (6.12) | Ref. | Ref. |
| Iron deficiency | ||||
| No | 48 (76.2) | 117 (79.6) | Ref. | Ref. |
| Yes | 15 (23.8) | 30 (20.4) | 0.82 [0.41;1.66] | 0.582 |
| Iron deficiency anemia | ||||
| No | 48 (76.2) | 147 (100) | Ref. | Ref. |
| Yes | 15 (23.8) | 0 (0.00) | — | < 0.001 |
Note: F=Female; M=Male; Or= Odd ratio; 95% CI = 95% Confidence Interval; IDA =Iron Deficiency Anemia; signifiance test p < 0.05; ‐ = not available. From this table, paid donation and decreased serum iron are a factor associated with iron deficiency anemia during blood donation in this study with respectively (Or=4.11, IC95%= [1.90;8.88], p < 0,001) and (Or=2.50, IC 95%= [0.94;6.64], p = 0.075).
3.2.3.1.1. Factors Associated With Iron Deficiency Anemia
The following Table 6 describes the factors associated with iron deficiency anemia in blood donors:
Table 6.
Factors associated with iron deficiency anemia in donors, univariate analyses.
| Parameters | No n = 195 | Yes n = 15 | OR [IC 95%] | p‐value |
|---|---|---|---|---|
| Sex | ||||
| F | 33 (16.9) | 0 (0.00) | Ref. | Ref. |
| M | 162 (83.1) | 15 (100) | — | 0.070 |
| Age range | ||||
| < 20 | 15 (7.69) | 0 (0.00) | Ref. | Ref. |
| [20;30] | 99 (50.8) | 9 (60.0) | — | 0.297 |
| [30;40] | 60 (30.8) | 3 (20.0) | — | 0.522 |
| [40;50] | 21 (10.8) | 0 (0.00) | — | 1.000 |
| > 50 | 0 (0.00) | 3 (20.0) | — | 0.001 |
| BMI | ||||
| Normal | 48 (24.6) | 9 (60.0) | Ref. | Ref. |
| Obese | 39 (20.0) | 0 (0.00) | — | 0.007 |
| Overweight | 108 (55.4) | 6 (40.0) | 3.38 [1.14;10.0] | 0.031 |
| Type de donor | ||||
| Volunteers | 66 (33.8) | 6 (40.0) | Ref. | Ref. |
| Family | 51 (26.2) | 6 (40.0) | 1.29 [0.39;4.25] | 0.680 |
| Paid | 78 (40.0) | 3 (20.0) | 0.42 [0.10;1.76] | 0.251 |
| Type of donation | ||||
| Sporadic | 84 (43.1) | 9 (60.0) | Ref. | Ref. |
| Repeat | 60 (30.8) | 3 (20.0) | 0.47 [0.12;1.80] | 0.279 |
| New | 51 (26.2) | 3 (20.0) | 0.55 [0.14;2.12] | 0.406 |
| WBC | ||||
| Leucopenia | 105 (53.8) | 9 (60.0) | Ref. | Ref. |
| Normal | 90 (46.2) | 6 (40.0) | 1.29 [0.44;3.75] | 0.661 |
| Lymphocyte | ||||
| Lymphopenia | 48 (24.6) | 6 (40.0) | Ref. | Ref. |
| Normal | 147 (75.4) | 9 (60.0) | 2.04 [0.69;6.03] | 0.214 |
| Granulocyte | ||||
| Low | 165 (84.6) | 15 (100) | Ref. | Ref. |
| Normal | 30 (15.4) | 0 (0.00) | — | 0.091 |
| MPV | ||||
| High | 66 (33.8) | 9 (60.0) | 2.93 [1.00;8.59] | 0.054 |
| Normal | 129 (66.2) | 6 (40.0) | Ref. | Ref. |
Note: F=Female; M=Male; Or= Odd ratio; 95% CI = 95% Confidence Interval; IDA =Iron Deficiency Anemia; significance test p < 0.05; ‐ = not available. From this table, gender is not a factor associated with iron deficiency anemia during blood donation. Furthermore, macroplateletosis was identified as a predictive factor of iron deficiency anemia during blood donation with (Or = 2.93; 95% CI = [1.00; 8.59]; p = 0.054).
4. Discussion
This study aimed to determine the prevalence of iron deficiency and iron deficiency anemia in blood donors. In terms of blood transfusion, the blood bank must adopt measures to ensure transfusion safety, which is the set of measures put in place to highlight situations in donors that could affect the quality of the donation and thus preserve the safety of the donors [10, 18]. Iron deficiency occurs when our body lacks iron, it can be the main cause of iron deficiency anemia in blood donors [3]. They develop gradually, causing anemia and presenting a transfusion risk for the recipient [21]. When donating blood, a significant amount of red blood cells, which contain iron, are collected. Thus, each whole blood donation (450–500 mL) causes an estimated iron loss of 200–250 mg. If a donor does not compensate for this loss by consuming iron‐rich foods, he or she may develop an iron deficiency [7]. In some countries, ferritin levels are evaluated before each donation, and potential donors are deferred if their ferritin is below a certain threshold (e.g., 30 μg/L). Note that while important for donor care, such a ferritin testing policy can significantly impact blood supply and donation frequency [22]. Thus, from this study, it appears that 63 donors (30%) presented anemia, and 45 (21.4%) donors presented an iron deficiency but it does not differ according to the presence of anemia. Of these, 15 (7.14%) presented anemia by iron deficiency. Waheed et al (2018) in Pakistan reported 20.2% iron deficiency and 9.68% of iron deficiency anemia [23], 31.66% anemia and 10.83% iron deficiency anemia reported by Atipo‐Tsiba 2023 et al. in Congo [24], 13.7% d'anémie et 12.0% d'anémie par carence martiale rapportée par Jeremiah et al. (2010) in Nigeria [25], 20% iron deficiency anemia reported by Mozaheb et al. (2011) [26]. The divergences in results could be explained by methodological divergences, and the complexity of definition due to the different factors surrounding the definition of iron deficiency in blood donors [27]; However, they still reflect a high prevalence of anemia and iron deficiency anemia in donors and the need for continuous exploration of the latter in the donor before any blood donation. In less developed countries where iron deficiency is already a public health problem, the prevention of anemia in general and iron deficiency anemia in particular must be a key issue for the safety of the blood donor but also quantitative and qualitative self‐sufficiency in blood products. Indeed, iron deficiency can be the cause of anemia with multiple clinical implications related to the reduction of oxygen transport in the body [28].
A total of 210 donors were included in our study, the male sex was the most represented in the population, i.e. 84.3% for a sex ratio of 5.3. Several authors report a male predominance during blood donation [29, 30, 31]. This male predominance could be explained by the fact that the eligibility criteria for donation are strict, particularly with regard to medical history, menstruation or pregnancy, which exclude women on the one hand [3]; and on the other hand, awareness campaigns which can affect men and women differently, which could influence the participation rate of the latter [18, 28]. The mean age of donors was 29.69 ± 7.98 years, which is relatively young. This could be explained by the good health of young people and the motivations for donation which are greater among them compared to older people [28, 32]. These observations have also been reported by several authors [23, 33, 34].
The most represented donation was paid donation (38.6%) and 44,29% of donations were sporadic. These results reflect the low culture of donation in countries with limited resources, particularly in African countries in general and in Cameroon in particular, which is the cause of low blood donation and insufficient blood supply to blood banks [35]. According to WHO data, of the 118.5 million blood donations collected each year worldwide, 40% are in high‐income countries, where 16% of the world's population lives. There are 31.5 blood donations per 1,000 people in high‐income countries, compared to 5.0 in low‐income countries, which still collect more than 50% of their blood supply through compensatory or paid donations [28, 36].
The hematological parameters explored for the biological characterization of anemias report a significant difference in these parameters in anemic donors compared to non‐anemic ones characterized by hypochromia, microcytosis, greater regeneration defined by values lower than the reference values. Indeed, iron deficiency is the cause of a decrease in the size of red blood cells, leading to a hemoglobin content and therefore its normal hemoglobin concentration more or less reduced, generally resulting from repeated blood loss as in the case of donations [37, 38, 39]. These observations have also been made by several authors [37, 39].
Furthermore, although not different according to the presence of anemia (p = 0.295), this study reports a decrease in serum ferritin level in blood donors; moreover, it reports a significant decrease in serum iron in anemic donors compared to non‐anemic donors (p < 0.001). Several authors also make these observations in blood donors [25, 40, 41, 42, 43]. Iron deficiency is a condition in which the body's iron content is below normal. Iron depletion is the earliest stage of iron deficiency and means that iron stores are decreased or absent, but serum iron concentration and blood hemoglobin levels are normal. Iron deficiency without anemia is a somewhat more advanced stage of iron deficiency, characterized by decreased or absent iron stores, usually low serum iron concentration and low blood hemoglobin concentration, but without anemia [24, 29, 34, 44].
Regarding other hematological parameters, 45.7% of patients had leukopenia, of which 85.7% had granulocytopenia. This could be explained by a dilution effect because frequent donations can lead to temporary dilution of blood cells including white blood cells. Incomplete recovery could also explain the results because if donors do not allow enough time for the body to fully recover, this can affect white blood cells [33]. Authors have also reported cases of leukopenia and granulocytopenia during blood donation [9, 45, 46]. As for platelets, macroplateletosis was reported with significantly different mean in anemic patients compared to those without anemia with macroplateletosis was identified as a predictive factor of iron deficiency anemia during blood donation with (Or = 2.93; 95% CI = [1.00; 8.59]; p = 0.054). This could be due to a deficiency in vitamin B12 or folic acid. These results are in agreement with those obtained by Mamadou et al (2016). They obtained 84.4% of the study population [46].
This study is of public health interest in that it provides useful information, particularly for donor protection, product quality and prevention of transfusion risks in recipients in general and anemia in particular in the context of blood bank supply. One of the limitations is that it did not explore iron status based on a complete iron assessment from determining transferrin concentration values and transferrin saturation index, and on the other hand it focused on the study of anemia in blood donors in general, rather than focusing on a particular group of donors; the latter opens up perspectives for future research.
Other limitations of this study include: the impact of donation frequency on ferritin values could be confounded by other factors like menstrual losses or diet, and the lack of a control group, makes it difficult to compare and isolate the effect of donation; the limited sample size, the differential impact of paid repeat donations versus altruistic/family replacement donations, and the potential influence of unmeasured comorbidities and treatments.
5. Conclusion
This study aimed to determine the prevalence of anemia and iron deficiency anemia and identify associated factors in blood donors. It appears that 63 donors (30%) presented anemia, and 45 (21.4%) donors presented iron deficiency. Of these, 15 (7.14%) presented iron deficiency anemia. Donations were mainly paid (38.6%) and sporadic (70%). The anemias observed in donors were mainly hypochromic and microcytic. Macroplateletosis was identified as a predictive factor of iron deficiency anemia during blood donation with (Or = 2.93; 95% CI = [1.00; 8.59]; p = 0.054). This study reports a high frequency of iron deficiency anemia in blood donors; this suggests a systematic exploration of anemia and iron deficiency anemia in blood donors to preserve donor safety and prevent transfusion risks and thus ensure recipient safety. One of the recommendations for future practice is ideally, ferritin should be measured prior to donation, and donors with low iron stores should be offered iron supplementation, as is practiced in some European countries.
Author Contributions
Laurenne Alicia Kouaya carried out the data collection, and analysis of the biological samples and drafted the manuscript. Romaric Tuono De Manfouo and Maryline Seuko Njopwouo interpreted the data and contributed to the drafting of the manuscript. Josué Louokdom Simo supervised the work. All authors read and approved the final version of the manuscript, and Romaric Tuono De Manfouo had full access to all of the data in this study and took complete responsibility for the integrity of the data and the accuracy of the data analysis. Claude Tayou Tagny reviewed the paper.
Funding
The authors received no specific funding for this work.
Conflicts of Interest
The authors declare that they have no conflicts of interest regarding the publication of this manuscript.
Transparency Statement
The lead author Romaric De Manfouo Tuono affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Acknowledgments
We offer our sincere thanks to all the staff of laboratories of the “Hôpital Regional de Bafoussam”, and “Université des Montagnes” for their help in carrying out this work. A similar version of this manuscript in preprint is available online [47].
Data Availability Statement
The authors confirm that the data supporting the findings of this study are available from the corresponding author.
References
- 1. Akbarpour E., Paridar Y., Mohammadi Z., et al., “Anemia Prevalence, Severity, Types, and Correlates Among Adult Women and Men in a Multiethnic Iranian Population: The Khuzestan Comprehensive Health Study (KCHS),” BMC Public Health 22 (2022): 168, 10.1186/s12889-022-12512-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Almashjary M. N., “Reticulocyte Hemoglobin Content: Advancing the Frontiers in Iron‐Deficiency Anemia Diagnosis and Management,” Journal of Applied Hematology 15 (2024): 1–8. [Google Scholar]
- 3. Hioui M. E., Ahami A. O. T., Aboussaleh Y., Lemrini J. D., and Loutfi H., “Anémie en Milieu Hospitalier Marocain: Typologie et Influences Des Facteurs Sociodémographiques Sur Son Incidence,” Antropo 12 (2006): 83–91. [Google Scholar]
- 4. 2011. Global Database on Blood Safety1–9.
- 5. Jin M., Wang Y., Li J., et al., “Anemia is Independently Associated With Mortality in People Living With Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome: A Propensity Score Matching‐Based Retrospective Cohort Study in China,” Frontiers in Medicine 10 (2023): 1–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Shen Y., Wang Z., Lu H., et al., “Prevalence of Anemia Among Adults With Newly Diagnosed HIV/AIDS in China,” PLoS One 8 (2013): e73807. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Nzengu‐Lukusa F., Yuma‐Ramazani S., Sokolua‐Mvika E., et al., “Carence en Fer, Anémie et Anémie Ferriprive Chez Les Donneurs De Sang À Kinshasa, République Démocratique du Congo,” Pan African Medical Journal 23 (2016): 1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Shaw J. G. and Friedman J. F., “Iron Deficiency Anemia: Focus on Infectious Diseases in Lesser Developed Countries,” Anemia 2011 (2011): 1–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Kabore S., Yao K. D., Yassongui M. S., Siransy B. L., Dembele B., and Assi A. U., “Anémies Chez Les Donneurs de Sang au Centre National de Transfusion Sanguine D'Abidjan, Côte d'Ivoire,” Transfusion Clinique et Biologique 23 (2016): 301–302. [Google Scholar]
- 10. Hichem N. A. A. S., Hamza B. E. N. B. A. C. H. I. R., and Fatima A. D. D. A., “Study of Iron Deficiency in a Population of Blood Donors in Tlemcen Algeria,” GSC Biological and Pharmaceutical Sciences 25 (2023): 042–054. [Google Scholar]
- 11. Amidou S., Aoua S., Ollo D., et al., Anémie et Carence Martiale Chez Les Hémodialysés à l’à l' Ouverture dudu Centre d' Hémodialyse dudu Centre Hospitalier Universitaire Sourô Sanou: Une Étude Transversale Descriptive Anemia and 2 Iron Deficiency Among Hemodialysis Patients at the Opening of the, 2024. 20–23.
- 12. Mamadou S. Y., Saydou K., Daniel Y. K., and Bamory D. Anemia to Blood Donors at the National Blood Transfusion Center of Abidjan Cote D' Ivoire. 2016.
- 13. Peng Y. Y. and Uprichard J., “Ferritin and Iron Studies in Anaemia and Chronic Disease,” Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 54 (2017): 43–48. [DOI] [PubMed] [Google Scholar]
- 14. Ruivard M., “Anémie Ferriprive Chez L'adulte: Diagnostic et Traitement,” Nutrition Clinique et Métabolisme 31 (2017): 104–106. [Google Scholar]
- 15. El Beshlawy A., Alaraby I., Abdel Kader M. S. E. M., Ahmed D. H., and Abdelrahman H. E. M., “Study of Serum Hepcidin in Hereditary Hemolytic Anemias,” Hemoglobin 36 (2012): 555–570. [DOI] [PubMed] [Google Scholar]
- 16. Bellakhal S., Ouertani S., Antit S., Abdelaali I., Teyeb Z., and Dougui M. H., “Iron Deficiency Anemia: Clinical and Etiological Features,” La Tunisie Medicale 97 (2019): 1389–1398. [PubMed] [Google Scholar]
- 17. Akinbami A., Dosunmu A., Adediran, et al., “Serum Ferritin Levels in Adults With Sickle Cell Disease in Lagos, Nigeria,” Journal of Blood Medicine 1 (2013): 59. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Fillet A. M. and Gross S., “Prévention de L'anémie Chez Les Donneurs de Sang,” Transfusion Clinique et Biologique 24 (2017): 143–147, 10.1016/j.tracli.2017.06.004. [DOI] [PubMed] [Google Scholar]
- 19. Corrons J. L. V., Albarède S., Flandrin G., et al., “Guidelines for Blood Smear Preparation and Staining Procedure for Setting up an External Quality Assessment Scheme for Blood Smear Interpretation. Part I: Control Material,” Clinical Chemistry and Laboratory Medicine (CCLM) 42 (2004): 922–926. [DOI] [PubMed] [Google Scholar]
- 20. Li S. J., Wu Y. Y., Li W., Wang S. J., and Fan Y. M., “Ultrastructural Observation in a Case of Mucinous Nevus,” JDDG: Journal der Deutschen Dermatologischen Gesellschaft 16 (2018): 778–780. [DOI] [PubMed] [Google Scholar]
- 21. Matsagos S., Verigou E., Kourakli A., et al., “High Frequency of Post‐Transfusion Microchimerism Among Multi‐Transfused Beta‐Thalassemic Patients,” Frontiers in Medicine 9 (2022): 845490. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22. Richard P., Fillet A.‐M., Malard L., et al., “Impact of Donor Ferritin Testing on Iron Deficiency Prevention and Blood Availability in France: A Cohort Simulation Study,” Vox Sanguinis 118 (2023): 24–32. [DOI] [PubMed] [Google Scholar]
- 23. Waheed U., Arshad M., Sultan S., et al., “Iron Deficiency and Iron Deficiency Anemia in Blood Donors at a Tertiary Care Hospital in Islamabad, Pakistan,” Global Journal of Transfusion Medicine 3 (2018): 17. [Google Scholar]
- 24. Atipo‐Tsiba F. O. G., Mouyabi E. Q. G., Angounda B. M., Mokono S. O., Gokaba L. T. O., and Dokekias A. E., “Prevalence of Iron Deficiency, Anemia, and Associated Factors in a Blood Donor Population in Brazzaville, Congo,” Anemia 1 (2023): 1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25. Jeremiah Z. A. and Koate B. B., “Anaemia, Iron Deficiency and Iron Deficiency Anaemia Among Blood Donors in Port Harcourt,” Nigeria 8 (2010): 113–117. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26. Mozaheb Z., Khayami M., and Sayadpoor D., “Iron Balance in Regular Blood Donors,” Transfusion Medicine and Hemotherapy: Offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie 38 (2011): 190–194. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27. Dignass A., Farrag K., and Stein J. Limitations of Serum Ferritin in Diagnosing Iron Deficiency in Inflammatory Conditions. 2018. [DOI] [PMC free article] [PubMed]
- 28. McLean E., Cogswell M., Egli I., Wojdyla D., and De Benoist B., “Worldwide Prevalence of Anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005,” Public Health Nutrition 12 (2009): 444–454. [DOI] [PubMed] [Google Scholar]
- 29. Mahida V. I., Bhatti A., and Gupte S. C., “Iron Status of Regular Voluntary Blood Donors,” Asian Journal of Transfusion Science 2 (2008): 9–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30. Abdullah S. M., “The Effect of Repeated Blood Donations on the Iron Status of Male Saudi Blood Donors,” Blood Transfusion = Trasfusione Del Sangue 9 (2011): 167–171. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31. Anupama K. V., Rao P. S., and Adappa S., Correlation between serum ferritin and bone marrow iron stores. 2016; 1–5. [DOI] [PubMed]
- 32. van den Berg K., Murphy E. L., Louw V. J., Maartens G., and Hughes S. D., “Motivations for Blood Donation by HIV‐Positive Individuals on Antiretrovirals in South Africa: A Qualitative Study,” Transfusion Medicine 33 (2023): 277–286. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33. Djalali M. and Saedisomeolia A. Relationship between blood donors' iron status and their age, body mass index and donation frequency Relação entre os níveis de ferro de doares de sangue e idade, índice de massa. 2013. [DOI] [PMC free article] [PubMed]
- 34. Boulahriss M. and Benchemsi N., “Iron Deficiency in Frequent and First Time Female Blood Donors,” East African Journal of Public Health 5 (2008): 157–159. [DOI] [PubMed] [Google Scholar]
- 35. Pérez R del S., Mantilla, Gutiérrez C. Y., and Cardona‐Arias J. A., “Prospective Study on the Effect of Blood Donation in the Iron Status,” Revista de Investigaciones Altoandinas 23 (2021): 37–50. [Google Scholar]
- 36. OMS . Dons du sang et sécurité des transfusions [Internet]. 2017, https://www.who.int/fr/news-room/fact-sheets/detail/blood-safety-and-availability.
- 37. Access O., “Carence en Fer, Anémie et Anémie Ferriprive Chez Les Donneurs de Sang À Kinshasa, République Démocratique du Congo Iron Deficency and Anemia Among Donors In,” Kinshassa 8688 (2016): 1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38. Waheed U. Iron deficiency and iron deficiency anemia in blood donors at a tertiary care hospital in Islamabad, Pakistan. 2018;5–9.
- 39. Fillet A., Martinaud C., Malard L., et al., “Analyse Des Informations Post‐Don en ES: Blocage Des Produits, Destruction, Relation et Échanges Avec L' Hémovigilant ES Courrier, Action, S17 Vigilances Donneur et Gestion Des Risques. Modérateurs: Caroline Lefort (Bouchemaine), Philippe Ca,” Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine Elsevier Masson SAS 26 (2019): S23–S24. [Google Scholar]
- 40. Ford E. S., Cowie C. C., Li C., Handelsman Y., and Bloomgarden Z. T., “Iron‐Deficiency Anemia, Non‐Iron‐Deficiency Anemia and HbA1c Among Adults in the US,” Journal of Diabetes 3 (2011): 67–73. [DOI] [PubMed] [Google Scholar]
- 41. Oppenheimer S. J., “Iron‐Deficiency Anemia: Reexamining the Nature and Magnitude of the Public Health Problem,” Journal of Nutrition 131 (2001): 616–635. [DOI] [PubMed] [Google Scholar]
- 42. Norashikin J., Roshan T. M., Rosline H., Zaidah A. W., Suhair A. A., and Rapiaah M., “A Study of Serum Ferritin Levels Among Male Blood Donors in Hospital Universiti Sains Malaysia,” Southeast Asian Journal of Tropical Medicine and Public Health 37 (2006): 370–373. [PubMed] [Google Scholar]
- 43. Gomez S., Diawara A., Gbeha E., et al., “Comparative Analysis of Iron Homeostasis in Sub‐Saharan African Children With Sickle Cell Disease and Their Unaffected Siblings,” Frontiers in Pediatrics 4 (2016): 8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 44. Cook J. D., “Diagnosis and Management of Iron‐Deficiency Anaemia,” Best Practice & Research Clinical Haematology 18 (2005): 319–332. [DOI] [PubMed] [Google Scholar]
- 45. Yassongui Mamadou S., Saydou K., Kouadio Daniel Y., Bamory D., Seidou K., and Sery Romuald D., “Anemia to Blood Donors at the National Blood Transfusion Center of Abidjan Cote D'Ivoire,” The European Journal of Clinical and Biomedical Sciences 6 (2020): 1. [Google Scholar]
- 46. Mamadou S. Y., Saydou K., Daniel Y. K., and Bamory D. Anemia to Blood Donors at the National Blood Transfusion Center of Abidjan Cote D' Ivoire. 2015.
- 47. Tedong L., Mekieje M. T., Djeukamgang M. M., et al. Associated Factors Among Diabetics in the West Region of Cameroon. 2024.
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The authors confirm that the data supporting the findings of this study are available from the corresponding author.