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Impact of a post‐donation hemoglobin testing strategy on efficiency and safety of whole blood donation in England: A modeling study

Kim, Lois G.; Bolton, Thomas; Sweeting, Michael J.; Bell, Steven; Fahle, Sarah; McMahon, Amy; Walker, Matthew; Ferguson, Eamonn; Miflin, Gail; Robert, David J.; di Angelantonio, Emanuele; Wood, Angela M.


Lois G. Kim

Thomas Bolton

Michael J. Sweeting

Steven Bell

Sarah Fahle

Amy McMahon

Matthew Walker

Gail Miflin

David J. Robert

Emanuele di Angelantonio

Angela M. Wood


Deferrals due to low hemoglobin are time-consuming and costly for blood donors and donation services. Furthermore, accepting donations from those with low hemoglobin could represent a significant safety issue. One approach to reduce them is to use hemoglobin concentration alongside donor characteristics to inform personalized inter-donation intervals.

Study Design and Methods
We used data from 17,308 donors to inform a discrete event simulation model comparing personalized inter-donation intervals using “post-donation” testing (i.e., estimating current hemoglobin from that measured by a hematology analyzer at last donation) versus the current approach in England (i.e., pre-donation testing with fixed intervals of 12-weeks for men and 16-weeks for women). We reported the impact on total donations, low hemoglobin deferrals, inappropriate bleeds, and blood service costs. Personalized inter-donation intervals were defined using mixed-effects modeling to estimate hemoglobin trajectories and probability of crossing hemoglobin donation thresholds.

The model had generally good internal validation, with predicted events similar to those observed. Over 1 year, a personalized strategy requiring ≥90% probability of being over the hemoglobin threshold, minimized adverse events (low hemoglobin deferrals and inappropriate bleeds) in both sexes and costs in women. Donations per adverse event improved from 3.4 (95% uncertainty interval 2.8, 3.7) under the current strategy to 14.8 (11.6, 19.2) in women, and from 7.1 (6.1, 8.5) to 26.9 (20.8, 42.6) in men. In comparison, a strategy incorporating early returns for those with high certainty of being over the threshold maximized total donations in both men and women, but was less favorable in terms of adverse events, with 8.4 donations per adverse event in women (7.0, 10,1) and 14.8 (12.1, 21.0) in men.

Personalized inter-donation intervals using post-donation testing combined with modeling of hemoglobin trajectories can help reduce deferrals, inappropriate bleeds, and costs.


Kim, L. G., Bolton, T., Sweeting, M. J., Bell, S., Fahle, S., McMahon, A., …Wood, A. M. (2023). Impact of a post‐donation hemoglobin testing strategy on efficiency and safety of whole blood donation in England: A modeling study. Transfusion,

Journal Article Type Article
Acceptance Date Dec 15, 2022
Online Publication Date Feb 16, 2023
Publication Date Mar 16, 2023
Deposit Date Mar 17, 2023
Journal Transfusion
Print ISSN 0041-1132
Electronic ISSN 1537-2995
Publisher Wiley
Peer Reviewed Peer Reviewed
Keywords Hematology; Immunology; Immunology and Allergy
Public URL
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