Transfusion of Sickle Cell Anemia Patients in Quebec: Challenges and Opportunities

Background: The Black population is the largest visible minority in Québec, comprising approximately 250,000 people (3%). But their needs per capita in red blood cells transfusions are much higher relative to the whole population for comparable age groups. The reason is the incidence of sickle cell anemia patients necessitating regular transfusions, especially those under an erythrapheresis exchange protocol. An extensive program to sensitize the Black community regarding the importance of blood donation was launched in 2010, yet we are still far from attaining the goals set in terms of units collected within the Black community. This leads to an ongoing significant burden especially on Rh negative Caucasian blood donors. Challenges to overcome are deferral for higher prevalence of Hb level below 12.5g/100ml (26%) among black women along with iron depletion <11μg/L (19%) among those who qualify for this Hb criteria.

Design and methods: Health Canada has accepted a lower Hb criteria for black women of 11.5g/100ml coupled with a program of ferritin monitoring and iron replacement. Since launching the program in August 2015, 553 black women have registered to participate. The % of women with ferritin level <11μg/L is 35% for those between 11.5 and 12.5g Hb vs 19% for those above 12.5gm. An increase of 33% in blood donations has resulted from this unique measure and an improvement in ferritin levels has been observed among compliant women who take ≥75% of the prescribed pills.

Future directions: Ina recent Issue of Transfusion, M.Goldman also reported that 20% of Canadian female donors are iron depleted despite meeting the qualification criteria of 12.5gm Hb/100ml. These observations, similar across ethnic origins, are now challenging the blood community about possible negative impacts on both donors and recipients. Consequently, we are planning to accumulate more data through our current program aimed at black female donors, and determine the feasibility and effectiveness of extending an iron replacement protocol to all female donors of childbearing age. We are namely planning to step up efforts to enhance iron intake regimen compliance to a more beneficial level.