Potential Impact of the 2026 ASH Guidelines for Iron Deficiency on Blood Donation: The Good, the Bad and the Ugly

Proposed Session Description: Iron deficiency has been identified by the World Health Organization as a tremendous global health problem with approximately 30% of the world’s population affected. Even in the U.S. where iron fortification in bread is mandatory, almost 40% of 12 to 21 year-old females, for example, are affected with 6% associated with anemia. Iron deficiency anemia can lead to fatigue, tiredness, brain fog, lack of concentration and poor athletic performance, and in pregnant females can lead to premature or low birth weight infants. Of interest, is the fact that even when diagnosed, iron deficiency can persist for several years.

While there are a variety of laboratory tests that can be used for assessment of iron deficiency, ferritin has remained the most useful biomarker for identifying this condition. However, numerous historical methodological issues in the establishment of ferritin reference have made ferritin reference intervals problematic for the diagnosis of iron deficiency. In this regard, the American Society of Hematology in 2026 has developed new guidelines using ferritin clinical decision limits to better diagnosis iron deficiency. With these new guidelines, selection of appropriate donors may adversely reduce donations from a screening and repeat donation perspective and change recommendations regarding iron supplementation. However, counterbalancing this is the overall improvement in iron status in the general population based on greater awareness of iron deficiency leading to better iron supplementation which may lead to improved donation rates particularly in female donors. The expert speakers in the session will review the supporting medical literature for use of ferritin clinical limits based on the ASH guidelines, current problems with ferritin reference intervals and methodological analysis, what is currently know about iron supplementation on donation rates, and show the potential impact of these higher ferritin thresholds on donor screening and initial and subsequent donation rates.