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BACKGROUND The number of red blood cell units transfused per capita in China is lower than in western countries and the reason(s) for the difference is unknown. STUDY DESIGN AND METHODS We randomly chose 5050 transfused patients from five Chinese hospitals. We compared transfused cases to nontransfused controls matched for the same underlying diagnosis. We assessed the pretransfusion hemoglobin (Hb) trigger and other clinical characteristics associated with transfusion. After stratifying by underlying disease, we compared pretransfusion Hb level in Chinese hospitals to 12 US hospitals. RESULTS In 5050 patients who received transfusion, the pretransfusion Hb levels were lower in medical (6.3 g/dL) compared to surgical patients receiving transfusion postoperatively (8.1 g/dL). In patients with nonsurgical diagnoses, the pretransfusion Hb was much lower than that in the United States; the difference in mean Hb level varied by underlying diagnosis from 0.4 to 1.8 g/dL. In case-control analysis of cases (n = 1356) compared to controls (n = 1201), the pretransfusion Hb showed the strongest association with transfusion. Compared to 10 g/dL, the odds ratio (95% confidence interval) for pretransfusion Hb of 7 to 7.9 g/dL was 37.7 (24.8-57.4). CONCLUSION Transfusion triggers in five Chinese hospitals appear comparable to those in the United States for surgical patients; however, medical patients have lower pretransfusion Hb levels (approx. 6 g/dL). Of the factors assessed, the pretransfusion Hb was most strongly associated with transfusion. The clinical impact of lower transfusion thresholds used in China is unknown.

Background Deferral for low hemoglobin (Hb) increases the likelihood that donors do not return for future donations. Zinc protoporphyrin (ZPP) has been described as a sensitive marker of iron-deficient erythropoiesis, before Hb decreases. It is a relatively cheap, rapid, and easy-to-perform measurement in a drop of whole blood. To assess the utility of ZPP measurement in donor management we examined whether ZPP and Hb levels among first-time donors differ from repeat donors. We further explored whether ZPP increases over subsequent donations at a donor population level and whether increasing ZPP levels coincide with decreasing Hb levels and donor deferral. Study design and methods We included first-time (n = 4983) and repeat (n = 3533) whole blood donors from the ZPP and Iron in the Netherlands Cohort (ZINC) study. ZPP and Hb were measured at each subsequent donation during a 4-year period after inclusion in the study. Results Median ZPP levels were higher in repeat than in first-time donors. In first-time donors, especially women, ZPP levels were increased with a corresponding decline in Hb levels over subsequent donations. ZPP levels were increased among first-time donors deferred for low Hb. Conclusion Our results suggest that adding ZPP to Hb measurements in the daily blood collection setting, especially for first-time donors and first-time female donors may add to the identification of a donor subpopulation with low functional iron stores.

Background Low hemoglobin (Hb) levels are a common reason for whole blood donor deferral. As some of the deferred donors do not return to donate blood later, the development of accurate tools to reliably detect low Hb levels is therefore important for donor safety and retention. Study design and methods In a prospective study, 1483 whole blood donors were enrolled in three study arms. In each study arm the Hb results measured with a point-of-care testing device were compared with the venous Hb results obtained in our central laboratory. Both an invasive capillary Hb (Compolab) and a noninvasive spectroscopy Hb (Haemospect) were tested. For the latter, two different application methods for the positioning of the Digiclip were assessed. In a second phase the Compolab was tested in routine conditions. Results The Haemospect device failed to reliably identify donors with Hb levels below the European cutoffs (125 g/L for females and 135 g/L for males). In contrast, the Compolab identified 72.4% of first-time donors and 78.9% of regular donors with Hb levels below these cutoffs. In routine conditions, the Compolab identified the majority of donors with low Hb levels. Conclusion Differences between Hb levels measured with invasive and noninvasive point-of-care devices and measured on venous samples exist. Implementing the Compolab at collection sites provides a high level of safety toward first-time donors.

BACKGROUND Low hemoglobin (Hb) is the most common reason for temporary blood donor deferral. However, factors that affect Hb measurement may not portray donor health but reflect external circumstances. STUDY DESIGN AND METHODS The effects of season, time of day, donor age, ABO, and D on capillary blood Hb level (cHb) and low Hb deferral were analyzed in 1,396,645 donor registrations from the years 2010 to 2014 in a national blood bank. RESULTS cHb was lower in the summer (July mean 154.1 g/L in men, 139.6 g/L in women) and in the evening (7 pm mean 153.8 g/L in men, 138.9 g/L in women) than in the winter (January mean 156.9 g/L in men, 141.8 g/L in women) and in the morning (11 am mean 157.2 g/L in men, 142.8 g/L in women; all p

BACKGROUND Most donor deferrals are due to low hemoglobin (Hb) levels. Previously measured Hb levels and donation intervals are known to be associated with Hb deferral. However, this relationship has never been quantified. In this study, we related the prevalence of Hb deferral to previously measured Hb levels and donation intervals. STUDY DESIGN AND METHODS A total of 220,946 whole blood donors were categorized into groups based on their Hb level at the previous donation and on the time interval since the previous donation. For each group, the prevalence of Hb deferral was assessed. RESULTS Hb deferral rates were higher when Hb levels at the previous donation were lower and donation intervals were shorter. With a donation interval shorter than 3 months, the prevalence of Hb deferral was below the 10% threshold only when the previous Hb level was at least 0.3 mmol/L above the cutoff level for donation. CONCLUSION To maintain appropriate Hb levels, the minimum donation interval of 56 days is only sufficient for donors with Hb levels far above the cutoff level for donation. Protocols for minimum donation intervals should be reconsidered and may be based on previously measured Hb levels. This may result in a decrease of low Hb deferral.

BACKGROUND Iron deficiency and blood donors with low hemoglobin (Hb) concentration are well-known challenges in any blood bank setting. In the Capital Region of Denmark, a new approach was adopted that centralized measurement of Hb, initiated ferritin (F) measurement, and established a center for donor Hb and iron. An algorithm was created based on Hb and F levels, which drove decisions on outreach by the donor Hb and iron resource team to the donor, including whether to provide iron supplementation or, on rare occasions, a referral to the donor's general practitioner. STUDY DESIGN AND METHODS The change in Hb for repeat donors was followed during the first 2 years of the intervention strategy, which included measurements of F and offering intermittent iron supplementation to some of the donors. RESULTS In 2 years, 62,663 blood donors donated 193,288 units of blood and 318 donors gave 754 complete blood count blood samples. Over time in the repeat donors, the Hb increased from 15.39 to 15.60 g/dL and 13.85 to 14.06 g/dL in male and female donors, respectively, and the proportion of donors with low Hb decreased from 0.9% to 0.3% and 3.9% to 2.7% for the male and female donors, respectively. CONCLUSION The program with goal-directed iron supplementation only to those that would benefit has led to an increase in Hb concentration and a reduction in the proportion of donors with low Hb concentration.

BACKGROUND In Mozambique, there is a limited supply of blood and elevated risks for transmission of infections. Prior studies have documented that many transfusions in Mozambique are potentially avoidable. Transfusion training workshops with a survey and exam were held for providers to understand their perceptions and to improve knowledge and clinical practice. STUDY DESIGN AND METHODS Health care providers completed a survey and a knowledge assessment. The Wilcoxon signed rank test was utilized to compare the relative importance of each factor in the survey, and pre- and posttraining exam scores were compared using Fisher's exact test. RESULTS A total of 216 health care providers participated; the majority worked in a referral hospital (74%) and reported transfusing blood at least once per week (56%). Most acknowledged the limited blood supply and transfusion risks. Providers rated low hemoglobin (Hb) levels and pallor as significantly important indications for transfusion (p

BACKGROUND: Recently, sex-specific prediction models for low hemoglobin (Hb) deferral have been developed in Dutch whole blood donors. In the present study, we validated and updated the models in a cohort of Irish whole blood donors. STUDY DESIGN AND METHODS: Prospectively collected data from 45,031 Irish whole blood donors were used. Hb cutoff levels for donation were approximately 0.35 mmol/L lower in Ireland than the Dutch cutoff levels (8.07 mmol/L vs. 8.40 mmol/L in men; 7.45 mmol/L vs. 7.80 mmol/L in women). The predictive performance of the models was assessed with calibration plots, calibration-in-the-large, and the concordance (c)-statistic. The models were updated by revising the strength of the individual predictors in the models. RESULTS: A total of 613 men (2.4%) and 1624 women (8.4%) were deferred from donation because of a low Hb level. Validation demonstrated underestimation of predicted risks and lower c-statistics for men and women compared to the Dutch cohort. The strength of most predictive factors, particularly previous Hb level, was lower in Irish donors. The updated models showed a c-statistic of 0.83 (95% confidence interval [CI], 0.81-0.84) for men and 0.76 (95% CI, 0.74-0.77) for women. CONCLUSION: The performance of Dutch prediction models for Hb deferral was limited when validated in Irish whole blood donors. Updating the models resulted in different predictor effects. This improved mainly the model calibration; the improvement in discrimination was small.

Anemia is an important healthcare concern among the elderly. In these patients, the anemia is often mild, with a hemoglobin level >10 g/dL. It is usually well tolerated, but might be responsible for several proteiform and/or atypical presenting complaints. In the elderly, anemia is usually of multifactorial origin, including chronic inflammation, chronic kidney disease, nutrient deficiencies and iron deficiency (approximately two-thirds of all cases). The remaining cases are unexplained (unknown etiology). In the elderly, the classic diagnosis of anemia, which is based on the mean corpuscular volume associated with a low hemoglobin level, might not be accurate. A predefined standardized diagnostic procedure should be followed. In the common case of frail elderly patients, all investigations should be carefully considered and invasive examinations undertaken where justified (risk-benefit balance). Nevertheless, most cases of anemia require further investigation and the underlying cause should be identified and treated whenever possible.

Background Increased zinc protoporphyrin (ZPP) levels can indicate iron deficiency and may be predictive for low hemoglobin (Hb) deferral in blood donors. Prediction models for Hb deferral in whole blood donors have already been developed. In this study, we examined if addition of ZPP to these prediction models improves risk estimation of Hb deferral. Study Design and Methods This study included 4598 Dutch whole blood donors. Information on ZPP levels measured at the previous visit was added to the existing prediction models to estimate the risk of Hb deferral. Models were compared using the following measures: concordance (c)-statistic, continuous net reclassification improvement (NRI), and clinical net benefit (NB). Results Seventy-six male donors (2.9%) and 69 female donors (3.5%) were deferred because of a low Hb level. Previous ZPP level was associated with risk of Hb deferral (odds ratio for interquartile range of previous ZPP level, men 2.0 [95% confidence interval {CI}, 1.7-2.3]; women 2.2 [95% CI, 1.9-2.4]) in a multivariable risk model. Addition of ZPP into the models resulted in an increase of the c-statistic from 0.93 to 0.94 for men and from 0.80 to 0.85 for women. The added value of ZPP was confirmed by measures of clinical usefulness. NRI for men was 0.42, and for women, 0.56. At relevant threshold probabilities between 10 and 15%, NB was higher for models considering ZPP. Conclusion This study shows that ZPP measurements obtained at the previous visit may have added value in the risk prediction of Hb deferral in whole blood donors.

Background and Objective In the United States, approximately 15 million whole blood products are collected each year from 10 million volunteer donors. African Americans are underrepresented in the donor pool. In 2008, 7% of white versus 4% of African American and Hispanics adults donated in the previous year. The donor rates vary by region in the United States: 77–93% for whites, 1–16% for African Americans and 1–13% for Hispanics. In the Atlanta metropolitan area whose donor pool is 77% white, 16% African American and 4% Hispanic, the blood donor rate (number of blood donors per population) was 11/1000 population for whites, 6/1000 for African Americans and 3/1000 population for Hispanics; and the blood donation rate (number of units donated by population over the total population) was 77 donations/1000 population for whites, 22/1000 population for African Americans and 10/1000 population for Hispanics. Thus, African Americans and Hispanics represent half of the donors as whites when adjusted for their percentage of the population and more strikingly donate a significantly fewer number of units per each donor. Materials and Methods Literature on reasons for racial/ethnic differences in donation rates and methods to address these differences was reviewed. Results The reasons for these differences are multifactorial. First, although 41% of the total US population is estimated to be eligible to donate, African Americans and Hispanics have lower eligibility rates (whites 46%, African Americans 36%, and Hispanics 41%). Second, donor deferral rates are higher for minorities: whites 11%, African Americans 18%, Hispanics 14% and Asians 16%. Deferral is most commonly secondary to temporary deferral reasons such as low hemoglobin level, yet donors are less likely to return once deferred, and thus deferral affects donor and donation rates. Third, minorities may have different motivators and barriers. The most cited motivators to blood donation are more convenient place and times, and being asked; and the most cited barriers are fear of catching a disease and feeling faint/dizzy, and not have time or knowing where to donate. Racial differences in motivating factors identified include African Americans are more likely than whites to donate to receive an item/gift and be tested for infectious disease, and if assured that donating is safe. Notably, these motivators are not the primary cited motivators. African Americans compared with whites more commonly cite fear, difficulty finding veins and not knowing where to donate as deterrents. In addition, African Americans have distrust in the healthcare system, which is correlated with lower donation rates. Fourth, different racial/ethnic groups may have different preferred marketing strategies, including methods of contact, as well as culturally specific motivators for behavioural change. Conclusion Thus, with an improved understanding of these differences as well as accurate tools to measure the outcomes, culturally targeted recruitment programs can be developed to increase donation rates.

Each year, 5 million regular donors meet almost half the transfusion needs of the United States by voluntarily giving their blood. In this issue of Transfusion, we learn how well the needs of these committed donors are being met from an analysis of enrollment data from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study of the National Heart, Lung, and Blood Institute.1 The RISE study is the largest and most comprehensive study yet conducted of iron deficiency in blood donors, with an enrollment of 2,425 women and men. The results are alarming. Among frequent donors, two-thirds (66%) of the women and almost half (49%) of the men were iron deficient.1 The true prevalence of iron deficiency among regular donors is surely higher; the RISE study enrolled only frequent donors who had been accepted for donation, excluding those deferred for a low hemoglobin concentration. Moreover, the enrolled, iron-deficient donors then each donated a unit of whole blood, further depleting their body iron by an additional 200 to 250 mg. Neither these loyal donors nor the national blood supply are well served by the collection practices and regulatory framework that have produced widespread iron deficiency among those who regularly give their blood.

BACKGROUND: This study investigated the effects of a 6-month deferral due to low hemoglobin (Hb) on the subsequent donation patterns of Australian whole blood donors. STUDY DESIGN AND METHODS: The study was a retrospective cohort study of the donation patterns of all whole blood donors deferred for low Hb during a 2-month period compared with donors who were not deferred. Donations 3 years after eligibility to give blood were recorded. Analysis of proportion returning, time to return, and frequency of donation was performed using logistic regression, survival analysis, and negative binomial regression. RESULTS: Among first-time donors, 20.9% of low Hb�deferred donors returned during the follow-up period versus 69.9% of those not deferred. Among repeat donors, 64.0% of deferred donors returned versus 91.0% of those not deferred. Temporary deferral delayed time to first return (p < 0.001), reduced frequency of donation (2.4 donations per donor before deferral compared to 1.1 per donor in first year of follow-up), and increased the likelihood of dropping out in later years of follow-up. However, if a donor returned promptly once eligible and gave more donations in the first year, the negative impact on future donation patterns was diminished. High frequency of attendance before deferral was the strongest predictor of time to return and future donation frequency. CONCLUSION: Deferral for low Hb had a strong effect on first-time and repeat donors. This study highlights the influence of strong donation habits on return after deferral and the importance of encouraging donors to return promptly once eligible.

Ninety-one previously untreated patients with chronic myeloid leukemia admitted to three Stockholm hospitals 1973-1978 were studied. There were 49 men and 42 women with a mean age of 56 years (range 15-93). Sixty-five patients were Philadelphia chromosome (Ph1) positive and 17 were Ph1 negative (mean age 51 and 70 years, respectively). After a mean observation time of 5.2 years, 64 patients had deceased, 45 of them in blast transformation. A low hemoglobin value and a high total blast cell count at diagnosis were associated with a poor prognosis in the Ph1 positive group. Other routine clinical and laboratory variables were of subordinate prognostic importance. Early splenectomy in 15 Ph1 positive patients did not improve survival. Median survival from diagnosis was 38 months for Ph1 positive patients as compared to 12 months for the Ph1 negative group.

SUMMARY Restrictive blood transfusion practice has modified the indications for blood transfusion. There is still a need for succinct definition of transfusion thresholds in different situations, based on physiological argument balancing the mechanisms by which blood is potentially beneficial against the deleterious effects of transfusion, whether known, speculative or unknown. The latter still need identification. The key physiological benefit is through oxygen delivery and thereby the provision of a margin of safety in tissue oxygenation. This can be achieved by a range of methods that safeguard blood volume, conserve blood or increase hemoglobin as well as by transfusion, and in many situations conservation methods can or could now preclude transfusion. There are still acute and less controlled or controllable situations where conservation methods are difficult to implement or may need to be complemented by transfusion. These are the indications that still need clarification. Difficult and confusing areas of practice include the management of patients with ischemic heart disease. This is a potential driver for transfusion to prevent ischemia, but clarity of efficacy or detriment is elusive beyond acknowledging that both too high and too low hemoglobin values are detrimental. The issue in all clinical situations, whether acute or chronic, is to continue to reevaluate the safety of current thresholds. This will help limit blood usage and ensure that blood is used when necessary but not otherwise.

BACKGROUND Iron deficiency leading to low hemoglobin concentration (cHb) is a common problem for blood donors as well as for blood banks. A standardized protocol offering iron supplementation based on P-ferritin determination may help to reduce the problem and retain donors. STUDY DESIGN AND METHODS This was a prospective study where 879 blood donors, presenting with cHb at or below the limit of acceptance for donation, were included. The predonation cHb result was read after donation. The donors received 50 iron tablets (JernC or Ferrochel, 100 or 25 mg elemental iron, respectively), and samples for P-ferritin, mean corpuscular volume, and control of cHb were secured. Based on a P-ferritin level of less than 60 microg per L, 20 iron tablets were offered after all following donations. RESULTS Mean cHb was 7.6 mmol per L (122 g/L) and 8.2 mmol per L (132 g/L) in women and men, respectively. In 80 percent of the women and 48 percent of the men, iron stores were low (P-ferritin < or = 30 microg/L). In the donors returning once or twice, an increase in cHb and P-ferritin was seen. Fifteen donors were permanently deferred due to disease and 36 due to low cHb, but 2 years after the start of the study, 79 percent of the women and 85 percent of the men were still active donors. CONCLUSION A standardized protocol offering iron supplementation and simple oral and written advice based on P-ferritin measurements is effective in normalizing cHb and retaining donors presenting with cHb at or below the limit of acceptance for donation.

Low hemoglobin (Hb) is a predictor of cardiovascular disease, thus, variables known to influence Hb are of clinical relevance. We examined the interrelationships of testosterone, erythropoietin (EP...

SUMMARy Anemia is one of the most commonly encountered abnormal laboratory findings in intensive care unit (ICU) patients, and many ICU patients will receive a blood transfusion during their ICU stay. However, the determinants of when and to whom transfusions should be given are not clear cut and have been the subject of considerable debate in recent years. Transfusion practice may vary considerably between institutions and across countries. The ABC (anemia and blood transfusion in critical care) study reported increased ICU and hospital mortality rates in patients who had received a transfusion. On the other hand, low hemoglobin levels are still associated with increased mortality and morbidity. The “traditional” transfusion trigger of 10 g/dL certainly no longer applies to all, but may well be relevant in certain groups, e.g., patients with cardiac disease. Transfusions should certainly be more restrictive than before, but applying this policy across the board cannot be recommended; each patient must be assessed individually on the basis of past and present clinical history, and in light of oxygenation and hemodynamic parameters. Clearly, further study is needed before we are able to determine the best transfusion strategies for our ICU patients.

The aim of this study was to assess the prevalence of restless legs syndrome in pregnancy. We distributed a questionnaire to 541 consecutive postpartum patients and received answers from 251 (46%) women. Of the participants, 34% reported restless legs syndrome in pregnancy. In 97% of the women in whom restless legs syndrome had started during the pregnancy, the symptoms disappeared within two to three days after delivery. There was no correlation between pregnancy-related restless legs syndrome and low hemoglobin levels in the first trimester, and the incidence of restless legs syndrome was not affected by use of iron supplementation. We conclude that in our population, restless legs syndrome in pregnancy is both frequent and transient, occurring in approximately one in three pregnancies and typically resolving within a few days after delivery.

Globally, hemoglobin (Hb) E β thalassemia accounts for approximately half the severe forms of β thalassemia. Because of its wide clinical diversity and the ability of patients with this condition to adapt unusually well to low hemoglobin levels, the management of Hb E β thalassemia, particularly the decision to instigate regular blood transfusion, is particularly difficult. Here, we present a summary of our work in patients with this condition, which attempts to define clinical, adaptive, and genetic factors of possible value in determining the early management of this condition.

Background Anemia in pregnancy is common in Tanzania. Previous information on distribu-ton of hemoglobin concentration in total populations is scarce.Methods Standard measurement of hemoglobin concentration in consecutive first visit at-tenders at the antenatal care clinic in Moshi, 1991-1994, for a total of 1800, divided into three series of 600 each.Results Hemoglobin concentrations ranged from 41 to 146 g/1, mean 96.9 and s.d. 16.3. For international comparison, 74.5% were below 110 g/1 and 7.0% below 70 g/1. The median was 97.0; other percentiles were 10th: 75.0, 90th: 116.0. The distribution did not change with mother's age, but in the years 1991 and 1994 there were more low hemoglobin values than in the intervening years.Conclusions Low hemoglobin concentrations are prevalent among pregnant women in Moshi, Tanzania. Seven percent were found to have severe anemia, defined as a hemoglobin concentration below 70 g/1.

Responses to the 1990 American Association of Blood Banks (AABB) Institutional Membership Questionnaire were submitted by 2126 regional blood centers, hospital-based blood banks, and transfusion facilities. Data from 2117 of these facilities were considered to be valid. The questionnaire included information on blood donor demographics, number of units collected, and collection procedures; services performed; usage of blood components; and transfusion-transmitted diseases reported during 1989. Institutional members collected 7.4 million whole blood units, of which 90.8 percent were donated for allogeneic use, 6.0 percent were donated for autologous use, and 3.2 percent were donated for directed use. Approximately 630,546 allogeneic and directed-use blood donors were deferred, most often for low hemoglobin or hematocrit values. Approximately 225,205 full allogeneic and directed-donor units were discarded, primarily for elevated alanine aminotransferase levels or the presence of hepatitis B core antibody. The 14.3 million transfused components included 56.7 percent red cell-containing components, 27.4 percent platelets, 11 percent fresh-frozen plasma, and 4.8 percent cryoprecipitate. Institutional members reported 1397 cases of transfusion-associated hepatitis. In this group, 921 patients were tested for hepatitis B surface antigen after the transfusion; 339 (36.8%) were found to be hepatitis B surface antigen positive. The AABB Institutional Questionnaire results provide recent data on blood donor and transfusion-related activities that are vital to the evaluation of current transfusion medicine practices.

The impact of low hemoglobin levels on the work performance of 74 rural Nepali villagers was examined with a 3 minute exercise step test. Work output was standardized at 75 watts for men and 55 watts for women. Hemoglobin values ranged from 4.2-15.7 g/dl, and averaged 12.0 ± 2.7 g/dl for 35 men and 10.9 ± 1.72 g/dl for 39 women. Low hemoglobin levels significantly elevated the heart rates and recovery times of the men, but not of the women. A positive relationship with oxygen uptake and a negative one with net mechanical efficiency was found for men but not for women (anemic men appeared more efficient as they used up marginally less oxygen during exercise). Values are in good agreement with those recently published for Gurkha soldiers, but are at variance with those examining the step test performance of Nepali women. In the light of behavioral data on work patterns, mild anemia may have little impact on the performance of moderate self-paced physical activity. Nepali villagers pause frequently during the course of subsistence activities, a behavior which allows time for recovery from an elevated pulse rate. © 1992 Wiley-Liss, Inc.

Before blood donors are deferred because of a low hemoglobin determination by the copper sulfate procedure, they are routinely retested with a microhematocrit. The copper sulfate test and the microhematocrit usually are performed on blood samples taken from the same finger (or earlobe) puncture. We studied 201 male and female volunteer blood donors who failed the copper sulfate test to determine if more donors would be accepted for donation if blood from a second fingerpuncture, Instead of the original fingerstick, was used for the microhematocrit determination. Venous blood samples were obtained to evaluate complete blood count and measures of iron status. The results indicated that the deferral rate was reduced by 46% using a fresh fingerpuncture for the microhematocrit determination. The iron status of the additional donors accepted on the basis of the second puncture was not significantly different from that of the donors accepted by the original fingerstick. We conclude that using a second fresh fingerpuncture for the microhematocrit determination after failing the copper sulfate test decreases the number of hematocrit deferrals and does not compromise the iron status of the additional donors.

Whole blood catalase levels were estimated using a disc flotation method in 209 random patients with a wide variety of malignancies. Fifty patients had received no treatment, and the remainder, although having undergone prior therapy, had recurrent or metastatic disease at the time of the study. No relationship was found between the presence of cancer and catalase levels. A direct relationship was found for catalase with hemoglobin levels in both normal and patients' samples. Whole blood catalase is of no value in diagnosis and monitoring of cancer. The decreased catalase values found here and reported previously by others are the result of low hemoglobin levels found in many patients with cancer.

The accuracy of the copper sulfate method of determining hemoglobin was investigated under usual blood bank conditions. In our hands this method was found to be grossly inaccurate. Using the cyanmethemoglobin technic, it was demonstrated that 83.9 per cent of females and 80.4 per cent of males rejected as having a low hemoglobin by the copper sulfate method, actually had hemoglobin values above minimum requirements for blood donors. Detailed instruction as to technics and pitfalls of the copper sulfate method was ineffectual in correcting errors as encountered by a large nursing staff carrying out the procedure. Donors found to have acceptable hemoglobin values by the copper sulfate method appeared to be safely accepted as donors; cyanmethemoglobin duplicate checks did not reveal any discrepancies in this group.