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When Blood Donations Cause Low Ferritin

Have you been donating blood and seeing low ferritin levels in your blood tests? Maybe you're feeling a little more tired. My name's Dr. Terranella, and in this video, we're going to look at the impact of blood donation causing low ferritin levels, whether that's something you need to worry about, is there a benefit to having low ferritin in terms of not needing to donate blood? And what is the overall impact on your body? So on this video, we're going to talk about how donating blood can cause low ferritin or low iron. It's not uncommon for people who donate blood on a regular basis, whether they're on TRT or just doing it because they want to be a good citizen, to get low in their stored iron called ferritin. I've certainly seen this enough in my practice to know that it's not unusual. But for most people, for those with normal absorption of iron and no regular, consistent loss of iron, either through some sort of internal bleeding or heavy menstruation, they're able to replenish those iron stores within two or three months without any problems. However, if you're donating blood on a regular basis every two or three months, and you're not consuming enough iron either in the form of your food or taking iron supplements, you will end up with low ferritin and eventually you may not be able to donate blood anymore. Sometimes the issue may be more with the absorption of iron, or you're taking a medication that may be limiting your iron absorption, such as with a proton pump inhibitor or other acid blockers. These medications reduce the absorption of iron. Of course, there are other digestive issues that can be playing a role in poor absorption of iron, but taking proton pump inhibitors or other acid blockers is a common one that I see as well. So what we're really talking about here is how donating blood can cause low ferritin. Is this really a problem and do you have to do anything about it? Well, ferritin reflects more of a global state of your body's stores of iron. When your body has plenty of iron circulating throughout the blood, it's going to put some into storage forms. As those storage forms start to come down, you still may have plenty circulating in the blood if you look at a serum test. And you may still even have normal hemoglobin and red blood cells, which also require iron levels, but that ferritin level may be really low. Now, again, this is something that I typically see in my patients who are on testosterone replacement therapy and donating blood on a regular basis. Because of the erythrocytosis or increased red blood cell production that happens with TRT, you're taking that iron that's in the stored form in the ferritin and building hemoglobin, and from that hemoglobin, the red blood cells on a regular basis. Depending on how much erythrocytosis you have going on, you may do that more rapidly than other people. You then go and donate that blood, and that stored iron that went into making those red blood cells and hemoglobin is exiting your body. So the question is, do you need to build that stored iron back up or can you just ignore it? Well, if you don't replace it, eventually you'll become anemic, and as I said, eventually, that hemoglobin level will go down to a low enough level to where you won't be able to donate blood. Which would be fine because then you're also not having high hematocrit either, and you're not at risk for blood clots and all the things associated with high hematocrit. And some have made the claim that you shouldn't take any iron because then you're just going to get more red blood cell production and be in the vicious cycle of donating blood. So the idea is that you donate enough blood until your ferritin is low enough to where you no longer have the erythrocytosis. Because there's not enough ferritin there, and then you don't have to donate blood anymore. In theory, that makes sense. But we have to remember that iron is used for more than just making hemoglobin and blood cells. It is also used in your mitochondria as an important part of making ATP. It is also used in our immune defenses in making free radicals that kill off microbes. And it is used in a lot of other areas as well. So if you barely have enough to make red blood cells and hemoglobin, then you barely have enough to do these other things as well. If you're always on the edge of being anemic, that's not really good either in terms of delivering oxygen to your tissues. And generally, I just don't think this is a very good strategy. In my patients, it's a frequent cause for people feeling fatigued when they're on TRT, either in a gradual sense or it can come on.