Vox Sanguinis (2015) 109, 410–413 © 2015 International Society of Blood Transfusion DOI: 10.1111/vox.12299
SHORT REPORT
Bone density in apheresis donors and whole blood donors C. L. Boot,1,* J. S. Luken,2 P. J. M. van den Burg,2 W. L. A. M. de Kort,3 M. M. W. Koopman,2 H. Vrielink,2 N. M. van Schoor,4 M. den Heijer1 & P. Lips1 1
Department of Internal Medicine/Endocrinology, VU University Medical Center, Amsterdam, The Netherlands Department of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, The Netherlands 3 Unit Donor Services, Sanquin Blood Supply, Nijmegen, The Netherlands 4 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands *Present address: Department of Internal Medicine, Ziekenhuis Zoetermeer, Zoetermeer, The Netherlands 2
Received: 22 July 2014, revised 13 April 2015, accepted 16 April 2015, published online 29 May 2015
Apheresis donation using citrate causes acute decrease in serum calcium and increase in serum parathyroid hormone. Long-term consequences, such as decrease in bone mineral density (BMD), are not known. In this study, we compared the BMD of 20 postmenopausal apheresis donors (mean donation number 115 times in up to 15 years) with that of 20 whole blood donors (for 15 years or more) aged 55–70. BMD in the lumbar spine was not lower in apheresis donors than in blood donors (mean – SD 100 – 018 vs. 092 – 012, P = 009). In the hip, BMD was not different between the groups. Key words: apheresis, blood donation, bone markers, bone mineral density, citrate.
Introduction During apheresis donation, blood components, such as platelets or plasma, are separated and collected and the processed blood is returned to the donor. The anticoagulant trisodium citrate complexes with calcium and the complex is excreted in the urine during and shortly after the apheresis procedure. Early side effects of apheresis donations have been reported, such as pins and needles and cramps in the hands as a consequence of hypocalcemia and hypomagnesemia [1–5]. An increase in serum parathyroid hormone (PTH) concentrations is seen lasting for 24 h. Long-term risks of hypocalcemia and the increased serum PTH during and after apheresis donation are not known. These potential adverse effects are important because it is allowed to undergo apheresis donation very often, in the Netherlands up to 23 times a year. One study reported a lower bone mineral density (BMD) in apheresis donors than in matched controls who were not donating blood [6]. Whole blood donation as well as apheresis donation is not financially compensated in the Correspondence: Paul Lips, Department of Internal Medicine/ Endocrinology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands E-mail: [email protected]
410
Netherlands. We compared these groups as both fulfil strict health criteria, but only the apheresis group receives frequent citrate anticoagulation. The hypothesis was that apheresis donors would have a lower BMD than blood donors. The primary aim of our study was to investigate whether BMD is lower in postmenopausal apheresis donors compared to postmenopausal whole blood donors of similar age. As secondary aim, we assessed vitamin D status, parathyroid hormone and bone turnover markers.
Participants and methods Study population This study was designed as a pilot study. Subjects were 20 female apheresis donors of 55–70 years of age, who underwent an apheresis procedure more than 100 times in maximally 15 years. The control group consisted of 20 female whole blood donors of similar age, being blood donor for 15 years or more. Participants in both groups were randomly recruited by Sanquin Blood Supply in Amsterdam. The potential participants received information about the study by a letter and were called by the research nurse after some days. When they agreed to participate, an appointment was made for visiting the VU
Bone density in apheresis donors and whole blood donors 411
University Medical Centre to undergo the examinations. Exclusion criteria were smoking and use of bisphosphonates, glucocorticoids, oestrogen and/or oestrogen antagonists during the inclusion period. The study was approved by the ethical review board of the VU University Medical Centre. All participants signed informed consent. All participants were studied in April and May 2012.
Data collection Participants completed a questionnaire, including questions on postmenopausal years, dairy use, physical activity and alcohol use, all relevant for BMD. Anthropometry and a fasting blood sample were obtained, and BMD was measured. All tests were done at least 1 week after the last donation, to exclude short-term effects of the donation procedure. BMD of the lumbar spine and the right or left hip was measured in the VU University Medical Center with dual Xray absorptiometry (Hologic Discovery A, software version 13.3.3). BMD is presented as g/cm2 and as T-score, that is number of standard deviations below the mean value for young adults. A T-score
SHORT REPORT
Bone density in apheresis donors and whole blood donors C. L. Boot,1,* J. S. Luken,2 P. J. M. van den Burg,2 W. L. A. M. de Kort,3 M. M. W. Koopman,2 H. Vrielink,2 N. M. van Schoor,4 M. den Heijer1 & P. Lips1 1
Department of Internal Medicine/Endocrinology, VU University Medical Center, Amsterdam, The Netherlands Department of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, The Netherlands 3 Unit Donor Services, Sanquin Blood Supply, Nijmegen, The Netherlands 4 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands *Present address: Department of Internal Medicine, Ziekenhuis Zoetermeer, Zoetermeer, The Netherlands 2
Received: 22 July 2014, revised 13 April 2015, accepted 16 April 2015, published online 29 May 2015
Apheresis donation using citrate causes acute decrease in serum calcium and increase in serum parathyroid hormone. Long-term consequences, such as decrease in bone mineral density (BMD), are not known. In this study, we compared the BMD of 20 postmenopausal apheresis donors (mean donation number 115 times in up to 15 years) with that of 20 whole blood donors (for 15 years or more) aged 55–70. BMD in the lumbar spine was not lower in apheresis donors than in blood donors (mean – SD 100 – 018 vs. 092 – 012, P = 009). In the hip, BMD was not different between the groups. Key words: apheresis, blood donation, bone markers, bone mineral density, citrate.
Introduction During apheresis donation, blood components, such as platelets or plasma, are separated and collected and the processed blood is returned to the donor. The anticoagulant trisodium citrate complexes with calcium and the complex is excreted in the urine during and shortly after the apheresis procedure. Early side effects of apheresis donations have been reported, such as pins and needles and cramps in the hands as a consequence of hypocalcemia and hypomagnesemia [1–5]. An increase in serum parathyroid hormone (PTH) concentrations is seen lasting for 24 h. Long-term risks of hypocalcemia and the increased serum PTH during and after apheresis donation are not known. These potential adverse effects are important because it is allowed to undergo apheresis donation very often, in the Netherlands up to 23 times a year. One study reported a lower bone mineral density (BMD) in apheresis donors than in matched controls who were not donating blood [6]. Whole blood donation as well as apheresis donation is not financially compensated in the Correspondence: Paul Lips, Department of Internal Medicine/ Endocrinology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands E-mail: [email protected]
410
Netherlands. We compared these groups as both fulfil strict health criteria, but only the apheresis group receives frequent citrate anticoagulation. The hypothesis was that apheresis donors would have a lower BMD than blood donors. The primary aim of our study was to investigate whether BMD is lower in postmenopausal apheresis donors compared to postmenopausal whole blood donors of similar age. As secondary aim, we assessed vitamin D status, parathyroid hormone and bone turnover markers.
Participants and methods Study population This study was designed as a pilot study. Subjects were 20 female apheresis donors of 55–70 years of age, who underwent an apheresis procedure more than 100 times in maximally 15 years. The control group consisted of 20 female whole blood donors of similar age, being blood donor for 15 years or more. Participants in both groups were randomly recruited by Sanquin Blood Supply in Amsterdam. The potential participants received information about the study by a letter and were called by the research nurse after some days. When they agreed to participate, an appointment was made for visiting the VU
Bone density in apheresis donors and whole blood donors 411
University Medical Centre to undergo the examinations. Exclusion criteria were smoking and use of bisphosphonates, glucocorticoids, oestrogen and/or oestrogen antagonists during the inclusion period. The study was approved by the ethical review board of the VU University Medical Centre. All participants signed informed consent. All participants were studied in April and May 2012.
Data collection Participants completed a questionnaire, including questions on postmenopausal years, dairy use, physical activity and alcohol use, all relevant for BMD. Anthropometry and a fasting blood sample were obtained, and BMD was measured. All tests were done at least 1 week after the last donation, to exclude short-term effects of the donation procedure. BMD of the lumbar spine and the right or left hip was measured in the VU University Medical Center with dual Xray absorptiometry (Hologic Discovery A, software version 13.3.3). BMD is presented as g/cm2 and as T-score, that is number of standard deviations below the mean value for young adults. A T-score
