A healthy donor will show normalization of hemoglobin relatively quickly with most normalized within 30 days. Failure to recover by 60 days is unusual without an underlying cause (the frequency of whole blood donation for the American Red Cross is every 56 days).
Blood donors are screened prior to donation and are:
(1) usually healthy
(2) usually not on drugs affecting the bone marrow or that cause a hemolytic anemia
(3) usually subjected to a limited blood loss (500 mL or less)
The usual cause for a failure to recover or a delay in recovery is iron deficiency.
Other causes may include:
(1) hypoproliferative marrow, such as early myelodysplasia or viral infection
(2) ongoing subacute or chronic blood loss (angiodysplasia, etc)
(3) idiosyncratic drug reaction
(4) hemolytic anemia
Steps to intervene requires a balance of prevalence in cause and cost containment:
(1) The first step is usually an assessment of iron stores with iron replacement if needed.
(2) Early testing may include a CBC with red cell indices, reticulocyte count and peripheral differential count. A persistently low reticulocyte count in the face of persistent anemia suggests a hypoproliferative marrow.
(3) If there is persistent anemia then a medical evaluation may be indicated.
(4) A bone marrow biopsy and additional studies may be required if an unexpected problem is identified.
