The BTRU in Donor Health and Genomics aims to establish a world-leading, cross-disciplinary unit that addresses major questions about the health of blood donors and produces evidence-based strategies to enhance donor safety while ensuring sustainability of blood supply.
Balancing a secure blood supply with maintaining donor health. Every blood donation removes 200-250mg of iron from the body. There is considerable individual variation in iron stores, dietary intake, and efficiency of absorption. If iron is not fully replaced, then donors’ iron stores become progressively depleted, leading to iron deficiency or the development of iron-deficiency anaemia, which may result in adverse health consequences and temporary rejection from giving further donations (“deferral”). Such deferral may de-motivate individuals from future donations and directly or indirectly increase the cost of collecting blood. NHSBT estimates that 5% of regular donors cannot be accepted because of failure to meet the pre-donation haemoglobin levels required to give blood. This figure is nearer to 10% in female donors younger than 30 years. Hence, our research aims to integrate genomic and other factors associated with capacity to give blood in evidence-based strategies to prevent deferral.
Defining the risks and any benefits associated with iron depletion. Iron deficiency has been associated with reduced well-being and cardiometabolic disorders (e.g. reduced physical activity) and neurocognitive disorders (e.g. reduced cognitive function, restless legs syndrome). Conversely, there are suggestions that repeated blood donation and/or lower iron stores may protect against cardiometabolic diseases (e.g. coronary disease, type 2 diabetes). However, the causal consequences of iron depletion and repeated blood donation remain largely uncertain and our research therefore aims to identify and understand molecular and biological determinants of potential adverse consequences of donation.
Moving towards a more personalised (stratified) blood service. In the longer term, ageing populations will demand more blood transfusions, but the blood supply may be limited by difficulties in attracting and retaining a decreasing pool of younger donors. A more personalised approach to donation could help ensure both donor health and the blood supply. For example, it may be that some donors should give blood less frequently, whereas other donors can give blood more frequently, based on a number of factors including, gender, weight, level of iron stores and genetics. We therefore aim to conduct research to identify, characterise and exploit biomarkers in personalising donation strategies to maximise donor health and the blood supply.
Key Research Questions and Strategy
The scientific questions underpinning the aims of this Unit are:
- Theme 1: Determinants of donation-related biomarkers
- What determines levels of iron stores and blood cell characteristics in donors?
- Following repeated donation, in whom do these biomarkers recover most (and least) quickly?
- Theme 2: Aetiology of donation-related health outcomes
- What are the health consequences of repeat donation?
- Who is most susceptible to them?
- Theme 3: Stratified approaches to blood donation
- How can donation approaches be more personalised?
- Align our research with NHSBT’s priorities
- Conduct novel large-scale integrative studies
- Build on existing strengths and studies within the NHSBT setting
- Develop strategic collaborations
- Strengthen infrastructure and human capacity
- Engage stakeholders to optimise service translation and donor involvement
- Deliver a programme of innovative research on donor health resulting in high-impact publications, increased grant income and outputs with demonstrable benefits for donors and NHSBT.
- Establish the Unit as a national and international hub for translational research on donor health and genomics, increasing collaboration with NHSBT and influencing NHSBT’s policies and the policies of blood services in other countries.
- Build human capacity by training a future generation of researchers at PhD, post-doctoral and senior levels.
- Strengthen our international academic partnerships and collaborations.
- Continue to enrich and broaden our research portfolio through conducting interdisciplinary research.
- Facilitate access to our large donor bioresources through collaboration with the wider scientific community, especially when such collaboration could lead to donor health benefits.
- Identify genetic, biochemical and lifestyle determinants of measures of iron homeostasis and red cell indices and their changes over time to enable stratification of donors into those more and less resilient to repeated donation.
- Conduct highly informative causal analyses on relationships of iron depletion and repeated donation with key cardiometabolic, neurocognitive and other health outcomes.
- Develop and validate practicable algorithms to support more personalised approaches related to inter-donation intervals and other aspects of donation.
- Integrate data with large studies of donors to develop and evaluate approaches that tailor donation to donors’ capacity to give blood safely.