According to Tartu University Hospital (TÜK) Blood Center director and hematology lecturer Helve König, people with too low a hemoglobin level account for 25-30 percent of all would-be blood donors who are turned away.

"Iron deficiencies are often caused by an imbalanced diet or blood loss," König noted. "This is mostly an issue for women. We're very surprised when we find low hemoglobin levels in a man, because that's actually pretty rare."

Sometimes, however, iron simply isn't absorbed by the body as it should be. The doctor noted that this can happen during pregnancy or while nursing, for example, but also during growth spurts. Some people are also simply more prone to iron deficiency than others, and the reasons for that aren't always clear.

"Some people are constantly struggling," she acknowledged. "They take another round of iron supplements, take a longer break between donations, manage to donate blood a few times, and then their hemoglobin starts dropping again. Some men may donate blood five times a year, for years, and never have any issues; women develop anemia more easily."

König noted that the number of blood center visitors that turn out to be iron deficient hasn't increased significantly over time, but some changes in society could nonetheless be contributing to a wider spread of iron deficiency.

"Vegetarianism is getting more popular nowadays," the center director explained. "If people don't know how to eat a varied diet, that can cause problems. There's also this general attitude now that eating red meat is bad somehow. People say we shouldn't eat or kill animals, but some nutrients are still best obtained through animal protein."

Then again, she continued, some may say they eat meat and fish and they still have low hemoglobin levels. "So diet isn't always the only issue," she acknowledged. "For example, some women experience heavy menstrual bleeding. All these factors affect our blood."

König recommends that blood donors take iron supplements. If someone already knows they tend to have lower hemoglobin levels but still want to donate blood, they can start taking iron supplements ahead of time. Taking them for another two to three months after donating blood is recommended as well.

"You can't really replace this iron with food," she explained. "If your hemoglobin is still too low, then iron supplements are necessary."

Which foods provide the most iron?

Ave Lellep, director of the Blood Center at North Estonia Medical Center (PERH), pointed out that donors are expected to have slightly elevated hemoglobin levels. For women, the minimum threshold is 125 grams per liter (g/L); for men, it's 135g/L.

"If a woman has 124 or 123 g/L, that's not actually pathological," she said. "No treatment is needed, and it doesn't count as anemia yet."

There are two main reasons why higher hemoglobin levels are expected in blood donors. The first is the donor's own health — blood donation should not harm the donor themselves, or cause them to end up iron deficient. Secondly, the blood product must contain enough hemoglobin for it to benefit the patient, the blood center director emphasized.

"Looking at last year, about 30,000 people came to PERH's Blood Center, and of those, around 4,200 couldn't donate blood for various reasons," Lellep said. "Indeed, for one-third of them, the reason was low hemoglobin levels."

She cited blood loss as the most common cause of iron deficiency. This primarily affects women of childbearing age.

"That's why the interval between donations is longer for women — 90 days," she explained. "For men, it's 60 days. Blood donation during menstruation isn't recommended, because the recovery takes longer."

Still, diet cannot be overlooked either, the center chief said.

"The best sources of iron are red meat and liver, but also legumes, soybeans and lentils," Lellep listed. "It's also worth keeping in mind that overdoing it with coffee, smoking and alcohol can inhibit iron absorption."

Estonians today may be eating more protein than ever before, but Lellep isn't so sure that also includes eating more meat specifically.

"If we look at the last 20-30 years, Estonians' diets have definitely changed," she acknowledged. "We seem to be moving toward diets with less meat. I'd hazard a guess that the number of vegetarians in our society has definitely gone up."

Lellep recommends coming to donate blood after eating — ideally something high in fiber, not fatty. Those who want to come donate should also be healthy and well-rested.

"We also recommend eating meat and iron-rich foods after donating blood," she added. "Vitamin C helps with iron absorption, so it's good to go with foods containing it. Iron supplements are an option too, but shouldn't be overused."

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