{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T11:37:38Z","timestamp":1773920258439,"version":"3.50.1"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Shenzhen Key Discipline Project of Blood Transfusion Medicine","award":["SZXK070"],"award-info":[{"award-number":["SZXK070"]}]},{"name":"Guangdong Medical Foundation","award":["A2024098"],"award-info":[{"award-number":["A2024098"]}]},{"name":"Sanming Project of Medicine in Shenzhen Municipality","award":["SZSM202311032"],"award-info":[{"award-number":["SZSM202311032"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to investigate the prevalence and etiological profile of decreased red blood cell osmotic fragility among voluntary blood donors in Shenzhen, China, and to assess the public health implications for donor screening policies and transfusion safety in thalassemia-endemic regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study enrolled 362 voluntary blood donors at the Shenzhen Blood Center from July to September 2025. All donors underwent initial hemoglobin screening and red blood cell osmotic fragility testing. Donors with decreased fragility received comprehensive evaluation including complete blood count, serum ferritin measurement, hemoglobin electrophoresis, and thalassemia gene detection. Transfusion efficacy was preliminarily assessed by analyzing recipient hemoglobin increments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 14 donors (3.87%) with decreased red blood cell osmotic fragility, 9 (64.3%) were confirmed as thalassemia gene carriers (7 with\n                      <jats:italic>\u03b1<\/jats:italic>\n                      -thalassemia, 1 with\n                      <jats:italic>\u03b2<\/jats:italic>\n                      -thalassemia, and 1 with compound \u03b1\/\u03b2-thalassemia), and 7 (50.0%) had biochemical iron deficiency (ferritin &amp;lt;30\u202fng\/mL), with 4 individuals meeting both criteria, while 2 donors had neither thalassemia nor iron deficiency. Blood components from donors with decreased osmotic fragility, including those from thalassemia carriers, demonstrated effective hemoglobin recovery in recipients, with post-transfusion increments observed in all transfused cases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In Southern China, decreased red blood cell osmotic fragility among blood donors is primarily associated with thalassemia trait and iron deficiency. These findings highlight the need for targeted screening strategies and evidence-based policies to optimize donor health management while ensuring blood safety and availability. The study provides a public health framework for managing subclinical hematological conditions in blood donor populations in endemic regions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1804892","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T06:50:12Z","timestamp":1773903012000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["High proportions of iron deficiency and thalassemia in blood donors with low RBC osmotic fragility: a call for targeted public health responses in Southern China"],"prefix":"10.3389","volume":"14","author":[{"given":"L. Y.","family":"Sun","sequence":"first","affiliation":[{"name":"Institution of Transfusion Medicine, Shenzhen Blood Center","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Shenzhen Blood Center","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. H.","family":"He","sequence":"additional","affiliation":[{"name":"The Third People\u2019s Hospital of Longgang, Clinical Institute of Shantou University Medical College (The Third People\u2019s Hospital of Longgang District Shenzhen)","place":["Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Z. S.","family":"Xie","sequence":"additional","affiliation":[{"name":"Institution of Transfusion Medicine, Shenzhen Blood Center","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. L.","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Blood Transfusion, Shenzhen Third People\u2019s Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. Q.","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Blood Transfusion, The Eighth Affiliated Hospital of Sun Yat-sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. F.","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Shenzhen Blood Center","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. X.","family":"Wang","sequence":"additional","affiliation":[{"name":"The Third People\u2019s Hospital of Longgang, Clinical Institute of Shantou University Medical College (The Third People\u2019s Hospital of Longgang District Shenzhen)","place":["Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"590","DOI":"10.4314\/ahs.v22i3.63","article-title":"Frequency of transfusion transmissible infections among blood donors of Rawalpindi District, Pakistan","volume":"22","author":"Ghazanfar","year":"2022","journal-title":"Afr Health Sci"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2241","DOI":"10.1111\/trf.18050","article-title":"Transfusion-transmissible coinfections among US blood donors","volume":"64","author":"Conti","year":"2024","journal-title":"Transfusion"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e0307101","DOI":"10.1371\/journal.pone.0307101","article-title":"Prevalence and factors associated with transfusion-transmissible infections (HIV, HBV, HCV and syphilis) among blood donors in Gabon: systematic review and meta-analysis","volume":"19","author":"Mangala","year":"2024","journal-title":"PLoS One"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1111\/tme.12750","article-title":"Comparison of four methods to measure haemoglobin concentrations in whole blood donors (COMPARE): a diagnostic accuracy study","volume":"31","author":"Bell","year":"2021","journal-title":"Transfus Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"150826","DOI":"10.1016\/j.tmrv.2024.150826","article-title":"HemoCue Hb-801 provides more accurate Hemoglobin assessment in blood donors than OrSense NBM-200","volume":"38","author":"Seekircher","year":"2024","journal-title":"Transfus Med Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e53417","DOI":"10.7759\/cureus.53417","article-title":"A case report of Hemolytic hyponatremia","volume":"16","author":"Manrique-Casta\u00f1o","year":"2024","journal-title":"Cureus"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e0314811","DOI":"10.1371\/journal.pone.0314811","article-title":"Lyophilized powder of calf bone marrow hydrolysate liposomes improved renal anemia: in vitro and in vivo evaluation","volume":"19","author":"Li","year":"2024","journal-title":"PLoS One"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e172656","DOI":"10.1172\/jci.insight.172656","article-title":"Mitapivat reprograms the RBC metabolome and improves anemia in a mouse model of hereditary spherocytosis","volume":"8","author":"Matte","year":"2023","journal-title":"JCI Insight"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1320697","DOI":"10.3389\/fphys.2023.1320697","article-title":"COVID-19 impairs oxygen delivery by altering red blood cell hematological, hemorheological, and oxygen transport properties","volume":"14","author":"Rogers","year":"2024","journal-title":"Front Physiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"638027","DOI":"10.3389\/fphys.2021.638027","article-title":"Impaired cytoskeletal and membrane biophysical properties of acanthocytes in Hypobetalipoproteinemia - a case study","volume":"12","author":"Cloos","year":"2021","journal-title":"Front Physiol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1080\/10245332.1999.11746471","article-title":"Erythropoiesis: erythrocyte deformability is reduced and fragility increased by Iron deficiency","volume":"4","author":"Anderson","year":"2000","journal-title":"Hematology"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1182\/blood.V62.1.99.99","article-title":"Red cell membrane stiffness in iron deficiency","volume":"62","author":"Yip","year":"1983","journal-title":"Blood"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"102389","DOI":"10.1016\/j.bcmd.2019.102389","article-title":"Genetic disruption of KCC cotransporters in a mouse model of thalassemia intermedia","volume":"81","author":"Shmukler","year":"2020","journal-title":"Blood Cells Mol Dis"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1146\/annurev.med.45.1.211","article-title":"Thalassemia: pathophysiology of red cell changes","volume":"45","author":"Schrier","year":"1994","journal-title":"Annu Rev Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2424504","DOI":"10.1080\/16078454.2024.2424504","article-title":"Prevalence and screening of hemoglobinopathies and glucose-6-phosphate dehydrogenase deficiency in Yemeni blood donors","volume":"29","author":"Almorish","year":"2024","journal-title":"Hematology"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"2767","DOI":"10.4103\/jfmpc.jfmpc_157_24","article-title":"Assessing NESTROFT as a preliminary screening tool for thalassemia in the Malayali tribes of Dharmapuri district, Tamil Nadu, India","volume":"13","author":"Pichamuthu","year":"2024","journal-title":"J Family Med Prim Care"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1080\/10245332.1999.11746471","article-title":"Erythrocyte deformability is reduced and fragility increased by Iron deficiency","volume":"4","author":"Anderson","year":"1999","journal-title":"Hematology"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"101074","DOI":"10.1016\/j.blre.2023.101074","article-title":"Thalassaemia in China","volume":"60","author":"Wang","year":"2023","journal-title":"Blood Rev"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2548970","DOI":"10.1080\/07853890.2025.2548970","article-title":"Prevention and control of thalassemia in Guangdong Province, southern China: insights from an 11-year retrospective study","volume":"57","author":"Qin","year":"2025","journal-title":"Ann Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1920","DOI":"10.1111\/trf.17983","article-title":"Iron deficiency-related symptoms in non-anemic whole blood donors","volume":"64","author":"Karregat","year":"2024","journal-title":"Transfusion"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/S0140-6736(24)01085-7","article-title":"Effectiveness of ferritin-guided donation intervals in whole-blood donors in the Netherlands (FIND'EM): a stepped-wedge cluster-randomised trial","volume":"404","author":"Meulenbeld","year":"2024","journal-title":"Lancet"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1111\/vox.13639","article-title":"Iron status in Dutch and Finnish blood donor and general populations: a cross-cohort comparison study","volume":"119","author":"Karregat","year":"2024","journal-title":"Vox Sang"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e108","DOI":"10.1002\/hem3.108","article-title":"Recommendations for diagnosis, treatment, and prevention of iron deficiency and iron deficiency anemia","volume":"8","author":"Iolascon","year":"2024","journal-title":"Hema"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2310","DOI":"10.1016\/s0140-6736(22)00536-0","article-title":"Thalassaemia","volume":"399","author":"Kattamis","year":"2022","journal-title":"Lancet"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"120211","DOI":"10.1016\/j.cca.2025.120211","article-title":"Screening and treatment of thalassemia","volume":"570","author":"Su","year":"2025","journal-title":"Clin Chim Acta"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1182\/hematology.2021000296","article-title":"Optimal strategies for carrier screening and prenatal diagnosis of \u03b1- and \u03b2-thalassemia","volume":"2021","author":"Mensah","year":"2021","journal-title":"Hematology Am Soc Hematol Educ Program"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/j.hoc.2022.12.001","article-title":"Molecular basis and genetic modifiers of thalassemia","volume":"37","author":"Tesio","year":"2023","journal-title":"Hematol Oncol Clin North Am"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"10760296221119807","DOI":"10.1177\/10760296221119807","article-title":"Molecular epidemiology and hematologic characterization of thalassemia in Guangdong Province, southern China","volume":"28","author":"Xian","year":"2022","journal-title":"Clin Appl Thromb Hemost"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1126099","DOI":"10.3389\/fgene.2023.1126099","article-title":"The gene spectrum of thalassemia in Yangjiang of western Guangdong Province","volume":"14","author":"Liang","year":"2023","journal-title":"Front Genet"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"824","DOI":"10.3967\/bes2021.112","article-title":"Molecular Spectrum of \u03b1- and \u03b2-thalassemia among young individuals of marriageable age in Guangdong Province, China","volume":"34","author":"Zhou","year":"2021","journal-title":"Biomed Environ Sci"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1111\/tme.70018","article-title":"Screening, genetic analysis, and clinical transfusion implications of thalassaemia and glucose-6-phosphate dehydrogenase deficiency in blood donors","volume":"36","author":"Chen","year":"2025","journal-title":"Transfus Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1097\/moh.0000000000000733","article-title":"Iron status of blood donors","volume":"29","author":"Spencer","year":"2022","journal-title":"Curr Opin Hematol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"775","DOI":"10.2147\/JBM.S375945","article-title":"Iron deficiency and blood donation: links, risks and management","volume":"13","author":"Mantadakis","year":"2022","journal-title":"J Blood Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"150860","DOI":"10.1016\/j.tmrv.2024.150860","article-title":"Whole blood donor iron management across Europe: experiences and challenges in four blood establishments","volume":"38","author":"van den Hurk","year":"2024","journal-title":"Transfus Med Rev"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1804892\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T06:50:13Z","timestamp":1773903013000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1804892\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,19]]},"references-count":34,"alternative-id":["10.3389\/fpubh.2026.1804892"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1804892","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,19]]},"article-number":"1804892"}}