- The most recognised and studied long term complication is iron deficiency, more frequently associated with whole blood donation(35). The collection of 450 or 500 mL of whole blood, plus an additional 30 to 50 mL for blood tests, results in 480 to 550 mL of blood loss per whole-blood donation. These losses equate to a 60 - to 88-g loss of haemoglobin (Hb) per whole-blood donation in women (based on a Hb range of 12.5 to 16.0 g per dL), and 204 to 299 mg of iron loss (based on 3.4 mg of iron per gram of Hb). Donation frequency accounts for the greatest impact on iron deficiency (36). In addition, collection of double red cell units by apheresis may increase the risk. Prevention of iron depletion could be achieved by increasing the inter-donation interval, switching to plasma or platelets apheresis instead of whole blood donation, or replacing iron lost through donation.

- Protein depletion may result from frequent plasma donation (37)

- Osteoporosis from calcium depletion may be a possible chronic effect of frequent citrate anticoagulation (38; 39). Some investigators showed altered bone metabolism, proven by changes in alkaline phosphatase, osteocalcin, intact parathyroid hormone (PTH) and 1,2 dihydroxyvitamin D levels. Protein and calcium depletion have only recently received attention and are not (yet) included in lists for reporting and surveillance.