Open Access Open Badges Research article

Predicting hemoglobin levels in whole blood donors using transition models and mixed effects models

Kazem Nasserinejad1*, Wim de Kort2, Mireille Baart2, Arnošt Komárek3, Joost van Rosmalen1 and Emmanuel Lesaffre14

Author Affiliations

1 Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands

2 Sanquin Blood Supply, Nijmegen, the Netherlands

3 Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic

4 L-Biostat, KU Leuven, Leuven, Belgium

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BMC Medical Research Methodology 2013, 13:62  doi:10.1186/1471-2288-13-62

Published: 2 May 2013



To optimize the planning of blood donations but also to continue motivating the volunteers it is important to streamline the practical organization of the timing of donations. While donors are asked to return for donation after a suitable period, still a relevant proportion of blood donors is deferred from donation each year due to a too low hemoglobin level. Rejection of donation may demotivate the candidate donor and implies an inefficient planning of the donation process. Hence, it is important to predict the future hemoglobin level to improve the planning of donors’ visits to the blood bank.


The development of the hemoglobin prediction rule is based on longitudinal (panel) data from blood donations collected by Sanquin (the only blood product collecting and supplying organization in the Netherlands). We explored and contrasted two popular statistical models, i.e. the transition (autoregressive) model and the mixed effects model as plausible models to account for the dependence among subsequent hemoglobin levels within a donor.


The predictors of the future hemoglobin level are age, season, hemoglobin levels at the previous visits, and a binary variable indicating whether a donation was made at the previous visit. Based on cross-validation, the areas under the receiver operating characteristic curve (AUCs) for male donors are 0.83 and 0.81 for the transition model and the mixed effects model, respectively; for female donors we obtained AUC values of 0.73 and 0.72 for the transition model and the mixed effects model, respectively.


We showed that the transition models and the mixed effects models provide a much better prediction compared to a multiple linear regression model. In general, the transition model provides a somewhat better prediction than the mixed effects model, especially at high visit numbers. In addition, the transition model offers a better trade-off between sensitivity and specificity when varying the cut-off values for eligibility in predicted values. Hence transition models make the prediction of hemoglobin level more precise and may lead to less deferral from donation in the future.

Blood donations; Hemoglobin level; Longitudinal data; Panel data; Transition models; Mixed effects models; Prediction; Kalman filter