Article Review by guest writer Hannah Polley “Addressing Iron Deficiency and Iron Deficiency Anemia in Women and Girls”

Summary of Prevalence of Iron Deficiency and Iron Deficiency Anemia in US Females Aged 12-21 Years, 2003-2020 by Weyand et al.

Many women and girls with bleeding disorders are unaware of their conditions and the potential consequences of abnormal bleeding. One often overlooked issue is iron deficiency and iron deficiency anemia. Unfortunately, due to a lack of diagnoses, many individuals with iron deficiency remain untreated, despite the availability of effective treatments.

Screening for iron deficiency has traditionally included preschool-aged children and pregnant women. The Centers for Disease Control and Prevention (CDC) in the United States recommend anemia screening every 5-10 years for nonpregnant female adolescents and women.¹ Remarkably, there are no current screening guidelines in place for nonpregnant female adolescents regarding iron deficiency as an independent condition, separate from iron deficiency anemia. Nonetheless, treating iron deficiency is crucial as it can yield significant improvements in exercise performance and alleviate fatigue.

A recent US study² examined the prevalence of iron deficiency and iron deficiency anemia among females aged 12-21. The study analyzed data from 2003 to 2020 and included 3940 participants. The results revealed that 38.6% of the participants had iron deficiency, and 6.3% had iron deficiency anemia. Among the participants, 188 were premenarchal, meaning they had not yet experienced their first period. Interestingly, the prevalence of iron deficiency among these premenarchal individuals was 27.1%, suggesting that while menstruation is a risk factor for iron deficiency and iron deficiency anemia, almost 30% of premenarchal females suffer from iron deficiency.

The study also identified associations between lower body mass, poverty, and food insecurity, and a higher prevalence of iron deficiency anemia. This emphasizes the need for accessible treatment, especially in economically disadvantaged areas. Additionally, the study found that 83.6% of participants with iron deficiency did not meet the criteria for iron deficiency anemia. This highlights the limitations of current screening guidelines, which solely focus on iron deficiency anemia, missing a substantial portion of individuals with iron deficiency who remain undiagnosed and untreated.

To improve consistency in screening, annual screening is recommended for high-risk patients. However, the specific factors that define high risk remain ambiguously defined. Factors such as heavy menstrual bleeding, low iron intake, and previous iron deficiency diagnoses should be established to streamline the screening process.

This insightful study demonstrates that nearly 40% of females aged 12-21 in the US experience iron deficiency. While these findings may not be entirely surprising, they emphasize the need for enhanced screening guidelines for both iron deficiency and iron deficiency anemia. By recognizing and addressing this hidden challenge, we can strive for better healthcare outcomes for women and girls affected by bleeding disorders.

References

1. Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. MMWR Recomm Rep. 1998;47 (RR-3):1-29.
2. Weyand, A. C., Chaitoff, A., Freed, G. L., Sholzberg, M., Choi, S. W., & McGann, P. T. (2023). Prevalence of Iron Deficiency and Iron-Deficiency Anemia in US Females Aged 12-21 Years, 2003-2020. JAMA, 329(24), 2191–2193. https://doi.org/10.1001/jama.2023.8020