The Iron Ladies: Prevalence and Risk Factors of Iron Deficiency in Females With Bleeding Disorders

Introduction

Iron deficiency (ID) impairs cognitive and physical function. Females with bleeding disorders (FBD) are at risk of ID as a result of bleeding symptoms.

Aim

This study aimed to report the overall incidence and prevalence of ID in FBD, identify factors associated with ID and describe the screening practices for and management of ID within haemophilia treatment centres (HTC).

Methods

Electronic surveys were distributed to medical providers caring for FBD within HTCs participating in the American Thrombosis Haemostasis (ATHN) affiliate network to gather data on practices for screening of ID and the use of iron supplementation. We next used the ATHNdataset to identify females 13–40 years of age receiving care at an ATHN-affiliated HTC between 2015 and 2019. Prevalence and incidence of ID were estimated based on the presence of one of the following lab results: transferrin >360 mg/dL, total iron binding capacity (TIBC) >460mcg/dL, % saturation <20% or ferritin <50 ng/mL, and clinical and demographic characteristics associated with ID were identified using logistic regression.

Results

Although all providers reported screening for ID, only 70% did so as part of their routine practice and significant variation existed in the form of iron supplementation used. Only 3.6% of participants in the ATHNdataset were tested for ID, and 71.9% of tested participants were ID. Black or African American race, platelet disorder and heavy menstrual bleeding were associated with increased risk of ID.

Conclusion

ID is highly prevalent among FBD and is underrecognised and undertreated. Practitioners should standardise practices to identify and manage ID.