A Review of Clinical Guidelines on the Management of Iron Deficiency and Iron-Deficiency Anemia in Women with Heavy Mens
- PDF / 1,728,798 Bytes
- 25 Pages / 595.276 x 790.866 pts Page_size
- 26 Downloads / 180 Views
REVIEW
A Review of Clinical Guidelines on the Management of Iron Deficiency and Iron-Deficiency Anemia in Women with Heavy Menstrual Bleeding Diana Mansour . Axel Hofmann . Kristina Gemzell-Danielsson
Received: October 14, 2020 / Accepted: November 6, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: Up to one-third of women of reproductive age experience heavy menstrual bleeding (HMB). HMB can give rise to iron deficiency (ID) and, in severe cases, iron-deficiency anemia (IDA). Aim: To review current guidelines for the management of HMB, with regards to screening for anemia, measuring iron levels, and treating ID/IDA with iron replacement therapy and noniron-based treatments. Methods: The literature was searched for English-language guidelines relating to HMB published between 2010 and 2020, using the PubMed database, web searching, and retrieval of clinical guidelines from professional societies. D. Mansour (&) Community Gynaecology, Newcastle Hospitals, Newcastle, UK e-mail: [email protected] A. Hofmann Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland A. Hofmann Medical School and Division of Surgery, The University of Western Australia, Perth, Australia K. Gemzell-Danielsson Department of Women’s and Children’s Health, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
Results: Overall, 55 guidelines mostly originating from North America and Europe were identified and screened. Twenty-two were included in this review, with the majority (16/ 22) focusing on guidance to screen women with HMB for anemia. The guidance varied with respect to identifying symptoms, the criteria for testing, and diagnostic hemoglobin levels for ID/IDA. There was inconsistency concerning screening for ID, with 11/22 guidelines providing no recommendations for measurement of iron levels and four contrasting guidelines explicitly advising against initial assessment of iron levels. In terms of treatment, 8/22 guidelines provided guidance on iron therapy, with oral iron administration generally recommended as first-line treatment for ID and/or IDA. Four guidelines recommended intravenous iron administration for severe anemia, in non-responders, or before surgery. Three guidelines provided hemoglobin thresholds for choosing between oral or intravenous iron treatment. Four guidelines discussed the use of transfusion for severe IDA. Conclusion: Many of the guidelines for managing HMB recognize the importance of treating anemia, but there is a lack of consensus in relation to screening for ID and use of iron therapy. Consequently, ID/IDA associated with HMB is likely to be underdiagnosed and undertreated. A consensus guidance, covering all aspects of screening and management of ID/
Adv Ther
IDA in women with HMB, is needed to optimize health outcomes in these patients.
PLAIN LANGUAGE SUMMARY Women who bleed heavily during menstruation are at risk of iron deficiency and anemia. This can have a negative effect on the well-being of women and can cause serious complications after surge
Data Loading...
