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Iron Deficiency Anemia in Women

A Practical Guide to Detection, Diagnosis, and Treatment

Friedman, Arnold J. MD*; Shander, Aryeh MD, FCCM, FCCP; Martin, Stephanie R. DO; Calabrese, Rebecca K. MD§; Ashton, Maria E. MS, RPh, MBA; Lew, Indu PharmD; Seid, Melvin H. MD, FAOCG, CPI**; Goodnough, Lawrence Tim MD††

Obstetrical & Gynecological Survey: May 2015 - Volume 70 - Issue 5 - p 342–353
doi: 10.1097/OGX.0000000000000172

Introduction Iron deficiency anemia (IDA) remains a widely underdiagnosed and unappreciated women’s health issue, affecting women of all ages. Despite the fact that IDA is easily diagnosed and treated, it continues to be a major public health issue. The World Health Organization estimates that 30% of nonpregnant and more than 42% of pregnant women have anemia.

Methods A multidisciplinary Group for the Research and Education on Anemia Therapy in Women (GREAT Women II) was formed, sponsored by the Society for the Advancement of Blood Management. The goal was to focus attention on the impact of IDA on women at various stages of life and evaluate and use published literature to provide a simple, evidence-based approach to diagnose and treat IDA.

Results The group developed specific recommendations for evaluating and treating IDA in women. Initial diagnosis is defined as hemoglobin less than 12 g/dL in nonpregnant women. A trial of iron therapy (4 weeks) can be considered a first-line diagnostic tool. Alternatively, a low or normal mean corpuscular volume (<100 fL), low serum ferritin (<30 μg/L), and/or low transferrin saturation (transferrin saturation <20%) is sufficient to confirm IDA. If the patient does not fit the diagnosis of IDA or fails to respond to a trial of oral iron, or mean corpuscular volume is elevated, further diagnostic evaluation is needed, including iron studies, B12, folate levels, and renal function tests. If results are not definitive, and IDA persists, a hematology referral is recommended.

Conclusion Clinicians should routinely identify and treat IDA, thereby decreasing its negative impact on health and quality of life of women.

Target Audience Providers of primary healthcare to women.

Learning Objectives After completing this CME activity, the learner will be better able to extend knowledge, increase awareness, and improve treatment of iron deficiency anemia in women; to summarize best practice for the detection and diagnosis of iron deficiency anemia in women; and to institute practical guidelines for the use of intravenous iron in women with iron deficiency.

*Chairman, Obstetrics & Gynecology, Mount Sinai Beth Israel Medical Center, and Clinical Professor of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; †Chief of Anesthesiology, Critical Care Medicine and Hyperbaric Medicine, Englewood Hospital & Medical Center, Englewood, NJ, and Clinical Professor of Anesthesiology, Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; ‡Director, Southern Colorado Maternal Fetal Medicine, Director Maternal Fetal Medicine Services St Francis Medical Center/Centura South State, Colorado Springs, and Visiting Associate Clinical Professor, Department of Obstetrics and Gynecology, University of Colorado, School of Medicine, Aurora, CO; §Associate Chief of Medicine, Erie County Medical Center, and Assistant Professor, Department of Medicine, State University of New York at Buffalo, Buffalo, NY; ¶Clinical Pharmacist, Ashton Medica, Mason, OH; ∥Vice President, Corporate Pharmacy, Barnabas Health, South Plainfield, NJ; **Director, Clinical Research, Lyndhurst OB/GYN Associates, Winston-Salem, NC; and ††Professor of Pathology & Medicine, Stanford University, Stanford, CA

Dr Friedman received honorarium from Society for the Advancement of Blood Management (SABM). Dr Shander received honorarium from SABM and consulted for Masimo, CSL, Gauss. He has been a paid advisor to the American Association of Blood Banks and the US Department of Health and Human Services. He has a financial interest in Gauss. Dr Martin received honorarium from SABM. Ms Ashton received honorarium from SABM and has consulted for American Regent. Dr Lew has been a paid speaker for Amgen and American Regent. Dr Seid received honorarium from SABM and has had grants from AMAG, Luitpold, Actavis, and Pharmacosmos. Dr Goodnough received honoraria from American Regent and Amgen.

Dr Calabrese, the spouses/life partners (if any) of all authors, and all staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

The authors has disclosed that the U.S. Food and Drug Administration has not approved the use of various parenteral iron products and erythrocyte-stimulating agents as discussed in this article. Please consult the product’s labeling for approved information.

The authors are members of the multidisciplinary Group for the Research and Education on Anemia Therapy in Women (The Great Women II Project), an initiative to expand on the findings of the GREAT Women I and develop working guidelines for the detection, diagnosis, and treatment of iron deficiency anemia in women. Resources for this project were provided through the SABM with financial support from American Regent, Inc, and Luitpold Pharmaceuticals, Inc.

Correspondence requests to: Arnold J. Friedman, MD, Department of Obstetrics & Gynecology, Mount Sinai Beth Israel Medical Center, 350 E. 17th St, New York, NY 10003. E-mail:

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