Anemia management in non-menopausal women in a primary care setting: a prospective evaluation of clinical practice

Abstract

Background: The study aimed to analyze anemia management in non-pregnant, and non-menopausal women aged from 18 to 50 years old, in a French primary care setting. Methods: An observational descriptive prospective study was conducted between November 2018 and February 2019. Inclusion criteria were as followed: anemia diagnosed in women aged from 18 to 50, not pregnant and not menopausal. Quantitative and qualitative data were anonymized and collected through an electronic survey. Investigating general practitioners completed the questionnaire for each newly diagnosed woman. Mean values and medians were calculated for the quantitative data. Answers to the open questions were encoded manually and proportions of the different modalities have been calculated. Results: Altogether, 43 women with anemia were ascertained. Moderate microcytic anemia, due to an iron deficiency in a context of menorrhagia, was the most observed anemia profile. The mean value of hemoglobin was 10.5 ± 1 g/dl. Among these women: 32 (74%) presented an iron deficiency, 17 (53%) had inappropriate intakes, and 9 (28%) reported menorrhagia. For 17 (40%) women, unnecessary or inappropriate exams were prescribed. The investigations did not allow to establish a differential diagnosis for 12 women (28%). Even for similar clinical situations, anemia management was variable. Among the women who presented iron deficiency, 15 (47%) were informed about an iron-rich diet and received a daily iron supplementation of ferrous sulfate between 80 mg and 160 mg. Conclusions: Our study highlights that, in the absence of specific national guidelines for anemia management in nonpregnant, non-menopausal women in primary care settings, French GPs undergo various clinical management strategies leading to a heterogeneous, sometimes inappropriate follow-up. Women with iron deficiency were prescribed higher daily iron supplementation than recommended, according to new evidence, suggesting a maximal daily dose of 50 mg of elementary iron in a context of Hepcidin up-regulation in the case of an iron overload. Additional longitudinal studies with a bigger sample size and randomized controlled trials are needed to confirm our results and to elaborate national guidelines.

Assessment of Trace Elemental Composition, Sex Hormones and Antioxidant Capacity of Young Women with Menstrual Irregularities

“…In women of child bearing age, heavy menstrual flow is the most frequent cause of iron deficiency anaemia [16,[21][22][23]. The role of selenium in the formation of a special protein known as an antioxidant has been noted [24].…”

Anemia as a Problem: GP Approach

“…Due to the aging of the population, an increase of anemia has been registered in elderly people and recently defined by Hb levels Dig Dis 2022;40:370-375 DOI: 10.1159/000517579 <12 g/dL in both genders [2,3]. As stated by the WHO in 2016, the estimated prevalence of anemia in women of childbearing age was 30.2% worldwide, while in Europe 20.2% [5]. Reduction of Hb levels in pregnancy as a result of physiological hemodilution is defined as pseudoanemia, maximal during 20-24 weeks of gestation [3,5].…”

“…As stated by the WHO in 2016, the estimated prevalence of anemia in women of childbearing age was 30.2% worldwide, while in Europe 20.2% [5]. Reduction of Hb levels in pregnancy as a result of physiological hemodilution is defined as pseudoanemia, maximal during 20–24 weeks of gestation [3, 5]. Furthermore, increased odds of having anemia were determined in African Americans and Hispanic race compared to Caucasians [1, 2].…”

The relationship between nutritional status, anthropometric measurements and hemogram parameters in preobese and obese women before and after menopause

“…Generally, between the ages of 45 and 55, there is a transition period to menopause (pre-menopausal period lasting 3 to 8 years). Since there is no monthly blood loss after menopause, the need for iron is less than in the premenopausal period (7,8).…”