Intravenous iron therapy in non‐anemic iron‐deficient menstruating adolescent females with fatigue

Abstract

Menstruating women, with or without underlying bleeding disorders, are at increased risk for developing iron deficiency-related fatigue, even in the absence of anemia. Oral iron therapy has limitations which include poor absorption and non-adherence due to gastrointestinal side effects. We performed a prospective clinical trial of post-menarchal adolescent females with iron-deficiency with or without mild anemia and fatigue who received a standardized regimen of intravenous iron sucrose. The baseline mean (SD) hemoglobin was 11.96 g dl(-1) (1.05) in 20 girls (ages 14-21 years); with a range of 10.3-14.1 g dl(-1) . In this cohort, intravenous iron was well tolerated and patients demonstrated a sustained increase in ferritin levels with means (SD) of 13.4 ng ml(-1) (13.1) at baseline to 141.5 ng ml(-1) (104.5) at 6 weeks and 85.2 ng ml(-1) (128.4) at 6 months after the infusions. We used a standardized (Peds QL(TM) Multidimensional) fatigue scale to objectively measure fatigue and proxy scores by parents with mean screening scores (SD) of 35.2 (16.8) and 31.9 (19.6), respectively. We demonstrated a clinically significant improvement both in patient as well as parent fatigue scores (in 19 out of 20 subjects) at 6 weeks (Mean (SD) 58.3 (21.3) [P < 0.0001] and 57 (24.4) [P < 0.0001], respectively); as well as 3 and 6 months after the iron infusions. In nonanemic patients, iron administration did not significantly influence hemoglobin concentration. Therefore, the fatigue-reducing effects of iron therapy reflect the nonhematological functions of iron. Am. J. Hematol. 91:973-977, 2016. © 2016 Wiley Periodicals, Inc.

Iron Deficiency Anemia

“…34 Another recent study also showed improvement in fatigue with iron supplementation to iron-deficient but nonanemic fatigued adolescents. 35 These studies, along with improvements in athletic performance cited previously, clearly demonstrate the role of iron in well-being beyond hemoglobin level.…”

How I approach iron deficiency with and without anemia

“…A randomized double‐blinded placebo‐controlled study demonstrated the efficacy of intravenous iron in nonanemic iron‐deficient premenopausal adult women with fatigue . A smaller single‐arm study of adolescent females with ID and mild/no anemia demonstrated improved fatigue and quality of life after a course of intravenous iron …”

Association Between Ferropenia Without Anemia and Minor Health Disorders in University Adolescents

“…La deficiencia de hierro o "ferropenia" representa la deficiencia nutricional más importante a nivel mundial [1][2][3][4] , pero la prevalencia aún no es del todo clara, por falta de estudios que hagan hincapié en esta importante deficiencia; empero algunos autores la sitúan alrededor del 10% a nivel mundial [4][5][6] ; Ortega P. y colaboradores, en un estudio realizado en Venezuela, determinaron que a nivel de América Latina un 10 -30% de mujeres, en edad fértil, cursan con ferropenia1.…”

“…Ferropenia hace referencia a la insuficiente presencia de hierro en el organismo, sea por disminución en sus reservas o por pérdidas excesivas 4,6 . Para dar con el diagnóstico hay múltiples estudios de laboratorio que podrían ser útiles, empero no todos ellos son costo -efectivos, de hecho, la gran mayoría no lo son; uno muy utilizado es el dosaje de ferritina sérica.…”

“…Hum. 2018;18(1):65-73. los requerimientos de nutrientes (por una serie de factores fisiológicos) hay un aporte dietético deficitario en relación con una serie de factores psicosociales" [4][5][6] . La ferropenia, definida incluso como un síndrome, se debe a múltiples causas, y aún no se define una que resalte sobre otras⁹.…”