The need to screen for anaemia in female populations

Abstract

Objectives: Anemia is the commonest disease to affect women’s health. 1 in 10 women will have anemia at any point in time and 1 in 3 women suffer with anemia at some point in their lifetime. The commonest cause of anaemia is iron deficiency (ID). Iron deficiency anaemia (IDA) is particularly common in women, due to increased iron loss from menstrual bleeding. Women who experience heavy menstrual bleeding (HMB) are at an even greater risk of both ID and IDA. Despite high prevalence rates, awareness is poor. This is relevant for women undertaking sport as anemia can lead to reduced physical performance. There is no current screening program or recommendation for testing of anemia for women. Therefore, we assessed a simple screening tool to predict anemia in women. Methods: 300 apparently fit and healthy women attending a national fitness festival randomly completed a Female Health Questionnaire (FHQ) about; previous iron status, menstrual blood loss (based on 4 symptoms), diet, and motherhood. Participants were asked to self-report any symptoms of iron deficiency, including; brain fog, palpitations, shortness of breath, restless legs, hair loss, and pica. Results were compared to fingerprick haemoglobin levels with anemia defined as [Hb]<120 g/L. Results: Average age was 31.21 years (s.d.7.72), average [Hb] was 131.76g/L (s.d.11.5) and 36 (12%) had anemia. A history of iron deficiency was reported by 127 (43.49%), 127 (43.49%) reported heavy menstrual bleeding (HMB), 75 were vegetarian (18%) or vegan (8%) and 33 were mothers (11%). In total 80 reported taking time off work (median 20, range 1-50, total 1612 days). Overall, the FHQ reporting of risk factors or symptoms relating to anemia appeared nonspecific, with little correlation to haemoglobin levels. However, those with HMB were significantly more likely to report a history of ID (51.18% vs. 37.58%, p=0.024) and there was a significant correlation between HMB and the overall self-reporting of symptoms relating to anemia (r=0.252, p<0.001). Women who reported the symptom of HMB were significantly more likely to report symptoms of brainfog (p=0.002), palpitations (p=0.009), restlessness in the legs (p=0.010) and or pica (p=0.001). Further, women with anemia more commonly reported HMB (58.33% vs. 41.57%, p=0.04), and those with HMB were more likely to report days off (39.37% vs. 18.18%, p<0.001). Conclusions: Anemia was common in apparently fit and healthy women, particularly those with HMB. A simple screening tool for HMB and testing for anemia is recommended in women undertaking exercise. Conflict of interest statement: Dr. Richards reports grants from UK, NIHR HTA, grants from Australian, NHMRC, grants, personal fees and non-financial support from Pharmocosmos, grants, personal fees and non-financial support from Vifor Pharma, grants from NIHR EME, personal fees from Medtronic, grants from Australian MRFF. The above listed grant providers played no formal role in this research project. Outside the submitted work; and TR is a regular speaker at national and international conferences on anaemia, blood transfusion, wound healing and vascular diseases for which he has received expenses for travel, accommodation and sundries. TR has worked with several agencies promoting meetings or healthcare. TR is a director of The Iron Clinic Ltd and director of Veincare London Ltd also TR is the vascular lead for 18-week wait Ltd. All other authors acknowledge no conflict of interest of relevance to the submission of this abstract.