Iron deficiency and fatigue among adolescents with bleeding disorders

Abstract

Iron deficiency anemia is associated with heavy menstrual bleeding (HMB) and, by extension, a bleeding disorder (BD). It is unknown if iron deficiency without anemia is associated with a BD in adolescents. Moreover, the threshold of ferritin associated with fatigue in adolescents with HMB is unclear. In this multicenter study, we enrolled adolescents with HMB without BD. Participants underwent BD and anemia work-up in Young Women's Hematology Clinics and completed the Peds QL™ fatigue scale. BDs were defined as von Willebrand Disease, platelet function defect, clotting factor deficiencies, and hypermobility syndrome. Two hundred and fifty consecutive adolescents were enrolled, of whom 196 met eligibility criteria. Overall, 43% (95% confidence interval: 36%-50%) were diagnosed with BD. A total of 61% (n = 119) had serum ferritin levels < 15 ng/mL, 23.5% (n = 46) had iron deficiency only, and 37% (n = 73) had iron deficiency anemia. Low ferritin or ferritin dichoto-

“If I wasn't a girl”: Experiences of adolescent girls with heavy menstrual bleeding and inherited bleeding disorders

“…We interviewed nine adolescents (median age: 17 years; range: [16][17][18] with an inherited BD, including VWD type I (n = 5), VWD type 2B (n = 2), VWD type 3 (n = 1), and inherited thrombocytopenia (n = 1; Table 1). The median Pictorial Bleeding Assessment Chart score was 465 (range 250-840), and the median ISTH-BAT score was 5 (range [3][4][5][6][7][8][9][10][11]. All participants were on hormonal menstrual suppression (n = 9) and as-needed antifibrinolytics (n = 7).…”

“…[1][2][3] Heavy menstrual bleeding results in hospitalizations, iron deficiency anemia, depression, and limitations of daily activities. [4][5][6][7] Among adolescents with HMB, up to 30% are diagnosed with an underlying BD in tertiary care settings. 2,8 Bleeding disorders are treatable and their complications are preventable.…”

“…Heavy menstrual bleeding (HMB) is a common presenting symptom of an inherited bleeding disorder (BD) 1‐3 . Heavy menstrual bleeding results in hospitalizations, iron deficiency anemia, depression, and limitations of daily activities 4‐7 . Among adolescents with HMB, up to 30% are diagnosed with an underlying BD in tertiary care settings 2,8 .…”

Initial von Willebrand factor antigen values in adolescent females predict future values

“…Data from our cohort stresses the importance of screening for iron deficiency in this population and treating with iron therapy when iron deficiency (ferritin <20 ng/mL) is present 18,19 . Earlier detection and treatment prevents progression to anaemia and addresses other clinical implications of iron deficiency including poor concentration, fatigue, restless legs and decreased school performance in adolescent females 27–31 . A previous study of adolescent females admitted for severe anaemia revealed that only 39% had any iron laboratory assessment and 37% of admissions did not initiate iron therapy 32 .…”

“…18,19 Earlier detection and treatment prevents progression to anaemia and addresses other clinical implications of iron deficiency including poor concentration, fatigue, restless legs and decreased school performance in adolescent females. [27][28][29][30][31] A previous study of adolescent females admitted for severe anaemia revealed that only 39% had any iron laboratory assessment and 37% of admissions did not initiate iron therapy. 32 Screening with serum ferritin is important over a haemoglobin or complete blood count alone as less than half of adolescent females may be anaemic or microcytic.…”