The misogyny of iron deficiency

Dugan, Cory; Maclean, Bernice L.; Cabolis, Katerina; Abeysiri, Sandaruwani; Khong, A; Sajic, Marija; Richards, Toby

doi:10.1111/anae.15432

Cited by 33 publications

(36 citation statements)

References 36 publications

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“…Previous literature has clearly established a relationship between HMB, anemia and quality of life. [ 12 , 13 , 16 , 17 , 19 , 20 , 22 , 24 , 27 , 35 , 36 ] Specifically, HMB is a significant predictor or both iron deficiency and anemia, all of which can worsen quality of life. However, to the best of our knowledge, no research has examined the underlying mechanisms which might predict individual risk and subsequent impact of anemia.…”

Section: Discussionmentioning

confidence: 99%

The need to screen for anemia in exercising women

et al. 2021

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Anemia is common, affecting 1 in 3 women in their lifetime. 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 for testing of anemia for exercising women. Therefore, the objective of the present study was to assess a simple screening tool to predict anemia in exercising women. Cross sectional survey study. National fitness festival. Three hundred exercising women. Screening methodology (Female Health Questionnaire and a haemoglobin concentration measurement). The Female Health Questionnaire inquired about; previous iron status, menstrual blood loss, 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. Average age was 31.21years (s.d.7.72), average [Hb] was 131.76 g/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 (total 1612 days). Women with anemia more commonly reported HMB (58.33% vs. 41.57%, P = .04), and those with HMB were more likely to report days off (39.37% vs. 18.18%, P < .001). Anemia was common in exercising women, particularly those with HMB. A simple screening tool for HMB and finger prick haemoglobin testing for anemia is recommended in women undertaking exercise.

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Section: Discussionmentioning

confidence: 99%

The need to screen for anemia in exercising women

et al. 2021

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“…Therefore, accepting a Hb level of 12 g/dl or less for women in the pre-surgery assessment while mean have a higher threshold of 13 g/dl, makes transfusion, with all its associated side effects and complications, more likely in women. In addition, the lower Hb threshold could preclude a large proportion of women undergoing surgery from receiving effective treatment [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of intravenous iron supplementation in elderly patients undergoing major surgery

et al. 2022

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Background Age and preoperative anaemia are risk factors for poor surgical outcome and blood transfusion. The aim of this study was to examine the effect of iron supplementation in iron-deficient (ID) elderly patients undergoing major surgery. Method In this single-centre observational study, patients ≥ 65 years undergoing major surgery were screened for anaemia and ID. Patients were assigned to the following groups: A− (no anaemia); A−,ID+,T+ (no anaemia, iron-deficient, intravenous iron supplementation); A+ (anaemia); and A+,ID+,T+ (anaemia, iron-deficient, intravenous iron supplementation). Results Of 4,381 patients screened at the anaemia walk-in clinic, 2,381 (54%) patients were ≥ 65 years old and 2,191 cases were included in analysis. The ID prevalence was 63% in patients with haemoglobin (Hb) < 8 g/dl, 47.2% in patients with Hb from 8.0 to 8.9 g/dl, and 44.3% in patients with Hb from 9 to 9.9 g/dl. In severely anaemic patients, an Hb increase of 0.6 (0.4; 1.2) and 1.2 (0.7; 1.6) g/dl was detected with iron supplementation 6–10 and > 10 days before surgery, respectively. Hb increased by 0 (-0.1; 0) g/dl with iron supplementation 1–5 days before surgery, 0.2 (-0.1; 0.5) g/dl with iron supplementation 6–10 days before surgery, and 0.2 (-0.2; 1.1) g/dl with supplementation > 10 days before surgery (p < 0.001 for 1–5 vs. 6–10 days). Overall, 58% of A+,ID+,T+ patients showed an Hb increase of > 0.5 g/dl. The number of transfused red blood cell units was significantly lower in patients supplemented with iron (0 (0; 3)) compared to non-treated anaemic patients (1 (0; 4)) (p = 0.03). Patients with iron supplementation > 6 days before surgery achieved mobility 2 days earlier than patients with iron supplementation < 6 days. Conclusions Intravenous iron supplementation increases Hb level and thereby reduces blood transfusion rate in elderly surgical patients with ID anaemia.

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“…The normal reference range typically reflects the mean and two standard deviations of values within a “healthy population,” which according to the Clinical Laboratory Standards Institute guidelines can be based on a minimum sample size of only 120 participants [ 18 , 19 ]. The World Health Organization (WHO) definitions may be outdated and biased against female patients, potentially including women with iron deficiency or anemia in the “normal population” range [ 20 ]. This is supported by a retrospective study of 1,388 women undergoing cardiac surgery by Blaudszun et al In this study, women with a preoperative hemoglobin concentration between 120 and 130 g/L (within the normal range for women, but regarded as anemic for men) showed that this population of women when compared to women with a preoperative hemoglobin concentration ≥ 130 g/L were more likely to receive a blood transfusion (68.6% vs. 44.5%; RR 1.5, 95% CI 1.4–1.7; p < 0.001) and had an increased length of hospital stay (8 [IQR 6–12] days vs. 7 [IQR 6–11] days; p = 0.0159) [ 21 ].…”

Section: Defining Anemia and Outcomes After Major Surgerymentioning

confidence: 99%

Hematinic and Iron Optimization in Peri-operative Anemia and Iron Deficiency

Miles

Richards

2022

Curr Anesthesiol Rep

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Purpose of Review Preoperative anemia is independently associated with worse postoperative outcomes following cardiac and noncardiac surgery. This article explores the current understanding of perioperative anemia and iron deficiency with reference to definition, diagnosis, and treatment. Recent Findings Iron deficiency is the most common cause of anemia. It can arise from reduced iron intake, poor absorption, or excess iron loss. Inflammation throughout the preoperative period can drive iron sequestration, leading to a functional deficiency of iron and the development of what was referred to until recently as the “anemia of chronic disease.” Current best practice guidance supports the routine administration of preoperative intravenous iron to treat anemia despite limited evidence. This “one size fits all” approach has been called into question following results from a recent large, randomized trial (the PREVENTT trial) that assessed the use of a single dose of intravenous iron compared to placebo 10–42 days before major abdominal surgery. Although there were no improvements in patient-centered outcomes apparent during the initial hospital stay, secondary endpoints of this trial suggested there may be some late benefit after discharge from the hospital (8 weeks postoperatively). This trial raises questions on (1) the mechanisms of iron deficiency in the perioperative patient; (2) the need to reassess our opinions on generic anemia management; and (3) the need to address patient outcomes after discharge from hospital. Summary Despite the known associations between preoperative anemia (particularly iron deficiency anemia) and poor postoperative outcome, recent evidence suggests that administering intravenous iron relatively close to surgery does not yield a tangible short-term benefit. This is made more complex by the interplay between iron and innate immunity. Iron deficiency irrespective of hemoglobin concentration may also impact postoperative outcomes. Therefore, further research into associations between iron deficiency and postoperative outcomes, and between postoperative anemia, delayed outcomes (hospital readmission), and the efficacy of postoperative intravenous iron is required.

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The misogyny of iron deficiency

Cited by 33 publications

References 36 publications

The need to screen for anemia in exercising women

The need to screen for anemia in exercising women

The impact of intravenous iron supplementation in elderly patients undergoing major surgery

Hematinic and Iron Optimization in Peri-operative Anemia and Iron Deficiency

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