Iron Deficiency Without Anaemia in Menstruating Women: A Case for Screening Before the Haemoglobin Falls
DOI:
https://doi.org/10.5281/zenodo.22275665Keywords:
Iron deficiency, Ferritin, Menstruation., Screening, FatigueAbstract
Iron deficiency develops long before haemoglobin falls, and the tests used routinely detect the anaemia rather than the deficiency.
Among 114 young women referred with heavy menstrual bleeding, 58 had ferritin below 20 ng/mL and only 24 of those, 41.4 per
cent, were anaemic. Haemoglobin alone identified iron deficiency with a sensitivity of 41.4 per cent and the full blood count with
46.3 per cent, against specificities of 91.1 and 83.9 per cent. A test that misses more than half of cases is not a screening test for
this condition. The case for measuring ferritin is therefore strong on detection, and two things qualify it. The threshold is
unsettled, with 15, 20, 30 and 50 ng/mL all in current use and a guideline panel suggesting 30 on low certainty evidence. And in a
randomised comparison of supplementation against a high-iron diet in 44 women, vitality and mental health improved in both
arms while ferritin rose more with supplement alone.
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