J Pediatr Adolesc Gynecol. 2017 Apr;30(2):247-250. doi: 10.1016/j.jpag.2016.10.010. Epub 2016 Oct 24.

Iron Deficiency Anemia in Adolescents Who Present with Heavy Menstrual Bleeding.

Cooke AG1, McCavit TL2, Buchanan GR3, Powers JM4.

1 Department of Pediatrics, Johns Hopkins All Children’s Hospital, St Petersburg, Florida.

2 Division of Hematology-Oncology, Department of Pediatrics, Cook Children’s Hospital, Fort Worth, Texas.

3 Division of Hematology-Oncology, Department of Pediatrics, UT Southwestern Medical Center and Children’s Medical Center, Dallas, Texas.

4 Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas. Electronic address: jmpowers@texaschildrens.org.



STUDY OBJECTIVE: To assess the clinical severity and initial treatment of iron deficiency anemia (IDA) in female adolescents with heavy menstrual bleeding (HMB) in our center.

DESIGN: Retrospective cohort study of electronic medical records via search of administrative records using International Classification of Diseases Ninth Revision codes for IDA or unspecified anemia and disorders of menstruation.

SETTING: Children’s Medical Center in Dallas, Texas.

PARTICIPANTS: One hundred seven patients with HMB and concomitant IDA (median age, 14.4 years) who presented to the outpatient, emergency department, and/or inpatient settings.

RESULTS: The median initial hemoglobin concentration for all patients (n = 107) was 7.4 g/dL, and most (74%, n = 79) presented to the emergency department or via inpatient transfer. Symptomatic IDA was treated with blood transfusion in 46 (43%, n = 46). Ferrous sulfate was the most commonly prescribed oral iron therapy. Seven patients received intravenous iron therapy either initially or after oral iron treatment failure. Combined oral contraceptives were commonly prescribed for abnormal uterine bleeding, yet 10% of patients (n = 11) received no hormonal therapy during their initial management. Evaluation for underlying bleeding disorders was inconsistent.

CONCLUSION: Severe anemia because of IDA and HMB resulting in urgent medical care, including hospitalization and blood transfusion, is a common but underemphasized problem in adolescent girls. In addition to prevention and early diagnosis, meaningful efforts to improve initial management of adolescents with severe HMB and IDA are necessary.

KEYWORDS: Abnormal uterine bleeding; Adolescents; Heavy menstrual bleeding; Iron deficiency anemia; Transfusion

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