Trip Answers

Question answered:10/07/06 Warning! this question is over two years old.

We found no guidelines or information specificially dealing with anaemia in female patients in their thirties; however we did locate information on anaemia in premenopausal women.

The PRODIGY guideline on iron deficiency anaemia [IAD] states:

“Iron deficiency anaemia is the most common type of anaemia in all countries. It affects up to 30% of the world's population, with prevalence in developed countries of about 8%...
It occurs in up to 14% of premenopausal women in developed countries.”
It occurs during pregnancy in 23% of pregnant women in developed countries, and 52% of pregnant women in developing countries [WHO et al, 2001].”

In the section on diagnosing IAD, PRODIGY emphasises:

“A reason for iron deficiency should always be sought. History-taking should attempt to determine whether gastrointestinal (GI) blood loss, menstrual loss, malabsorption, or nutritional deficiency is likely. Drug history of nonsteroidal anti-inflammatory use is particularly important, as this might point to possible GI bleeding. In developed countries dietary deficiency, by itself, is rarely a cause of iron deficiency anaemia unless there are increased physiological demands for iron (e.g. during infancy, adolescence, pregnancy, lactation, and in menstruating women).”

It also notes:

“Difficulties in diagnosis may occur when more than one type of anaemia is present. A dimorphic blood picture may be present, and additional investigations such as vitamin B12 and folate levels may help diagnose the different causes of anaemia.” [1]

NHS Direct gives similar information in a patient information leaflet on anaemia:

“Iron deficiency anaemia is the most common type of anaemia. It affects up to 30% of the world’s population. Up to 14% of menstruating women in developed countries have iron deficiency anaemia. Megaloblastic anaemia (the red cells are megablastic i.e. large and abnormal) develops if vitamin B12 or folic acid are lacking. A lack of folic acid, leads to megaloblastic anaemia. Another type of megablastic anaemia is called ‘pernicious’ anaemia, in which there is insufficient absorption of vitamin B12 from the diet.” [2]

An e-Medicine article, published this year, adds:

“In North America and Europe, iron deficiency is most common in women of childbearing age and as a manifestation of hemorrhage. Iron deficiency caused solely by diet is uncommon in adults in countries where meat is an important part of the diet. Depending upon the criteria used for the diagnosis of iron deficiency, approximately 4-8% of premenopausal women are iron deficient. In men and postmenopausal women, iron deficiency is uncommon in the absence of bleeding

• During childbearing years, women have a high incidence of iron deficiency anemia because of iron losses sustained with pregnancies and menses.
• Gastrointestinal neoplasms become increasingly more prevalent with each decade of life. They frequently present with gastrointestinal bleeding that may remain occult for long intervals before it is detected. Usually, bleeding from neoplasms in other organs is not occult, prompting the patient to seek medical attention before developing severe iron depletion.” [3]

References
1. PRODIGY guidance on iron deficiency anaemia. Last revised July 2005. (http://www.prodigy.nhs.uk/anaemia_iron_deficiency/).
2. NHS Direct. Anaemia. January 2006. (http://www.nhsdirect.nhs.uk/articles/article.aspx?articleid=19).
3. Conrad E. Anemia. E-Medicine. March 2006. (http://www.emedicine.com/med/topic132.htm).

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