Recommended Guidelines For Preventing And Treating Iron Deficiency Anemia In Nonpregnant Women Of Childbearing Age
A. General Screening of Women of Childbearing Age
- All nonpregnant women should be screened for anemia between 15 and 25 years of age.
- Consider screening once every 5 to 10 years if there are no risk factors for anemia. If medical or social risk factors for anemia are present (high parity, frequent blood donation, high menstrual blood loss, previous diagnosis of iron deficiency anemia, poverty, or recent immigration), more frequent screening is warranted.
B. Anemia Screening Procedure, if Necessary
- Obtain blood by venipuncture. If anemia was suspected on the basis of a skin puncture sample, confirm analysis on venipuncture blood.
- Use appropriate cutoff values for anemia as follows:
C. Counseling and Preventive Therapeutic Measures for Nonanemic Women
- Most women do not require an iron supplement.
- Women planning a pregnancy and at increased risk of iron deficiency anemia can take an iron-folate combination supplement containing folate at 0.4 mg/day and iron at about 30 mg/day.
- In women with increased risk of nutrient deficiencies, consider a multivitamin-mineral supplement of appropriate composition that contains about 30 mg of iron.
- Iron-containing supplements are best taken between meals or at bedtime with water or juice, not with tea, coffee, or milk. Keep out of reach of children, because iron is a very common cause of poisoning in children.
D. Treatment for Anemic Women
- Mild anemia. If the concentration of hemoglobin is no more than 2 g/dl below the cutoff value (<10.0 g/dl), treat with a therapeutic dose of iron of about 60 mg twice a day (total daily dose, 120 mg). Provide dietary advice. Check for a response after 1 to 1.5 months. If there has been no response (an increase of at least 1.0 g/dl in hemoglobin or 3 percent in hematocrit), despite what appears to be good compliance, determine the serum ferritin con-
- centration and consider other causes of anemia. Anemia and a serum ferritin concentration of <15 µg/liter suggest iron deficiency'. If there has been a response, continue the therapeutic dose of iron for 2-4 months or until the hemoglobin concentration is 12.0 g/dl. After that time, the dosage of iron can be reduced to about 30 mg of iron per day for 6 months. A repeat serum ferritin concentration within normal limits is recommended prior to termination of iron therapy to determine repletion of iron stores.
- Blacks may normally have slightly lower hemoglobin values than other races (0.8 g/dl less, on average). Anemia combined with a serum ferritin concentration of <15 µg/liter suggests iron deficiency. If the ferritin concentration is higher, the anemia is unlikely to be due to iron deficiency.
- Severe anemia is unusual and may not be due to iron deficiency. Further history, including dietary history, a more thorough physical exam, and additional laboratory studies (i.e., complete blood count, reticulocyte count, and serum ferritin concentration) are indicated to determine the cause of anemia.
E. Advise on Diet
Eat a varied diet and enhance iron absorption by including meat, ascorbic acid-rich foods (fruit juice or fruit), or both in meals. Avoid tea or coffee with meals.