Mandate Testing of Blood Iron Levels Might be Beneficial for Young Women

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Screening guidance for iron deficiency should include even people who are not associated with iron-deficiency anemia, considering the high prevalence of iron deficiency found among 12- to 21-year-old US females.

A new study published in JAMA suggests that 4 out of every 10 teen girls and young women may have iron levels low enough to cause symptoms such as low energy and dizziness. But most of them probably do not know it, because regular health screenings for their age group don't include a blood test that measures the body's iron reserves, called a ferritin test ().

‘Among 12- to 21-year-old US females between 2003 and 2020, almost 40% were iron deficient and 6% had iron-deficiency anemia.#anemia #iron level #menstruration’

On the more severe side, the study finds that one in every 17 females aged 12 to 21 has low enough iron levels to qualify them for a diagnosis of iron-deficiency anemia, which can cause life-limiting symptoms if not treated.

Current Testing Guidelines May Not Catch Low Iron Level in Teen Girls

The study used national data from a broad sample of young women who took part in a health survey carried out by the Centers for Disease Control and Prevention. While the overall iron deficiency rate in the study group was 40%, the rate was about 30% higher among both Black and Latina young women compared with their non-Hispanic white peers.

Even though the study confirms menstruation's general link to lower iron levels, it also shows that 27% of girls who had not yet gotten their first period already had low iron levels. Meanwhile, the rate of iron deficiency in the rest of the study group didn't change with the number of years the young women had been menstruating.

The findings suggest it's high time to consider the routine screening of iron levels in adolescents and young women -- even if they don't have symptoms such as fatigue, cognitive or mental health concerns, shortness of breath when exercising, pale or sallow skin, rapid heartbeat, or headache.

Iron deficiency is an under-recognized problem with adverse impacts (), but its symptoms and even those of anemia are normalized in young females. Screening for a condition that is highly prevalent, easily diagnosed, easily treated, and associated with serious symptoms is not addressed properly.

The current testing recommendations focus on toddlers, and people who are pregnant or have a cluster of symptoms suggestive of anemia. Besides the lack of screening at routine health care visits, both young females and their health care providers may not routinely discuss menstrual bleeding.

For the new study, researchers used ferritin and hemoglobin blood test data, and other information, from a national survey called NHANES. They analyzed data from 3,490 females aged 12 to 21 who took part between 2003 and 2020 except for several years when ferritin levels weren't collected.

The study focused on ferritin, which is the form of protein-coated iron that's stored in the liver and called up into the blood when the body needs more iron to assist with sending oxygen to tissues and organs, or to make hormones and build cells, hair, skin, and nails.

The team set a level of under 25 micrograms per liter of blood (μg/L) as the definition for iron deficiency. But because experts don't have a clear international standard for what level of ferritin is too low, they also looked at levels under 15 ug/L and 50 ug/L.

Overall, 39% of the young women had ferritin levels below 25 ug/L, and 17% were below 15 ug/L. When it came to iron-deficiency anemia, 6% qualified for this diagnosis using a combined cutoff of 12 mg/dL of hemoglobin and 25 ug/L of ferritin.

Then, they looked at how ferritin and hemoglobin/ferritin levels varied among young women based on their different characteristics. In addition to race, ethnicity, and poverty, the researchers found other links.

About one-third of all the young women in the study had family incomes below 130% of the poverty level, and a slightly lower percentage reported experiencing food insecurity. Members of the low-income group were more likely to have iron deficiency and those with food insecurity were more likely to qualify for a diagnosis of anemia ().

Researchers hope that the findings will act as a spur for healthcare providers to order ferritin tests in young female patients, and to counsel them on eating foods rich in iron -- both the form found in animal-based foods and that found in fruits, vegetables, nuts, and seeds.

If ferritin levels are low even with a well-rounded diet, healthcare providers can recommend a multivitamin with iron, or oral iron supplements, which are low-cost and come in formulations designed not to cause digestive issues. For those with more serious iron deficiencies, intravenous iron is also available.

References:

1. Prevalence of Iron Deficiency and Iron-Deficiency Anemia in US Females Aged 12-21 Years, 2003-2020 - (https:jamanetwork.com/journals/jama/fullarticle/2806540?)
2. Daily iron supplementation for improving anaemia, iron status and health in menstruating women - (https:www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009747.pub2/full)
3. Physiologically based serum ferritin thresholds for iron deficiency in children and non-pregnant women: a US National Health and Nutrition Examination Surveys (NHANES) serial cross-sectional study - (https:www.sciencedirect.com/science/article/abs/pii/S235230262100168X)

Source: Eurekalert