By Emily A. Roush
In May, we welcomed Dr. Kristina Haley, director of the Hemophilia Center at the Oregon Health and Science University, for a webinar on iron deficiency in women and girls. This article summarizes the webinar and what you need to know.
Iron deficiency is one of the most common nutritional deficiencies worldwide, but it carries unique and often overlooked challenges for women and girls living with bleeding.
With inherited conditions like vWD and hemophilia, adding menstruation and other bleeding episodes only compounds the development of iron deficiency anemia. This condition can have far-reaching effects on physical and mental well-being.
The Role of Iron in the Body
People often think of iron as found in the blood and in muscles, the liver, the heart, enzymes, and more.
Red blood cells contain hemoglobin, which is a protein that carries oxygen and carbon dioxide, playing an essential role in the body. Each red cell can contain 300 million hemoglobin molecules.
Without enough iron, the body can’t produce enough hemoglobin, resulting in anemia.
Recognizing Iron Deficiency
The signs of iron deficiency can be subtle at first, but progressively worsen over time. Common symptoms include:
- fatigue
- weakness
- shortness of breath
- pale skin
- headaches
- dizziness
- brittle nails
- cold hands and feet
Some women may experience pica, which is a craving to eat non-food items such as ice, dirt, or starch.
In cases of iron deficiency anemia, where hemoglobin levels drop due to insufficient iron, symptoms become more severe and may include chest pain, rapid heartbeat, and difficulty concentrating.
For women with bleeding disorders, heavy or prolonged menstrual bleeding (menorrhagia) adds to iron depletion. Frequent nosebleeds, easy bruising, and bleeding after minor injuries or dental work are warning signs of an underlying clotting disorder that may worsen iron loss.
Diagnosing Iron Deficiency
Diagnosis of iron deficiency and anemia requires a blood panel ordered by your HTC or a healthcare provider. Key tests include:
- Complete Blood Count (CBC): Measures red blood cell count, hemoglobin, and hematocrit levels. Low values can indicate anemia.
- Serum Ferritin: Reflects stored iron levels in the body and is the most specific test for diagnosing iron deficiency. Low ferritin often signals depleted iron stores even before anemia develops.
- Serum Iron and Total Iron-Binding Capacity (TIBC): These assess circulating iron levels and the blood’s capacity to transport iron.
- Transferrin Saturation: Calculated from serum iron and TIBC, this test helps determine how much iron is transported in the blood.
For women with known bleeding disorders, regular monitoring is essential, especially during reproductive years when iron needs increase due to menstruation and potential pregnancy.
Treating Iron Deficiency in Bleeding Disorders
Treatment for iron deficiency anemia requires replenishing iron stores through dietary changes, supplements, or IV in more severe cases. Iron-rich foods such as red meat, poultry, fish, lentils, and spinach could be included in the daily diet. Still, it’s essential to speak to your HTC following testing and diagnosis about their recommendation.
Oral iron supplements (typically ferrous sulfate, gluconate, or fumarate) are a standard therapy. However, some individuals experience gastrointestinal side effects. In such cases, intravenous iron infusions may be recommended, especially if oral iron is not tolerated or doesn’t effectively replenish iron supplies.
Iron deficiency is a preventable and treatable condition, but is often underrecognized and undertreated. It requires special attention by women with bleeding disorders to recognize signs and advocate for proper testing and treatment. With early recognition, appropriate testing, and comprehensive care that addresses both iron loss and bleeding symptoms, women can manage iron deficiency effectively and improve their overall quality of life.
Watch the full webinar:
English 
Español de Puerto Rico