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Patients with heavy menstrual bleeding who have been diagnosed with anemia or iron deficiency are treated with oral and/or intravenous iron.
Patients presenting with heavy menstrual bleeding are at an increased risk of developing anemia and iron deficiency due to the excessive blood loss they experience each month. Anemia and iron deficiency need to be treated to improve the patient’s mental and physical functioning and prevent the need for transfusion. In addition, dietary counselling may be considered.
All patients who have anemia (hemoglobin concentration below 120 g/L in a non-pregnant menstruating patient), a low mean cell volume, a low red blood cell count, and a clear history of bleeding should be treated with iron but do not need a ferritin test. However, if patients with anemia do not respond to oral iron, their ferritin should be tested. Patients who are not anemic but exhibit symptoms of iron deficiency, such as restless legs, fatigue, or hair loss, should also have a ferritin test. Ferritin levels below 15 mcg/L are diagnostic of iron deficiency and levels of 15 to 50 mcg/L are strongly suggestive of iron deficiency.
If you have low iron or anemia (low red blood cell count), you should be advised to take iron pills. You may need iron in liquid form through a needle (intravenously).
If your patient has iron deficiency anemia from heavy menstrual bleeding, treat them with iron: first oral, then intravenous. Use transfusion only if the patient is suffering from serious side effects such as hypotension, chest pain, syncope, or tachycardia.
Ensure systems, processes, and resources are in place such that patients with heavy menstrual bleeding have equal access to all options to correct their iron deficiency anemia. Ensure clinicians have access to the appropriate laboratory tests for their patients and to protocols to avoid unnecessary transfusions in this population.
Percentage of patients with heavy menstrual bleeding diagnosed with anemia or iron deficiency who were treated with iron, by delivery method (oral or intravenous)
Denominator: number of patients with heavy menstrual bleeding diagnosed with anemia or iron deficiency
Numerator: number of patients in denominator treated with iron, by delivery method:
Oral
Intravenous
Data source: local data collection
Note: Each type of iron treatment should be calculated separately as well as the overall rate.
Percentage of patients with heavy menstrual bleeding diagnosed with anemia who had a blood transfusion
Denominator: number of patients with heavy menstrual bleeding who had anemia
Numerator: number of patients in the denominator who had a blood transfusion
Data sources: local data collection; for system level, Ontario Health Insurance Plan claims database, Discharge Abstract Database
Anemia and iron deficiency should be treated with oral or intravenous iron, in the following order:
Oral iron for a minimum of 3 months to correct hemoglobin level and treat symptoms of iron deficiency (fatigue, cognitive impairment, exercise intolerance, restless legs)
Intravenous iron for patients with severe anemia (hemoglobin concentration of less than 90 g/L), severe symptoms of anemia, patients unresponsive or intolerant to oral iron, or patients in need of rapid correction prior to an operative procedure
Transfusion only if the patient is suffering from serious side effects such as hypotension, chest pain, syncope, or tachycardia. Transfusion is associated with adverse events including a 1-in-13 risk of alloimmunization that can complicate future pregnancies
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