Abstract
In women of fertile age, iron loss consequent to excessive menstrual discharge is by far the most frequent cause of iron-deficient anemia. However, the relationship between menstrual discharge and iron loss is poorly understood. In this prospective study, total menstrual and iron losses were assayed in a large cohort of non-anemic women and women with excessive menstrual blood losses (menorrhagia) in order to provide data useful for intervention. One hundred and five Caucasian women aged 20–45 years were recruited. Blood cell count and serum ferritin (SF) levels were determined in each case before menses. Menstrual fluid losses (MFL) were determined using a standardized pads’ weight method. Hematin concentration was assayed by a variant of the Alkaline Hematin Method from which iron concentration was calculated. Mean SF levels were 36.2 (range 8.6–100) ng/ml in healthy women and 6.4 (range 5–14) ng/ml in patients with menorrhagia. Median values of iron lost/cycle were 0.87 mg in healthy women and 5.2 mg in patients with menorrhagia (ranges 0.102–2.569 and 1.634–8.665 mg, respectively, p < 0.001). In women with menorrhagia, iron lost/cycle strongly correlated (0.789, p < 0.001) with MFL. In conclusion, healthy women with normal menses lose, on average, 1 mg iron/cycle. Average iron losses in patients with menorrhagia are, at least in our cohort, on average, five-to-six times higher than normal. Most women with menorrhagia had totally depleted iron stores. Indirect, quantitative evaluation of iron lost with menses may be useful to assess the risk of developing iron-deficient anemia in individual patients.
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Acknowledgments
The authors would like to thank all physicians and women involved in this study.
Authors’ contributions
Mariasanta Napolitano and Guglielmo Mariani ideated the work and wrote the paper. Alberto Dolce performed the statistical analysis of results. Mariasanta Napolitano, Elvira Grandone, Sergio Siragusa, Assunta Orecchioni enrolled patients and critically revised the results. Giuseppe Celenza and Maria Grazia Perilli supported the laboratory research. Gaspare Carta contributed to the study design and enrolment. Guglielmo Mariani critically revised all the research process. All the authors have significantly contributed to the research; they have read and approved the submitted version of the article.
In addition to institutional funds, an unrestricted grant from Novo Nordisk helped to conduct the study.
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Napolitano, M., Dolce, A., Celenza, G. et al. Iron-dependent erythropoiesis in women with excessive menstrual blood losses and women with normal menses. Ann Hematol 93, 557–563 (2014). https://doi.org/10.1007/s00277-013-1901-3
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DOI: https://doi.org/10.1007/s00277-013-1901-3