Community screening for iron deficiency in reproductive aged women: Lessons learnt from Australia

Abstract

Background and objectives: Reproductive-aged women are at an increased risk of developing iron deficiency (ID). We aimed to develop a non-invasive screening tool to identify ID in women and assess the acceptability of screening.

Study design and methods: We screened women (age 18-49 years) in the community of Western Australia.

Primary outcome: acceptability of screening, assessed by the feasibility of recruiting the required sample size (n = 323).

Secondary outcomes: Hand grip strength, finger prick haemoglobin concentration (Hb), prevalence of heavy menstrual bleeding (HMB), diet, pregnancy history, blood donation, symptoms of ID and history of ID or anaemia (Hb < 120 g/L). Those with Hb <130 g/L and no history of iron therapy in the past 2 years were given referrals for venous full blood count and ferritin sampling.

Results: Across 5 days, we recruited 640 eligible women. Of which, 178 (28%) had HMB and 79 (12%) were anaemic. Mean age was 33.5 ± 9.2 years, and mean Hb was 132.4 ± 11.9 g/L. In the past 2 years: 335 (52%) were diagnosed with ID or anaemia; 322 (50%) had taken oral iron; and 210 (33%) had an intravenous iron infusion. Vegetarian diets were followed by 89 (14%); 40 (6%) were regular blood donors; 290 (45%) had a previous pregnancy. HMB increased the risk of symptoms of ID and having prior ID/anaemia diagnosis (67% vs. 47%) or treatment (p < 0.022). Hand grip strength showed a positive relationship with both Hb (adjusted R² = 0.012, p = 0.004) and ferritin (adjusted R² = 0.135, p = 0.005).

Conclusion: ID screening was well accepted by women in the community, with high recruitment rates over a short period. Future screening tool development may consider incorporating hand grip strength and HMB assessment.

Keywords: anaemia; iron deficiency; women's health.

FIGURE 1

Linear regression analysis of the impact of haemoglobin concentration (Hb) on grip strength. The maximum grip strength of either hand recording is plotted against Hb for the entire cohort. The linear regression showed adjusted R ² = 0.012, F‐statistic = 8.524, p = 0.004.

FIGURE 2

The influence of number of periods in a year on haemoglobin concentration (Hb). The number of periods reported in the past 12 months is plotted individually against Hb for the entire cohort. Linear regression analysis showed adjusted R ² = 0.022, F‐statistic = 13.77 and p < 0.001.

FIGURE 3

Venous haemoglobin concentration against log‐transformed ferritin. Linear regression analysis showed adjusted R ² = 0.038, F‐statistic = 2.973, p = 0.091.

FIGURE 4

Relationship between grip strength and log‐transformed ferritin. Linear regression analysis showed adjusted R ² = 0.135, F‐statistic = 8.829, p = 0.005.

FIGURE 5

Accuracy of finger prick testing haemoglobin concentration (Hb). The above diagram displays the calibration curve of observed Hb (venous sampling) against predicted Hb (capillary/finger prick sampling). On 1000 bootstrap replicates with a 95% confidence interval, the accuracy of finger prick sampling lies between 4.941 and 7.696 g/L.