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The Impact of COVID-19 on Iron Deficiency Anemia Due to Heavy Menstrual Bleeding in Adolescents
Ana Ravelo1, Melissa Verdolotti1, Griffin Cherniss2
1Division of Hematology/Oncology, Department of Pediatrics, Hasbro Children's/Brown University Health, Providence, Rhode Island.
Insights
The COVID-19 pandemic led to a twofold increase in iron deficiency anemia (IDA) due to heavy menstrual bleeding (HMB) in young women. This suggests reduced access to routine care worsened disease severity and incidence.
Area of Science:
- Women's Health
- Hematology
- Public Health
Background:
- Heavy menstrual bleeding (HMB) is a significant cause of iron deficiency (ID) in women.
- The COVID-19 pandemic disrupted routine healthcare access, impacting women's health services.
- Understanding the pandemic's effect on HMB and ID management is crucial.
Purpose of the Study:
- To investigate the impact of the COVID-19 pandemic lockdown on the diagnosis and management of HMB and associated ID.
- To analyze changes in the incidence and severity of iron deficiency anemia (IDA) in patients with HMB during and after the pandemic.
Main Methods:
- Retrospective chart review of patients aged 11-25 with HMB and ID between March 2018 and February 2023.
- Identification of patients using ICD-10 codes and manual chart review.
- Comparison of pre-pandemic, pandemic, and post-pandemic periods.
Main Results:
- The annual incidence of IDA due to HMB doubled during the pandemic/post-pandemic period compared to pre-pandemic levels.
- Patients with IDA during the pandemic were more likely to be treated in acute care settings and receive blood transfusions or intravenous iron.
- A significant increase in disease severity and incidence of IDA due to HMB was observed.
Conclusions:
- The study highlights a significant rise in IDA incidence and severity linked to HMB during and after the COVID-19 pandemic.
- Reduced access to preventive healthcare during the pandemic is a likely contributing factor.
- These findings underscore the need for continued monitoring and accessible healthcare for women's health conditions.
Purpose:
Heavy menstrual bleeding (HMB) is a common cause of iron deficiency (ID). The COVID-19 pandemic was associated with reduced access to routine healthcare with significant impacts on women's health. The aim of this study is to improve our understanding of the effect of the pandemic associated lockdown on diagnosis and management of HMB and ID.
Methods:
An IRB-approved retrospective chart review was conducted on patients assigned female at birth aged 11-25 with HMB and ID presenting to Hasbro Children's hematology clinic or inpatient service between March 2018 and February 2023. Patients were identified using ICD-10 codes and manual chart review.
Results:
Of 224 patients included, 155 had iron deficiency anemia (IDA) and 69 had iron deficiency without anemia (IDwA). The annual incidence of IDA due to HMB increased by twofold from pre-pandemic levels (n = 14, 2018-2019; n = 18, 2019-2020) to pandemic/post-pandemic levels (n = 36, 2020-2021; n = 46, 2021-2022; n = 41, 2022-2023) (P<.001). Patients with IDA presenting during the pandemic were more likely to be treated in the acute care setting than outpatient (69.4% vs 30.6%, respectively) compared to pre-pandemic (46.9% vs 53.1%) and post-pandemic (36.8% vs 63.2%) groups (P=.004), and were more likely to have received a blood transfusion or intravenous iron (50% and 44.4%, respectively) when compared to pre-pandemic (28.1%, 12.5%) and post-pandemic (20.7%, 39.1%) groups (P=.006, P=.008).
Discussion:
This study reveals a significant increase in both disease severity and incidence of IDA due to HMB during and after the pandemic, likely due to reduced access to preventive care.
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