Prevalence of iron deficiency in reproductive-age females on anticoagulation

The use of anticoagulation in reproductive-aged females increases the risk of heavy menstrual bleeding (HMB). Excessive blood loss from HMB can lead to iron deficiency (ID), without or with anemia (IDA). We investigated the frequency with which reproductive-aged female patients on anticoagulants undergo screening for and receive a diagnosis of ID/IDA. We conducted a retrospective cohort study using the TriNetX global dataset of females aged 18-55 without a diagnosis of cancer who started anticoagulation therapy. The cohort was divided into sub-groups based upon ferritin testing within 90 days of starting anticoagulation and descriptive statistics were calculated. The initial cohort included 1,463,349 unique female patients across 93 healthcare organizations. Exclusion of those with cancer and those without laboratory values resulted in a final cohort of 783,196. Out of the final cohort, 9.2% had a ferritin level checked within 90 days of starting anticoagulation. Of those, 36.6% had a ferritin level ≤ 50 ng/mL while 25.8% had ferritin levels ≤30 ng/mL. Among individuals with ferritin ≤30 ng/mL, 19.7% (n = 3655) had a hemoglobin ≥12 and 44.0% (n = 8170) had MCV < 80 fL. These findings highlight a significant gap in the evaluation of ID for reproductive-aged females taking anticoagulation and emphasize the importance of using ferritin for the diagnosis of ID with or without anemia. Future studies and interventions are indicated to increase screening and expedite treatment of ID/IDA in reproductive-aged female patients starting anticoagulation.