Correction of iron deficiency states in reproductive-aged patients with chronic abnormal uterine bleeding
Objective: To evaluate the effectiveness of correcting iron deficiency states (IDS) in chronic abnormal uterine bleeding (AUB) in reproductive-aged patients.Savelyeva I.V., Nosova N.V., Bukharova E.A., Prodanchuk E.G., Galyanskaya E.G.
Materials and methods: The investigation enrolled 155 patients with chronic AUB. Group 1 included 53 patients with latent iron deficiency (LID); Group 2 consisted of 58 women with mild iron deficiency anemia (IDA); Group 3 comprised 44 patients with moderate IDA. The investigation methods included the determination of the level of serum iron (SI), total serum iron-binding capacity (TSIC), ferritin, and complete blood cell count parameters (hemoglobin, red blood cell count, mean corpuscular volume (MCV), cellular hemoglobin content (CHC) in serum). IDS was treated with a combination agent containing ferrous fumarate and folic acid (Ferretab comp.) for 12 and 24 weeks. Therapy outcome assessments were based on determination of hemoglobin and ferritin levels and on clinical evaluation of complaints potentially associated with iron deficiency.
Results: It was established that effective correction of IDS in chronic AUB in reproductive-aged patients could be achieved by routine administration of the drug containing ferrous fumarate and folic acid (Ferretab comp.), by taking into account its efficacy and good tolerability, which determined adherence to therapy. After 12 weeks of taking this drug, there was a rise in hemoglobin and ferritin levels in Groups 1 and 2 and a statistically significant increase in hemoglobin levels in Group 3 (p=0.01). In addition, the common symptoms of anemia were recorded to be relieved in all the women included in the investigation.
Conclusion: The combination drug Ferretab comp. is effective in restoring hemoglobin levels and iron stores in patients with IDS in chronic AUB. This combination drug has prescription benefits for IDS, since folic acid is an iron synergist for erythropoiesis and also due to the need to maintain optimal serum folate levels in reproductive-aged patients.
Authors' contributions: Savelyeva I.V. – concept and design of the investigation, editing; Nosova N.V., Bukharova E.A., Prodanchuk E.G., Galyanskaya E.G. – material collection and processing, statistical data processing, writing the text.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: This investigation has not been sponsored.
Ethical Approval: The investigation has been approved by the Ethics Committee, Omsk State Medical University, Ministry of Health of Russia (Minutes No. 11 dated September 16, 2022).
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Savelyeva I.V., Nosova N.V., Bukharova E.A., Prodanchuk E.G., Galyanskaya E.G. Correction of iron deficiency states in reproductive-aged patients
with chronic abnormal uterine bleeding.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; 1: 93-98 (in Russian)
https://dx.doi.org/10.18565/aig.2023.12
Keywords
abnormal uterine bleeding
latent iron deficiency
iron deficiency anemia
oral iron agents
References
- Соловьева А.В., Чегус Л.А. Аномальные маточные кровотечения у женщин в репродуктивном возрасте и пременопаузе. Акушерство и гинекология. 2020; 8: 29-38. https://dx.doi.org/10.18565/aig.2020.8.29-38. [Solovyeva A.V., Chegus L.A. Abnormal uterine bleeding in women of reproductive age and premenopause. Obstetrics and Gynecology. 2020; (8): 29-38. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.8.29-38.
- Министерство здравоохранения Российской Федерации. Клинические рекомендации. Аномальные маточные кровотечения. М.; 2021. [Ministry of Health of the Russian Federation. Clinical guigelines. Abnormal uterine bleeding. Moscow; 2021. (in Russian)].
- Munro M.G., Critchley H.O., Broder M.S., Fraser I.S.; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int. J. Gynaecol. Obstet. 2011; 113(1): 3-13. https://dx.doi.org/10.1016/j.ijgo.2010.11.011.
- Munro M.G., Critchley H.O.D., Fraser I.S.; FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int. J. Gynaecol. Obstet. 2018; 143(3): 393-408. https://dx.doi.org/10.1002/ijgo.12666.
- Кузнецова И.В., Беришвили М.В. Латентный дефицит железа и железодефицитная анемия у женщин с обильными менструациями. Женская клиника. 2022; 3: 29-37. [Kuznetsova I.V., Berishvili M.V. Latent iron deficiency and iron deficiency anemia in women with copious menstruation. Women’s Clinic. 2022; (3): 29-37. (in Russian)].
- Camaschella C. Iron deficiency. Blood. 2019; 133(1): 30-9. https://dx.doi.org/10.1182/blood-2018-05-815944.
- Friedman A.J., Chen Z., Ford P., Johnson C.A., Lopez A.M., Shander A. et al. Iron deficiency anemia in women across the life span. J. Womens Health (Larchmt). 2012; 21(12): 1282-9. https://dx.doi.org/10.1089/jwh.2012.3713.
- Milman N., Taylor C.L., Merkel J., Brannon P.M. Iron status in pregnant women and women of reproductive age in Europe. Am. J. Clin. Nutr. 2017; 106(Suppl. 6): 1655S-662S. https://dx.doi.org/10.3945/ajcn.117.156000.
- Suchdev P.S., Williams A.M., Mei Z., Flores-Ayala R., Pasricha S.R., Rogers L.M., Namaste S.M. Assessment of iron status in settings of inflammation: challenges and potential approaches. Am. J. Clin. Nutr. 2017; 106(Suppl. 6): 1626S-33S. https://dx.doi.org/10.3945/ajcn.117.155937.
- Coad J., Pedley K. Iron deficiency and iron deficiency anemia in women. Scand. J. Clin. Lab. Invest. 2014; 244(Suppl.): 82-9. https://dx.doi.org/10.3109/00365513.2014.936694.
- Townsley D.M. Hematological complications of pregnancy. Semin. Hematol. 2013; 50(3): 222-31. https://dx.doi.org/10.1053/j.seminhematol.2013.06.004.
- Burdge G.C., Lillycrop K.A. Folic acid supplementation in pregnancy: Are there devils in the detail? Br. J. Nutr. 2012; 108(11): 1924-30. https://dx.doi.org/10.1017/S0007114512003765.
- WHO Guidelines Approved by the Guidelines Review Committee. Guideline: daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization; 2012.
Received 18.01.2023
Accepted 27.01.2023
About the Authors
Irina V. Savelyeva, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology No. 1, Omsk State Medical University, Ministry of Health of Russia, +7(913)654-35-77, saveljeva_iv_omsk@mail.ru, https://orcid.org/0000-0001-9342-7342, 644099, Russia, Omsk, Lenina str., 12.Natalya V. Nosova, Assistant Professor, Department of Obstetrics and Gynecology No. 1, Omsk State Medical University, Ministry of Health of Russia,
+7(951)417-44-52, natalya-nosova-85@mail.ru, https://orcid.org/0000-0002-2362-5367, 644099, Russia, Omsk, Lenina str., 12.
Elena A. Bukharova, Assistant Professor, Department of Obstetrics and Gynecology No. 1, Omsk State Medical University, Ministry of Health of Russia,
+7(913)661-98-88, buxarova88@mail.ru, https://orcid.org/0000-0002-6093-3721, 644099, Russia, Omsk, Lenina str., 12.
Eugene G. Prodanchuk, PhD, Associate Professor, Department of Obstetrics and Gynecology No. 1, Omsk State Medical University, Ministry of Health of Russia,
+7(913)973-50-33, ompeg@mail.ru, https://orcid.org/0000-0003-4498-5836, 644099, Russia, Omsk, Lenina str., 12.
Elena G. Galyanskaya, PhD, Associate Professor, Department of Obstetrics and Gynecology No. 1, Omsk State Medical University, Ministry of Health of Russia,
+7(904)580-63-44, galaynskaya@mail.ru, https://orcid.org/0000-0002-9603-7363, 644099, Russia, Omsk, Lenina str., 12.
Сorresponding author: Irina V. Savelyeva, saveljeva_iv_omsk@mail.ru
Similar Articles
