Prevalence of iron deficiency anemia associated with malabsorption syndromes among African American women Free

Introduction:

Iron deficiency anemia (IDA) is one of the most prevalent blood disorders in the world, disproportionately affecting women of reproductive age, who are more prone to recurrent blood loss, insufficient nutritional intake, and higher physiological demands (i.e. menstrual bleeding, nutrient preservation for potential pregnancy, hormonal fluctuations, and lactation). Notably, malabsorption syndromes such as celiac disease (4.9%), inflammatory bowel disease (33.2%), megaloblastic anemia secondary to chronic gastritis (8%) also affect the body's capacity to absorb iron and other essential nutrients. In this clinical study, we evaluated the association between key malabsorption syndromes and iron deficiency anemia in African American women of reproductive age.

Methods:

A retrospective cohort study was initiated at Brooklyn Cancer Care, New York City, in October 2024. The study population included non-gravid African American women aged 18 to 50 years who were diagnosed with IDA, which is defined as hemoglobin < 12 g/dL and/or hematocrit < 36%, according to the guidelines from the American Society of Hematology (ASH). The study (malabsorption) group (n=58) consisted of patients with IDA and documented malabsorption syndromes (such as celiac disease and megaloblastic anemia), and the control group (n=422) included patients with IDA but no medical history of malabsorption.

The primary outcome measures included comparing laboratory parameters between patients with IDA who had malabsorption syndromes and those who did not: serum iron, ferritin, vitamin B12, folate, hemoglobin (Hb), hematocrit (Hct), parietal cell antibody (PCA) levels, and tissue transglutaminase (TTG) IgA antibodies. Hemoglobin and hematocrit values were assessed using ASH standard reference ranges: 12-15.5 g/dL and 36–46%, respectively. Anemia was defined as microcytic (MCV < 80 fL), normocytic (MCV 80-10 fL), and macrocytic (MCV >100 fL). Megaloblastic anemia was defined by Hgb < 12 g/dL, reduced vitamin B12 levels and/or the presence of PCA.

Vitamin B12 levels were established as low (< 148 pmol/L), normal (148 – 701 pmol/L) and high (>701 pmol/L); low, normal and high folate levels were < 7 nmol/L, 7.0 – 45.3 nmol/L, and >45.3 nmol/L, respectively. Serum iron levels were categorized as low (< 50 µg/dL), normal (50–170 µg/dL), and high (> 170 µg/dL); ferritin levels were considered as low (< 10 ng/ml), normal (10 -120 ng/ml), and high (> 120 ng/ml). TTG IgA levels were described as weak positive (4.0-10.0 U/mL), positive (> 10 U/mL) and negative (< 4 U/mL).

Results:

Compared to the control group (with a mean age of 47), the malabsorption group (with a mean age of 37) had lower mean hemoglobin levels (9.03 g/dL vs 7.5 g/dL) and higher frequency of iron deficiency (37.9% vs 64.3%). All malabsorption patients exhibited microcytosis (MCV <80 fL). After 12 months, the anemia rate in the malabsorption group (83.9 %) was higher than the control group (83.5 %). However, after 24 months, the rate of anemia in the malabsorption group (31.8%) was lower than the control group (69.5%). The malabsorption group had more micronutrient deficiencies (iron, B12, folate) than controls. Ferritin abnormalities remained comparable between the groups.

Conclusion:

The results of our study showed that patients with malabsorption syndromes experience more severe anemia and micronutrient deficiencies, particularly in iron and vitamin B12 levels. This highlights the significant influence of malabsorption on hematological conditions. These findings underscore the relevance of comprehensive evaluation for malabsorption syndromes, such as celiac disease and megaloblastic anemia, in women of reproductive age with iron deficiency anemia, as well as the importance of promptly starting treatment for malabsorption for better clinical outcomes.