Management of iron deficiency in women in Scotland

TO THE EDITOR:

I write in response to the recent publication by Fingrut et al,¹ which highlights the need for studies reporting health equity in the field of hematology, in particular, iron deficiency. I present recent health equity observations evaluating iron deficiency management for reproductive-aged women across Scottish National Health Service (NHS) health boards.

On 31 August 2023, data on iron deficiency management were requested from the 14 NHS Scotland health boards in accordance with the Freedom of Information (Scotland) Act 2022. The survey questioned whether health boards provided routine iron deficiency screening for reproductive-aged women and the diagnostic criteria used to identify iron deficiency.

Of the 13 responding health boards, no board reports providing routine iron deficiency screening for women during their reproductive years, although anemia and consequent iron deficiency screening is routinely conducted for either/both obstetric patients and those undergoing major surgery across all 13 health boards.

The standard diagnostic criteria operated by each board to define iron deficiency ranged from a ferritin level <45 μg/L to a ferritin level <10 μg/L (see table). Standard diagnostic criteria of ferritin <30μg/L was used by 6 boards²; 2 boards lowered the diagnostic criteria specifically for women; 1 board lowered the diagnostic threshold based on menstruation status; and 2 boards did not use specific diagnostic criteria (see table).

Despite iron deficiency affecting 40% of women of reproductive age,³ there is an evident lack of consensus regarding diagnostic criteria across the health boards. Substantial guidance on iron deficiency screening can be found in specific at-risk groups: obstetrics, renal failure, cardiac failure, and inflammatory bowel disease. There is however a distinct lack of guidance available for women of reproductive age.⁴ There is a need for clear guidance to be provided to the health boards to ensure equal and appropriate access to iron deficiency treatment is available for women across Scotland.

Contribution: B.M. instigated the project, collected and analyzed data, and wrote the corresponding letter.

Conflict-of-interest disclosure: B.M. declares no competing financial interests.

Correspondence: Beth MacLean, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, 6009, WA, Australia; email: beth.maclean@research.uwa.edu.au.