title: Intravenous iron therapy in non-anemic iron-deficient menstruating adolescent females with fatigue.
abstract: Menstruating women, with or without underlying bleeding disorders, are at increased risk for developing iron deficiency-related fatigue, even in the absence of anemia. Oral iron therapy has limitations which include poor absorption and non-adherence due to gastrointestinal side effects. We performed a prospective clinical trial of post-menarchal adolescent females with iron-deficiency with or without mild anemia and fatigue who received a standardized regimen of intravenous iron sucrose. The baseline mean (SD) hemoglobin was 11.96 g dl(-1) (1.05) in 20 girls (ages 14-21 years); with a range of 10.3-14.1 g dl(-1) . In this cohort, intravenous iron was well tolerated and patients demonstrated a sustained increase in ferritin levels with means (SD) of 13.4 ng ml(-1) (13.1) at baseline to 141.5 ng ml(-1) (104.5) at 6 weeks and 85.2 ng ml(-1) (128.4) at 6 months after the infusions. We used a standardized (Peds QL(TM) Multidimensional) fatigue scale to objectively measure fatigue and proxy scores by parents with mean screening scores (SD) of 35.2 (16.8) and 31.9 (19.6), respectively. We demonstrated a clinically significant improvement both in patient as well as parent fatigue scores (in 19 out of 20 subjects) at 6 weeks (Mean (SD) 58.3 (21.3) [P < 0.0001] and 57 (24.4) [P < 0.0001], respectively); as well as 3 and 6 months after the iron infusions. In nonanemic patients, iron administration did not significantly influence hemoglobin concentration. Therefore, the fatigue-reducing effects of iron therapy reflect the nonhematological functions of iron. Am. J. Hematol. 91:973-977, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Hematology/Oncology/Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio.|Department of Pediatrics, the Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Ruchika
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Division of Hematology/Oncology/Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Stanek
authors.affiliation: Division of Hematology/Oncology/Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Terah L
authors.initials: TL
authors.lastname: Koch
authors.affiliation: Division of Hematology/Oncology/Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Linda
authors.initials: L
authors.lastname: Grooms
authors.affiliation: Division of Hematology/Oncology/Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio. sarah.o'brien@nationwidechildrens.org.|Department of Pediatrics, the Ohio State University College of Medicine, Columbus, Ohio. sarah.o'brien@nationwidechildrens.org.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: O'Brien
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D018798:Anemia, Iron-Deficiency; D005221:Fatigue / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000008:administration & dosage*; D000090463:Iron Deficiencies; D008598:Menstruation / Q000097:blood; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D005293:Ferritins; D007501:Iron