Irish journal of medical science · 2026
Low-dose iron therapy during menstruation to prevent recurrence of iron deficiency anaemia: the role of RDW in monitoring.
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Irmak Kaya Zeynep, Sağdıç Abdülkadir, Görmez Fatma Nur, Kılıç Mesut, Konur Kamil, Hamarat Hatice, Tali Özge Alkan, Gürcü Sinem, Keskin Nadi, Kaya Berrin Yalınbaş, Özgeyik Müfide
Аннотация
BACKGROUND: To evaluate the efficacy of maintenance iron therapy focused on the menstrual period in preventing anaemia recurrence in women of reproductive age and to examine the accuracy of red cell distribution width (RDW) change in predicting recurrence.
AIM: To evaluate the efficacy of low-dose iron supplementation administered only during menstruation in preventing recurrence of iron deficiency anaemia and to assess the predictive value of RDW dynamics for early detection of relapse.
METHODS: One hundred and twenty-four female patients who had completed treatment for iron deficiency anaemia (IDA) were divided into maintenance (n = 62) and control (n = 62) groups using Propensity Score Matching (PSM). The maintenance group received only 100 mg of elemental iron during menstruation; the control group was followed without treatment. Patients were followed up for 12 months in terms of haematological parameters.
RESULTS: At the end of the twelve-month follow-up, the anaemia recurrence rate was determined to be 8.1% in the maintenance group and 32.3% in the control group (p < 0.001). The maintenance strategy reduced the risk of recurrence by 78% (HR: 0.22; 95% CI: 0.08-0.58). While a progressive decrease in ferritin levels and a marked increase in RDW values were observed in the control group, the parameters remained stable in the maintenance group. ROC analysis determined that a ≥ 0.8% relative increase in RDW predicted anaemia recurrence (Hb < 12 g/dL) approximately three months in advance with 82% sensitivity and 90% specificity (AUC: 0.89). In multivariate analysis, not receiving maintenance therapy and a baseline RDW > 14.8% were identified as independent risk factors.
CONCLUSIONS: Low-dose maintenance iron therapy synchronised with the menstrual cycle is highly effective in preventing IDA recurrence. RDW, a routine haematological parameter, is a dynamic and inexpensive biomarker that reflects depletion of iron stores months before a decrease in haemoglobin. This proactive approach offers clinicians an important intervention opportunity in the management of chronic iron deficiency.
AIM: To evaluate the efficacy of low-dose iron supplementation administered only during menstruation in preventing recurrence of iron deficiency anaemia and to assess the predictive value of RDW dynamics for early detection of relapse.
METHODS: One hundred and twenty-four female patients who had completed treatment for iron deficiency anaemia (IDA) were divided into maintenance (n = 62) and control (n = 62) groups using Propensity Score Matching (PSM). The maintenance group received only 100 mg of elemental iron during menstruation; the control group was followed without treatment. Patients were followed up for 12 months in terms of haematological parameters.
RESULTS: At the end of the twelve-month follow-up, the anaemia recurrence rate was determined to be 8.1% in the maintenance group and 32.3% in the control group (p < 0.001). The maintenance strategy reduced the risk of recurrence by 78% (HR: 0.22; 95% CI: 0.08-0.58). While a progressive decrease in ferritin levels and a marked increase in RDW values were observed in the control group, the parameters remained stable in the maintenance group. ROC analysis determined that a ≥ 0.8% relative increase in RDW predicted anaemia recurrence (Hb < 12 g/dL) approximately three months in advance with 82% sensitivity and 90% specificity (AUC: 0.89). In multivariate analysis, not receiving maintenance therapy and a baseline RDW > 14.8% were identified as independent risk factors.
CONCLUSIONS: Low-dose maintenance iron therapy synchronised with the menstrual cycle is highly effective in preventing IDA recurrence. RDW, a routine haematological parameter, is a dynamic and inexpensive biomarker that reflects depletion of iron stores months before a decrease in haemoglobin. This proactive approach offers clinicians an important intervention opportunity in the management of chronic iron deficiency.