Prevalence of iron deficiency in patients with mild to moderate bleeding disorders and bleeding disorder of unknown cause.

Background: Iron deficiency (ID) and ID anemia (IDA) are often caused by chronic bleeding, especially heavy menstrual bleeding, and thus may occur at a high frequency in patients with mild to moderate bleeding disorders (MBDs). Objectives: To study the prevalence of iron deficiency in mild to moderate bleeding disorders and bleeding disorder of unknown cause. Methods: The iron status of patients with MBD from the Vienna Bleeding Biobank, a prospective cohort study, was analyzed and compared with age- and sex-matched healthy controls. ID was defined as ferritin ≤30 μg/L, transferrin saturation <16%, or iron therapy at inclusion. IDA was defined as hemoglobin <12 g/dL in women and <13 g/dL in men diagnosed with ID. Results: The rates of ID and IDA were comparable between 646 patients with MBD and 118 controls, as 250 patients with MBD (39%) had ID and 40 (6%) had IDA, compared with 37 controls with ID (31%) and 6 with IDA (5%). von Willebrand disease showed a significantly higher rate of ID than controls (49%) before correction for multiple testing, while there was no significant difference between other MBD diagnoses and controls (bleeding disorder of unknown cause: 39%; platelet function disorders: 33%; and coagulation factor deficiencies: 28%). In multivariable regression, we identified female sex, younger age, and higher body mass index, but not MBD diagnoses, bleeding score, or blood group O, associated with ID. Conclusion: ID was common among MBDs, especially von Willebrand disease and female patients, but also in controls. Our data highlight the importance of assessing iron status in patients with MBDs, especially in young female individuals, regardless of the presence of bleeding symptoms.