Iron deficiency anaemia in menstruating females

Patient

Q: I am anemic due to menstrual complications (5 months long, obgyn can't find any reason for it). I am short of breath, dizzy, tired, weak, can't go from room to room without feeling like I am going to pass out, and frankly I am scared. My hemoglobin count is 9.1. At what point should I be seriously concerned? Is this level of hemoglobin not really something to worry about?

Doctor

A:   Iron deficiency anaemia is common in menstruating females, due to excessive loss of blood in heavy periods. Treatment is aimed at identifying the underlying cause and managing blood loss by menstruation in your case. If excessive menstruation is not controlled, you will continue to be anaemic even with adequate intake of iron. Treatment of iron-deficiency anaemia is with oral iron, intravenous iron and blood transfusion. The latter treatments are reserved for those with severe intolerance to oral iron or haemodynamic instability (abnormal pulse and blood pressure). On commencement of iron supplementation the hemoglobin concentration should rise slowly, usually beginning after about one to two weeks of treatment, and will rise approximately 2 g/dL over the ensuing three weeks. The hemoglobin deficit should be halved by about one month and should return to normal by 6 to 8 weeks. A haemoglobin of 9.1g/dL is low but not sufficiently low to warrant transfusion.

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