15. Assessment of Iron Status in Adolescents Presenting to the Emergency Department with Heavy Menstrual Bleeding

Background Heavy menstrual bleeding (HMB) is experienced by many adolescents and often leads to iron deficiency (ID), which can decrease quality of life. The purpose of this study was to evaluate whether adolescent patients who present to the Emergency Department (ED) with HMB are appropriately screened and treated for ID, rather than only for anemia. Methods This was a retrospective study with IRB approval. Data was gathered from an Emergency Department and Inpatient Unit at a National Tertiary Care Hospital from 2006-2018 on adolescents aged 11-19 years with ICD-9 and 10 codes for HMB. Pregnant patients were excluded. Data included patient demographics, presenting symptomatology, past medical history, BMI, diagnosis of bleeding disorder, labs ordered and their results, treatments rendered, documented diagnosis of etiology of bleeding at time of presentation to the ED, and whether there was admission to the hospital. The main outcome measure was evaluating the number of adolescents who had iron evaluation through serum ferritin testing and how many of these met laboratory criteria for ID. ID was defined as serum ferritin Results There were 258 adolescents who sought care for HMB in the ED, 225 (87.2%) of whom were evaluated with serum hemoglobin testing. Ninety-three (41.6%) of those tested were anemic. Only 23 (8.9%) of the 258 patients had serum ferritin testing performed. Of these, 18/23 (78.3%) were iron deficient and 21/23 (92.3%) were anemic. Patients presenting with fatigue, lightheadedness, headache, shortness of breath, and/or palpitations were more likely to have iron studies performed than those without these symptoms (p Conclusions Adolescents presenting to the ED with HMB are at significant risk of ID but are not appropriately screened or treated, which can have substantial consequences for their health and quality of life.