Health Education Thames Valley, UK.
Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
Anaesthesia. 2021 Apr;76 Suppl 4:84-95. doi: 10.1111/anae.15405.
Iron deficiency and anaemia are global health problems and major causes of morbidity in women. Current definitions of anaemia in women are historic and have been challenged by recent data from observational studies. Menstrual loss, abnormal uterine bleeding and pregnancy put women at risk of developing iron deficiency which can result in severe fatigue, reduced exercise capacity and poor work performance. Iron deficiency and anaemia during pregnancy are associated with adverse maternal and fetal outcomes, including neurocognitive deficits in children born to iron-deficient mothers. Both iron deficiency and anaemia are common in women undergoing surgery but their association with poor outcomes remains uncertain. The enduring burden of iron deficiency and anaemia in women suggests that current strategies for recognition, prevention and treatment are limited in their utility. Improvements in our understanding of iron homeostasis and the development of new iron preparations, which are better absorbed with fewer side-effects, may improve therapeutic effectiveness of oral iron. Intravenous iron is efficacious for correcting anaemia rapidly but high-quality data on patient-centred outcomes and cost-effectiveness are currently lacking. Many recommendations for the treatment of iron deficiency and anaemia in national guidelines are not supported by high-quality evidence. There is a need for robust epidemiological data and well-designed clinical trials. The latter will require collaborative working between researchers and patients to design studies in ways that incorporate patients' perspectives on the research process and target outcomes that matter to them.
缺铁和贫血是全球性的健康问题，也是导致女性发病率升高的主要原因。目前女性贫血的定义是历史性的，已经受到最近观察性研究数据的挑战。月经失血、异常子宫出血和妊娠使女性面临缺铁的风险，这可能导致严重疲劳、运动能力下降和工作表现不佳。妊娠期间的缺铁和贫血与不良的母婴结局相关，包括缺铁母亲所生儿童的神经认知缺陷。缺铁和贫血在接受手术的女性中很常见，但它们与不良结局的关联仍不确定。女性缺铁和贫血的持续负担表明，目前用于识别、预防和治疗的策略在其应用上存在局限性。对铁稳态的理解的提高和新铁制剂的开发，这些制剂吸收更好、副作用更少，可能会提高口服铁的治疗效果。静脉铁对快速纠正贫血有效，但目前缺乏关于以患者为中心的结局和成本效益的高质量数据。国家指南中许多关于缺铁和贫血治疗的建议都没有高质量证据支持。需要有强有力的流行病学数据和精心设计的临床试验。后者需要研究人员和患者之间的协作，以患者对研究过程的看法和对他们重要的目标结果为设计研究的方式。
