Transfusion Practices and Hematologic Recovery in Adolescents With Heavy Menstrual Bleeding and Anemia: A Retrospective Cohort Study.

OBJECTIVE: To evaluate transfusion practices and short-term hematologic recovery in adolescents presenting with heavy menstrual bleeding (HMB) and hemoglobin levels <10 g/dL, with particular focus on changes in hemoglobin and iron stores during follow-up. METHODS: This retrospective cohort study included adolescents aged 10-19 years who presented with HMB and anemia (hemoglobin <10 g/dL) at a tertiary referral center between January 2020 and January 2023. Follow-up clinical and hematologic data were analyzed when available. Clinical characteristics, laboratory findings, treatments, transfusion practices, and follow-up data were obtained from medical records. Changes in hemoglobin (ΔHb) and ferritin (ΔFerritin) were assessed. Multivariate logistic regression was used to identify factors associated with transfusion. RESULTS: Ninety-four adolescents were included (mean age 14.5±2.0 years), with a mean hemoglobin level at presentation of 7.47±1.63 g/dL. Blood transfusion was administered to 34 patients (36.2%). Lower hemoglobin levels at presentation and active bleeding were independently associated with transfusion. Follow-up hemoglobin measurements were available in 81 patients, with a mean increase of 3.28±1.91 g/dL during follow-up. The mean interval between hemoglobin measurements was 47.33±37.30 days. Although transfused patients showed greater hemoglobin increases in univariate analysis, transfusion was not independently associated with hemoglobin change after adjustment, whereas baseline hemoglobin level remained the only significant predictor of ΔHb. Baseline ferritin measurements were available in 76 patients, of whom 93.4% had ferritin levels <15 µg/L. Ferritin recovery lagged behind hemoglobin improvement, indicating slower restoration of iron stores during follow-up. CONCLUSION: Adolescents with HMB demonstrated substantial hemoglobin recovery during follow-up. However, restoration of iron stores appeared to occur more gradually, emphasizing the need for continued follow-up beyond hemoglobin normalization. While transfusion may be necessary in selected cases, it does not appear to independently determine hematologic recovery, supporting individualized transfusion strategies.