National Bleeding Disorder Foundation Clinical Practice Recommendations for Laboratory Screening of Iron Deficiency With and Without Anemia in the Inherited Bleeding Disorders Population

INTRODUCTION: The National Bleeding Disorder Foundation (NBDF) Medical and Scientific Advisory Council (MASAC) was formed in 1954 and issues recommendations and advisories pertinent to the bleeding disorders community. MASAC is comprised of > 25 rotating members from different medical disciplines and lived experience experts. AIM: The Iron Deficiency Taskforce was formed to address the concern for undertreatment and misdiagnosis of iron deficiency with and without anemia in the inherited bleeding disorder community. Members included MASAC members and individuals outside of MASAC with clinical, research, and lived experience expertise and/or interest in iron deficiency and screening in the bleeding disorders community. Currently, there are no published standardized approaches, guidelines, or recommendations that address iron deficiency screening for a population of individuals at high risk of experiencing iron deficiency and its associated complications METHOD: Due to the limited published peer-reviewed data on the prevalence of iron deficiency and anemia in this population, this document was devised by consensus recommendations amongst members of the Iron Deficiency Taskforce with additional review and feedback from all MASAC members. RESULT: This document identifies individuals within the inherited bleeding disorder population at risk for iron deficiency with and without anemia providing consensus recommendations on indications for screening, approach to screening, and general management considerations if iron deficiency and anemia are identified. Recommendations for higher hemoglobin (< 13 g/dL) and ferritin (< 50 ng/mL) thresholds for anemia and iron deficiency diagnoses, respectively, are also discussed. CONCLUSION: Further research is necessary to understand the impact of iron deficiency in inherited bleeding disorders.