IRON DEFICIENCY AND ANAEMIA IN ADOLESCENTS: DIAGNOSTIC CRITERIA AND THE PATIENT BLOOD MANAGEMENT PATHWAY

Abstract

Introduction: Adolescence (10–19 years) is a period of rapid growth and pubertal maturation during which haemoglobin values differ by sex and iron requirements increase, particularly after menarche. Because iron deficiency often develops before haemoglobin falls below diagnostic thresholds, a haemoglobin-only approach may underestimate depleted haematological reserves.

Aim: To present practical criteria for anaemia and iron deficiency in adolescence and translate them into a feasible patient blood management (PBM) clinical pathway for routine practice.

Methods: A narrative review of key international guidelines and selected recent publications, focusing on three interpretive domains: iron stores, iron availability for erythropoiesis, and the confounding effect of inflammation.

Results: Clinically significant iron deficiency frequently exists without overt anaemia, especially in adolescent girls. Therefore, the minimum laboratory work-up should extend beyond the complete blood count to include serum ferritin and transferrin saturation, with C-reactive protein when inflammation is suspected, to avoid falsely elevated ferritin. Heavy menstrual bleeding is the most practical trigger for early evaluation and treatment; additional high-risk situations include chronic inflammatory diseases and malabsorption.

Conclusion: PBM in adolescence is most effective when implemented through early risk recognition, confirmation of iron deficiency and its cause, timely initiation of iron therapy, and documentation of response until iron stores are replenished. Red blood cell transfusion should be reserved for clearly indicated acute conditions and should not substitute for delayed aetiological management.