Christine D. Lett

Heavy menstrual bleeding and iron deficiency are both commonly underrecognized and undertreated conditions. In fact, over 2 billion people globally are iron deficient. Iron deficiency disproportionately impacts reproductive-aged women and negatively impacts their quality of life. The most common etiology of iron deficiency anemia in premenopausal women is excessive menstruation. Heavy menstrual bleeding is defined as excessive menstrual blood loss, which interferes with a woman’s quality of life. Heavy menstrual bleeding is one of the most common reasons for gynecologic consultation, and impacts one-third of reproductive-aged women. Improving the quality of life for women with heavy menstrual bleeding requires recognizing the condition, identifying its cause, ruling out iron deficiency, and tailoring treatment to reduce menstrual blood loss and replenish iron stores.

Background: Spot-check hemoglobin co-oximetry analyzers measure hemoglobin transcutaneously and offer the benefit of a hemoglobin measurement without phlebotomy. The objective of this study was to determine the validity of non-invasive spot-check hemoglobin co-oximetry testing for the detection of postpartum anemia (hemoglobin < 10 g/dL). Methods: Five hundred eighty-four women aged 18 and over were recruited on postpartum day one following a singleton delivery. Two non-invasive spot-check hemoglobin co-oximetry monitors, Masimo Pronto Pulse CO-Oximeter (Pronto) and Masimo Rad-67 Pulse CO-Oximeter (Rad-67), were evaluated and compared to the postpartum phlebotomy hemoglobin value. Results: Of 584 participants, 31% (181) had postpartum anemia by phlebotomy hemoglobin measurement. Bland–Altman plots determined a bias of + 2.4 (± 1.2) g/dL with the Pronto and + 2.2 (± 1.1) g/dL with the Rad-67. Low sensitivity was observed: 15% for the Pronto and 16% for the Rad-67. Adjusting for the fixed bias, the Pronto demonstrated a sensitivity of 68% and specificity of 84%, while the Rad-67 demonstrated a sensitivity of 78% and specificity of 88%. Conclusion: A consistent overestimation of hemoglobin by the non-invasive spot-check hemoglobin co-oximetry monitors compared to phlebotomy hemoglobin result was observed. Even after adjusting for the fixed bias, the sensitivity for detecting postpartum anemia was low. Detection of postpartum anemia should not be based on these devices alone.