Guideline Video

Guideline Resources

  • Laboratory Screening of Iron Deficiency With and Without Anemia in the Inherited Bleeding Disorders Population
  • National Bleeding Disorders Foundation
  • March 9, 2026
  • Summary
  • Full-text

Video Transcription

Just published March 9th, 2026, the National Bleeding Disorders Foundation’s newest guideline on Laboratory Screening of Iron Deficiency With and Without Anemia in the Inherited Bleeding Disorders Population. 

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.

In today’s rapid update, we’ll just be going over a summary of the recommendations so for the full guideline, make sure to check it out on guidelinecentral.com

Let’s get started.

Starting with the section on The Impact of Iron Deficiency

  • The document recommends that all individuals with an inherited bleeding disorder should be routinely and periodically screened for iron deficiency and anemia irrespective of sex, age, or bleeding disorder severity
  • The document recommends a multi-disciplinary approach to laboratory testing for iron deficiency and anemia including collaboration between primary care providers and specialists to ensure timely diagnosis, monitoring, and resolution of iron deficiency.

Next the section on Frequency of Laboratory Screening for Iron Deficiency and Anemia,

  • The document recommends that laboratory screening for iron deficiency and anemia should be performed annually in all individuals with an inherited bleeding disorder at all ages.
  • The document recommends additional laboratory screening for iron deficiency and anemia during high-risk settings when clinically indicated in all individuals with inherited bleeding disorders.
  • The document recommends that laboratory screening for iron deficiency and anemia should be performed at any time an individual with an inherited bleeding disorder presents with signs or symptoms suggestive of iron deficiency with or without anemia.
  • The document recommends that laboratory screening for iron deficiency and anemia should be considered prior to the transition of adolescents and young adults with inherited bleeding disorders to adult providers if not previously performed.

Then the section on Risk of Iron Deficiency During Pregnancy and Postpartum in the Inherited Bleeding Disorders Population

  • The document recommends that individuals with inherited bleeding disorders should be screened for iron deficiency and anemia prior to conception, at least once in the first trimester, and again during the second or third trimester of pregnancy.
  • The document recommends that individuals with inherited bleeding disorders should be screened for iron deficiency and anemia after delivery and at 6–12 weeks postpartum.

Moving on to the section on Recommended Tests for Laboratory Screening of Iron Deficiency and Anemia

  • In individuals with inherited bleeding disorders, the document recommends that laboratory screening should include testing for anemia and iron studies.
  • The document recommends a hemoglobin level < 13 g/dL as the cut-off for diagnosing anemia in males and females with inherited bleeding disorders.
  • The document recommends a ferritin level of < 50 ng/mL as the cut-off for diagnosing iron deficiency in males and females with inherited bleeding disorders at all ages.
  • The document recommends that the levels and pattern of the iron studies are evaluated collectively with the hemoglobin and reticulocyte count to confirm the diagnosis of iron deficiency and anemia.

Next the section on Diagnostic Considerations for Laboratory Screening

  • The document recommends that other causes of anemia are considered if 1) the laboratory pattern of iron indices is not consistent with iron deficiency, 2) the individual is not responsive to iron replacement therapy, or 3) there are additional signs/symptoms concerning for alternative causes of anemia when accounting for the individual's medical and/or family history.
  • If another cause of anemia or specific site of blood loss is identified, the document recommends subspecialty consultation where applicable and further diagnostic evaluation per standards of care.
  • The document recommends that diagnostic VWF panels and platelet function testing are performed in the non-anemic state, if possible. If anemia is present at the time of initial testing, repeat testing is recommended once the anemia is corrected.

And last the section on Management of Iron Deficiency and Anemia

  • The document recommends that iron replacement with oral or IV iron formulations should be implemented in a timely manner once iron deficiency with or without anemia has been identified.
  • During second and third trimester of pregnancy, the document recommends iron replacement with IV iron formulations over oral iron formulations for rapid correction of iron deficiency in individuals with inherited bleeding disorders.
  • The document recommends that the response to treatment should be monitored until resolution of iron deficiency and anemia, with repeated treatment as necessary.
  • The document recommends assessment for the need of supportive measures or hemostatic therapies to prevent chronic blood loss and iron deficiency in the inherited bleeding disorders population.
  • The document recommends addressing any other risk factors that may be contributing to iron deficiency and anemia when applicable.

And there you have it. Make sure to check out the full guideline from the National Bleeding Disorders Foundation and other related clinical decision support tools at guidelinecentral.com.

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