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Shannon Brasil
Nurse Practitioner, Women’s Excellence ObGyn
Shannon Brasil, MSN, NP, ANP-BC, works at the Menopause Center of Excellence in Lake Orion, Michigan. She completed her master’s degree in nursing at Wayne State University and is a member of the International Society for the Study of Women’s Sexual Health, the Menopause Society, and the National Association of Nurse Practitioners in Women’s Health. Shannon’s expertise was pivotal in opening one of the first freestanding menopause clinics in Oakland County, and throughout her career, she has served as a consultant for Bonafide health and contributed to many publications on women’s health topics, including reducing heart disease risk during and after menopause, misconceptions about weight management, and perimenopausal nutrition. For more than 20 years, Shannon served as a mentor and preceptor for nurse practitioner students.
Racial Disparities in Anemia Screening Among Pregnant Women
Iron deficiency anemia (IDA) during pregnancy is prevalent in the US, with a rate of 18%. This study aims to investigate the screening practices for anemia among pregnant women at the University of Michigan (UM) and explore potential racial disparities in these practices.
The study, which included 16,073 pregnant women who received prenatal care at UM, found that while screening for anemia was common, Caucasian women were slightly more likely to be screened than African American women (98.88% vs. 97.47%). Anemia was more prevalent among African American women (39.79%) compared to Caucasian women (21.41%). Additionally, African American women had a lower mean hemoglobin (Hgb) and mean corpuscular volume than Caucasian women. Despite low testing rates for iron deficiency with ferritin or transferrin saturation, nearly one-third of the women received iron supplementation, with African American women more likely to be prescribed iron than Caucasian women (45.65% vs. 28.81%). These findings highlight the need for further research to determine the effectiveness of empirically prescribing iron supplements without thorough laboratory workup and to address the disparities in anemia screening and management.
Reference: Shevell L, Sood S. Racial Disparities in Screening and Management of Anemia Among Pregnant Women. Blood. 2022;140 Suppl 1: 7979–7980. doi: 10.1182/blood-2022-169188.
Shannon Brasil
MSN, NP, ANP-BC
Managing Anemia: Diagnosis, Treatment, and Collaboration
Anemia, marked by low red blood cell count or hemoglobin levels, affects millions globally, primarily due to iron deficiency. Diagnosis involves routine exams and complete blood count (CBC) testing, with further assessments necessary to pinpoint the type and cause. Microcytic anemia, characterized by small red blood cells, often indicates iron deficiency and requires additional tests like serum ferritin. Normocytic anemia, featuring normal-sized cells, may stem from chronic disease or acute bleeding, prompting evaluations like reticulocyte counts. Macrocytic anemia, with larger cells, is typically linked to deficiencies in vitamin B12 or folate, often associated with malabsorption or alcoholism. Treatment targets the underlying cause, such as iron or vitamin supplementation.
Managing anemia in primary care entails identifying its root cause using patient history, physical exams, and CBC results. Educating patients about anemia signs, diagnostics, and treatment is essential, tailored to specific types and causes. Collaboration between primary care providers and specialists ensures comprehensive care, with personalized treatment plans for each patient.
Reference: O'Neil J. Diagnosing and Classifying Anemia in Adult Primary Care. Clinician Reviews. 2016;26(1), 29-34.
Shannon Brasil
MSN, NP, ANP-BC
Efficient Anemia Supplements: What to Look For?
Anemia, a common condition, requires supplements that are effective, gentle on the stomach, and contain the right ingredients in the correct proportions. With numerous anemia supplements on the market making various claims, it's important for consumers to identify which ones actually deliver results and are worth the money. Many products lack transparency about their ingredient dosages, leading to potential ineffectiveness. This has led to detailed guidelines on what to look for in a high-quality anemia supplement, emphasizing natural, easily digestible formulations.
Criteria such as third-party monitoring, a risk-free money-back guarantee, and third-party testing were set to ensure product quality and efficacy. This thorough assessment aimed to eliminate ineffective and overpriced options, focusing on supplements that provide clinically effective doses of essential nutrients like iron bisglycinate chelate, vitamin B12, folate, and absorption enhancers like BioPerine; however, only a select few met these strict standards, highlighting that while many supplements exist, few are properly formulated to manage anemia effectively.
Reference: Murphy E. Is Your Anemia Supplement Effective? Consumer Review. Accessed June 5, 2024. https://consumereview.org/reviews/anemia/?msclkid=
Shannon Brasil
MSN, NP, ANP-BC
Study Reveals Challenges in Treating Iron Deficiency Anemia in Autistic Children
Children with autism spectrum disorder (ASD) often encounter feeding difficulties, which can lead to various nutritional deficiencies, including iron deficiency anemia (IDA). These feeding problems are typically due to behavioral issues and food aversions common among children with ASD. Pediatric nurse practitioners play a crucial role in assessing these children for mineral deficiencies and need to be vigilant about the potential complexities in managing IDA in this population.
A case study of a 4-year-old child with ASD illustrates the challenges in treating IDA when the usual oral iron supplements do not suffice. Despite adherence to standard iron supplementation protocols, the child continued to exhibit signs of persistent IDA, prompting a review of other possible causes for the anemia and a reevaluation of treatment strategies. The study underscores the necessity for tailored management approaches in handling IDA in children with ASD, considering their unique behavioral and dietary challenges.
Reference: Burd E, Doyle EA. Challenges in the Treatment of Iron Deficiency Anemia in a Child With Autism Spectrum Disorder: A Case Study. J Pediatr Health Care. 2019 Sep-Oct;33(5):578-584. doi: 10.1016/j.pedhc.2018.11.010. Epub 2019 Jan 23. PMID: 30683579.
Shannon Brasil
MSN, NP, ANP-BC
Anemia: Filling the Data Gaps to Better Help Children and Women
A study looked at anemia as a major public health concern, especially affecting young children, menstruating adolescent girls and women, and pregnant women, as well as related data needs. The most common underlying physiological mechanisms of anemia, researchers noted, are ineffective erythropoiesis (ie, inadequate production of erythrocytes), hemolysis (ie, erythrocytes are destroyed), and blood loss. Iron deficiency is the most common cause of anemia globally.
Researchers highlighted gaps in knowledge on the causes and risk factors of anemia, including a lack of data on anemia in many countries, especially in low- and middle-income countries. Even in countries with data, the data is often not collected on a regular basis or in a standardized way. Strategies to improve the use of existing data and collect new relevant data were also presented, including conducting national surveys on anemia in countries with little or no data, collecting data on anemia in all population groups, not just children and women of reproductive age, and sharing data and biospecimens between countries and researchers.
Reference: Hess SY, Owais A, Jefferds MED, et al. Accelerating action to reduce anemia: Review of causes and risk factors and related data needs. Ann N Y Acad Sci. 2023 May;1523(1):11-23. doi: 10.1111/nyas.14985. Epub 2023 Mar 29. PMID: 36987993; PMCID: PMC10918744.
Shannon Brasil
MSN, NP, ANP-BC
Limited Progress in Combating Anemia, Multifaceted Approaches Needed
A study noted that, despite efforts, progress in reducing anemia has been slow, with only a slight decrease in prevalence over two decades. The prevalence in women of reproductive age even increased slightly between 2012 and 2019. Anemia's complexity arises from various causes, including nutritional deficiencies, infections (such as malaria and HIV), inherited blood disorders, and factors related to women's reproductive biology. The study found that interventions such as dietary improvements, food fortification, malaria control, and reproductive health have shown efficacy in improving hemoglobin concentrations and reducing anemia prevalence. The implementation of these strategies requires coordinated efforts across multiple sectors, high-quality service delivery, and the use of diverse platforms like antenatal care, community events, and schools. Despite the availability of effective interventions and delivery platforms, gaps remain in policy and program implementation, highlighting the need for comprehensive, context-specific, and integrated approaches to effectively address the global burden of anemia.
Reference: Mildon A, Lopez de Romaña D, Jefferds MED, et al. Integrating and coordinating programs for the management of anemia across the life course. Ann N Y Acad Sci. 2023 Jul;1525(1):160-172. doi: 10.1111/nyas.15002. Epub 2023 May 17. PMID: 37194608; PMCID: PMC10918752.
Shannon Brasil
MSN, NP, ANP-BC
A Look Into the Diagnosis and Management of Iron Deficiency Anemia
A recent study reviewed the evaluation and management of iron deficiency anemia. Diagnosis typically involves confirming anemia alongside evidence of low iron stores, often assessed through serum ferritin levels. While anemia is common in pregnant women and children, screening recommendations vary. Treatment strategies encompass oral iron therapy as the first-line approach, with parenteral therapy reserved for those unable to tolerate or absorb oral supplements. Follow-up involves monitoring blood counts periodically, with transfusions considered in severe cases, especially in pregnant women with significantly low hemoglobin levels.
Men and postmenopausal women with anemia should undergo endoscopic evaluation to rule out gastrointestinal bleeding. In premenopausal women, gynecologic causes should be considered, with further investigation warranted if initial treatments fail. Treatment involves addressing the underlying cause and administering oral or parenteral iron therapy based on individual needs.
Reference: Short MW, Domagalski JE. Iron deficiency anemia: evaluation and management. Am Fam Physician. 2013 Jan 15;87(2):98-104. PMID: 23317073.
Shannon Brasil
MSN, NP, ANP-BC
AGA Guidelines for Iron Deficiency Anemia: Diagnosis and Management Strategies
Iron deficiency anemia (IDA) is prevalent worldwide, affecting 3% of adults and more commonly observed in women under 50. The American Gastroenterological Association (AGA) provides guidelines for its assessment in adults, emphasizing ferritin levels below 45 ng/mL for diagnosis and recommending noninvasive testing for H. pylori and celiac disease alongside bidirectional endoscopy.
Key aspects of management include diagnosing iron deficiency through serum ferritin testing and addressing associated conditions like H. pylori infection and celiac disease, which can impair iron absorption. Bidirectional endoscopy is recommended for men, postmenopausal women, and premenopausal women with IDA, although routine gastric biopsies are not advised. Oral iron supplementation is the mainstay treatment, with intravenous iron considered for specific cases such as malabsorption or chronic kidney disease.
Reference: Sonoda K. Iron Deficiency Anemia: Guidelines from the American Gastroenterological Association. Am Fam Physician. 2021 Aug 1;104(2):211-212. PMID: 34383429.
Shannon Brasil
MSN, NP, ANP-BC
Anemia Prevalence High Among Women and Girls: Urgent Need for Better Screening
Anemia, a common blood disorder affecting millions, is particularly prevalent among women and girls due to various factors such as menstruation, poor nutrition, and underlying health conditions. A 2023 JAMA study revealed that nearly 40% of nonpregnant US females aged 12 to 21 are iron deficient, with 6% developing iron-deficiency anemia. During pregnancy, these risks increase further. Despite its widespread impact, anemia often goes undiagnosed due to vague symptoms and inadequate screening, leading to severe health consequences if left untreated.
Screening for anemia is crucial, with the Centers for Disease Control recommending checks every five to ten years for nonpregnant women and teen girls. Diagnosis involves blood tests to measure hemoglobin levels and red blood cell counts. Treatment typically includes addressing underlying conditions, iron supplements, and dietary changes to include iron-rich foods. Experts emphasize the importance of awareness and proactive health management to prevent anemia from causing chronic fatigue, irregular heart rhythms, and other severe complications.
Reference: Pelham V. Anemia: A Barrier to Women’s Health. Cedars-Sinai. Published Dec 22, 2023. Accessed July 9, 2024. https://www.cedars-sinai.org/blog/anemia-a-barrier-to-womens-health.html
Shannon Brasil
MSN, NP, ANP-BC
The Importance of Addressing Iron in Maternal-Fetal Medicine
In a single-blinded, randomized controlled trial involving young women with overweight/obesity and iron deficiency anemia, a weight loss intervention over three months led to significant reductions in body weight and improvements in iron status markers. The intervention group, who received tailored energy-restricted diets and individual consultation sessions with a dietitian, experienced notable increases in hemoglobin, serum ferritin, and serum iron. The intervention group also experienced decreases in high-sensitivity C-reactive protein and serum hepcidin level by the end of the trial.
These findings suggest that diet-induced weight loss can positively impact iron status and related clinical markers in young women with overweight/obesity and iron deficiency anemia. The study underscores the potential of tailored energy-restricted diets and individualized consultation sessions with a dietitian in improving both weight management and iron status among this population, highlighting the importance of holistic approaches to health interventions.
Reference: Alshwaiyat NM, Ahmad A, Al-Jamal HAN. Effect of diet-induced weight loss on iron status and its markers among young women with overweight/obesity and iron deficiency anemia: a randomized controlled trial. Front Nutr. 2023 May 22;10:1155947. doi: 10.3389/fnut.2023.1155947. PMID: 37284649; PMCID: PMC10240069.
Shannon Brasil
MSN, NP, ANP-BC
Understanding Anemia: Symptoms, Causes, and Importance of Timely Intervention
Anemia, characterized by a deficiency of healthy red blood cells or hemoglobin, can lead to fatigue, weakness, and shortness of breath due to insufficient oxygen delivery to tissues. Its various forms stem from diverse causes, spanning from short-term to chronic, mild to severe. Often serving as a harbinger of underlying health issues, anemia necessitates prompt attention and treatment, which may involve supplements, medical procedures, or dietary adjustments.
Symptoms of anemia vary depending on its severity and cause, with manifestations such as fatigue, weakness, pale skin, irregular heartbeat, and headaches. However, some cases may initially present no symptoms or have symptoms masked by underlying conditions. Therefore, it's essential to seek medical attention if experiencing unexplained fatigue or breathlessness. Low hemoglobin levels, detected through blood tests or donor screenings, serve as a primary indicator of anemia and should prompt further medical evaluation to address potential underlying health concerns.
Reference: Mayo Clinic Staff. Anemia. Mayo Clinic. Updated May 11, 2023. Accessed April 16, 2024. https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360
Shannon Brasil
MSN, NP, ANP-BC
Iron-Deficiency Anemia in Women: An Asian Expert Consensus
The lack of standardized clinical practices for managing iron deficiency (ID) and iron deficiency anemia (IDA) in women poses a significant challenge globally, particularly in the Asia-Pacific region. To address this concern, a Delphi consensus process was employed to determine best practices. Experts rated their agreement with 99 statements across four domains in two rounds. Consensus was achieved for 84% of the statements, with agreement on the significance of symptoms and risk factors in prompting assessments, the importance of preventive iron supplementation for pregnant women and those in high-prevalence areas, and the use of oral ferrous iron as first-line therapy for uncomplicated ID/IDA. Recommendations and clinical pathway algorithms generated from this process aim to standardize care for women at risk or presenting with ID/IDA in the Asia-Pacific region, highlighting the critical role of obstetrician-gynecologists in their identification, diagnosis, and management.
Patient involvement in decision-making around iron supplementation was emphasized to improve adherence and clinical outcomes. These consensus statements represent an important step towards standardizing care for women with ID/IDA and should be periodically reviewed to align with evolving medical literature and international guidelines, ensuring consistency in clinical practice within the region.
Reference: Pai RD, Chong YS, Clemente-Chua LR, et al. Prevention and Management of Iron Deficiency/Iron-Deficiency Anemia in Women: An Asian Expert Consensus. Nutrients. 2023 Jul 13;15(14):3125. doi: 10.3390/nu15143125. PMID: 37513543; PMCID: PMC10383547.
Shannon Brasil
MSN, NP, ANP-BC
New Strategies Needed to Combat Widespread Anemia, Especially in Women
Researchers analyzed iron deficiency (ID) and iron deficiency anemia (IDA)–common health issues affecting two billion people worldwide, particularly prevalent among women of reproductive age. Traditional treatment has relied on oral iron supplementation, which often yields less-than-ideal results, and there is a growing concern about the number of babies born with ID due to inadequate maternal iron levels. The wide prevalence of anemia among women varies regionally, from around 20% in the United States and Western Europe to much higher rates in parts of Africa and Asia. The key to addressing ID and IDA, researchers note, lies in understanding their interconnections and root causes, which often involve a combination of physiological demands, socioeconomic factors, and healthcare access issues. With the current treatments being insufficient for many, there is a growing need for more effective strategies, including the possibility of scaling up parenteral iron supplementation as a new standard of care.
Reference: Bellad MB, Patted A, Derman RJ. Is It Time to Alter the Standard of Care for Iron Deficiency/Iron Deficiency Anemia in Reproductive-Age Women? Biomedicines. 2024 Jan 25;12(2):278. doi: 10.3390/biomedicines12020278. PMID: 38397880; PMCID: PMC10886917.
Shannon Brasil
MSN, NP, ANP-BC
Disparities in Iron Deficiency Treatment Among Women
In a collaborative fireside chat by the National Association of Nurse Practitioners in Women's Health (NPWH) and Shield Therapeutics, experts Dr. Wendy Wright and Dr. Lisa Gittens-Williams addressed the diagnosis and treatment of iron deficiency (ID) and iron deficiency anemia (IDA) in women, emphasizing the existing disparities in care. Dr. Gittens-Williams focused on the disparities in diagnosis, screening, and treatment among women of color and minority groups. Dr. Wright presented key findings from important studies, particularly noting the effectiveness and safety of ferric maltol in treating ID with or without anemia. The session, featuring real-life case studies and an interdisciplinary approach, concluded with a live Q&A session moderated by Michael Cody, MD. This fireside chat is free to watch by anyone logged into their free NPWH account.
Reference: Interdisciplinary Approach to Iron Deficiency and Iron Deficiency Anemia: Disparities in Diagnosis, Screening, and Treatment particularly in Women of Color or in Minority Groups. National Association of Nurse Practitioners in Women's Health. Accessed March 25, 2024. https://www.pathlms.com/npwh/courses/55097
Shannon Brasil
MSN, NP, ANP-BC
Diet Rich in Heme and Non-Heme Iron Enhances Treatment for Iron Deficiency Anemia
Incorporating specific foods into the diets of people with iron deficiency anemia can help increase red blood cell counts and hemoglobin levels. Foods rich in heme iron, such as meat, poultry, and fish, are highly effective as they are well absorbed by the body. Additionally, plant-based sources of non-heme iron, including dark green leafy vegetables, nuts, and legumes, also play a crucial role despite being less efficiently absorbed.
It is also important to be aware of foods that hinder iron absorption, such as dairy products and those rich in tannins like tea and coffee, which should be limited. For optimal iron uptake, pairing iron-rich foods with vitamin C-rich fruits and vegetables like citrus or tomatoes can be beneficial. Additionally, understanding the interaction between your diet and any medications you're taking is crucial, as some might impede iron absorption. With appropriate dietary adjustments and possibly supplements, iron levels can often be normalized within a few months, though severe cases might take longer and require more intensive interventions.
Reference: Cornforth T. Verywell Health. Top Foods to Eat For Anemia (And What to Avoid). Updated November 3, 2025. Accessed May 14, 2024. https://www.verywellhealth.com/treatments-for-iron-deficiency-anemia-3522500
Shannon Brasil
MSN, NP, ANP-BC