Relationship Between Iron Deficiency Anemia and Microvascular Health in Women

Abstract

Iron deficiency anemia (IDA) is a prevalent hematologic condition among women and has systemic vascular implications that remain underrecognized in routine clinical evaluation. In this study, retinal microvascular integrity was assessed using Optical Coherence Tomography Angiography (OCT-A) to quantify capillary perfusion, branching architecture, and foveal avascular zone (FAZ) morphology in women with laboratory-confirmed IDA compared to age-matched healthy controls. The IDA group demonstrated significantly reduced vessel density in both the superficial and deep capillary plexuses, along with decreased skeletonized branching index (SBI) and enlarged FAZ, indicating structural rarefaction and compromised endothelial support. These alterations were most pronounced in the deep plexus, reflecting the heightened metabolic vulnerability of inner retinal layers under reduced oxygen availability. The findings establish a strong physiological link between iron deficiency and microvascular remodeling and support retinal OCT-A as a sensitive, non-invasive biomarker for early detection and monitoring of systemic hypoxic microvascular compromise in women with IDA.