Iron Deficiency Without Anemia

The most prevalent mineral deficiency is iron deficiency, iron deficiency anemia affects 20% of the world’s population. Iron deficiency without anemia is even more common.

Anemia is the most well-known consequence of iron deficiency because hemoglobin, a component of red blood cells, contains about 70% of the iron in adults.

Iron deficiency without anemia has been associated with:

• Weakness.
• Fatigue.
• Reduced exercise performance.
• Difficulty in concentrating.
• Poor work productivity.
• Neurocognitive dysfunction including irritability.
• Fibromyalgia syndrome.
• Restless legs syndrome.
• Symptom persistence in patients treated for hypothyroidism.
• Poor neurodevelopmental outcomes in infants born to mothers with iron deficiency.

Iron deficiency can occur secondary to: –

• Inadequate dietary intake.
• Increased requirements (e.g., pregnancy and breastfeeding).
• Impaired absorption (e.g., coeliac disease, bariatric surgery).
• Blood loss (e.g., menstrual, blood donation, gastrointestinal).

The most precise and sensitive biomarker for determining ID is ferritin, which is a measure of iron stores.

Low ferritin is defined by the WHO as levels below 15 μg/L for adults and <12 μg/L for children.

In clinical practice, ID can be determined when ferritin levels fall below 30 μg/L.

A full blood count may indicate changes in iron status before the onset of anemia by falling values for mean corpuscular volume and mean cell hemoglobin as well as increasing red cell distribution width.

The first-line and safest treatment for symptomatic patients or those who are at risk of developing anemia is oral iron therapy. It is convenient and cost-effective.

Although there are many different types of iron supplements, ferrous salts (fumarate, sulfate, and gluconate) are preferred because they are most readily absorbed.