Identifying Iron Deficiency and Iron Deficiency Anemia

Signs and symptoms of iron deficiency and iron deficiency anemia

Understanding the impact of iron deficiency (ID) and iron deficiency anemia (IDA) on patients will help you treat them quickly, leading to improved outcomes.8-11

Improving patient outcomes

Early testing and diagnosis of iron deficiency and iron deficiency anemia, especially for high-risk patients such as those with inflammatory conditions, are critical.8-11

Symptoms of iron deficiency and iron deficiency anemia are easy to overlook early on but can worsen over time.12-17

Common symptoms of iron deficiency may include:  

  • Fatigue, irritability, and poor concentration
  • Cold hands and feet
  • Reduced exercise tolerance
  • Headache, dizziness, or palpitations

As the deficiency progresses to anemia, patients may also experience: 

  • Pale skin
  • Tingling or numbness in hands and/or feet
  • Poor memory and a decrease in neural processing speed
  • Hair loss
  • Pica or pagophagia
  • Atrophy of lingual papillae
  • Systolic heart murmur, tachycardia, or chest pain

Help patients reach a diagnosis faster by testing for key iron indices

Iron deficiency is more than just anemia, so testing needs to go beyond hemoglobin levels, which may not be the most specific indicator of iron deficiency.12

Decreased ferritin and TSAT levels are among the first signs of iron deficiency and iron deficiency anemia.27 By knowing the symptoms and testing accordingly for these key iron indices, you can find the right treatment to help reduce the likelihood of iron deficiency progressing to anemia.12

Laboratory Parameters for ID and IDA

Female

Lab Markers

Normal

ID

IDA

Hemoglobin12,20≥12 g/dL <12 g/dL
Ferritin820-200 μg/L§ <30 μg/Lserum ferritin <30 μg/L
OR
serum ferritin <100 μg/L in the presence of inflammation
TSAT2820%-45%<16% OR <20% in the presence of inflammation 

 

Pregnant Female

Lab Markers

Normal

ID

IDA

Hemoglobin12,20≥11 g/dL in 1st and 3rd trimesters
≥10.5 g/dL in 2nd trimester		 <11 g/dL
Ferritin820-200 μg/L§<30 μg/Lserum ferritin <30 μg/L
OR
serum ferritin <100 μg/L in the presence of inflammation
TSAT2820%-45%<16% OR <20% in the presence of inflammation 

 

Male

Lab Markers

Normal

ID

IDA

Hemoglobin12,20≥13 g/dL <13 g/dL
Ferritin840-300 μg/L§<30 μg/Lserum ferritin <30 μg/L
OR
serum ferritin <100 μg/L in the presence of inflammation
TSAT2820-45%<16% OR <20% in the presence of inflammation 

Ferritin may be elevated as a result of iron overload or other causes, including liver disease, obesity, inflammation, and malignancy.40

Testing guidelines and guidance for ID/IDA vary depending on specific patient characteristics

Guidance for pregnant women:36

The American College of Obstetrics and Gynecology recommends that all pregnant women be screened for iron deficiency anemia with a complete blood count in the first trimester and again between the beginning of the 24th week and the end of the 28th week of gestation.

Guidance for the general population:37

The Centers for Disease Control and Prevention recommends blood test screening:

  • Every 5–10 years for iron deficiency anemia in all non-pregnant women throughout their childbearing years.
  • Annually for women with risk factors for iron deficiency.

Guidance for people with underlying conditions:38,39

Screening is recommended at least every 3 months for outpatients with active inflammatory bowel disease (IBD), and once every 6–12 months for outpatients in remission or with mild IBD.

For individuals with IDA and chronic kidney disease that is not being treated with erythropoiesis-stimulating agents, the nonprofit Kidney Disease Improving Global Outcomes recommends that hemoglobin concentration be measured: 

  • At least every 3 months in patients with CKD ND (CKD stages 3–5) and CKD 5PD (peritoneal dialysis)
  • Monthly in patients with CKD 5HD (hemodialysis)

Downsides of Oral Iron Salts

Learn why iron supplements can make your patients feel worse instead of better.

Risks of ID/IDA

Left untreated, ID can progress to IDA and eventually lead to long-term issues.

References:
8. Iron-deficiency anemia. National Heart Lung and Blood Institute. Accessed October 30, 2023. https://www.nhlbi.nih.gov/health/anemia/iron-deficiency-anemia 
9. Jimenez K, Kulnigg-Dabsch S, Gasche C. Management of iron deficiency anemia. Gastroenterol Hepatol (N Y). 2015;11(4):241-250. 
10. Badireddy M, Baradhi KM. Chronic anemia. In: StatPearls. StatPearls Publishing; 2023  
11. Kessy JP, Philemon RN, Lukambagire A, et al. Iron depletion, iron deficiency, and iron deficiency anaemia among children under 5 years old in Kilimanjaro, Northern Tanzania: a hospital-based cross-sectional study. East Afr Health Res J. 2019;3(1):42-47. doi:10.24248/EAHRJ-D-18-00017 
12. Al-Naseem A, Sallam A, Choudhury S, Thachil J. Iron deficiency without anaemia: a diagnosis that matters. Clin Med (Lond). 2021;21(2):107-113. doi:10.7861/clinmed.2020-0582 
13. Bermejo F, García-López S. A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. World J Gastroenterol. 2009;15(37):4638-4643. doi:10.3748/wjg.15.4638  
14. National Institutes of Health. Your Guide to Anemia. Published online 2011. Accessed November 3, 2023. https://www.nhlbi.nih.gov/sites/default/files/publications/11-7629.pdf
15. Iron deficiency anemia. Mayo Clinic. Accessed October 30, 2023. https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034
16. Miller JL. Iron deficiency anemia: a common and curable disease. Cold Spring Harb Perspect Med. 2013;3(7):a011866. doi:10.1101/cshperspect.a011866 
17. Anemia. Mount Sinai Health System. Accessed October 30, 2023. https://www.mountsinai.org/health-library/diseases-conditions/anemia
20. Mirza FG, Abdul-Kadir R, Breymann C, Fraser IS, Taher A. Impact and management of iron deficiency and iron deficiency anemia in women's health. Expert Rev Hematol. 2018;11(9):727-736. doi:10.1080/17474086.2018.1502081 
27. Alleyne M, Horne MK, Miller JL. Individualized treatment for iron-deficiency anemia in adults. Am J Med. 2008;121(11):943-948. doi:10.1016/j.amjmed.2008.07.012 
28. Elsayed ME, Sharif MU, Stack AG. Transferrin saturation: a body iron biomarker. Adv Clin Chem. 2016;75:71-97. doi:10.1016/bs.acc.2016.03.002  
36. Anemia in Pregnancy: ACOG Practice Bulletin, Number 233. Obstet Gynecol. 2021;138(2):e55-e64. doi:10.1097/AOG.0000000000004477  
37. Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. Published April 3, 1998. Accessed November 3, 2023. https://www.cdc.gov/mmwr/preview/mmwrhtml/00051880.htm
38. Kaitha S, Bashir M, Ali T. Iron deficiency anemia in inflammatory bowel disease. World J Gastrointest Pathophysiol. 2015;6(3):62-72. doi:10.4291/wjgp.v6.i3.62  
39. Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl. 2012;2(4):279-335. 
40. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: World Health Organization; 2020. Accessed November 3, 2023. https://www.who.int/publications/i/item/9789240000124