Iron deficiency (ID) refers to a reduction in the amount of stored iron (ferritin) in the body. Historically, the literature has defined iron deficiency as a serum ferritin level below 30 ng/mL (many studies use this value; however, there are some discrepancies among authors).
Iron deficiency might not always come with anaemia, but it should still be addressed. If you have iron deficiency, it’s important to correct it before surgery to lower the risk of post-surgery anaemia or before pregnancy to reduce the risk of iron-deficiency anaemia during pregnancy.
Iron deficiencies are common and can cause various symptoms, but they are often overlooked by healthcare providers. This can lead to iron deficiency anaemia, which is usually treated with medications that may cause digestive issues. The sooner you identify and address iron deficiency, the easier it is to manage and avoid needing medication.
Here’s a quick overview:
- Ferritin levels below 30 ng/mL usually indicate iron deficiency, as most studies use this level for diagnosis.
- Recent research (Nutrients 2023) suggests breaking down iron deficiency into three stages:
- Latent Stage: Ferritin <70 ng/mL, low iron but normal haemoglobin. Early stages may show normal serum iron while ferritin decreases.
- Pre-anaemic Stage: Ferritin <30 ng/mL, low haemoglobin.
- Anaemic Stage: Ferritin <15 ng/mL, low haemoglobin, and anaemia. Symptoms often start in the latent stage.
Early detection and treatment can help you manage iron deficiency more effectively and avoid the need for medications.
Although there isn't a formal diagnosis for iron deficiency without anaemia yet, low ferritin levels between 15 and 70 ng/mL, combined with symptoms like fatigue, weakness, and poor concentration, can suggest iron deficiency.
From my experience, it’s uncommon for menstruating women to have ferritin levels consistently between 50-80 ng/mL. Most of the women I see for trichology and aesthetic consultations have ferritin levels around 20-30 ng/mL, and often even below 15 ng/mL. Such low levels indicate a serious iron deficiency and depletion of iron stores, which can significantly affect overall health, including hair loss, poor wound healing, and the condition of the skin.
Women who managed to increase their ferritin levels from about 15 ng/mL to around 50 ng/mL typically saw improvements in their well-being, skin, and hair growth, often without needing additional treatments.
Anaemia is when the level of haemoglobin in your blood drops below what’s considered normal for your age and gender. It can also involve a decrease in red blood cells, haematocrit, and/or the amount of haemoglobin in those cells.
According to the World Health Organisation (WHO), anaemia is defined as:
- Haemoglobin levels below 13 g/dL for adult men
- Haemoglobin levels below 12 g/dL for non-pregnant adult women
Here’s a breakdown of anaemia definitions by WHO:
A decrease in ferritin is diagnostic for iron deficiency. However, a higher ferritin level does not necessarily rule out iron deficiency if there are inflammatory conditions present.
Iron deficiency anaemia (IDA) occurs when there is both anaemia (as defined in the table above) and iron deficiency (which I’ll explain further below). It is the most common type of anaemia.
Example form my practise:
A 28-year-old woman with a ferritin level of 22 ng/mL and a haemoglobin level of 12.2 g/dL has iron deficiency without anaemia.
There are no uniform criteria for identifying iron deficiency and iron deficiency anaemia in the literature, so it’s important to consider lab results, symptoms, and the patient’s overall well-being.
In practice, I often see people with ferritin levels around 20 ng/mL being sent home with no advice, as this level falls within the lab’s reference range. This can be a mistake, as patients may not realise the severity of the issue and might not seek help from a dietitian, assuming a ferritin level of 20 ng/mL is "normal."Remember: Just because a lab result is marked in green (indicating normal levels and no problem) does not always mean there is no issue.
Summary
Iron deficiency and anaemia are important health concerns. Iron deficiency, marked by low ferritin levels, can cause symptoms like fatigue, hair loss, and poor wound healing. Anaemia is diagnosed when haemoglobin levels drop below certain thresholds. It’s crucial to evaluate both lab results and symptoms for accurate diagnosis and treatment.
This article introduces the basics of iron deficiency and anaemia. In the next instalment, we'll explore diagnostic methods, treatment options, and practical tips for managing these conditions. Stay tuned for more insights to better manage your health.
Please note: The information provided here is for informational purposes only and does not constitute medical advice. If you have any serious health issues, are taking medications, or have concerns about your health, please consult your GP or a medical advisor.
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