Can I be iron deficient but not anemic? What to know.
Virtually every cell in the body requires iron in order to function well. Iron is involved in key bodily processes, including the transportation of oxygen in the blood. It also plays a central role in building energy and proteins, and it can be found in your red blood cells, bone marrow, muscles and the brain.
You may hear the terms "iron deficient" and "iron deficient anemia" frequently. But what exactly do those words mean?
Can I be iron deficient but not anemic?
Yes, it’s possible to experience iron deficiency, but not have iron deficiency anemia.
“Iron deficiency anemia is just a later stage of iron deficiency,” says Dr. Casey O’Connell, a hematologist and an associate professor of Clinical Medicine at Keck Medicine of the University of Southern California. Before iron deficiency anemia sets in, “the body will do everything it can to retain the right number of red blood cells. So, it will deplete the storage iron before it depletes the red blood cell number,” she says. When the iron storage is gone, your red blood cell count can become severely low, because there’s not enough iron to keep up with the production of new cells.
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It’s very important to catch iron deficiency before it has developed into iron deficiency anemia, says Dr. Annette von Drygalski, a board-certified hematologist and director of the Center for Bleeding and Clotting Disorders at UC San Diego Health. It can put you at a greater risk for poor heart function. In women, iron deficiency anemia has also been linked to mortality during pregnancy, lower birth rates, difficulty with milk production and possible lower IQs in children if the iron deficiency isn't corrected, says Dr. Danielle Nance, a hematologist and co-director of the multidisciplinary programs at Banner MD Anderson Cancer Center.
A complete blood count (CBC) test is an essential part of diagnosing anemia, says O’Connell. In a CBC, there's three main indicators of how much red blood cell action you have: red blood cell count (RBC), hemoglobin (HGV) and hematocrit (HCT). In general, these indicators all have “slightly different ways of measuring the same thing.” To confirm that the anemia is the result of iron deficiency, doctors will cross reference the results of the CBC with a ferritin test and a full iron panel, she says.
How is iron deficiency diagnosed?
Ferritin is a biomarker that reflects iron stores in the body. Testing ferritin levels on a blood panel is one of the diagnostic thresholds of diagnosing iron deficiency, says von Drygalski. The problem is, there is disagreement within the medical community of what that threshold actually is. The World Health Organization defines low ferritin in adults as below 15 nanograms per milliliter, but in clinical practice, iron deficiency may be diagnosed when ferritin is below 30 nanograms per milliliter.
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In 2024, the American Society of Hematology released a report detailing the steps and timeline the organization is taking to revise the guidelines for diagnosing iron deficiency (one of which includes the threshold for ferritin), says von Drygalski.
Ferritin levels are undoubtedly important for diagnosing iron deficiency. However, healthcare providers need to assess the ferritin levels in conjunction with a patient’s whole picture of health, says Nance. This will make the difference in achieving a correct diagnosis of iron deficiency.
This article originally appeared on USA TODAY: What is iron deficiency anemia?
