Iron Deficiency Without Anaemia

Iron Deficiency Is Often Misdiagnosed When Anaemia Is Not Present

When conducting a Bariatric practice, ensuring patients maintain an appropriate level of vitamins and minerals is an ongoing focus.

As part of our ongoing care of many of our patients, we conduct regular blood tests to ensure bloods values are in a healthy range.

One aspect of this which we have often seen, is low iron levels through low ferritin (which normally indicates low iron stores) and TSAT scores, without the patient being anaemic.

This research paper from the Royal College of Physicians provides a comprehensive look at the issue and offers clinical guidelines to help practitioners identify and treat the condition known as Iron Deficiency Without Anaemia(IDWA).

Click here to view the paper. 

Misdiagnosis of IDWA Is Common

As stated in the paper, and also with our own experience, patients are presenting with clear iron deficiency symptoms even though ferritin and other iron levels may be within the "normal" range.

A patient may also have no signs of anaemia, known to them. That is to say, lack of focus, poor sleep, coping with fatigue and exhaustion becomes the norm. The body compensates mentally until it reaches a tipping point.

The question then becomes, what ranges are really "normal" and when do the normal ranges apply?

In the case of ferritin, a range of 30 - 250 ug/L is relatively standard. By contrast our practice is looking to achieve a value of 100 ug/L for good health both pre and post operatively.

The latest evidence suggests we need to reevaluate our approach to Iron Deficiency in many cases, and look more critically other iron readings, not just serum iron levels, and adjust diagnoses accordingly.