A new study published in Blood Advances indicates that more than half of individuals diagnosed with iron deficiency continue to have low iron levels three years later. Among those whose condition was treated effectively during this period, many experienced longer delays than anticipated, highlighting significant deficiencies in proper detection and effective management of iron deficiency.
Iron deficiency occurs when the body lacks sufficient iron, which can affect up to 40% of teenagers and young women. Iron plays a crucial role in numerous bodily functions, including hemoglobin production – the protein in the blood that transports oxygen. It is vital for maintaining healthy cells, skin, hair, and nails. If iron deficiency goes untreated, it can lead to various symptoms such as mood swings, fatigue, hair loss, reduced exercise capacity, and eventually to anemia. Initial treatment usually involves taking oral iron supplements, but if levels remain low after a few months or if side effects arise, intravenous (IV) iron treatment is initiated. Previous studies revealed that as many as 70% of cases may go undetected in high-risk groups, such as individuals with bleeding disorders, malabsorption issues, or menstruating women.
“Iron deficiency is likely a more significant issue than we recognize. I’ve encountered numerous cases where individuals do not have anemia but still have minimal or nonexistent iron levels, which can severely affect their daily well-being,” stated Dr. Jacob Cogan, an assistant professor of medicine at the University of Minnesota and the lead author of the study. “While diagnosing iron deficiency can be complex, treating it is straightforward. Our results emphasize the necessity of coordinated efforts to identify and manage iron deficiency to enhance individuals’ quality of life.”
This study is the first to assess how effectively iron deficiency is recognized and treated in clinical settings. Dr. Cogan and his team retrospectively analyzed electronic medical record (EMR) data from one of Minnesota’s largest health systems, identifying 13,084 adults diagnosed with iron deficiency (with or without anemia) between 2010 and 2020 who had follow-up data over three years.
In this research, iron deficiency was characterized by a ferritin level of 25 ng/mL or lower. Patients were required to have at least two ferritin tests: one at the initial diagnosis and another within the three-year period. Adequate resolution of iron deficiency was defined as achieving a ferritin level of 50 ng/mL or above. Treatment was fairly consistent across genders.
From the 13,084 patients studied, 5,485 (42%) reached normal iron levels within three years post-diagnosis, while 7,599 (58%) continued to show low ferritin levels indicative of ongoing iron deficiency. Remarkably, just 7% of patients normalized their iron levels within the first year of diagnosis.
Several factors increased the chances of patients returning to normal iron levels, including being older (60 years and up), male, having Medicare insurance, and receiving IV iron treatment alone. Moreover, those who resolved their condition underwent more follow-up blood tests to monitor ferritin levels (six tests compared to four for those still deficient). Notably, younger patients, women, and Black individuals tended to have more prolonged iron deficiency or faced longer delays in recovering their iron stores.
Even among patients whose iron levels normalized during the study, it took almost two years (the median time until resolution was 1.9 years), which researchers describe as unexpectedly long, signaling missed chances for more effective management. Dr. Cogan also suggests that while there was no direct data examining the treatment differences between anemia-related iron deficiency and non-anemic iron deficiency, it’s likely that the latter is often harder to diagnose and therefore less frequently treated.
“Two years is excessive and exceeds the expected timeframe for adequate treatment and resolution of iron deficiency through either oral or IV therapies,” said Dr. Cogan. “The data is quite shocking and indicates a pressing need to establish better systems for identifying and treating patients promptly.”
Dr. Cogan attributes the ongoing iron deficiency trends and the identified treatment delays to missed or improperly managed diagnoses. He noted a clear necessity for enhanced education regarding non-anemic iron deficiency, agreement on standard ferritin levels for diagnosis, and the establishment of specialized clinics or pathways to “efficiently assess and treat patients, helping them to feel better more quickly.”
However, the study had limitations, as it was based on EMR data and its retrospective design, which meant researchers could not ascertain the reasons for the ordering of ferritin tests or the underlying causes of iron deficiency among patients.
