Can I be iron deficient but not anemic? What to know.
Every cell in our body depends on iron for optimal functioning. This vital mineral is essential for several bodily functions, including transporting oxygen in the bloodstream. Additionally, iron is critical for energy production and protein synthesis, and it is present in our red blood cells, bone marrow, muscles, and brain.
You may frequently encounter the phrases “iron deficiency” and “iron deficiency anemia,” but what do they really signify?
Can I be iron deficient but not anemic?
Absolutely, you can have iron deficiency without having iron deficiency anemia.
According to Dr. Casey O’Connell, a hematologist and an associate professor of Clinical Medicine at Keck Medicine of the University of Southern California, “Iron deficiency anemia is simply a more advanced stage of iron deficiency.” Before progressing to anemia, “the body makes efforts to maintain its red blood cell quantity. It will use up stored iron first before the count of red blood cells starts to drop,” she explains. Once the body depletes its iron stores, the production of new red blood cells suffers as there isn’t enough iron available.
Identifying iron deficiency before it progresses to iron deficiency anemia is crucial, as highlighted by Dr. Annette von Drygalski, a board-certified hematologist and director of the Center for Bleeding and Clotting Disorders at UC San Diego Health. Ignoring this deficiency heightens the risk of poor heart function. In women, untreated iron deficiency anemia can lead to complications during pregnancy, including increased mortality risks, lowered birth weights, challenges with breastfeeding, and potential cognitive impacts on offspring due to untreated iron deficiency, warns Dr. Danielle Nance, a hematologist and co-director of the multidisciplinary programs at Banner MD Anderson Cancer Center.
A complete blood count (CBC) is essential in diagnosing anemia, according to O’Connell. A CBC typically focuses on three key metrics regarding red blood cells: red blood cell count (RBC), hemoglobin (HGB), and hematocrit (HCT). While these measurements may differ slightly, they reflect similar aspects of red blood cell health. To determine if the anemia is due to iron deficiency, doctors will correlate CBC results with additional tests like a ferritin test and a complete iron panel.
How is iron deficiency diagnosed?
Ferritin serves as a biomarker indicating the iron reserves in the body. Assessing ferritin levels through blood tests is fundamental for diagnosing iron deficiency, explains von Drygalski. However, the medical community has varying opinions on what constitutes low ferritin. The World Health Organization considers ferritin levels below 15 nanograms per milliliter to be low in adults, while in practice, diagnosis may occur at levels under 30 nanograms per milliliter.
The American Society of Hematology released a report in 2024 outlining a timeline for updating the diagnostic criteria for iron deficiency, which includes reassessing the ferritin threshold, according to von Drygalski.
While ferritin levels are undeniably crucial for diagnosing iron deficiency, Nance emphasizes that medical professionals should interpret these levels alongside a patient’s overall health to ensure an accurate diagnosis.
