From the Guidelines
Iron deficiency without anemia can cause symptoms such as fatigue, weakness, and difficulty concentrating, and treatment involves oral iron supplements, typically ferrous sulfate 325 mg taken 1-2 times daily between meals with vitamin C to enhance absorption. According to the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1, oral iron supplements are the first line of treatment for iron deficiency without anemia. The guidelines recommend a once daily dose of 50–100 mg of elemental iron, taken in the fasting state, as the best compromise option for initial treatment.
Some common symptoms of iron deficiency without anemia include:
- Fatigue
- Weakness
- Difficulty concentrating
- Headaches
- Hair loss
- Brittle nails
- Restless leg syndrome
Treatment options for iron deficiency without anemia include:
- Oral iron supplements, such as ferrous sulfate 325 mg taken 1-2 times daily between meals with vitamin C to enhance absorption
- Dietary changes, including consuming iron-rich foods like red meat, spinach, beans, and fortified cereals
- Vitamin C-rich foods to help with iron absorption
- Avoiding coffee, tea, and calcium around meal times to minimize interference with iron absorption
It is essential to identify the underlying cause of iron deficiency, as it may result from blood loss, poor absorption, or increased requirements during pregnancy 1. Treatment typically continues for 3-6 months to replenish iron stores, with follow-up blood tests to monitor progress. Regular Hb monitoring is recommended to ensure an ultimately satisfactory response, with the optimal interval being every 4 weeks until the Hb is in the normal range 1.
In cases where patients experience significant intolerance to oral iron supplements, alternative options such as oral ferric maltol, alternate day oral iron, or parenteral iron may be considered 1. However, parenteral iron is usually reserved for cases with severe symptomatic and/or circulatory compromise, or when there is a need for rapid replenishment of iron stores 1.
Overall, iron deficiency without anemia is a condition that requires prompt attention and treatment to prevent progression to anemia and to improve quality of life. Oral iron supplements, combined with dietary changes and regular monitoring, are the cornerstone of treatment for iron deficiency without anemia.
From the Research
Iron Deficiency Without Anemia: Symptoms and Treatment
- Iron deficiency without anemia is a common condition that can cause symptoms such as fatigue, irritability, depression, difficulty concentrating, restless legs syndrome, and exercise intolerance 2, 3.
- Individuals with nonanemic iron deficiency may be asymptomatic or experience mild symptoms, but long-standing iron deficiency can be challenging to treat 3.
- The diagnosis of iron deficiency without anemia relies on a combination of tests, including haemoglobin and ferritin levels, as well as transferrin saturation 2, 4.
Risk Factors and Causes
- Risk factors for iron deficiency without anemia include heavy menstrual bleeding, pregnancy, inflammatory bowel disease, chronic kidney disease, heart failure, and cancer 2, 4.
- Causes of iron deficiency may sometimes be obvious, but many tend to be overlooked, such as inadequate dietary iron intake, impaired iron absorption, and bleeding 2, 4.
Treatment and Management
- Oral iron is the first-line treatment for managing iron deficiency without anemia, but intravenous supplementation should be used in chronic inflammatory conditions and when oral therapy is poorly tolerated or ineffective 2, 4, 5.
- Counselling and oral iron therapy are usually combined as a first step in treatment, and integrating haem and free iron regularly into the diet is beneficial 6.
- The use of preparations with reasonable but not excessive elemental iron content (28-50 mg) seems appropriate to prevent reduced compliance due to gastrointestinal side effects of oral treatment 6.
- Long-term daily oral or intravenous iron supplementation in the presence of normal or even high ferritin values is not recommended and is potentially harmful 6.
Diagnosis and Screening
- Testing for iron deficiency is indicated for patients with anemia and/or symptoms of iron deficiency, and should be considered for those with risk factors such as heavy menstrual bleeding, pregnancy, or inflammatory bowel disease 2, 4.
- Ferritin and/or transferrin saturation are required for diagnosis and screening, and a ferritin cut-off of 30 µg/l is appropriate for healthy males and females aged >15 years 6, 2.