From the Guidelines
The patient's current iron levels are within normal limits, but a downward trend is observed, and monitoring these values in 3-6 months is recommended to prevent potential iron deficiency. The lab results show a 40-year-old female with iron studies that are currently within normal limits. Her most recent iron level is 73 mcg/dL (normal range 37-145), TIBC is 346 mcg/dL (normal range 228-428), and iron saturation is 21% (normal range 20-55%) 1. Compared to 4 months ago, her iron level has decreased from 99 mcg/dL, TIBC has increased from 318 mcg/dL, and iron saturation has decreased from 31%. While all values remain within normal ranges, there is a downward trend in iron parameters. Some key points to consider in this patient's case include:
- Iron deficiency can have negative implications for aerobic performance, even without anaemia, and is more common in postpubertal female players due to regular blood loss during menstrual bleeding 1.
- The current RDA for iron is 18 mg for females, and iron should be consumed from highly bioavailable sources, including meat and seafood, with vitamin C co-ingested to enhance absorption 1.
- If the patient experiences symptoms like fatigue, weakness, or shortness of breath, earlier follow-up would be appropriate, as iron levels can fluctuate due to dietary changes, menstrual cycles in women, or underlying conditions affecting iron absorption or utilization.
- Maintaining adequate dietary iron through foods like lean red meat, beans, spinach, and fortified cereals is recommended to prevent future deficiency, and a period of iron supplementation may be considered at levels above the RDA after consultation with qualified medical and dietetic practitioners 1. Given the patient's current iron levels and downward trend, it is essential to monitor her iron parameters closely and consider dietary changes or supplementation if necessary to prevent iron deficiency and its potential complications.
From the Research
Iron Levels and Saturation
- The provided iron levels are 73 mcg/dL (3 days ago) and 99 mcg/dL (4 months ago), with a reference range of 37-145 mcg/dL 2.
- The total iron-binding capacity (TIBC) levels are 346 mcg/dL (3 days ago) and 318 mcg/dL (4 months ago), with a reference range of 228-428 mcg/dL.
- The iron saturation levels are 21% (3 days ago) and 31% (4 months ago), with a reference range of 20-55% 3.
Iron Deficiency and Supplementation
- Iron deficiency is a common micronutrient deficiency worldwide, and oral iron supplementation is often recommended as first-line treatment 4.
- The optimal dose and duration of iron supplementation for treating iron deficiency anemia in children and adolescents are still unclear, but a systematic review and meta-analysis suggest that low-dose iron supplementation (<5 mg/kg/day) combined with treatment durations of either less than 3 months or more than 6 months may be optimal 5.
- Iron supplementation can cause undesirable side-effects, and it is essential to develop new iron-rich ingredients, iron-fortified products with high bioavailability, better stability, and lower cost 2.
Monitoring Iron Status
- Serum ferritin and transferrin saturation (TFS) are indirect measurements of iron status, and ferritin levels should be measured before starting recombinant human erythropoietin (r-HuEPO) therapy to ensure adequate iron stores 3.
- The percentage of hypochromic red blood cells is a direct measure of marrow iron status, but not all departments may have access to the required equipment 3.