Should a 17-year-old female with a history of anemia and currently low ferritin levels, but normal hemoglobin (Hb) and hematocrit (Hct) levels, be referred for further evaluation and management?

From the Guidelines

A 17-year-old female with a history of anemia and currently low ferritin levels, but normal hemoglobin and hematocrit levels, should be referred for further evaluation and management to address the iron deficiency and prevent potential complications. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of treating iron deficiency even in the absence of anemia 1. The study highlights that iron deficiency can have negative implications for overall health and quality of life, and that treatment should aim to replenish iron stores.

Key Considerations

• Iron deficiency without anemia still requires treatment to prevent progression to anemia and improve quality of life 1
• Oral iron supplementation, typically ferrous sulfate 325 mg once or twice daily, is a recommended approach for treating iron deficiency 1
• Dietary counseling should be provided to encourage iron-rich foods like lean red meat, beans, fortified cereals, and leafy greens 1
• Regular follow-up with repeat ferritin levels after 2-3 months of therapy is recommended to monitor response to treatment 1

Treatment Approach

The treatment approach should include oral iron supplementation, with the goal of replenishing iron stores and improving quality of life. Ferrous sulfate 325 mg once or twice daily, taken on an empty stomach with vitamin C to enhance absorption, is a commonly recommended regimen 1. Additionally, dietary counseling should be provided to encourage iron-rich foods and improve overall nutritional intake.

Monitoring and Follow-up

Regular follow-up with repeat ferritin levels after 2-3 months of therapy is recommended to monitor response to treatment 1. This will help to assess the effectiveness of the treatment and make any necessary adjustments to the treatment plan.

From the Research

Referral Considerations for a 17-Year-Old Female with Low Ferritin Levels

• The patient's history of anemia and current low ferritin levels, despite normal hemoglobin (Hb) and hematocrit (Hct) levels, may indicate a need for further evaluation and management 2, 3.
• According to the World Health Organization (WHO), anemia is defined as Hb levels <12.0 g/dL in women, but normal Hb distribution varies with sex, ethnicity, and physiological status 3.
• A study published in 2021 evaluated the current WHO Hb cutoffs for defining anemia among healthy individuals and found that the current cutoffs may be higher than the pooled fifth percentile of Hb among healthy persons 4.
• The patient's low ferritin level, despite normal iron levels, may indicate iron deficiency or insufficiency, which can have significant health implications if left untreated 2, 5.
• Referral to a healthcare specialist, such as a hematologist or a primary care physician, may be necessary to determine the underlying cause of the patient's low ferritin level and to develop an appropriate treatment plan 3, 6.
• The specialist can evaluate the patient's medical history, perform physical examinations, and order additional tests, such as serum ferritin and iron studies, to determine the best course of action 2, 5.

Key Considerations for Referral

• The patient's age, sex, and medical history, including the history of anemia, should be taken into account when determining the need for referral 3.
• The patient's current symptoms, such as fatigue or weakness, should also be evaluated to determine if they are related to the low ferritin level 6.
• The specialist can help determine if the patient's low ferritin level is due to iron deficiency, insufficiency, or another underlying condition, and develop a treatment plan accordingly 2, 5.