Does a 78-year-old female with normal Hemoglobin (Hgb) and Hematocrit (Hct) levels, low iron saturation, and low ferritin levels have iron deficiency without anemia?

From the Guidelines

Yes, a 78-year-old female with normal hemoglobin and hematocrit levels but low iron saturation and low ferritin levels has iron deficiency without anemia. This condition, often called non-anemic iron deficiency, occurs when iron stores are depleted but haven't yet affected red blood cell production enough to cause anemia. The patient's lab results, including a ferritin level of 17 and iron saturation of 0.17, are consistent with iron deficiency without anemia, as defined by a serum ferritin level < 30 μg/L and transferrin saturation < 16% 1. Treatment typically involves oral iron supplementation, such as ferrous sulfate 325 mg once or twice daily, ferrous gluconate 300-325 mg daily, or ferrous fumarate 300 mg daily, taken on an empty stomach with vitamin C to enhance absorption. Side effects may include constipation, nausea, and black stools. The underlying cause of iron deficiency should be investigated, particularly in this age group, as it could indicate gastrointestinal blood loss from conditions like colorectal cancer, peptic ulcer disease, or other gastrointestinal pathologies. Iron deficiency develops in stages, with depletion of iron stores (indicated by low ferritin) occurring first, followed by decreased iron transport (low iron saturation), and finally reduced hemoglobin synthesis resulting in anemia. Early treatment can prevent progression to iron deficiency anemia and improve symptoms like fatigue, reduced exercise tolerance, and cognitive effects that can occur even before anemia develops 1. It is essential to monitor the patient's iron status and adjust treatment as needed to prevent complications and improve quality of life. In addition to oral iron supplementation, the patient should be advised to consume a diet rich in iron, particularly red meat, and to avoid foods or fluids that impair iron absorption, such as tea and coffee, around meal times 1.

From the Research

Iron Deficiency Without Anemia

The patient's lab results show a Hemoglobin (Hgb) level of 131, which is within the normal range, and a Hematocrit (Hct) level of 0.41, also within the normal range. However, the patient's iron saturation is 0.17, and ferritin level is 17, which are both low.

• The patient's low iron saturation and ferritin levels indicate iron deficiency, despite the absence of anemia 2.
• Iron deficiency without anemia is a common condition, especially in women, and can be caused by inadequate dietary iron intake, impaired iron absorption, or chronic blood loss 3.
• The diagnosis of iron deficiency without anemia is typically made by measuring serum ferritin and transferrin saturation, which are more sensitive indicators of iron status than hemoglobin and hematocrit alone 4.

Diagnostic Criteria

The patient's ferritin level of 17 is below the normal range, which is typically considered to be above 30 ng/mL 2. Additionally, the patient's transferrin saturation of 0.17 is below the normal range, which is typically considered to be above 20% 2.

• The patient's low ferritin and transferrin saturation levels meet the diagnostic criteria for iron deficiency without anemia 2.
• The patient's normal hemoglobin and hematocrit levels do not rule out iron deficiency, as iron deficiency can occur without anemia 4.

Clinical Implications

Iron deficiency without anemia can have significant clinical implications, including fatigue, exercise intolerance, and difficulty concentrating 2. Additionally, iron deficiency can increase the risk of developing anemia, which can have more severe clinical consequences.

• The patient's iron deficiency without anemia should be treated to prevent the development of anemia and to alleviate symptoms 2.
• Oral iron supplementation is typically the first-line treatment for iron deficiency without anemia, although intravenous iron may be necessary in some cases 2.