This Patient Does NOT Have Iron Deficiency Anemia
Based on the laboratory values provided, this 45-year-old female does not have iron deficiency anemia and should not be treated with iron supplementation. Her ferritin is 273 ng/mL and transferrin saturation is 47%, both indicating adequate to replete iron stores, despite mild anemia (hemoglobin 11.4 g/dL).
Laboratory Interpretation
The iron studies definitively exclude iron deficiency:
- Ferritin 273 ng/mL is well above the threshold for iron deficiency (typically <15-30 ng/mL indicates depleted stores) 1, 2
- Transferrin saturation of 47% is normal to elevated (iron deficiency typically shows <20%) 1, 2
- Serum iron 102 and transferrin 180 are within normal ranges 1
The mild anemia (Hgb 11.4 g/dL, Hct 34.4%) with normal iron stores suggests an alternative cause such as anemia of chronic disease, early chronic kidney disease, or other nutritional deficiencies (B12, folate).
Why Iron Therapy Would Be Inappropriate
Iron supplementation is contraindicated in this patient because:
- Men and postmenopausal women with normal iron stores should not receive iron supplements 1, 3
- Excessive iron supplementation can cause iron overload and should be avoided 3
- The elevated ferritin and normal transferrin saturation exclude iron deficiency as the cause of anemia 1, 2
Recommended Next Steps
Instead of iron therapy, this patient requires:
- Investigation for the underlying cause of anemia with normal iron stores, including complete blood count with differential, reticulocyte count, comprehensive metabolic panel (to assess renal function), vitamin B12, and folate levels 4, 5
- Consideration of chronic disease evaluation including inflammatory markers (CRP, ESR) if chronic inflammation is suspected 4
- Gastrointestinal evaluation if indicated by symptoms or risk factors, though this is less urgent given normal iron stores 1, 4
Common Pitfall to Avoid
The most critical error would be initiating iron supplementation based solely on mild anemia without recognizing that the iron studies are normal. At age 45, if this patient is premenopausal with heavy menstrual bleeding, she would be expected to have low ferritin and low transferrin saturation if iron deficiency were present 1. The normal iron parameters mandate investigation for other causes of anemia rather than empiric iron therapy.