From the Guidelines
A hemoglobin level of 11.1 g/dL indicates mild anemia, according to the World Health Organization's definition, and requires further evaluation to determine the underlying cause. This value falls within the range of mild anemia, which is defined as a hemoglobin concentration of 11.0-11.9 g/dL for women ≥ 15 years old 1. To determine the underlying cause of the anemia, I recommend a full iron panel, which includes a complete blood count with reticulocyte count, ferritin, serum iron, transferrin, transferrin saturation, and total iron binding capacity, as ferritin alone may not be sufficient due to its potential to be falsely elevated in the setting of illness or stress 1.
Some key points to consider in the evaluation and management of this patient include:
- Iron deficiency and anemia are not synonymous, and it is possible for an individual to be iron deficient but not anemic, or to have iron deficiency anemia 1
- Athletes, particularly female athletes, are at higher risk for iron deficiency due to factors such as restrictive diets, high amounts of repetitive ground strikes, endurance training, and heavy menstrual bleeding 1
- Iron from meat (heme iron) is better absorbed than plant-based iron (non-heme), and athletes with restrictive diets may need to consult a sports dietitian to optimize their daily nutrition plans for iron intake 1
- The current USDA recommended daily allowance for iron may not be sufficient for athletes with risk factors, and higher levels of iron consumption may be necessary 1
In terms of management, consider starting an over-the-counter iron supplement such as ferrous sulfate 325 mg once daily with vitamin C to enhance absorption if iron deficiency is suspected, and dietary modifications to increase iron intake, such as consuming lean red meat, beans, spinach, and fortified cereals 1. Follow-up testing in 4-6 weeks is recommended to assess response to treatment and may require dose adjustments based on results.
From the Research
Hemoglobin and Anemia
- Hemoglobin is a crucial component of red blood cells, responsible for carrying oxygen from the lungs to the tissues and carbon dioxide from tissues to lungs 2.
- A low hemoglobin concentration is characteristic of anemia, which can result from a deficiency of iron, vitamin B12, or folate 2, 3.
- Symptoms of anemia include weakness, lethargy, palpitation, headache, and shortness of breath, resulting from reduced tissue oxygenation 2.
Iron Deficiency and Anemia
- Iron deficiency is a common cause of anemia, and its detection, evaluation, and management are essential for proper clinical attention 4.
- Iron is necessary for hemoglobin synthesis, and a deficiency can lead to anemia, characterized by smaller, less hemoglobinized red blood cells 3.
- Iron supplementation, with or without erythropoiesis-stimulating agents, can be effective in reducing red blood cell utilization in patients with preoperative anemia undergoing elective surgery 5.
Fortification and Supplementation
- Fortifying rice with iron can increase hemoglobin levels and reduce anemia in infants, as demonstrated in a community intervention trial 6.
- The effectiveness of iron supplementation, with or without erythropoiesis-stimulating agents, in reducing red blood cell utilization and anemia prevalence has been investigated in various studies 4, 5.
- The route of iron administration (oral or intravenous) and the type of iron supplement used can influence the effectiveness of iron therapy in managing anemia 5.