Iron Deficiency Without Anemia: Why Your Labs Look "Normal"

"Your hemoglobin is fine" - but you're still exhausted. Sound familiar? Iron deficiency without anemia (IDNA) affects millions of women yet goes undiagnosed because doctors focus on hemoglobin alone.

Understanding Iron Deficiency

Iron deficiency progresses in stages: 1. Depleted iron stores: Ferritin drops, but hemoglobin is normal 2. Iron-deficient erythropoiesis: Iron supply can't meet red blood cell needs 3. Iron deficiency anemia: Hemoglobin finally drops

By the time you're anemic, you've been iron deficient for a long time.

Why Ferritin Matters

Ferritin is your iron storage protein. It drops long before hemoglobin does. Research shows that ferritin below 50 ng/mL can cause fatigue symptoms, even when hemoglobin is perfectly normal.

Symptoms of Low Ferritin

• Fatigue and weakness
• Hair loss
• Restless leg syndrome
• Difficulty concentrating
• Shortness of breath with exercise
• Cold hands and feet
• Brittle nails

Optimal Ferritin Levels

Labs often list 12-150 ng/mL as normal. But optimal for energy is: - Minimum: 50 ng/mL - Optimal: 70-100 ng/mL - For hair loss: >70 ng/mL

The Complete Iron Panel

Don't just test ferritin. A complete picture includes: - Ferritin - Serum Iron - TIBC (Total Iron Binding Capacity) - Transferrin Saturation

References

• Camaschella, C. (2015). Iron-deficiency anemia. *New England Journal of Medicine*, 372(19), 1832-1843.
• Vaucher, P., et al. (2012). Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. *Canadian Medical Association Journal*, 184(11), 1247-1254.
• Lopez, A., et al. (2016). Iron deficiency anaemia. *Lancet*, 387(10021), 907-916.