The Iron Maiden – The Progression of Iron Deficiency

There are three stages of iron deficiency, each with specific symptoms to. The sooner the iron deficiency is diagnosed the easier the treatment. Treatment can be as simple as iron rich diet and oral iron supplements to intravenous iron and blood transfusion.

Iron deficiency is simply having a less than adequate iron supply in the body. Iron deficiency anemia is the final stage of iron deficiency, the result of not enough iron to support the production of adequate amount of hemoglobin.

Hemoglobin, what makes red Blood Cells (erythrocytes) red, carry oxygen throughout the body. Low hemoglobin means tissues are not getting enough oxygen.

A Few Facts:

  • Men, on average, have 5.2 million red blood cells per cubic millilitre of blood. Women have 4.7 million.
  • Each red blood cells contains 280 million hemoglobin molecules
  • Red blood cells are produced in the bone marrow (erythropoiesis)
  • Red blood cells live for 90-120 days, old red blood cells are broken down in the liver and spleen and the iron is returned to the bone marrow to be used in new red blood cells
  • Extra iron is stored in the bone marrow and liver

Stage 1 Iron Deficiency: Iron Depletion
This stage, which normally goes undetected, is characterized by the depletion of iron stores in the liver. The lab test that shows this is a ferritin level. Normal ferritin levels range from 20-300 nanograms per millilitre (ng/ml) however patients are commonly symptomatic of stage one iron deficiency once the ferritin level drops below 50 ng/ml. Ferritin levels are NEVER falsely low, but may be falsely elevated, therefore cannot solely be used to rule-out iron deficiency. If the ferritin level is less than 20 ng/ml is difficult if not impossible to replete using oral iron alone. Hallmark symptoms of this stage are often referred to the “Triad of Iron Deficiency”:

*difficulty concentrating may include memory deficits, ability to focus, and ability to multitask etc.

Stage 2 Iron Deficiency: Iron Deficiency
Iron stores in the bone marrow are significantly reduced which starts to affect the production of hemoglobin. Symptoms of this stage include the “Triad of Iron Deficiency”, sleeplessness (including restless leg syndrome), quick to tire, pale skin, decreased appetite, and feeling cold when others are comfortable. 

Lab work used to diagnose stage two iron deficiency is known as an “Iron Panel” which includes 3 blood tests:

  • Total Iron Binding Capacity (TIBC)
  • Serum Iron
  • % Transferrin Saturation
If the TIBC is elevated and Serum Iron and % Transferrin Saturation are low stage 2 iron deficiency may be suspected. 

Stage 3 Iron Deficiency: Iron Deficiency Anemia
Iron stores in the liver and bone marrow have advanced to the stage that normal hemoglobin production can no longer be supported; as the deficiency increases the anemia worsens and symptoms intensify. This stage is characterized by a considerably low hemoglobin and hematocrit (both values obtained in a CBC). 

Symptoms of Iron Deficiency Anemia include those of stage one and two as well as those common to other forms of anemia. Symptoms of anemia can be related to the lack of hemoglobin: low exercise tolerance and pronounced lack of energy, thin/fragile fingernails, inflamed tongue, dull brittle hair, and pica (craving for strange non-food items: ice, dirt, paper etc.) 

Early detection of iron deficiency can be difficult as symptoms often mimic other conditions and/or can often be ignored (tired because of stress). Often physicians will not even consider iron deficiency until the hemoglobin is affected. Often patients endure debilitating symptoms for years before their iron deficiency is diagnosed. 

If you suspect iron deficiency or iron deficiency anemia you need to be proactive in discussing your concerns with your primary health care provider and insist on the proper lab work and definitive treatment!

Leona "Oknee" Dove

Leona "Oknee" Dove

With my background as a registered nurse consultant in patient blood management at a Toronto community hospital, in combination with my own personal health struggles, I am an advocate for the early diagnosis and treatment for iron deficiency.