Iron deficiency without anemia: indications for treatment

Abstract

Background and Purpose: Iron deficiency without anemia (IDWA) is the predominant form of iron deficiency (ID). In IDWA a negative iron balance reduces the iron stores responsible for keeping the hemoglobin concentration stable. The medical consequences of IDWA and the need for treatment of the condition are debated. Methods: An electronic-based search was performed using the Embase, Ovid Medline and and Cochrane library databases. The following medical subject heading (MeSH) terms, keywords and their combinations were used: 'iron deficiency', 'oral iron',' iron supplements', 'anemia', 'iron deficiency without anemia' and 'iron adverse events'. Results: Mounting evidence suggests that even mild ID (serum ferritin <20-35 ug/L) can result in symptoms such as fatigue, altered cognitive functions, decreased aerobic performance, restless legs syndrome, reduced quality of sleep, and so on. Individuals, especially from the well-known risk groups such as growing children, menstruating and pregnant women, but also endurance athletes and the elderly, frequently develop mild forms of ID. Current evidence strongly indicates that to ensure optimal health and development, it is important to prevent and treat even mild ID through iron supplementation. Treatment with oral ferrous iron preparations is known to be effective and safe in most patients. Despite much progress also with parenteral iron preparations, oral iron therapy is clearly the first-line treatment in all subjects with diagnosed ID. Conclusions: IDWA is an under-recognized, underdiagnosed and certainly undertreated entity. The balance of current evidence strongly indicates that to ensure optimal health and development, it is important to prevent and treat even mild ID.