Correct assessment of iron depletion and iron deficiency anemia

Nutr Health. 2006;18(2):133-9. doi: 10.1177/026010600601800205.


Objective: Iron deficiency anemia is caused by decreased production of red blood cells (RBCs) and is characterized by a reduction in either the hematocrit (Ht) or the concentration of hemoglobin (Hb). It is detected by blood iron status measures that are below population reference standards and also below the "usual or normal" levels for an individual. In some medicine practices, usually only hemoglobin and hematocrit are routinely measured with a full blood count, without measuring the indicators of iron status. Biochemical measures that are collected on single occasion are difficult to interpret in individuals, and normal ranges of hemoglobin and hematocrit do not necessarily confirm an iron deficiency condition, because they decrease only when severe iron depletion is present and are often unreliable or misleading. Thus, iron-depleted individuals can quickly develop iron deficiency if not detected early.

Methods: Information from hematological laboratory tests records on female patients at reproductive ages were collected and analysed.

Results: In this study, measurement of general test for anemia in some individuals revealed normal levels of RBCs count, Hb, Ht, mean corpuscular volume (MCV), mean cell hemoglobin concentration (MCHC), and cell morphology, whereas the levels of parameters of iron depletion and iron deficiency anemia such as serum iron and ferritin showed reduced values. The results indicate that individuals who are ordered cell blood count (CBC) measures alone without examining the indicators of iron status (Group C vs Group D) may not be correctly assessed with a definitive diagnosis and categorized as normal individuals. But in fact, they are susceptible to iron depletion and could develop iron deficiency anemia.

Conclusions: In evaluation of iron deficiency status it is important that total CBC test be accompanied by the other tests of iron status to pinpoint true iron deficiency. Otherwise, many cases may be missed out and misdiagnosed as normal individuals.

MeSH terms

  • Adolescent
  • Adult
  • Anemia, Iron-Deficiency / blood*
  • Anemia, Iron-Deficiency / diagnosis*
  • Diagnosis, Differential
  • Erythrocyte Count*
  • Female
  • Ferritins / blood
  • Health Status
  • Hematocrit
  • Hemoglobins / analysis
  • Humans
  • Iron / blood*
  • Iron Deficiencies*
  • Middle Aged


  • Hemoglobins
  • Ferritins
  • Iron