Iron deficiency without anaemia: is it possible and how do you notice it?

Yes, you can have iron deficiency while your haemoglobin is still normal. Doctors call this iron deficiency without anaemia, and it is often the first phase of a deficiency (Pasricha 2021). I find it one of the most underrated situations: you do not feel fit, but a standard blood test looks reassuring. Yet your stores are already low.

This article expands on the overview about anaemia and iron deficiency, focusing on the phase before anaemia.

How can iron be low without anaemia?

Your body uses its reserve iron before haemoglobin drops. That reserve shows up in your ferritin. When ferritin runs low, your body still keeps red cell production going for a while. Only when the store gets truly low does haemoglobin fall, and then it is anaemia. So there is a period where iron is low but Hb is still normal, and you can already feel it. Picture a savings account draining slowly: you notice the smaller buffer before the account is truly empty.

Which symptoms fit a low ferritin?

• Fatigue that does not match your sleep
• Hair loss or brittle nails
• Trouble concentrating
• Restless legs, especially in the evening
• Getting short of breath on exertion

Why a plain Hb test can miss this

So a ferritin measurement can give an explanation slightly sooner than Hb alone. Read more at the ferritin level explained and ferritin and iron storage.

Which blood values give insight?

To spot an early deficiency, ferritin is often the most sensitive value. Iron and transferrin can complete the picture. How the transport values work is covered in transferrin and saturation.

What can you do?

To measure your stores without a referral, you can have your iron status tested at Vitalcheck. If your ferritin is low, discuss the result with your GP before changing supplements on your own.

References

• Pasricha SR, et al. Iron deficiency. Lancet. 2021. PMID: 33285139.
• Camaschella C. Iron deficiency. Blood. 2019. PMID: 30401704.
• Thuisarts.nl. Iron deficiency.

Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.