Often, a person’s anemia is found through routine screening at the doctor’s office or after they begin to experience the symptoms of iron deficiency, commonly fatigue. Iron deficiency anemia doesn’t just happen though, but rather progresses through different stages that take it from iron depletion to full-blown anemia.
Simply put, iron deficiency depicts having less than adequate iron levels in the body; this can occur from a number of conditions, mainly due to blood loss, or impaired absorption. Iron deficiency anemia presents with a low red blood cell count or inadequate hemoglobin, which is due to insufficient iron.
Red blood cells (erythrocytes) carry oxygen throughout the body via their hemoglobin. Hemoglobin binds to oxygen and enables the red blood cells to supply oxygenated blood throughout the body. Iron is necessary to produce hemoglobin. Thus, when the body lacks iron, the result is altered production of hemoglobin.
Here are a few facts:
- On average, men have 5.2 million red blood cells per cubic millimeter of blood and women have 4.7 million red blood cells;
- Each red blood cell contains 280 million hemoglobin molecules;
- Red blood cell production (erythropoiesis) primarily occurs in the bone marrow;
- The lifespan of a red blood cell is 90 to 120 days; when old red blood cells are broken down for removal by the liver and the spleen, iron is returned to the bone marrow to make new cells;
- The extra iron in the body is stored in the liver and bone marrow for hemoglobin synthesis.
Now that we understand a bit of what is happening in the body, the following are the three stages of iron deficiency to help give you a clearer understanding of how iron deficiency progresses.
First Stage: Iron Depletion
First, an insufficient supply of iron causes the iron stored in the liver to be depleted. Generally, this stage goes undetected – typically there are no symptoms and no overt effect on red blood cell production (erythropoiesis) – escaping detection during hemoglobin or hematocrit screening as these levels are usually normal when tested.
This stage is often characterized by low serum ferritin levels, indicating decreased iron storage in the liver. Blood tests will show a decrease in ferritin levels, the normal range being 20 – 300 nanograms per milliliter (ng/mL); however it is possible that the patient becomes symptomatic with ferritin levels less than 50 ng/mL.
During this stage, iron storage is significantly reduced, or sometimes absent, and continued iron store depletion leads to the second stage.
Second Stage: Iron Deficiency
Second, iron deficiency develops and begins to affect hemoglobin production, and iron stores in the bone marrow are substantially reduced. Though this is not always the case, in what I consider to be the “triad of symptoms” related to iron deficiency, patients may experience chronic fatigue, difficulty concentrating, and irritability.
This stage is characterized by abnormalities in certain iron parameters. While hemoglobin or hematocrit levels may be reduced, iron deficiency may not be detectable using the normal cut off values. Decreased ferritin levels are typically present and can be detected, but there is also increased capacity of binding and transporting iron; this signifies your body being prepared should iron become available.
The tests most frequently used to assess patients suspected of having iron deficiency include total iron-binding capacity (TIBC) and a serum iron test. Combined, these two tests are used to evaluate the transferrin saturation, a useful indicator of iron status. About 20% – 40% of available transferrin sites are used to transport iron in a healthy patient. In a patient with iron deficiency, iron levels are low but the TIBC will be increased, which results in a very low transferrin saturation.
Final Stage: Iron Deficiency Anemia
In this advanced stage, due to chronic insufficient iron in the body, the iron stores have depleted to a point where they can no longer produce the hemoglobin needed to make enough red blood cells. As the body becomes increasingly deficient in iron, anemia worsens and symptoms intensify. This stage is characterized by a significant reduction in hemoglobin levels. As such, blood tests at this stage will show considerably low hemoglobin and hematocrit levels.
As you can see, early detection of iron deficiency isn’t easy. Symptoms generally associated with the first stage (and sometimes even the second stage) often mimic other conditions or are brushed off as just simply feeling tired. Further, by the time changes in hemoglobin and hematocrit can be detected through blood screening, a person’s iron stores have already been significantly depleted and are in need of replenishment to avoid further symptoms and complications.
I will leave you with this: If you suspect iron deficiency or anemia, it is extremely important to be proactive and talk with your primary healthcare provider!
Content and advice provided on The Iron Maiden is for information purposes only and should not serve as a substitute for a licensed health care provider, who is knowledgeable about an individual’s unique health care needs