Am Fam Physician. 2009 Sep 1;80(5):441.
Original Article: Iron Deficiency Anemia
Issue Date: March 1, 2007
Available at: http://www.aafp.org/afp/20070301/671.html
to the editor: After reading the excellent review of iron deficiency anemia by Dr. Killip and colleagues last year, my threshold for testing for this condition decreased substantially. However, in the following year, I was surprised that I made the diagnosis of iron deficiency without anemia nearly as often as iron deficiency anemia. The most common type of patient for whom I made this diagnosis was a middle-aged frequent blood donor complaining of fatigue, angular cheilitis, or restless legs. Often, patients would express surprise at the diagnosis, recalling that the blood bank had informed them hat their “iron level” was normal.
Much of the available research on iron deficiency is grouped with iron deficiency anemia. However, there is evidence of morbidity associated with iron deficiency in non-anemic patients. Iron supplementation has been shown to improve fatigue in non-anemic women with iron deficiency.1 The duration of exercise achieved before muscle fatigue has been shown to improve with iron therapy in non-anemic iron-deficient women.2 In a study measuring verbal learning and memory in iron-deficient adolescent girls without anemia, both of these parameters improved with iron supplementation.3 Additionally, treating low iron levels has been shown to reduce symptoms of restless legs syndrome.4
The American Red Cross Blood Donation Eligibility Guidelines require a hemoglobin level of at least 12.5 g per dL (125 g per L) for blood donation.5 However, iron deficiency is not listed as an exclusion criterion. The American Red Cross does not require testing for adequate iron stores even for long-term frequent blood donors. Perhaps guidelines should be established to determine which blood donors would benefit from screening for iron deficiency in the absence of anemia.
REFERENCESshow all references
1. Verdon F, Burnand B, Stubi CL, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ. 2003;326(7399):1124....
2. Brutsaert TD, Hernandez-Cordero S, Rivera J, Viola T, Hughes G, Haas JD. Iron supplementation improves progressive fatigue resistance during dynamic knee extensor exercise in iron-depleted, nonanemic women. Am J Clin Nutr. 2003;77(2):441–448.
3. Bruner AB, Joffe A, Duggan AK, Casella JF, Brandt J. Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls. Lancet. 1996;348(9033):992–996.
4. Sun ER, Chen CA, Ho G, Earley CJ, Allen RP. Iron and the restless legs syndrome. Sleep. 1998;21(4):371–377.
5. American Red Cross. Blood donation eligibility guidelines. http://www.redcross.org/en/eligibility. Accessed August 5, 2008.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: email@example.com, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2009 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions