Chokri Ben Lamine on Iron Deficiency Without Anemia (IDWA): Symptoms, Diagnosis, and Management Tips
Chokri Ben Lamine, Adult Hematology and Stem Cell Transplantation Assistant Consultant at Oncology Center of Excellence at King Faisal Specialist Hospital and Research Center, shared a post on, recently shared on X:
“Iron Deficiency Without Anemia (IDWA) – teaching pearls for fellows
Definition
•Hb ≥110 g/L
•Ferritin ≤25–30 µg/L (≤100 µg/L if inflammation)
Low iron stores but Hb still above anemia threshold.
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Why it matters?
•Early stage of iron deficiency may progress → IDA
•Symptoms can occur before anemia:
fatigue, cognitive issues, restless legs, ↓ exercise tolerance
•High-risk groups: pregnancy, heart failure, CKD, perioperative
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Management
•Oral iron if tolerated + monitor
•IV iron if: intolerance, severe symptoms, urgent optimization (HF, surgery, CKD)
•Do not ignore – even without anemia
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Guideline cutoffs
•WHO: ferritin <15 µg/L = ID
•Most hematology/clinical practice: <30 µg/L in healthy adults
•With chronic disease/inflammation: <100 µg/L
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Exam Pearl (MCQ)
Q: A 35-y/o woman has Hb 120 g/L, ferritin 18 µg/L, fatigue. Diagnosis?
a) Iron deficiency anemia
b) Iron deficiency without anemia
c) Normal iron status
d) Anemia of chronic disease
Correct: b. Explanation: Hb normal, ferritin low.
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OSCE Scenario
•Patient pre-op with Hb 115 g/L, ferritin 20 µg/L
•Examiner asks: ‘Would you treat?’
Answer: Yes, this is iron deficiency without anemia. Perioperative guidelines recommend iron supplementation (often IV) to reduce transfusion risk.
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Key References
•WHO. Serum Ferritin Concentrations for Assessment of Iron Status. 2020. link
•KDIGO Anemia Guidelines (CKD). Kidney Int Suppl. 2012. link
•ESC Heart Failure Guidelines 2021. Eur Heart J. link”
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