William Wallace: Iron Deficiency Can be Present Before Hemoglobin Falls and Before Anemia Appears
William Wallace, Co-Founder and Chief Scientific Officer at Supplement Success Solutions, shared a post on X:
“Iron deficiency can be present before hemoglobin falls and before anemia appears.
That distinction matters because a standard CBC primarily tells you whether red cell production has already been affected. It does not fully describe iron status.
Ferritin is generally the most useful marker of stored iron, but interpretation is not always straightforward.
Ferritin is also an acute phase reactant, so inflammation can raise it even when available iron is limited.
Transferrin saturation provides additional information about circulating iron availability.
Reticulocyte hemoglobin reflects how much iron is reaching newly produced red blood cells, while soluble transferrin receptor can provide information about cellular iron demand and is less influenced by inflammation.
These markers are not interchangeable. They reflect different parts of iron physiology and may become abnormal at different stages of deficiency. The practical implication is that normal hemoglobin does not, by itself, exclude iron deficiency.
When deficiency is clinically plausible, assessment may require ferritin together with other iron indices and appropriate consideration of inflammation, blood loss, dietary intake, absorption, and other potential causes.
The goal is not to order every available marker routinely. It is to recognize that iron deficiency and iron deficiency anemia are related, but they are not synonymous.
References: Camaschella C. Blood. 2019;133:30 39. PMID: 30401704. Iriarte Gahete M, et al. Blood Rev. 2024;68:101227. PMID: 39142965. WHO. Guideline on use of ferritin concentrations to assess iron status. 2020.”
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