Iron is an important mineral for healthy red blood cells. Without enough iron, you have a higher risk of developing anemia. However, it’s also possible to have an iron deficiency without anemia.

Iron deficiency is the most common cause of anemia. Anemia is when your level of red blood cells is too low, which can cause fatigue and weakness. Iron-deficiency anemia affects about 20% of people in the world.

Iron is a mineral that your body needs to make healthy red blood cells. Without enough iron, your body can’t make enough red blood cells.

It’s also possible to have an iron deficiency without anemia, though it may progress to anemia. One study estimates that iron deficiency without anemia is actually three times as common as iron-deficiency anemia.

Iron deficiency with and without anemia are preventable and treatable conditions. This article will take a closer look at the signs and symptoms of iron deficiency without anemia, who is at risk, and how it’s treated.

An iron deficiency can cause some of the same symptoms as iron-deficiency anemia. The only way to know for sure is through blood work.

Common symptoms of iron deficiency include:

  • difficulty concentrating or focusing
  • feeling tired or lethargic
  • changes in mood
  • feeling weak, especially when doing an activity

It’s a good idea to talk with your doctor if you notice any of these symptoms. They can order blood work to find out more. Blood tests will measure your iron levels and may also be able to determine if low iron levels have caused iron-deficiency anemia.

It may take several weeks for iron levels in your body to drop below normal. If there are multiple factors that affect your ability to get enough iron, your body’s iron stores may be used up more quickly.

Iron deficiency has different causes. Sometimes it’s a combination of factors.

Common causes of iron deficiency include:

  • low iron intake from food or supplements
  • increased iron needs
  • poor iron absorption

Some people are at greater risk of developing iron deficiency. This includes people who:

About ferritin and hemoglobin

Ferritin levels also play a role in iron deficiency. Ferritin is a storage form of iron. The World Health Organization (WHO) defines low iron as a ferritin level below 12 micrograms/L. There’s good evidence that a ferritin level under 30 micrograms/L should be considered an iron deficiency.

A transferrin saturation test is also useful to see how much iron in the blood is bound to transferrin. Transferrin is a protein that helps bind and transport iron in the blood. A low transferrin saturation usually indicates iron deficiency.

Hemoglobin can also be affected by iron levels. Hemoglobin is a part of the red blood cell that carries oxygen. Your body needs iron to make hemoglobin. When hemoglobin levels are low, it means that your red blood cell levels are also low.

Iron deficiency without anemia may be diagnosed when ferritin is low but hemoglobin levels are in the normal range. On the other hand, iron-deficiency anemia is diagnosed if ferritin and hemoglobin are both low.

How much iron do you need each day?

Anyone who menstruates needs more iron due to monthly blood loss.

People ages 19–50 who menstruate need 18 milligrams (mg) of iron daily. Anyone who is pregnant or lactating may need additional iron. Everyone else needs 8 mg of iron daily. You can get iron from both plant and animal sources.

Some of the best sources of iron include:

  • iron-fortified breakfast cereal
  • oysters
  • pumpkin seeds
  • liver
  • lentils
  • sardines
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Blood work is the best way for iron deficiency to be diagnosed, with or without anemia.

The main blood tests that are used include ferritin and hemoglobin. Other tests might be done at the same time to find out more about the health of your red blood cells.

If your ferritin is low, but your hemoglobin is normal, you may have iron deficiency without anemia. If your hemoglobin level is also low, it means your red blood cell count is low. This may be diagnosed as iron-deficiency anemia.

The first-line treatment for iron deficiency is usually dietary counseling and oral iron supplements. If your doctor recommends iron supplements, make sure you understand what type and dose to take.

Iron infusions are another option, but this is typically only done in more severe cases of iron-deficiency anemia.

Increasing iron intake from food may help, but this is most effective in nonsymptomatic people who don’t have any absorption issues. In many instances, dietary changes alone isn’t enough to raise iron levels into the normal range.

You’ll likely need to have follow-up blood work done within 2 to 3 months of starting a supplement. This is a good timeline to recheck your iron levels to see if they are going up.

If iron deficiency is not treated, the amount of iron in your body may continue to drop. Over time, this may affect your body’s ability to make red blood cells which could, ultimately, cause anemia.

An iron deficiency is when the levels of iron in your body are low. Iron deficiency is the most common cause of anemia, but an iron deficiency can also occur without anemia. Blood work is the only way to know for sure.

Iron deficiency with and without anemia are both treatable conditions. Many people may be able to normalize their levels within a few months with the right treatment.