57% of Women in India Live with Anaemia
Iron deficiency can occur even with normal haemoglobin levels, as ferritin levels can be influenced by various factors such as inflammation and clinical history
Iron deficiency can develop gradually, with the body’s stored iron being depleted before there is a measurable fall in haemoglobin. This means that a normal haemoglobin level does not always indicate adequate iron stores.
Haemoglobin and ferritin measure different aspects of iron in the body. Haemoglobin is the protein in red blood cells that carries oxygen, while ferritin reflects the body’s iron reserves. The body can maintain haemoglobin for some time by drawing on these reserves, which is why iron deficiency may be present even when a routine blood test shows normal haemoglobin.
Ferritin is a key marker used to assess iron stores in the body. It is often compared to a warehouse where iron is stored for use whenever the body needs it. Iron is stored mainly in tissues such as the liver and spleen and within cells called macrophages. However, ferritin levels can be influenced by factors such as age, sex, pregnancy, menstruation, and clinical history.
Inflammation can also cause ferritin levels to rise, making iron stores appear better than they actually are. The World Health Organization recommends taking inflammation into account when interpreting ferritin and, where appropriate, using markers such as C-reactive protein alongside it. A transferrin saturation below 20% can also support a diagnosis of iron deficiency, particularly when ferritin is difficult to interpret.
## Why it matters Iron deficiency without anaemia can be missed if testing is limited to just haemoglobin measurement. This is a significant concern, especially in India, where 57% of women aged 15-49 years live with anaemia, according to the latest available NFHS-5 data. It is essential to consider ferritin levels and other factors when assessing iron deficiency, rather than relying solely on haemoglobin levels.
## What happens next Healthcare professionals must take a comprehensive approach to diagnosing and treating iron deficiency, considering multiple markers and factors that can influence iron stores. By doing so, they can ensure that individuals with iron deficiency receive proper treatment, even if their haemoglobin levels appear normal.
