Symptomatic Iron Deficiency Without Anemia

Allan S. Brett, MD


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In This Article

Abstract and Introduction


Oral iron improved fatigue symptoms in nonanemic menstruating women with low ferritin levels.


Does iron deficiency cause fatigue in the absence of anemia? If so, can oral iron therapy improve symptoms? To find out, Swiss researchers identified 198 menstruating women with fatigue who had normal hemoglobin levels (≥12.0 g/dL; mean, 13.5 g/dL), low or low-normal serum ferritin levels (<50 µg/L; mean, 23 µg/L), and no other obvious cause of fatigue. Participants were randomized to receive either daily ferrous sulfate (80-mg elemental iron) or placebo.

At baseline, the average score on a standardized fatigue index was 25 (maximum score, 40). At 12 weeks, mean decrease in fatigue score was significantly greater in the iron group than in the placebo group (–12.2 vs. –8.7). In the iron group, mean hemoglobin concentration increased by 0.3 g/dL and mean ferritin level increased by 12 µg/L. These changes, although modest, were statistically significant relative to the essentially unchanged levels in the placebo group.