Iron deficiency often remains unresolved 3 years after diagnosis
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More than half of people with iron deficiency continued to have low iron levels 3 years after diagnosis, according to retrospective study results.
Gaps in prompt recognition and efficient treatment of the condition appeared most apparent among women, Black individuals and younger people.
“Iron deficiency can be challenging to diagnose, but it’s easy to treat,” researcher Jacob Cogan, MD, assistant professor of medicine at the University of Minnesota, said in a press release. “Our findings underscore the need for a more coordinated effort to recognize and treat iron deficiency to help improve quality of life.”
Background
Iron is critical for hemoglobin production and other body functions.
An estimated 40% of adolescents and young women in the United States may have iron deficiency. The condition may go undiagnosed for up to 70% of high-risk individuals, such as those who have problems with malabsorption or those with bleeding disorders, according to study background.
Treatment typically begins with oral iron supplementation. IV iron can be used for patients who experience adverse events or whose low iron levels persist.
If left untreated, however, the condition can cause fatigue, hair loss, mood changes and exercise intolerance. It also may lead to anemia.
“Iron deficiency is probably a bigger problem than we realize,” Cogan said. “I’ve seen a lot of cases where people don’t have anemia, but they are walking around with very little to no iron in their body and it can have a big impact on how people feel in their day-to-day life.”
For this reason, Cogan and colleagues assessed whether iron deficiency is recognized promptly and treated efficiently in clinical practice.
Methods
Researchers used electronic medical records of patients treated in the M Health Fairview system to identify 13,084 adults diagnosed with iron deficiency — with or without anemia — from 2010 to 2020. Investigators defined iron deficiency as ferritin value of 25 ng/mL or less.
All patients included in the cohort had at least 3 years of follow-up data and at least two recorded ferritin values during that period.
Investigators defined adequate treatment and resolution as a subsequent ferritin value of at least 50 ng/mL.
Key findings
More than half (58%) of study participants had persistent iron deficiency based on low ferritin levels 3 years after diagnosis.
The other 42% had normal iron levels within 3 years of diagnosis. In this group, median ferritin level increased from 12 ng/mL at diagnosis to 78 ng/mL at resolution.
Patients whose iron levels returned to normal had more follow-up blood work to assess ferritin values (median, 6 tests vs. 4 tests).
Researchers identified several factors linked to greater likelihood of iron levels returning to normal. These included treatment with IV iron (adjusted HR = 2.96; 95% CI, 2.66-3.3), male sex (adjusted HR = 1.58; 95% CI, 1.48-1.7) and being aged older than 60 years (adjusted HR = 1.56; 95% CI, 1.44-1.69).
Black individuals had lower likelihood of resolution (adjusted HR = 0.73; 95% CI, 0.66-0.8), as did women and younger patients.
An analysis of patients whose iron levels returned to normal showed 7% had resolution within 1 year of diagnosis, with median time to resolution of 1.9 years (interquartile range, 0.8-3.9).
“Two years is too long and well beyond the timeframe within which iron deficiency should be able to be sufficiently treated and resolved,” Cogan said in the release. “The numbers are pretty striking and suggest a need to put systems in place to better identify patients and treat them more efficiently.”
Cogan and colleagues provided potential explanations for the findings, including the potential that iron deficiency diagnosis is missed or treatment does not continue to resolution.
“Potential interventions to improve care delivery could include provider education about the symptoms of [non-anemic iron deficiency], laboratory flags for ferritin levels suggestive of iron deficiency despite falling within test reference ranges, and increased use of IV iron,” Cogan and colleagues wrote.
Researchers acknowledged study limitations, noting the retrospective nature and reliance on EMR data precluded them from determining the cause of iron deficiency or the reasons why ferritin tests had been ordered.
It is possible that some patients sought treatment outside the M Health Fairview system, and lack of standardized post-treatment ferritin testing could limit estimates of time to resolution, they wrote.
References:
- Cogan J, et al. Blood Adv. 2024;doi:10.1182/bloodadvances.2024013197.
- Over half of iron deficiency cases in large health systems still unresolved at three years (press release). Available at: https://www.hematology.org/newsroom/press-releases/2024/over-half-of-iron-deficiency-cases-in-large-health-system-still-unresolved-at-three-years. Published Aug. 15, 2024. Accessed Aug. 15, 2024.
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