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[QUOTE=ElleDi;2963864]My doctor (the old one) says that my hemoglobin is normal. According to the test results, it is. I guess he thinks that because my hemoglobin is normal, I'm not anemic. Ok, fair enough. But he is very casual about my low ferritin levels (which was 9). I'm going to a new doctor and want to sound informed about this. What's the difference?

If your hemoglobin, hematocrit, and RBCs are all within normal range, you are not anemic. Usually, if the three of those are below normal you have some type of anemia, could be iron, B12, or folate.

Ferritin is a protein that is tied to the amount of iron stores in your body. You can be iron deficient yet not be anemic (this is where I am now and my ferritin is 5). Prior to iron supplementation, I was anemic. Anemia is the "end stage" or last phase of iron depletion. Depending on the cause, iron depletion can happen rapidly (big bleeding tumor) or it can happen slowly over years (small bleeding polyp or heavy monthly cycles). After your iron is depleted long enough, the anemia starts.

Many doctors in the U.S. only care about what the CBC says (hemoglobin, hematocrit, RBCs). If they are normal, the doctor thinks everything is okay and doesn't do more. Many doctors do not feel that an iron deficiency without anemia is cause for concern. Some doctors do.
Ferritin is the best way to measure the body's iron store. In iron deficiecy anemia and the prelude to it (where you likely are), the ferritin falls first as a result of iron deficicency. For anemia, a fall in hemoglobin below 12 is the marker, along with an MCV below 80 (microcytic). If it is caused by iron deficiceny, then it is "iron deficiency anemia" IDA.

Concerning what level defines iron deficiency or iron depletion without anemia, I had bookmarked some articles on the subject for myself. Some of the articles are very technical and narrowly focused, but contain gems of info on the standard being used to [I]define[/I] iron deficiecy/ depletion within that article/study.

I did check with the rules of posting and it says posting books and authors is fine, so I presume the same is true about journal articles and titles. Most of the articles I mention are available in full text on the web.

American Journal of Clinical Nutrition, Vol 77 441-448 February 2003, [I]Iron supplementation improves progressive fatigue resistance during dynamic knee extensor exercise in iron-depleted, nonanemic women[/I], states iron depletion is at [B]<20 ug/ serum ferritin[/B]

Journal of the American College of Nutrition, Vol 21 545-552 2002, [I]Non-Anemic Iron Depletion, Oral Iron Supplementation and Indices of Copper Status in College-Aged Females[/I], states [B]<20 ug/ serum ferritin[/B]

Same journal Vol 20,477-484 2001
[I]Can Dietary Treatment of Non-Anemic Iron Deficiency Improve Iron Status?[/I] states that mild iron deficiiency is [B]serum ferritin <20 g/L and hemoglobin >=120 g/L[/B]

If you dr need more heavy hitters outside the nutriition world, then how about Blood? the premier journal of that big association of hematologists?

Blood, February 15 2006, Vol107, 1673-1679, [I]Variable hematologic presentation of autoimmune gastritis: age-related progression from iron deficiency to cobalamin depletion[/I] states deficiency is [B]serum ferritin level less than 15 g/L.[/B]

Same journal February 15 2002 Vol 99, pp1489-1491, [I]Clinical utility of the reticulocyte hemoglobin content in the diagnosis of iron deficiency[/I]
stated that [B]serum ferritin of 12 g/L[/B] or less is the most specific indicator of iron deficiency.

For a really [U]good general read[/U] that your dr would most likely see, check out American Family Physician Vol. 62 No. 7 October 1, 2000, [I]Anemia in the Elderly [/I] say iron def is at serum ferritin is less than [B]15 ng per mL[/B] (15 g per L)

Another good read : same journal Vol. 75 No. 5 March 1, 2007, [I]Iron Deficiency Anemia[/I]

Lastly, if your dr says "so, you are iron deficiient, but you don't have anemia", let him know there are tons of articles out there on decreased work ability and increased fatigue in iron deficiiency without anemia. See: BMJ 2003;326:1124, 24 May,[I] Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial[/I] shows that there was a benefit from supplementation in people with [B]less than 50 ferritin[/B].

Ok. hope this is helpful. It took me a while to gather all this info, and I figured I would share it and put it to good use. :wave:

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