Iron Deficiency without Anemia: Diagnostic Challenge and the Role of Lifestyle and Dietary Intervention

Background:

Iron Deficiency without Anaemia (IDWA) or Non-Anaemic Iron Deficiency (NAID) is frequently overlooked, especially in women from developing nations. This condition is characterized by low serum ferritin levels and low transferrin saturation levels, accompanied by normal haemoglobin counts. Early diagnosis and treatment are important in avoiding the development of iron deficiency anaemia and its associated systemic effects.

Case Presentation:

A 28-year-old female came to the dermatology clinic with complaints of sudden skin pigmentation, diffuse hair loss, generalized weakness, dizziness, and depressive symptoms for the last three months. She reported having very poor dietary habits, with a minimal intake of iron-rich foods for nearly four years. The full blood count was within normal limits (e.g., haemoglobin 13.2 g/ dL). However, key findings included low serum ferritin (19.5 ng/mL), low serum iron (35.6 mg/ dL), elevated TIBC (503.8 µg/dL), and low transferrin saturation (11.50%). The diagnosis of Iron Deficiency without Anaemia was confirmed by a peripheral smear showing a normocytic normochromic picture. The patient initially received ferrous sulphate but was switched to ferrous fumarate due to constipation, leading to better tolerability. She also received advice regarding improved dietary habits.

Results:

After one year of sustained therapy and dietary changes, follow-up testing showed normalization of iron studies, including serum ferritin (33.3 ng/mL) and transferrin saturation (20.76%). The patient reported significant improvement in symptoms, including fatigue, hair loss, and mood.

Conclusion:

This case underscores the need to recognize iron deficiency without anaemia as a distinct clinical syndrome that may present with dermatological and neuropsychiatric complaints despite normal haemoglobin levels. Early recognition through targeted laboratory evaluation and appropriate therapy is essential to improve patient outcomes. Switching from ferrous sulphate to ferrous fumarate demonstrated improved compliance due to better gastrointestinal tolerability.