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Iron Deficiency Without Anaemia — RACP Adult Medicine MCQ

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EasyHaematologyIron Deficiency Without AnaemiaRACP Adult Medicine

A 30-year-old woman with heavy menstrual bleeding has fatigue, restless legs, and hair thinning. Hb is 125 g/L (normal). Ferritin is 8 μg/L (very low). TSAT 10%. MCV is 82 fL (low-normal). What is the most appropriate management?

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Correct answer: A — Oral iron supplementation (ferrous sulfate 325 mg daily)

Iron deficiency WITHOUT anaemia (Hb normal but ferritin <30, TSAT <20%) is increasingly recognised as causing symptoms: fatigue, impaired cognition, restless legs, hair loss, and exercise intolerance. The FAIR-HF and AFFIRM-AHF trials demonstrated benefit of IV iron even without anaemia in heart failure. For non-cardiac patients, oral iron is first-line (ferrous sulfate 325 mg alternate-day dosing has better absorption than daily — IRONMAN study). IV iron for oral intolerance or malabsorption.

Reference: BSH – 2024 – Iron Deficiency; WHO 2024 Iron Deficiency