Iron Deficiency Without Anemia: Recognition, Causes, and Clinical Management

Abstract

Iron deficiency without anemia (IDWA) represents a hidden yet prevalent condition that disrupts fundamental physiological processes long before classical pre-anemia becomes apparent. Although hemoglobin concentration remains within reference limits, depleted iron stores impair energy metabolism, cognitive capacity, and physical endurance (Camaschella, 2019). Across diverse populations—women of reproductive age, children, older adults, and athletes—this latent deficiency compromises health, productivity, and quality of life (Lopez et al., 2016). Modern diagnostic tools now make early detection possible through measurement of ferritin, transferrin saturation, and inflammatory indicators such as hepcidin (Pasricha et al., 2021). Still, awareness among clinicians and the general public remains limited. This review integrates contemporary evidence concerning iron metabolism, mechanisms of deficiency, epidemiology, clinical presentation, and management strategies, highlighting the importance of early recognition. By synthesising insights from haematology, nutrition science, and performance physiology, the paper aims to provide a comprehensive foundation for improved prevention and treatment of this under-recognised disorder.