Iron deficiency diagnostics and treatment are in the dark ages

Open letter

The diagnosis and treatment of iron deficiency is in the dark ages.

In recent years, ferritin measurement has repeatedly been called a fad.

Patients are denied ferritin measurement, and iron deficiency is not considered a diagnostic possibility behind patients' symptoms, even if the anamnesis would clearly indicate iron deficiency, had the anamnesis been inquired from the patients. Instead, patients undergo more and more complex examinations costing tens or even hundreds of thousands of euros, after which they are given various diagnoses or called hypochondriacs.

Common claim 1. Ferritin measurement is irrelevant in the diagnosis of iron deficiency.

However, according to international experts, ferritin (concentration below 30 μg/L) is the best indicator of iron deficiency, but a patient can be iron deficient with much higher ferritin values.

Common claim 2. Ferritin measurement is not necessary if hemoglobin and complete blood count are good.

It has been known for decades that iron depletes from stores before any changes occur in hemoglobin or complete blood count. Thus, it is textbook knowledge from Wintrobe's Hematology that iron deficiency can also be detected by ferritin measurement in such cases.

Common claim 3. Ferritin levels should not be measured if complete blood count and hemoglobin are good, because latent iron deficiency is rare.

According to the previous point, this claim cannot be true, which has also been stated in leading international medical journals worldwide, noting that iron deficiency without anemia is much more common than iron deficiency anemia, which is estimated to affect over 1.2 billion people globally.

Common claim 4. If hemoglobin is good and ferritin, i.e., stored iron, is low, there is no need to investigate the cause of iron deficiency.

International experts refute this claim as well, stating that all iron-deficient patients should be investigated to determine the cause of iron deficiency, and the iron deficiency should also be treated.

Based on the accounts of hundreds of my patients, it is evident that the approach outlined in claims 1-4 is widely followed throughout the Finnish healthcare system. This violates the rights of tens of thousands of patients, endangers their patient safety, significantly lowers their quality of life, exposes them to incorrect diagnoses, and delays correct diagnosis and treatment, which in extreme cases can result in the patient being unable to attend school, manage their work, or even care for themselves. This is also not without cost. Problems in the diagnosis and treatment of iron deficiency cost society at least 100 million euros annually, likely much more. Isn't it time to act and take iron deficiency seriously?

 

In Kaarina, November 29, 2021

- Esa Soppi, MD, Docent of Internal Medicine