A lot of patients may have symptoms of iron deficiency like fatigue even before they develop anemia and microcytosis. I didn’t know this until I worked with a naturopathic doctor, Scott Buesing, and he brought that up. I asked heme-onc, Dr. Bucher and she said she had several patients she is treating for iron deficiency who have normal hgb/hct and normal MCV.
The following Up to date article says
“Symptoms of anemia — The usual presenting symptoms in adults with iron deficiency are primarily due to anemia. The same symptoms may also be present in those with severely reduced iron stores and extremely low serum ferritin who are not anemic. Typical symptoms include [22]:
Fatigue
Weakness
Headache
Irritability
Exercise intolerance
Exertional dyspnea
Vertigo
Angina pectoris
These may be present in varying degrees and may not be appreciated at all until after iron deficiency is identified and treated. Many patients recognize in retrospect that they had fatigue, weakness, exercise intolerance, and/or pica only after successful iron repletion.”
I haven’t yet researched this further yet. It is worth considering.
if you have any literature on this, please send it my way to put up here.
thanks.
Resources
https://www.uptodate.com/contents/causes-and-diagnosis-of-iron-deficiency-and-iron-deficiency-anemia-in-adults?