AI-generatedYour haemoglobin is normal, but you feel exhausted and your ferritin is low. This is not a contradiction: iron deficiency and iron-deficiency anaemia are different things.
Distinguish stores from blood formation
Iron is needed for blood formation, among other functions. If supply is insufficient, stores may fall first. At that point, the Hb concentration need not have fallen below the appropriate reference range.
Iron-deficiency anaemia occurs when iron deficiency is accompanied by corresponding anaemia. Whether anaemia is present is determined by the blood count and clinical context, rather than a ferritin value of 15, 30 or 50.
Which symptoms can occur?
Fatigue, reduced exercise tolerance or concentration problems may also be reported without anaemia. However, these symptoms are non-specific. Sleep disorders, thyroid disease, psychological stress, medicines and other causes can have similar effects.
When should treatment be discussed?
Low ferritin, typical risk factors and compatible symptoms are reasons for a joint assessment. Whether and how to treat also depends on why the deficiency developed. The finding “Hb normal” should not remove documented depleted stores from consideration.
More iron is not automatically the whole solution
Heavy menstrual bleeding can cause ongoing iron loss. Frequent blood donation or absorption disorders create different circumstances again. If iron is only replaced without considering the cause, deficiency can recur.
Follow progress rather than a fixed optimal value
Symptoms, Hb and storage parameters are considered over time. This does not establish a universal ferritin target above 100 for every tired woman. Treatment response is also individual and does not prove that all previous symptoms were caused solely by iron.
Use the iron status check to organise your results. If you already take tablets, the iron tablets check can also help.
Sources
- ASH 2026 – diagnostic guideline, official teaching slides
- Vaucher et al. 2012 – fatigue without anaemia
