Iron deficiency isn’t being effectively treated in the United States, with low iron levels persisting for years in most patients, a new study finds.

Almost 3 of 5 (58%) patients with iron deficiency still had low iron levels three years after their diagnosis, researchers found.

Further, it took nearly two years to resolve iron deficiencies in most of the 42% of patients who did recover, results showed.

Only 7% of patients had their iron levels return to normal within a year of diagnosis, the study added.

“Two years is too long and well beyond the timeframe within which iron deficiency should be able to be sufficiently treated and resolved [with oral or IV treatments],” said lead researcher Dr. Jacob Cogan, an assistant professor of medicine with the University of Minnesota. “The numbers are pretty striking and suggest a need to put systems in place to better identify patients and treat them more efficiently.”

Iron deficiency affects nearly 40% of teenagers and young women, but as many as 70% of cases go undiagnosed in these groups, researchers said.

Most iron deficiency cases don’t involve full-blown anemia, researchers said. Anemia occurs when the body doesn’t have enough iron to make hemoglobin, the substance in red blood cells that allows them to transport oxygen throughout the body.

Cases of non-anemic iron deficiency can cause symptoms like fatigue and impaired thinking, researchers said.

“Iron deficiency is probably a bigger problem than we realize,” Cogan said. “I’ve seen a lot of cases where people don’t have anemia, but they are walking around with very little to no iron in their body and it can have a big impact on how people feel in their day-to-day life.” 

Doctors treat iron deficiency through iron tablets or injections, as well as recommending a well-balanced diet in which people get iron from both animal and plant sources.

“Iron deficiency can be challenging to diagnose, but it’s easy to treat,” Cogan said.

For this study, researchers analyzed data from a major Minnesota health system, identifying more than 13,000 adults with blood test results that indicated iron deficiency between 2010 and 2020.

They found that most were still struggling with iron deficiency three years after their initial blood test.

People most likely to recover from iron deficiency were 60 or older, male, treated with IV iron alone and covered by Medicare, results show. Younger patients, women and Black people were most likely to either remain iron-deficient or take a long time to recover.

Patients who recovered also had more follow-up blood tests to keep track of their iron levels — six versus four for those who remained iron-deficient.

This indicates that many diagnosed cases of iron deficiency aren’t being treated to resolution, Cogan said, while other cases are being missed entirely.

The results, published Aug. 15 in the journal Blood Advances, show a clear need for better education among health professionals on iron deficiency, Cogan said.

There also need to be efforts to create iron deficiency clinics or other standards to “assess and treat patients more efficiently and get people feeling better faster,” Cogan said in a journal news release.