journal article
Mar 24, 2026
Assessment of Anemia Symptoms in People with Normal Hemoglobin and Low Ferritin
Abstract
Aim: Anemia symptoms are common problems in humans. This study aimed to research symptoms of anemia in participants observed to have low ferritin without anemia.Material and Methods: This study was performed in the Konya Beyhekim Health Application and Research Center Internal Medicine and Family Medicine clinics from 01.12.2022 to 01.07.2023. Participants accepting participation were met face-to-face and symptoms were explained clearly. Participants completed a 13-question survey, the Fatigue Severity Scale (FSS) and a form including sociodemographic information. Among participants in the study, those with normal hemoglobin (HGB) and low ferritin levels were placed in Group 1, while those with normal HGB and ferritin levels were included in Group 2.Results: The mean age of participants in our study was 30.3±9.5 years. There were statistically significant differences between the groups in terms of sex (p<0.001), smoking (p=0.025), age (p=0.044), height (p<0.001), weight (p<0.001) and body mass index (BMI, p=0.007). Among the study groups, the group with normal HBG and low ferritin had significantly high restless leg syndrome (p=0.012), dizziness (p=0.001), shortness of breath symptoms (p=0.006), FSS scores (p=0.039) and presence of fatigue according to FSS (p=0.029). Between the study groups, there were no significant differences for pica (p=0.142), itching (p=0.295), hair loss (p=0.106), palpitations (p=0.064), tinnitus (p=0.680), and angular cheilitis (p=0.482) symptoms.Conclusion: In this study, restless leg syndrome, dizziness, shortness of breath, FSS scores and fatigue according to FSS were observed significantly more in the group with normal hemoglobin and low ferritin compared to the other group.
Topics
No keywords indexed for this article. Browse by subject →
References
50
[1]
1. Pasricha S-R, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet. 2021;397(10270):233-48. doi:10.1016/S0140-6736(20)32594-0.
10.1016/s0140-6736(20)32594-0
[2]
A systematic analysis of global anemia burden from 1990 to 2010
Nicholas J. Kassebaum, Rashmi Jasrasaria, Mohsen Naghavi et al.
Blood
10.1182/blood-2013-06-508325
[3]
3. World Health Organization. Iron deficiency anaemia. Assessment, prevention and control: a guide for programme managers [Internet]. Geneva: Word Health Organization; 2001 [cited 2026 Feb 14]. Available from: https://cdn.who.int/media/docs/default-source/2021-dha-docs/ida_assessment_prevention_control.pdf
[4]
4. Balendran S, Forsyth C. Non-anaemic iron deficiency. Australian Prescr. 2021;44(6):193. doi:10.18773/austprescr.2021.052.
10.18773/austprescr.2021.052
[5]
5. Pratt JJ, Khan KS. Non‐anaemic iron deficiency–a disease looking for recognition of diagnosis: a systematic review. Eur J Haematol. 2016;96(6):618-28. doi:10.1111/ejh.12645.
10.1111/ejh.12645
[6]
6. Wurzinger B, König P. Eisenmangel, Müdigkeit und Restless-Legs-Syndrom. Wien Med Wochenschr. 2016;13(166):447-52. doi:10.1007/s10354-016-0497-3.
10.1007/s10354-016-0497-3
[7]
7. Premjeyanth V, Shipman A. Iron deficiency without anaemia. Clin Med (Lond). 2021;21(4):e427. doi:10.7861/clinmed.Let.21.4.3.
10.7861/clinmed.let.21.4.3
[8]
8. Fawcett EJ, Fawcett JM, Mazmanian D. A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. Int J Gynaecol Obstet. 2016;133(3):277-83. doi:10.1016/j.ijgo.2015.10.012.
10.1016/j.ijgo.2015.10.012
[9]
9. Sayin S, Atilla FD. Demir eksikliğinin gözden kaçan klinik prezantasyonu; huzursuz bacak sendromu. Ankara Med J. 2019;19(3):694-7. doi:10.17098/amj.624542.
10.17098/amj.624542
[10]
10. Goddard AF, James MW, McIntyre AS, Scott BB; British Society of Gastroenterology. Guidelines for the management of iron deficiency anaemia. Gut. 2011 Oct;60(10):1309-16. doi: 10.1136/gut.2010.228874.
10.1136/gut.2010.228874
[11]
11. Grote Beverborg N, Klip IT, Meijers WC, Voors AA, Vegter EL, van der Wal HH, et al. Definition of iron deficiency based on the gold standard of bone marrow iron staining in heart failure patients. Circ Heart Fail. 2018;11(2):e004519. doi:10.1161/CIRCHEARTFAILURE.117.004519.
10.1161/circheartfailure.117.004519
[12]
The Fatigue Severity Scale
Lauren B. Krupp
Archives of Neurology
10.1001/archneur.1989.00520460115022
[13]
13. Gencay-Can A, Can SS. Validation of the Turkish version of the fatigue severity scale in patients with fibromyalgia. Rheumatol Int. 2012;32(1):27-31. doi:10.1007/s00296-010-1558-3.
10.1007/s00296-010-1558-3
[14]
14. Camaschella C. Iron-deficiency anemia. New Engl J Med. 2015;372(19):1832-43. doi:10.1056/NEJMra1401038.
10.1056/nejmra1401038
[15]
15. Abuaisha M, Itani H, El Masri R, Antoun J. Prevalence of iron deficiency (ID) without anemia in the general population presenting to primary care clinics: a cross-sectional study. Postgrad Med. 2020;132(3):282-7.
doi:10.1080/00325481.2020.1715701.
10.1080/00325481.2020.1715701
[16]
16. Aviner S, Armoni-Sivan R, Bibi H. Microcytic anemia. The N Engl J Med. 2014;371(26):2536. doi:10.1056/NEJMc1413161.
10.1056/nejmc1413161
[17]
17. Korom VG, Lueff S, Liposits A, Kellner A, Pavlovics A, Egyed M. Is iron deficiency anemia always microcytic. Pol Arch Intern Med. 2021;131:199-201. doi:10.20452/pamw.15714.
10.20452/pamw.15714
[18]
18. Leung AK, Hon KL. Pica: a common condition that is commonly missed-an update review. Curr Pediatr Rev. 2019;15(3):164-9. doi:10.2174/1573396315666190313163530.
10.2174/1573396315666190313163530
[19]
19. Ganesan PR, Vasauskas AA. The association between pica and iron-deficiency anemia: a scoping review. Cureus. 2023;15(4):e37904. doi:10.7759/cureus.37904.
10.7759/cureus.37904
[20]
20. Miao D, Young SL, Golden CD. A meta‐analysis of pica and micronutrient status. Am J Hum Biol. 2015;27(1):84-93. doi:10.1002/ajhb.22598.
10.1002/ajhb.22598
[21]
21. Bryant BJ, Yau YY, Arceo SM, Hopkins JA, Leitman SF. Ascertainment of iron deficiency and depletion in blood donors through screening questions for pica and restless legs syndrome. Transfusion. 2013;53(8):1637-44.
doi:10.1111/trf.12061.
10.1111/trf.12061
[22]
22. Ekbom K-A. Restless legs syndrome. Neurology. 1960;10(9):868-73. doi:10.1212/wnl.10.9.868.
10.1212/wnl.10.9.868
[23]
23. Matthews W. Letter: iron deficiency and restless legs. Br Med J. 1976;1(6014):898. doi:10.1136/bmj.1.6014.898-a.
10.1136/bmj.1.6014.898-a
[24]
24. Beatrix J, Piales C, Berland P, Marchiset E, Gerbaud L, Ruivard M. Non-anemic iron deficiency: correlations between symptoms and iron status parameters. Eur J Clin Nutr. 2022;76(6):835-40. doi:10.1038/s41430-021-01047-5.
10.1038/s41430-021-01047-5
[25]
25. O'keeffe S, Gavin K, Lavan J. Iron status and restless legs syndrome in the elderly. Age and ageing. 1994;23(3):200-3. doi:10.1093/ageing/23.3.200.
10.1093/ageing/23.3.200
[26]
26. Chenini S, Delaby C, Rassu AL, Barateau L, Vialaret J, Hirtz C, et al. Hepcidin and ferritin levels in restless legs syndrome: a case–control study. Sci Rep. 2020;10(1):11914. doi:10.1038/s41598-020-68851-0.
10.1038/s41598-020-68851-0
[27]
27. Demir EY, Özcan T, Özer F, Parlakoğlu BA, Enginyurt Ö, Çankaya S. Restless legs syndrome and depression-anxiety disorder association in iron deficiency anemia patients. J Exp Clin Med (Samsun). 2014;31(4):356-65.
[28]
28. Gonzalez-Latapi P, Malkani R. Update on restless legs syndrome: from mechanisms to treatment. Curr Neurol Neurosci Rep. 2019;19(8):54. doi:10.1007/s11910-019-0965-4.
10.1007/s11910-019-0965-4
[29]
29. Lewiecki EM, Rahman F. Pruritus: a manifestation of iron deficiency. JAMA. 1976;236(20):2319-20. doi:10.1001/jama.236.20.2319.
10.1001/jama.1976.03270210045024
[30]
30. Vickers CF. Iron-Deficiency pruritis. JAMA. 1977;238(2):129. doi:10.1001/jama.238.2.129c.
10.1001/jama.1977.03280020033014
[31]
31. Takkunen H. Iron-deficiency pruritus. JAMA. 1978;239(14):1394.
10.1001/jama.1978.03280410036008
[32]
32. Weisshaar E, Szepietowski JC, Dalgard FJ, Garcovich S, Gieler U, Giménez-Arnau AM, et al. European S2k guideline on chronic pruritus. Acta Derm Venereol. 2019;99(5):469-506. doi:10.2340/00015555-3164.
10.2340/00015555-3164
[33]
33. Obaidat NA, Rawashdeh BT, Wreikat AA, Awamleh AA. A potential relation between telogen effluvium and iron deficiency in adult females. Jrms. 2005;12(1):62-6.
[34]
34. Özden MG, Öztaş MO, Gülekon A, Gürer MA. Kadın olgularda yaygın saç kaybı ve eşlik eden bulgular. J Exp Clin Med (Samsun). 2008;25(2):50-6. doi:10.5835/jecm.v25i2.1049.
[35]
35. Kantor J, Kessler LJ, Brooks DG, Cotsarelis G. Decreased serum ferritin is associated with alopecia in women. J Invest Dermatol. 2003;121(5):985-8. doi:10.1046/j.1523-1747.2003.12540.x.
10.1046/j.1523-1747.2003.12540.x
[36]
36. Rushton D, Norris M, Dover R, Busuttil N. Causes of hair loss and the developments in hair rejuvenation. International journal of cosmetic science. 2002;24(1):17-23. doi:10.1046/j.0412-5463.2001.00110.x.
10.1046/j.0412-5463.2001.00110.x
[37]
37. Tuncez Akyurek F, Ulutas Demirbas G, Demirbas A, Akyurek F, Saylam Kurtipek G. Retrospective evaluation of laboratory data of patients with telogen effluvium. Ann Med Res. 2019;26(12):2754-7.
10.5455/annalsmedres.2019.06.355
[38]
38. Shrivastava SB. Diffuse hair loss in an adult female: approach to diagnosis and management. Indian J Dermatol Venereol Leprol. 2009;75(1):20-7. doi:10.4103/0378-6323.45215.
10.4103/0378-6323.45215
[39]
39. Ghazzay H, Jasim MA, Shukur AS, MahasinAltaha, İbrahim SQ. Low ferritin with normal hemoglobin, a common neglected and hidden hematological disorder. Annals of Tropical Medicine and Public Health. 2021;24(02):242-25.
10.36295/asro.2021.24225
[40]
40. Sunwoo W, Lee DY, Lee JY, Lee M, Kang Y, Park MH, et al. Characteristics of tinnitus found in anemia patients and analysis of population-based survey. Auris Nasus Larynx. 2018;45(6):1152-8. doi:10.1016/j.anl.2018.04.001.
10.1016/j.anl.2018.04.001
[41]
41. Kim HJ, Lee HJ, An SY, Sim S, Park B, Kim SW, et al. Analysis of the prevalence and associated risk factors of tinnitus in adults. PloS One. 2015;10(5):e0127578. doi:10.1371/journal.pone.0127578.
10.1371/journal.pone.0127578
[42]
42. Martens P, Claessen G, Van De Bruaene A, Verbrugge FH, Herbots L, Dendale P, et al. Iron deficiency is associated with impaired biventricular reserve and reduced exercise capacity in patients with unexplained dyspnea. J Card Fail. 2021;27(7):766-76. doi:10.1016/j.cardfail.2021.03.010.
10.1016/j.cardfail.2021.03.010
[43]
43. Farthing MJG. Iron and immunity. Acta Paediatr. 1989;78(S361):44-52. doi:10.1111/apa.1989.78.s361.44.
10.1111/apa.1989.78.s361.44
[44]
44. Lu SY, Wu HC. Initial diagnosis of anemia from sore mouth and improved classification of anemias by MCV and RDW in 30 patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98(6):679-85.
doi:10.1016/j.tripleo.2004.01.006.
10.1016/j.tripleo.2004.01.006
[45]
45. Cullen W, Kearney Y, Bury G. Prevalence of fatigue in general practice. Irish J Med Sci. 2002;171(1):10-2. doi:10.1007/BF03168931.
10.1007/bf03168931
[46]
46. Bates DW, Schmitt W, Buchwald D, Ware NC, Lee J, Thoyer E, et al. Prevalence of fatigue and chronic fatigue syndrome in a primary care practice. Arch Intern Med. 1993;153(24):2759-65.
10.1001/archinte.1993.00410240067007
[47]
47. Houston BL, Hurrie D, Graham J, Perija B, Rimmer E, Rabbani R, et al. Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials. BMJ Open. 2018;8(4):e019240. doi:10.1136/bmjopen-2017-019240.
10.1136/bmjopen-2017-019240
[48]
48. Verdon F, Burnand B, Stubi CF, Bonard C, Graff M, Michaud A, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ. 2003;326(7399):1124.
doi:10.1136/bmj.326.7399.1124.
10.1136/bmj.326.7399.1124
[49]
49. Krayenbuehl PA, Battegay E, Breymann C, Furrer J, Schulthess G. Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration. Blood. 2011;118(12):3222-7.
doi:10.1182/blood-2011-04-346304.
10.1182/blood-2011-04-346304
[50]
50. Becker LA. Oral iron therapy reduced unexplained fatigue in nonanemic women with serum ferritin levels</= 50 microg/L. ACP Journal Club. 2004;140(2):43.
10.7326/acpjc-2004-140-2-043
Metrics
0
Citations
50
References
Details
- Published
- Mar 24, 2026
- Vol/Issue
- 18(1)
- Pages
- 49-55
Authors
Funding
This research received no external funding.
Cite This Article
Hatice Şifayi, İbrahim Solak (2026). Assessment of Anemia Symptoms in People with Normal Hemoglobin and Low Ferritin. Konuralp Tip Dergisi, 18(1), 49-55. https://doi.org/10.18521/ktd.1788824
Related
You May Also Like
Gestasyonel Diyabet Taramasında Karşılaşılan Önemli Bir Problem: Gebeler Neden Oral Glukoz Tolerans Testi Yaptırmak İstemiyor?
Alper Basbug, Cemil İşık SÖNMEZ · 2018
8 citations
Traditional and Complementary Medicine Practices Used by Women with Premenstrual Syndrome
Hanife UÇAK, Filiz SÜZER ÖZKAN · 2022
3 citations
Distinguishing Venous Outflow Insufficiency from Ischemia–Reperfusion Injury Using a Hydro-Manometer: A Case Series
Onur Çetin, Sinan Kılıç · 2026
Nasal Carriage of Methicillin-Resistant Staphylococcus aureus in Prediabetes and Type 2 Diabetes Mellitus
Şeyma Taştemur, Tuba Doğan Karataş · 2026