Iron deficiency occurs when the body’s iron stores are depleted and a restricted supply of iron to various tissues becomes apparent. If not corrected, iron deficiency can lead to iron deficiency anemia, which is a condition defined by a low hemoglobin concentration in the blood. Iron deficiency commonly occurs in three stages.

Stage 1: Diminished total-body iron content. This stage is identified by a reduction in serum ferritin. Serum ferritin concentration typically correlates well with total-body iron stores. However, within this stage, there may be varying degrees of depletion. Typically, a reduction in athletic performance is not apparent when iron stores in the liver are low but may likely occur when iron stores are depleted in the skeletal muscle or other tissues.If you suspect your iron is low, ask your healthcare provider to measure the concentration of your serum transferrin receptors as well as serum ferritin. Keep in mind, however, that serum ferritin is often elevated in endurance athletes and is not by itself a good indicator of body iron stores in athletes.

Stage 2: Reduced red blood cell formation. This stage occurs when the iron supply is insufficient to support the formation of red blood cells. High levels of a bloodmarker called zinc protoporphyrin (ZPP) can indicate this stage. When iron is not readily available, zinc is used in its place, producing ZPP. To help diagnose this stage,your physician might measure your transferrin saturation. Transferrin is a protein that carries iron in the blood. This test indicates iron deficiency if less than 15 percent of this protein contains iron.

Stage 3: Iron deficiency anemia. In this final stage, hemoglobin concentration is affected and drops below the normal range, which is typically 12 to 15 grams per deciliter for women and 14 to 16.5 grams per deciliter for men. The normal range, however, will be slightly higher for athletes living at higher altitudes.

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