Iron deficiency—Challenging to diagnose: A retrospective chart review of referrals to Classical Hematology Clinic

Background: Iron deficiency (ID) is the leading nutritional deficiency and a major public health concern globally. Although anemia is the most widely known consequence of ID, ID is also an underrecognized cause of white blood cell and platelet count abnormalities.The primary objective of the current study is to assess physicians’ abilities to diagnose ID. Methods: This study is a retrospective chart review of 862 adults (mean age +/- SD of 52.5 ± 18.4, 447 female) seen by a classical hematologist at an academic center. Data analysis included specialty type of referring provider, referral reason, and the diagnosis made by the consulting hematologist. ID was defined as a serum ferritin level/mL or/mL in the presence of inflammatory comorbidities. Results: Out of 862 initial patient charts, 103 were lost to follow up before completing the workup. Out of the remaining 759 patient charts, 304 (40.0%) patients received a new diagnosis with ID or iron deficiency anemia (IDA) by the consulting classical hematologist. Of these patients, 21% were referred from internal medicine (IM), 18% from family medicine (FM), 14% from hematology-oncology for a second opinion, and 25% from other IM subspecialties. In a sub-analysis of 364 patients who had complete blood cell count (CBC) abnormalities, ID was found to play a role in 54.7% of CBC abnormalities analyzed. Conclusion: This analysis demonstrates that diagnosing ID is a challenge for first-contact physicians and may easily be missed. This leads to delays in ID treatment and resulting clinical consequences.