The Curbsiders Internal Medicine Podcast REBOOT: #471 Iron Deficiency Anemia with Dr. Tom DeLoughery
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Oct 27, 2025 In this discussion, Dr. Tom DeLoughery, a seasoned hematologist at Oregon Health & Science University, dives into the intricacies of iron deficiency anemia. He highlights the importance of ferritin as the primary iron test and shares insights on dietary influences on iron absorption. Tom differentiates between iron deficiency and thalassemia using clever CBC metrics. He also discusses management strategies, including oral versus IV iron, and when to refer patients to a specialist. Throughout, he emphasizes the impact of menstrual history on diagnosis and treatment.
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Narrow Microcytosis Differential
- Use reticulocyte count to separate production vs loss; a rising retic points to bleeding or hemolysis.
- For microcytosis the main causes are thalassemia, iron deficiency, anemia of chronic disease, and sideroblastic anemia.
Make Ferritin Your First-Line Test
- Order ferritin as your primary iron test because it best predicts iron deficiency in most settings.
- Use transferrin saturation/TIBC only when ferritin is borderline or inflammation complicates interpretation.
Raise Ferritin Thresholds
- Traditional lab reference ranges under-detect iron deficiency; consider physiologic thresholds instead.
- Aim for ferritin ≥30–50 ng/mL (50 for fatigue) rather than relying solely on lab lower limits.
