JAMA Clinical Reviews Iron Deficiency in Adults: Advances in Diagnosis and Treatment
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Mar 30, 2026 Michael Auerbach, clinical professor and hematologist who specializes in iron deficiency diagnosis and treatment. He discusses how iron deficiency often occurs without anemia and its wide health impacts. He covers iron’s roles beyond blood, who is most at risk, diagnostic strategies using ferritin and TSAT, oral dosing limitations, and when intravenous iron or GI evaluation is warranted.
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Iron Is Vital Beyond Hemoglobin
- Iron is crucial beyond blood: it supports fetal brain development, myoglobin, enzymes, and neurotransmitters.
- Auerbach stresses pregnancy needs aggressive iron replenishment because growing babies take half the mother's iron.
Menstrual Blood Loss Drives Most Cases
- The most common cause of iron deficiency is heavy or abnormal uterine bleeding due to iron loss with bleeding.
- A normal diet covers losses up to ~40 mL/month; beyond that supplemental or medical intervention is necessary.
Obesity Raises Hepcidin and Blocks Iron
- Obesity raises hepcidin through chronic inflammation, reducing iron absorption and utilization.
- Auerbach explains hepcidin is an acute phase reactant that blocks iron uptake, making obese patients prone to iron deficiency.