New iron deficiency recommendations in Ontario have the potential to transform lives, according to experts

A significant update to Ontario's guidelines on iron deficiency detection, set to take effect on September 9, is expected to greatly improve patient care across the province.

The new guidelines will raise the baseline level of ferritin — the protein that stores iron — which determines when a person is considered iron deficient. This change aims to help more people who previously were told their iron levels were normal, even though they may have felt unwell, to now be diagnosed and treated effectively.

Dr. Menaka Pai, a hematology professor at McMaster University and clinical lead for hematology in Ontario, highlighted how transformative this adjustment will be, allowing more Ontarians to recognize iron deficiency as a possible cause of their symptoms and receive appropriate treatment. Identifying iron deficiency early is critical, as treatment is highly effective.

The new guidelines address health equity concerns, says Dr. Michelle Sholzberg, director of hematology at the University of Toronto and the Hemequity lab at St. Michael's University. The previous thresholds for ferritin levels varied across labs, typically ranging from under 10 to 15 micrograms per litre. Now, the threshold will be set at 30 micrograms per litre for adults and 20 micrograms per litre for children.

While healthcare providers ultimately decide whether to implement these new guidelines, iron infusions are covered by the province if administered in hospitals. For non-hospital clinics, only the administration is insured, not the medication itself.

Dr. Michelle Sholzberg estimates that approximately 40% of women and girls, or those with reproductive capacity, in Ontario are affected by iron deficiency, with higher rates among people from lower socioeconomic and marginalized groups. She highlights the structural nature of the issue, emphasizing that early diagnosis is crucial because iron deficiency is entirely correctable.

"This is a structural problem, and we're structurally solving it," Sholzberg said, adding that addressing it earlier can prevent unnecessary suffering.

Dr. Menaka Pai also described the change as a "feminist issue," noting how it will significantly benefit patients, particularly women who often bear the brunt of undiagnosed iron deficiency. Both doctors stress that correcting these baseline levels will improve lives, given the significant impact iron deficiency has on daily functioning.

Symptoms of iron deficiency include fatigue, poor concentration, underperformance at work or school, and even mental health challenges such as anxiety and depression. Sholzberg mentioned that the previous thresholds for diagnosing iron deficiency were based on flawed data, but thanks to increased research into women's health, particularly over the past few years, new data has supported the advocacy that people like her have been involved in.

Sholzberg, alongside Life Labs and Alpha Labs, has been advocating for this change for over four years. To help healthcare providers, her Hemequity lab has launched a website called "Raise The Bar," which offers resources on iron deficiency treatment and management.

The journey toward this change has been long, but Sholzberg believes the positive impact on healthcare for many people will be worth it.

Dr. Michelle Sholzberg emphasized the profound impact of addressing iron deficiency, particularly for young women, stating, "We want young women to feel good. We want young women to be productive. We want young women to achieve their potential."

She highlighted the risks of untreated iron deficiency, which can escalate into anemia, potentially requiring hospitalization, blood transfusions, or even resulting in death. However, Sholzberg stressed that treatment—whether through oral supplements or intravenous infusions—effectively resolves the symptoms and can dramatically improve lives.

"It's one of the most satisfying things to treat in all of hematology," Sholzberg remarked. "And I've heard other care providers say in all of medicine—because you can fix it."