Monitoring Recovery from Iron Deficiency Using Total Hemoglobin Mass

Introduction Using hemoglobin concentration ([Hb]) to diagnose borderline iron deficiency and monitor the progress of its treatment is difficult because of the confounding effects of plasma volume. Because hemoglobin mass (Hbmass) is not affected by plasma volume, it may be a more sensitive parameter. The aim of this study was to monitor Hbmass, iron storage, and maximal oxygen consumption (V(center dot)O2max) during and after oral iron therapy in subjects with severe and moderate iron deficiency. Methods Three groups of female recreational athletes were monitored for at least 22 wk, as follows: 1) severe iron deficiency group (SID) (n = 8; ferritin, <= 12 ng.mL), 2) moderate iron deficiency group (MID) (n = 14; ferritin, <= 25 ng.mL), and 3) control group (n = 8; ferritin, >25 ng.mL). Hbmass and iron status were determined before, during, and up to 12 wk after at least 10 wk of oral iron supplementation. In total, five V(center dot)O2max tests were performed before, during, and after the supplementation period. Results Hbmass increased markedly in the SID group (15.6% +/- 11.0%, P < 0.001) and slightly in the MID group (2.2% +/- 3.7%, P < 0.05) by the end of the supplementation period and remained at this level for the following 12 wk. [Hb] and Hbmass were similarly affected, but Hbmass was more closely related to mean corpuscular volume and mean corpuscular hemoglobin than [Hb]. The SID group incorporated 534 +/- 127 mg of iron into ferritin and hemoglobin, whereas the MID group incorporated 282 +/- 68 mg of iron. V(center dot)O2max increased only in the SID group by 0.20 +/- 0.18 L.min (P < 0.05) and was closely related to Hbmass (P < 0.01). Conclusions Hbmass is a sensitive tool for monitoring recovery from iron deficiency anemia and assessing the effectiveness of iron supplementation in individuals with severe or moderate iron deficiency.