Iron Deficiency in Indian Women: What to Track Beyond Haemoglobin

More than half of Indian women aged 15-49 are anaemic, per the National Family Health Survey. Most are told to take iron for a few months, feel slightly better, stop, and drift back into anaemia within a year. The reason the cycle repeats is that haemoglobin alone is the wrong metric — the underlying iron stores are what matter, and the record that would show them is rarely kept.

The three tests, in order

• Test: Haemoglobin (Hb) · What it shows: Current red-cell load · When it matters: The first thing checked; not the whole story
• Test: Ferritin · What it shows: Iron stores · When it matters: The single most useful — low means depleted
• Test: Serum iron / TIBC / transferrin saturation · What it shows: Iron in transit · When it matters: Adds nuance for complex cases

A woman with Hb of 11 (borderline) and ferritin of 8 (very low) is more depleted than her Hb suggests. Treatment that raises Hb to 12 but leaves ferritin at 15 has not restored the stores — she is set up to relapse. Ferritin should reach 50+ before iron therapy stops.

Why the deficiency happens

• Menstrual blood loss — the commonest source.
• Dietary iron in vegetarian Indian diets is low-bioavailability.
• Frequent pregnancy without full recovery between.
• Undiagnosed GI blood loss (haemorrhoids, ulcers, occult malignancy in older women).
• Malabsorption (celiac disease, chronic H. pylori).

The right treatment sequence

• Oral iron 60-120 mg elemental iron daily, taken with vitamin C, away from tea/coffee/calcium.
• Continue for 3 months AFTER haemoglobin normalises — this refills stores.
• Recheck ferritin at 3-4 months to confirm stores are restored.
• Investigate underlying cause if recurrence — the pill is a fix, not a diagnosis.

What to record long-term

• Hb and ferritin at least annually.
• Menstrual pattern with any change.
• Diet — vegetarian, ovo-lacto, non-vegetarian — as it affects intake.
• Any GI symptoms — even mild ones that come and go.
• Iron supplement history — what dose, how long, what response.

For women planning pregnancy

Pregnancy requires roughly 1000mg additional iron over 9 months. A woman entering pregnancy with a ferritin of 15 is starting behind; one with 50 is well-stocked. Pre-conception iron optimisation is one of the most useful interventions in Indian obstetrics and is often skipped. If planning a pregnancy, check ferritin 6 months before trying — that is enough time to correct any deficiency before the demand starts.

References

• NFHS-5 — anaemia data India
• WHO — iron deficiency anaemia guidance
• PMC — iron deficiency in Indian women