The Problem with Normal — Iron Deficiency Mind Map

1. Patient context

Choose the best patient frame

Patient context not selected yet Reproductive-age woman / ongoing menses Male patient Woman over 40, postmenopausal, or no clear heavy menstrual bleeding Pregnant, postpartum, or planning pregnancy

Only overlay checkbox

Active inflammatory disorder / acute illness may make ferritin harder to interpret

2. Symptoms / CBC clues

Symptoms

Symptoms not selected yet No clear iron-deficiency symptoms reported Fatigue, reduced stamina, cognitive fog, bruising/bleeding symptoms, pica, or restless legs

Hemoglobin pattern

Hemoglobin not selected yet Hemoglobin technically “normal,” but symptomatic or low-for-self Hemoglobin low or clearly low-for-patient

CBC clue

CBC clue not selected yet No microcytosis or thrombocytosis Microcytosis / low MCV Thrombocytosis, especially in a young woman Both microcytosis and thrombocytosis

3. Ferritin / iron studies

Ferritin status

Ferritin not checked yet / not selected Ferritin < 50 ng/mL Ferritin 50–100 with RLS, CHF, dialysis, pregnancy, or inflammatory condition Ferritin clearly adequate and patient stable

Iron-panel pattern, if available

No iron-panel clue selected / ferritin alone is available Elevated TIBC Serum iron / percent saturation is high, normal, or confusing Patient took iron recently or labs were not fasting Elevated TIBC plus confusing serum iron / percent saturation

4. Cause / loss / absorption

No clear cause yet Heavy menstrual bleeding GI alarm features, occult blood loss, weight loss, or unexplained recurrence Blood donation, surgery, trauma, or recent major blood loss Roux-en-Y, total gastrectomy, celiac disease, IBD, or major absorption concern Restricted intake / GLP-1 / PPI / vegan or vegetarian diet seems like the tempting explanation

5. Replacement choice

Replacement path not selected yet Initial oral iron is reasonable Cannot tolerate oral iron, stopped because of GI effects, or no response after a reasonable trial Need faster repletion or higher target: RLS, CHF, dialysis, pregnancy, inflammatory condition Prior IV iron reaction / concern for infusion reaction IV iron has been given or is being planned

6. Follow-up / recurrence

Follow-up phase

Follow-up phase not selected yet Following oral iron response Following IV iron response Thrombocytosis persists after iron repletion

Ongoing source status

Ongoing source status not selected yet Cause fixed: hysterectomy, stopped bleeding source, one-time surgery/trauma, etc. Ongoing heavy menses or recurrent/ongoing loss remains

The Problem with “Normal”