CMAJ Podcasts Fixing the flag: A new standard for diagnosing iron deficiency
Jul 28, 2025
Michelle Scholzberg, a hematologist dedicated to reducing gender bias in medical testing, and Rita Selby, an expert in laboratory medicine, discuss the critical issue of iron deficiency diagnosis. They highlight how outdated ferritin standards contribute to underdiagnosis, particularly among women. The conversation reveals their collaborative effort to implement province-wide changes in Ontario's labs, allowing for better identification of subclinical iron deficiency. The guests passionately advocate for structural changes that improve patient care and tackle systemic obstacles.
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Persistent Patient Stories Inspire Change
- Dr. Michelle Scholzberg has repeatedly seen patients with undiagnosed iron deficiency symptoms late in their disease course.
- This frustration motivated her to seek structural solutions to improve early detection.
Flawed Lab Standards Cause Underdiagnosis
- Iron deficiency affects 30-40% of menstruating and pregnant individuals, far higher than typically recognized.
- Flawed lab reference ranges and stigma around menstruation contribute to widespread underdiagnosis.
Screen High-Risk Patients with Ferritin
- Don't rely solely on CBC to detect iron deficiency; use ferritin testing in at-risk patients.
- Routinely assess menstrual blood loss and pregnancy status to guide screening.