| Sumario: | Objective: To provide an updated review of iron deficiency without anemia (IDWA), focusing on diagnostic challenges, neurocognitive consequences, and clinical implications across age groups. The aim is to summarize current evidence and highlight the importance of recognizing IDWA as a clinically significant condition despite normal hemoglobin levels. Methods: A narrative review of 25 peer reviewed publications from hematology, neurology, and nutrition literature was performed using data from PubMed and leading academic journals. Studies included reviews, randomized controlled trials, systematic reviews, and observational cohorts assessing epidemiology, diagnostic thresholds, physiological mechanisms, cognitive effects, and treatment outcomes in IDWA. Results: IDWA is common across all age groups but frequently underdiagnosed due to reliance on hemoglobin as the primary diagnostic criterion. Evidence shows that ferritin levels below 30 ng/mL strongly correlate with depleted iron stores, reduced iron absorption, and increased hepcidin. Neurocognitive consequences of IDWA include impaired attention, memory deficits, slower processing speed, sleep disturbances, and reduced executive function. These effects are especially pronounced in children and adolescents due to ongoing brain development, but also affect adults through fatigue, reduced work performance, and impaired mood. Older adults often present with inflammation related iron sequestration, diminished physical capacity, and cognitive decline. Clinical trials demonstrate that iron supplementation, delivered orally or intravenously, improves fatigue, cognitive performance, sleep quality, and physical function in symptomatic individuals with low ferritin despite normal hemoglobin levels. Conclusions: IDWA is a physiologically and clinically relevant condition with measurable neurocognitive, functional, and quality of life consequences across age groups. Early detection requires expanded diagnostic assessment incorporating ferritin, transferrin saturation, and inflammatory markers rather than hemoglobin alone. Evidence supports treatment of symptomatic IDWA to improve cognitive and physical outcomes and prevent progression to anemia. Increased clinical awareness and standardization of diagnostic criteria are essential to optimize care for individuals affected by this underrecognized condition.
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