Iron deficiency anemia defined as diminished red blood cells due to several causes which lead to low iron stores in the body. In this case report, an adult female who has a symptomatic iron deficiency, while her complete blood count and serum ferritin level were within lower normal levels. Continuous treatment with oral iron over many years never improved her complain. She responded to parenteral iron infusions, which she still require over the last three years. This case is a clear example that patients biochemical elements level is variant, and not all patients respond to one scale of treatment; it also shows the effect of the flexibility in using the guideline protocols in treating the rare cases.