AI-generated“Your ferritin is still in the normal range.” This does not always answer whether your iron stores are sufficient. The numerical value, symptoms, risk factors and the presence of inflammation are decisive.
What does ferritin show?
Ferritin helps assess iron stores. Haemoglobin, or Hb, describes the red blood pigment. Iron stores can already be reduced while Hb remains within the reference range. Ferritin alone therefore does not establish whether anaemia is present.
Ferritin up to 30 ng/ml
The ASH diagnostic guideline from 2026 names a threshold of ≤30 ng/ml for adults. A low result strongly suggests iron deficiency. The units ng/ml and µg/l are numerically equivalent: 25 ng/ml equals 25 µg/l.
However, the laboratory result establishes neither the cause nor the treatment automatically. Iron deficiency requires questions about blood loss, low intake or an absorption disorder, for example.
What does a value above 30 up to 50 mean?
This range should not simply be ignored when symptoms are present. The new ASH guideline explains that a decision threshold of ≤50 ng/ml may be used with matching symptoms or additional risks. Examples include fatigue, heavier bleeding or other circumstances that increase iron-deficiency risk.
“Symptom range” is an understandable guide, but not a guarantee that every symptom is caused by iron. A randomised trial in menstruating women with fatigue and ferritin below 50 showed a benefit of oral iron for fatigue. Its result cannot be applied generally to everyone with a value of 49.
Why does the AGA use 45?
The AGA uses 45 ng/ml in a specific diagnostic context: people who already have anaemia. This is not a competing general rule for an optimal value. Different thresholds may concern different patient groups and questions.
What changes with inflammation?
Inflammation can raise ferritin despite insufficient iron availability. A value above 50 is then not a reliable all-clear. Other parameters and the underlying condition must be considered.
What helps at your appointment?
Bring ferritin, your blood count and any inflammation results. Information about bleeding, blood donation, diet and symptoms also helps. Our iron status check organises your answers to prepare for the conversation. It does not prescribe treatment.
Sources
- ASH 2026 – diagnostic guideline, official teaching slides
- Vaucher et al. 2012 – fatigue without anaemia
- AGA 2020 – diagnosis of iron-deficiency anaemia
