Iron
What does low ferritin mean?
The short answer
Ferritin is a blood protein that reflects how much iron your body has stored. A low ferritin result means your iron stores are low or used up; the American Gastroenterological Association uses below 45 ng/mL to diagnose iron deficiency in people with anaemia. Ferritin also rises with inflammation, so a normal or high result does not always rule out iron deficiency.
What Ferritin measures
Ferritin is the protein your body uses to store iron. When there is no inflammation, the small amount in your blood tracks the size of your iron stores: low in people who are iron deficient, high in people who are iron loaded. The lower the ferritin, even within the normal range, the more likely it is that stores are short.
The catch is that ferritin rises with inflammation. Infection, chronic inflammatory conditions, liver disease and alcohol can push it up regardless of how much iron you have, so inflammation can make ferritin look normal, or even high, when stores are low. That is why it is best read alongside hs-CRP.
To complete the iron picture, a doctor can add serum iron, transferrin saturation and a full blood count (complete blood count, or CBC), which shows whether anaemia is present.
Ferritin ranges
Cut-offs for low ferritin come from the American Gastroenterological Association (AGA) and, for people with inflammation, the World Health Organization (WHO); limits for high ferritin come from the American College of Gastroenterology (ACG).
| Result | Range |
|---|---|
| Iron deficiency, in people with anaemiaAGA, preferred over the older 15 ng/mL cut-off | Below 45 ng/mL |
| Iron deficiency still possible with inflammationWHO, adults with infection or inflammation | Below 70 ng/mL |
| Typical lab range, womenMedlinePlus | 13 to 150 ng/mL |
| Typical lab range, menMedlinePlus | 30 to 400 ng/mL |
| Above the ACG normal limitRead with transferrin saturation | Above 200 ng/mL (premenopausal women) or 300 ng/mL (men and postmenopausal women) |
| Higher risk of liver damage in haemochromatosisACG; needs prompt review | Above 1,000 ng/mL |
Ferritin is reported in ng/mL. Ranges differ by sex, age and laboratory. The AGA's 45 ng/mL cut-off applies to people with anaemia and sits above many labs' lower limit, so a result inside the printed range can still mean low stores. Reference ranges vary between laboratories, and the range printed on your own report takes priority. Ranges vary between laboratories, and the range printed on your own report takes priority.
What a high ferritin result means
High ferritin is common, and iron overload is only one cause. The ACG notes that fatty liver disease and alcohol-related liver disease are more common than haemochromatosis among people with a raised ferritin who do not carry the main haemochromatosis gene type. Chronic inflammation, hepatitis B or C, some cancers and insulin resistance can also raise it, often with normal circulating iron.
The key follow-up test is transferrin saturation, which shows how much iron is moving in the blood. The ACG calls it the preferred first test for suspected iron overload: a saturation above 45% picks up almost everyone with the common form of hereditary haemochromatosis, while a normal ferritin with a saturation below 45% largely rules overload out. Haemochromatosis is one of the most common genetic disorders in people of northern European descent.
Common causes
- Inflammation or infection
- Fatty liver disease and insulin resistance
- Alcohol-related liver disease or long-term heavy drinking
- Hepatitis B or C
- Hereditary haemochromatosis
- An overactive thyroid, or autoimmune conditions such as rheumatoid arthritis or lupus
- Repeated blood transfusions, iron injections or long-term dialysis
- Some cancers
What a low ferritin result means
A low ferritin means your iron stores are depleted. Symptoms overlap with iron deficiency anaemia: tiredness or weakness, headaches, dizziness, palpitations, pale skin and shortness of breath. Heavy periods and pregnancy are common causes in younger women. In men and in women after the menopause with iron deficiency anaemia, the AGA recommends examining the gut with endoscopy, because bleeding there is one possible cause. A doctor will want to find the cause rather than just replace the iron.
Common causes
- Heavy, long or frequent periods
- Pregnancy and breastfeeding
- A diet low in iron, including strict vegetarian diets
- Poor absorption, such as coeliac disease, Crohn's disease or gastric bypass surgery
- Bleeding from the gut, including from ulcers or long-term aspirin or ibuprofen use
- Frequent blood donation
- Long-distance running
What moves Ferritin
Nutrition
Iron comes from lean red meat, poultry, fish, eggs, beans and other legumes, dried fruit, dark leafy greens and whole grains. Vitamin C-rich foods such as citrus, strawberries and tomatoes increase absorption, and eating meat, fish or poultry with beans or greens can raise absorption of plant iron up to threefold. Black tea binds iron, so timing matters as well as content.
Training
Long-distance runners are at higher risk of iron deficiency, so heavy training volume matters when ferritin is low. Where fatty liver or insulin resistance sits behind a high ferritin, regular training is part of the plan.
Sleep and stress
There is no strong evidence that either changes ferritin directly. They matter through eating, drinking and body weight.
Habits
Chronic alcohol use raises ferritin and transferrin saturation, and the ACG advises counselling people with raised iron to stop drinking where alcohol is a factor. Frequent blood donation lowers iron stores. Speak to your doctor before taking iron for a low result, because the cause needs finding first.
How fast Ferritin can change
Rebuilding iron stores is slow. MedlinePlus notes that anaemia often improves within 6 weeks of iron treatment, but iron usually needs to continue for another 6 months to refill stores, so diet changes alone take months to show. A high ferritin changes as its cause is treated, so the pace depends on what is driving it. A Day 90 re-test shows the direction of change, though not always the end point.
Before your test
- Infection or inflammation can raise ferritin regardless of iron. Test when well, and read the result alongside hs-CRP.
- Blood transfusions and iron injections raise ferritin. Tell your doctor about either, and about any iron supplements you take.
- Some labs ask for a morning sample after a 12-hour fast. Follow the instructions for your test.
When to speak to your doctor
Speak to your doctor about a ferritin below your lab's range, or below 45 ng/mL if you have been told you are anaemic, especially if you are a man or a woman after the menopause, because the cause of iron loss needs finding. Contact them promptly if you notice blood or black, tar-like stools, or if a low ferritin comes with very heavy periods, unexplained weight loss or worsening breathlessness. A high ferritin on a repeat test needs transferrin saturation and liver tests, and prompt review if it is above 1,000 ng/mL. Vomiting blood, chest pain or severe breathlessness need urgent medical care.
On the Wolfburgh panel
Ferritin is one of the 17 markers on the Wolfburgh blood panel. Your sample is collected at home with RedDrop One, an FDA-cleared collection device, and a licensed physician reviews every panel before your care team sees it.
The Partner Physician reads ferritin alongside hs-CRP, to judge whether inflammation is masking low stores, and alongside ALT and AST, since liver strain is a common cause of a high result. The Nutritionist works on iron intake and absorption; the Trainer and Behaviour Specialist work on training load, alcohol and weight. Members re-test at Day 90, backed by the 90-Day Results Guarantee.
Common questions about Ferritin
What is a good ferritin level?
MedlinePlus gives typical lab ranges of about 13 to 150 ng/mL for women and 30 to 400 ng/mL for men. For diagnosing iron deficiency in people with anaemia, the American Gastroenterological Association uses below 45 ng/mL. With inflammation present, the WHO treats below 70 ng/mL as possible iron deficiency in adults. Ranges vary between labs, so the range on your own report takes priority.
How can I raise my ferritin levels?
First find out why it is low, because heavy periods, blood loss from the gut and absorption problems such as coeliac disease need different responses. Iron-rich foods include lean red meat, poultry, fish, beans, dark leafy greens and dried fruit; vitamin C-rich foods help absorption, while black tea reduces it. If a doctor prescribes iron, stores usually take months to refill.
Can you have low iron with a normal ferritin?
Yes. Inflammation, infection and liver disease raise ferritin, so it can look normal or even high when stores are low. For adults with infection or inflammation, the WHO treats ferritin below 70 ng/mL as possible iron deficiency, which is well above the lower limit on many lab reports. A doctor will usually check transferrin saturation and CRP to get a clearer picture.
Is high ferritin always haemochromatosis?
No. The American College of Gastroenterology notes that fatty liver disease and alcohol-related liver disease are more common causes of a raised ferritin than haemochromatosis in people without the main gene type. Inflammation, hepatitis and some cancers raise it too. Transferrin saturation helps separate them: above 45% alongside a high ferritin calls for haemochromatosis gene testing.
Sources
- American Gastroenterological Association (2020). Gastrointestinal evaluation of iron deficiency anemia (AGA Clinical Practice Guideline)
- American College of Gastroenterology (American Journal of Gastroenterology, 2019). ACG Clinical Guideline: Hereditary Hemochromatosis
- MedlinePlus (NIH). Ferritin blood test: MedlinePlus Medical Encyclopedia
- MedlinePlus (NIH). Iron deficiency anemia: MedlinePlus Medical Encyclopedia
- MedlinePlus (NIH). Iron in diet: MedlinePlus Medical Encyclopedia
- World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations
This page is general information, not medical advice, and it does not replace a consultation with your own doctor. Never start, stop or change a medicine or supplement because of something you read here.
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