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Ferritin, iron deficiency, and iron deficiency anemia: Symptoms, measurement, and treatment

Ferritin indicates the amount of iron stored in the body. Low ferritin level is a sign of low iron stores.

Ferritin and iron deficiency

  • Ferritin indicates the amount of iron stored.
  • Iron deficiency should be suspected if the ferritin value is under 30 µg/L. 
  • Most common symptoms of iron deficiency anemia are fatigue and impaired physical performance.

Ferritin

Ferritin is the primary test for iron deficiency. In addition to ferritin, iron levels and anemia can be determined through hemoglobin measurements; low hemoglobin indicates anemia.

Iron is recycled extensively in the body. The most important function of iron is to transport oxygen to the organs. Most of iron is used to form hemoglobin in red blood cells in order to transport oxygen from the lungs to the tissues. 

80% of the body’s iron is functional (70% in hemoglobin, 10% in myoglobin and less than 1% in enzymes). The share of stored iron is 20% (in ferritin and hemosiderin). 

Ferritin measurement

Ferritin indicates the amount of iron stored. Low ferritin is a sign of low iron stores. Ferritin can be used to detect deminished iron stores before the development of iron deficiency anemia. Restoring low iron stores can prevent the development of iron deficiency anemia.

Ferritin is the primary test for iron deficiency.

You can check your ferritin levels via Vital without a doctor’s referral.

Iron deficiency

Iron deficiency is the most common nutrient deficiency in the world. In simple terms, iron deficiency means that more iron is lost than is obtained from food. 

Iron deficiency anemia

Iron deficiency is most common cause of anemia. Low hemoglobin reveals anemia. The most common symptoms of iron deficiency anemia are fatigue and impaired physical performance.

Roughly 25-40 % of women will experience iron-deficiency anemia at some point in their lives. Although this condition can affect anyone, it is rare in men and children.

Iron deficiency without anemia

If a person has a normal hemoglobin level but ferritin level is low, it is called as iron deficiency without anemia. That is a sign of low iron stores. The cause of low ferritin should always be investigated to ensure the right treatment.

In women, the most common cause of low iron stores is heavy menstruation. Iron can also be lost due to any other bleeding. Insufficient iron absorption (due to celiac disease or other intestinal diseases, for example) may also be the reason for low iron stores. 

Symptoms of iron deficiency anemia

The symptoms of iron deficiency anemia are diverse. Symptoms can also be due to factors other than iron deficiency anemia. The symptoms are more pronounced the worse the anemia is. Iron deficiency anemia can cause, for example, the following symptoms:

Symptoms can also be related to some other condition or disease.

If you suspect an illness or have symptoms, we recommend contacting a healthcare professional.

High-risk groups for iron deficiency 

There are several high-risk groups for iron deficiency. Iron deficiency often occurs, for example, in women of childbearing age, the elderly, athletes, and in connection with bleeding or blood donation. Iron deficiency occurs especially in the following groups: 

What are the functions of ferritin and how does it work?

Ferritin indicates the amount of iron stored. Ferritin also transports iron within the body.

Reference values for ferritin

The notation µg/l means micrograms per liter.

Reference levels may vary depending on the laboratory and the test analysis method.

Reference values for ferritin in adults

In the table below, you can see the reference values for ferritin:

Women13–150 µg/l
Men30–400 µg/l

However, on the basis of recent research, a limit value of 30 µg/L for ferritin has been accepted as an indicator of iron deficiency. Iron deficiency should be suspected if the ferritin value is under 15–30 µg/L and the person shows typical iron deficiency symptoms and is in a high-risk group of iron deficiency (due to, for example, heavy menstruation, multiple births, long-term proton pump inhibitor therapy, regular blood donations). 

Ferritin values above 100 µg/L generally exclude the possibility of iron deficiency anemia. 

Ferritin tests when planning pregnancy 

When planning pregnancy, ferritin can be tested to ensure that the person’s iron stores are in order at the beginning of pregnancy. During pregnancy, the need for iron increases and blood is also lost during childbirth. These may lead to iron deficiency anemia. 

How can I increase my ferritin levels? 

The cause of low ferritin should always be investigated to ensure the right treatment. Making healthy choices and taking oral iron supplements are the primary methods for normalizing ferritin levels. If iron deficiency is caused by heavy menstrual bleeding, treating the symptom of bleeding is a priority. Otherwise, the heavy loss of iron will continue and iron supplements will not be enough to replace the lost iron. 

The greater the lack of iron, the more iron is absorbed. 

According to research, the intake of oral iron supplements can be reduced to every other day. This can help, in particular, with any stomach issues. 

Restoring the body’s iron stores is slow and iron supplements are recommended to be used for a long time. Oral iron supplements are recommended for at least several months or even 6–12 months. However, ask your doctor for your personal needs.

Hemoglobin levels may return to the reference values quite rapidly, over a period of weeks or months. Iron stores, on the other hand, may take up to six months to replenish. 

Intravenous iron infusion is rarely needed but in certain cases it is necessary. However, healthy individuals are primarily advised to take oral iron supplements. 

Anemia can be caused by factors other than iron deficiency

In anemia, the level of hemoglobin in the blood is lower than normal. It is important to diagnose the correct type of anemia to ensure the right treatment. The most common cause of anemia is iron deficiency, but vitamin B12 or folate deficiency may also cause anemia. 

The most common symptoms of vitamin B12 deficiency are cognitive symptoms related to thinking and memory, muscle weakness, and sensory symptoms. 

Deficiency of folic acid or folate (vitamin B9) can be avoided by following a varied diet and avoiding excessive alcohol consumption. 

Vitamin B12 deficiency is mainly found in elderly people and vegans. In young people, vitamin B12 deficiency is less common. Those following a vegetarian diet, and especially vegans, should take a dietary supplement containing vitamin B12, as this vitamin is only obtained from products of animal origin. 

Treatment for iron deficiency

The treatment of iron deficiency is based on what causes it. Treating heavy menstrual periods is the primary approach if it is the cause of iron deficiency. Iron deficiency can be effectively treated through both dietary adjustments and dietary supplements.

How does diet affect iron deficiency?

The body’s iron levels can be influenced through diet. Iron must be obtained from the diet. Those suffering from iron deficiency should favor food that is rich in iron. If changing dietary habits is not possible or is difficult, takinkg an iron supplement is an option.

In the case of iron deficiency anemia, changing the diet alone is not sufficient, and iron supplements are necessary.

Vitamin C aids in the absorption of iron.

It is advisable to avoid drinking coffee, tea, and milk at the same time as iron-rich foods, as they interfere with the absorption of iron from food.

Calcium and magnesium supplements reduce iron absorption.

Alcohol and smoking also interfere with iron absorption.

Which foods are rich in iron? 

The following foods, for example, are great sources of iron: 

Remember to combine these foods with foods with vitamin C, and avoid foods and beverages that decrease iron absorption at the same meal. 

Which foods decrease the absorption of iron? 

High ferritin 

Ferritin may also be elevated. High ferritin can produce a variety of symptoms that may resemble iron deficiency and low ferritin. Elevated iron is a rare condition. However, iron can accumulate in the body if it is absorbed more than normal in connection with an illness. Repeated blood transfusions as well as heavy and prolonged use of iron supplements can lead to an excessive accumulation of iron in the body. 

What causes high ferritin? What raises ferritin levels? 

Ferritin can also increase due to an inflammatory condition or a disease, in which case it may not reflect adequate iron stores. Examples of inflammatory conditions: 

High ferritin levels can also be caused by hemochromatosis, an inherited disorder that affects the absorption of iron. 

Hemochromatosis 

Hemochromatosis is a condition in which the body stores too much iron. The condition stems from a gene mutation that increases the absorption of iron through the intestines. 

FAQ

The increase in ferritin levels per month depends on several factors, such as the dosage of iron supplements and the individual’s initial ferritin level. In some cases, the increase can be 20-50 micrograms per liter per month.

Ferritin is too low when its concentration in the blood is below the lower limit of reference values, which may indicate iron deficiency. This can cause fatigue, weakness, and other symptoms.

Results of a ferritin test are usually available the next business day after the sample is taken, depending on the laboratory’s schedule.

Ferritin levels decrease by reducing iron intake in the diet and avoiding the use of iron supplements. In some cases, the doctor may recommend blood donation to reduce iron overload.

Ferritin reference values vary by age and gender, but the generally accepted lower limit for adults is about 30 micrograms per liter. The upper limit can be up to 300 micrograms per liter.

Ferritin is measured with a blood test taken from a vein. The test measures the body’s iron stores and is used to assess iron deficiency or iron overload.

Ferritin levels can drop quickly if the body uses its iron stores, for example, due to heavy bleeding or iron deficiency. The decrease can be significant within a few weeks.

Ferritin levels can start to increase within a few weeks of starting iron supplements, but significant rise and replenishment of iron stores can take several months. The exact time depends on several factors, such as the initial ferritin level and iron intake.

Article updated:
23 October 2024

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