Medical guidelines for diagnosing iron deficiency have been updated following a review by the American Society of Hematology of the thresholds used to identify low iron stores. The change could help detect cases that may not have been clearly identified under previous testing criteria.
The updated recommendations are particularly relevant to women, as depleted iron stores can be associated with recurring blood loss, especially during menstruation, as well as pregnancy. In some cases, iron stores may begin to decline before a noticeable reduction in hemoglobin levels occurs.
What Is the New Iron Deficiency Threshold?
Ferritin testing is the primary measure used to assess the body’s stored iron. Under the updated recommendations, a ferritin level of 30 nanograms per milliliter or lower is considered an indicator of iron deficiency in adults and pregnant women, compared with a previous threshold of 15 nanograms per milliliter used in some earlier criteria.
For some groups at higher risk of iron deficiency, a threshold of up to 50 nanograms per milliliter may also be considered, depending on the individual’s health status, risk factors and accompanying symptoms.
The revised thresholds mean that some results previously considered within the normal range may now require further evaluation. For example, a woman with a ferritin level of 22 nanograms per milliliter may now require assessment for iron deficiency under the updated criteria, even though the same result might not have been classified as a deficiency under the former 15 nanograms per milliliter threshold.
Iron Deficiency Does Not Always Mean Anemia
One important point in the updated recommendations is that iron deficiency can develop before anemia occurs. Iron stores may gradually decline while hemoglobin levels remain within the normal range, making the condition difficult to identify if testing relies solely on a blood count.
During this stage, women may experience symptoms including fatigue, exhaustion, dizziness, weakness and difficulty concentrating. If the depletion of iron stores continues without addressing its underlying cause, the condition may eventually progress to iron-deficiency anemia.
The updated criteria also highlight the importance of interpreting ferritin results within the broader context of a woman’s health. Assessing iron deficiency requires consideration of symptoms, medical history, possible sources of blood loss and other laboratory results, rather than relying on ferritin levels alone.
A low ferritin level does not mean that the same treatment is appropriate for everyone. Diagnosis and decisions about treatment should therefore be made under medical supervision, particularly for pregnant women and those experiencing recurrent bleeding.
