Ferritin Levels: Normal Range, Low vs High Ferritin and What to Do

What is ferritin?

Ferritin is a protein that stores iron inside your cells, mostly in the liver, spleen and bone marrow; about a quarter of the body's iron is held this way. A small amount of ferritin leaks into the blood, and the serum ferritin level tracks how much iron your body has in storage. Your body draws on this reserve to make hemoglobin, the part of red blood cells that carries oxygen.

Ferritin is different from serum iron, which is the iron moving in the blood at that moment and can change from hour to hour. Ferritin is the slower, steadier measure of your iron reserve, which is why it is the most useful single test for iron deficiency.

What is a normal ferritin level?

Normal ferritin for most adults is roughly 24 to 336 ng/mL for men and 11 to 307 ng/mL for women, though each lab sets its own reference ranges. Results are reported in nanograms per milliliter (ng/mL), which is the same as micrograms per liter (mcg/L). Always compare your number with the range printed on your own report.

• Women of childbearing age usually run lower than men, because of monthly blood loss and pregnancy.
• Ferritin tends to rise after menopause and with age.
• Children and teens have their own ranges, adjusted by age.

A result inside the normal range does not always mean your reserve is full. Many doctors treat a ferritin under about 30 ng/mL as a sign of depleted iron, even when the lab flags it as normal. In people with inflammation or chronic disease, iron deficiency can still be present at a ferritin up to about 100 ng/mL.

What does a low ferritin level mean?

A low ferritin level almost always means your iron reserve is running out. It is the earliest blood sign of iron deficiency and often drops months before hemoglobin falls. A ferritin below about 15 ng/mL is a strong sign of iron deficiency, and below about 30 ng/mL is commonly used as the adult cutoff.

A ferritin under range with normal hemoglobin means iron deficiency without anemia: your reserve is running out, but your red blood cells are still holding up. When hemoglobin is also down, it means iron deficiency anemia, the most common type of anemia.

What causes low ferritin?

Ferritin drops when the body loses more iron than it takes in, or cannot absorb enough. The most common causes are:

• Heavy menstrual bleeding: the leading reason for iron deficiency in women before menopause.
• Pregnancy: the baby and the extra blood volume need much more iron, especially in the second and third trimesters.
• Diet: vegetarian and vegan diets, or simply eating little iron-rich food. Iron from plants is absorbed less well than iron from meat, poultry and fish.
• Slow blood loss from the gut: stomach ulcers, regular use of NSAIDs such as ibuprofen or aspirin, hemorrhoids, colon polyps or, less often, colon cancer.
• Poor absorption: celiac disease, inflammatory bowel disease, weight loss surgery and H. pylori infection of the stomach.
• Long-term acid-reducing medicines such as omeprazole or pantoprazole, which lower the absorption of iron from food.
• Frequent blood donation, intense endurance training and rapid growth in teens.

What are the symptoms of low ferritin?

Iron deficiency may produce no symptoms for months at first, then tiredness, weakness and shortness of breath as iron runs lower. Common signs of iron deficiency include:

• Fatigue, low energy and trouble exercising.
• Pale skin, dizziness or headaches.
• Shortness of breath or a fast heartbeat with activity.
• Cold hands and feet.
• Brittle or spoon-shaped nails and a sore tongue.
• Hair shedding.
• Restless legs at night.
• Cravings for ice, clay or starch (called pica).

At what ferritin level do you feel tired?

There is no single ferritin number at which tiredness starts; it varies from person to person. Fatigue is common once ferritin falls below about 30 ng/mL, and some people have symptoms even before hemoglobin drops. Tiredness also has many other causes, such as thyroid problems, low vitamin D or B12, poor sleep and depression, so ferritin is usually checked as part of a wider set of blood tests.

Read why you might be always tired, and which tests help

Can low ferritin cause hair loss?

Iron deficiency is linked to hair shedding, especially in women, though it is rarely the only cause. Iron deficiency can contribute to telogen effluvium, a diffuse thinning where more hairs than usual enter the resting phase and fall out a few months later. Other common contributors include thyroid disease, hormone changes around menopause, stress, crash dieting and genetics.

When hair thinning comes with depleted iron, correcting the iron deficiency is a sensible step, and regrowth, if it happens, usually takes 3 to 6 months or longer. Taking iron when your ferritin is already normal does not grow hair and can be harmful.

Learn about menopause hair loss care at The Pur Health

What does a high ferritin level mean?

A high ferritin level most often means inflammation or an irritated liver, not too much iron. Ferritin is an inflammatory marker, sometimes called an acute-phase protein: it rises within days of infection, injury or a flare of a chronic inflammatory condition, even when iron reserves are normal, and can stay up for weeks. That is why a high result is read together with other iron tests.

What causes high ferritin?

• Inflammation or infection: rheumatoid arthritis, inflammatory bowel disease, recent illness or surgery.
• Liver disease: fatty liver disease, alcohol use and hepatitis are among the most common causes of elevated ferritin in adults.
• Metabolic conditions: obesity, insulin resistance and type 2 diabetes.
• Hemochromatosis: an inherited condition where the body absorbs too much iron, leading to iron overload.
• Frequent blood transfusions, or taking iron supplements you do not need.
• Kidney disease, and, less often, some cancers and blood disorders.

What is a concerning ferritin number?

A ferritin under 15 ng/mL, or a ferritin over 1,000 ng/mL, is generally a reason for prompt follow-up. Very low values point to significant iron deficiency that needs treatment and a search for the cause. Very high levels raise concern for iron overload, organ damage or a serious inflammatory illness. Values that are only mildly high are common and are often due to fatty liver, alcohol or inflammation.

How is hemochromatosis checked?

Hemochromatosis is checked with transferrin saturation and, if that is high, a gene test for HFE. A transferrin saturation above about 45% together with a high ferritin suggests the body is absorbing too much iron. Untreated iron overload can damage the liver, heart, pancreas and joints over years. Treatment is usually regular blood removal (phlebotomy), managed with a hematologist or hepatologist. People with high iron should avoid iron supplements, avoid extra vitamin C supplements and limit alcohol.

How does the ferritin test work?

The ferritin test is a simple blood draw from a vein in your arm and takes about 5 minutes. Results usually come back within 1 to 2 days. It is often ordered with a complete blood count (CBC), serum iron, total iron-binding capacity (TIBC) and transferrin saturation, together called an iron panel.

• Preparation: fasting is not needed for ferritin alone. If an iron panel is ordered too, your doctor may ask you to fast and test in the morning.
• Supplements: tell your doctor about iron pills or multivitamins with iron, since recent doses can affect serum iron.
• Recent illness: a cold, infection or surgery can push ferritin up for a few weeks, so testing is best done once you are well.

How do you fix low ferritin levels?

Iron deficiency is corrected by replacing iron, usually with iron pills for 3 months or more, and by finding and treating the reason iron ran low. Food alone is rarely enough to refill an empty reserve, but it supports it.

Iron pills

• Common forms include ferrous sulfate, ferrous gluconate and ferrous fumarate. They differ in how much elemental iron each tablet contains.
• Taking iron once a day or every other day may be absorbed as well as, or better than, several doses a day, with fewer stomach side effects.
• Take iron on an empty stomach if you can, or with a small amount of food if it upsets your stomach. Vitamin C, such as a glass of orange juice, improves absorption.
• Keep iron 2 hours apart from tea, coffee, milk, calcium, antacids and acid reducers, which block absorption. Separate it from thyroid medicine by 4 hours.
• Side effects can include constipation, nausea, stomach cramps and dark or black stools.
• Keep iron out of reach of children. An accidental overdose is a serious poisoning risk in young children.

Iron-rich foods

• Heme iron, which is absorbed best: red meat, poultry, fish and shellfish.
• Plant iron: beans, lentils, tofu, spinach, fortified cereals and nuts. Pair them with vitamin C foods such as citrus, peppers or tomatoes.

How long does it take to raise ferritin?

Hemoglobin usually starts to rise within 2 to 4 weeks of taking iron, but refilling the reserve takes longer. Most people continue iron for about 3 months after hemoglobin returns to normal. Ferritin and a CBC are usually rechecked 6 to 12 weeks after starting treatment to make sure the plan is working.

When is IV iron used?

IV iron is considered when iron pills do not work, cannot be tolerated or cannot be absorbed, such as with celiac disease, inflammatory bowel disease, weight loss surgery, ongoing heavy bleeding or late pregnancy. It is given as an infusion, typically at an infusion center or through a hematologist. If IV iron looks like the right step, Dr. Munib can refer you.

When should you look for a source of bleeding?

Any man or post-menopausal woman with iron deficiency should be evaluated for blood loss from the digestive tract. In these groups there is no monthly bleeding to explain the low iron, so slow bleeding from the stomach or colon has to be ruled out. This usually means an upper endoscopy and a colonoscopy with a gastroenterologist, and testing for celiac disease.

Younger women with iron deficiency and heavy periods may not need this workup if the periods explain it, but they do need the heavy bleeding itself evaluated. Anyone with digestive symptoms, a family history of colon cancer or iron deficiency that does not improve with pills should be checked as well.

Is low ferritin a sign of cancer?

A low ferritin by itself is not cancer, and it is most often due to periods, pregnancy or diet. But unexplained iron deficiency in men and older women can be the first sign of slow bleeding from a colon polyp or colon cancer, which is why the source is always looked for.

When should you see a doctor right away?

• Black, tarry stools or blood in your stool or vomit.
• Chest pain, fainting or severe shortness of breath.
• Very heavy periods that soak a pad or tampon every hour for several hours.
• A child who may have swallowed iron pills: call Poison Control at 1-800-222-1222 or 911.

How Dr. Munib approaches abnormal ferritin

Dr. Munib reads ferritin together with your symptoms, history and other blood tests, because the same number can mean different things in different people. An evaluation usually includes:

1. 1.A review of symptoms, periods, pregnancy plans, diet, medicines such as acid reducers or NSAIDs, blood donation and family history.
2. 2.Blood tests: CBC, ferritin and a full iron panel, plus related checks such as thyroid, B12, vitamin D or celiac antibodies when they fit the picture.
3. 3.A plan that depends on the results: iron pills with a recheck, referral to a gynecologist for heavy periods, a gastroenterologist to look for bleeding or absorption problems, or a hematologist for iron overload or IV iron.

See preventive care and annual lab work at The Pur Health

Get your ferritin checked in Irvine

If you are tired, losing hair or have a ferritin result you are not sure about, a visit can work out what it means and what to do next. The Pur Health is at 114 Pacifica, Suite 280, Irvine, and is in-network with most PPO plans. Cash visits are $190 for new patients and $150 for returning patients. Call (949) 647-5234 to book.