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Re-evaluating ferritin thresholds to diagnose iron deficiency.
Katie M Troike1, Adam J McShane1
1Cleveland Clinic, Cleveland, OH, United States.
Clinical Biochemistry
|October 1, 2025
Summary
New ferritin reference intervals are needed for diagnosing iron deficiency (ID) and iron deficiency anemia (IDA), especially in women. This study proposes higher ferritin cutoffs to improve diagnostic accuracy for ID and IDA.
Area of Science:
- Clinical Biochemistry
- Hematology
- Women's Health
Background:
- Iron deficiency (ID) and iron deficiency anemia (IDA) disproportionately affect women.
- Serum ferritin is a key biomarker, but current reference intervals (RIs) are often too low for accurate ID/IDA diagnosis.
- Expert consensus suggests a lower ferritin cutoff of 30 µg/L to enhance sensitivity.
Purpose of the Study:
- To assess and establish updated ferritin reference intervals (RIs) for diagnosing ID and IDA in a specific patient population.
- To determine optimal ferritin cutoffs for improved diagnostic sensitivity.
Main Methods:
- Extracted patient data (age, sex, hemoglobin, iron markers) from laboratory information systems.
- Stratified patients into iron replete (IR), ID, or IDA groups.
- Generated new ferritin RIs from the IR group and used ROC curves to identify optimal diagnostic cutoffs.
Main Results:
- New ferritin RIs had lower limits of 16.9 µg/L (females) and 30 µg/L (males).
- Optimal cutoffs of 45 µg/L (females) and 70 µg/L (males) for ID diagnosis were identified.
- Diagnostic sensitivity for ID in females improved by 44%.
Conclusions:
- Findings support recommendations for higher ferritin cutoffs.
- Clinical laboratories should re-evaluate ferritin RIs, particularly for diagnosing ID in females.
- Updated RIs can improve the accuracy of ID and IDA diagnosis.
