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Serum ferritin as an indicator of iron status: what do we need to know?
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Determination of iron status in pregnancy and in young children is essential for both clinical and public health practice. Clinical diagnosis of iron deficiency (ID) through sampling of bone marrow to identify the absence of body iron stores is impractical in most cases. Serum ferritin (SF) concentrations are the most commonly deployed indicator for determining ID, and low SF concentrations reflect a state of iron depletion. However, there is considerable variation in SF cutoffs recommended by different expert groups to diagnose ID. Moreover, the cutoffs used in different clinical laboratories are heterogeneous. There are few studies of diagnostic test accuracy to establish the sensitivity and specificity of SF compared with key gold standards (such as absent bone marrow iron stores, increased intestinal iron absorption, and hemoglobin response to SF) among noninflamed, outpatient populations. The limited data available suggest the commonly recommended SF cutoff of <15 μg/L is a specific but not sensitive cutoff, although evidence is limited. Data from women during pregnancy or from young children are especially uncommon. Most data are from studies conducted >30 y ago, do not reflect ethnic or geographic diversity, and were performed in an era for which laboratory methods no longer reflect present practice. Future studies to define the appropriate SF cutoffs are urgently needed and would also provide an opportunity to compare this indicator with other established and emerging iron indexes. In addition, future work would benefit from a focus on elucidating cutoffs and indexes relevant to iron adequacy.
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“It is a usual practice in many specialties and guidelines to assume that, regardless of the lower normality value of the ferritin test used, SF <30 ng/mL (irrespective of the TSAT value) or SF <100 ng/mL and TSAT <20% are the hallmarks of absolute ID; while SF >100 ng/mL and TSAT <20% usually indicate AI in the context of infection or inflammation [1,2,15,16,17,18,19,20].”
From Defining Global Thresholds for Serum Ferritin: A Challenging Mission in Establishing the Iron Deficiency Diagnosis in This Era of Striving for Health Equity (2025) · cites this paper as [20]
In the citing paper
“Although many laboratory indexes may be helpful for the ID differential diagnostic workup, such as the mean corpuscular volume (MCV), the reticulocyte count and reticulocyte Hb content, the soluble transferrin receptor and its correlation with SF, and hepcidin measurement, based on the real-life evidence, the determination of iron status by using SF and TSAT is the most commonly deployed strategy”
From Defining Global Thresholds for Serum Ferritin: A Challenging Mission in Establishing the Iron Deficiency Diagnosis in This Era of Striving for Health Equity (2025) · cites this paper as [20]
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Metadata
- Authors
- Daru, J., Colman, K., Stanworth, S. J., De La Salle, B., Wood, E. M., & Pasricha, S.-R.
- Affiliations
- Queen Mary University of London (GB)
- Monash University (AU)
- NHS Blood and Transplant (GB)
- University of Oxford (GB)
- Corresponding author
- Pasricha, Sant-Rayn
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2017-12
- Volume
- 106
- Issue
- Suppl 6
- Pages
- 1634S-1639S
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC5701723
- OpenAlex
- W2765394563
- Cited by
- 246
- References
- 45
- Citations by year
- 2026: 21 · 2025: 36 · 2024: 34 · 2023: 32 · 2022: 31 · 2021: 34 · 2020: 28 · 2019: 19 · 2018: 9 · 2017: 2
- FWCI
- 2.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- Funders
- Cooley's Anemia Foundation
- National Institute for Health and Care Research (ACF-2012-19-001)
- Topics
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Nursing › Nutrition and Dietetics › Trace Elements in Health
- Health Sciences › Nursing › Nutrition and Dietetics › Infant Nutrition and Health
- Keywords
- serum ferritin, iron status, iron deficiency, diagnostic thresholds, diagnostic accuracy, iron depletion, pregnancy, young children, bone marrow iron stores, hemoglobin response
- MeSH terms
- Child, Preschool, Female, Ferritins, Hemoglobins, Humans, Iron, Nutritional Status, Pregnancy, Receptors, Transferrin, Sensitivity and Specificity, Anemia, Iron-Deficiency
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