Hypoferritinemia

In contrast to elevated serum ferritin, which has many possible causes, a low serum ferritin has just one cause: iron deficiency.

• Healthy adults:
  • Serum ferritin level cutoffs for diagnosis of iron deficiency vary by guidelines and patient population:¹
    • 12–15-mg/L threshold for ferritin was proposed in 10 guidelines.
    • 25–30-mg/L threshold for ferritin was proposed in 9 guidelines for the general population.
    • 45–50-mg/L threshold for ferritin was proposed in 3 guidelines, and involved the general population.
    • 100-mg/L threshold for ferritin was proposed in 12 guidelines, mainly in the context of chronic kidney disease.
  • In cohort of 53 healthy persons:²
    • Serum ferritin with cut off 15 ng/ml had:
      • Sensitivity 60%
      • Specificity 100%
    • Serum ferritin with cut off 30 ng/ml had:
      • Sensitivity 100%
      • Specificity 89%
  • In cohort of 123 outpatients diagnosed with gastritis and peptic ulcer disease:²
    • Serum ferritin with cut off 15 ng/ml had:
      • Sensitivity 72%
      • Specificity 96%
    • Serum ferritin with cut off 30 ng/ml had:
      • Sensitivity 92%
      • Specificity 92%
• Ferritin concentration may be falsely normal despite a low iron store in the setting of inflammation, cancer, chronic kidney disease and congestive heart failure.