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:3
      • 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.
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