What is iron?
Iron is an essential mineral involved in a range of vital processes in your body. Without iron, you couldn't form the red blood cells needed to transport oxygen throughout your body, build the proteins you need to metabolize energy, make the collagen that keeps your skin stretchy or create neurotransmitters that help you feel emotions, move and concentrate.¹ ²
Needless to say, you need iron and want to avoid a deficiency. But too much isn’t a good thing either. Both low and high iron levels can contribute to health problems or signal a serious underlying medical issue.
The good news is that if you or your doctor have reason to believe you have low or excessive levels of iron, a ferritin blood test can help.
What is a ferritin blood test?
Ferritin is a protein that stores iron and releases it in a controlled manner to fuel various cellular processes.
While ferritin is found in tissues throughout the body, a small amount also circulates in the bloodstream — this is called serum ferritin.³ A ferritin test is a simple blood test that measures these serum ferritin levels, which are an indirect marker of the total amount of iron in your body.
Why do you need a ferritin test?
A ferritin blood test is a very effective way to screen for low iron stores, which can lead to iron deficiency anemia, a potentially serious condition caused by low iron.⁴
Ferritin blood tests can also help identify conditions associated with too much iron, such as hemochromatosis⁵ – a rare genetic disorder resulting in excessive iron deposits in many organs.
Abnormal ferritin levels may also be a signal of chronic inflammatory disorders, alcohol abuse, liver disease, hyperthyroidism, certain cancers and other medical issues⁶ – but more tests may be needed to diagnose these conditions and determine next steps.
If you supplement with iron, ferritin tests can be done periodically to ensure your levels stay in a healthy, normal range.
What is a normal ferritin level?
The imaware medical advisory board recognizes the following as normal levels of ferritin:
- For men: 40 – 250 ng/mL
- For women: 12 – 150 ng/mL
Low ferritin is anything below the normal levels:
- For men: <40 ng/mL
- For women: <12 ng/mL
High ferritin is anything above normal levels:
- For men: >250 ng/mL
- For women: >150 ng/mL
Low ferritin levels
It’s important to identify low ferritin early since it can lead to iron deficiency anemia, with symptoms like skin pallor, fatigue and brain fog. Iron deficiency anemia can also lead to serious complications such as depression, increased risk of infection, pregnancy problems and heart failure.⁷ Even iron deficiency in earlier stages (i.e. before iron deficiency anemia has developed) can negatively impact quality of life and weaken the heart and bones.⁸
Symptoms of low ferritin levels
Not everyone gets screened for ferritin levels at their annual physical. Here are some signs to watch for that may warrant a ferritin blood test. Just keep in mind this isn’t an exhaustive list of all the reasons your doctor may want to check your ferritin levels.
Symptoms of low iron can include:⁹ ¹⁰ ¹¹ ¹² ¹³ ¹⁴ ¹⁵
- Pallor
- Cold hands and feet
- Dizziness
- Exercise intolerance
- Fatigue
- Restless legs
- Weakness
- Craving ice (pagophagia)
- Craving clay, dirt or other non-nutritive substances (pica)
Causes of low ferritin
Iron deficiency and full blown iron deficiency anemia have several causes, including:¹⁶
- Blood loss, which may be caused by heavy menstrual periods, bleeding in the gastrointestinal tract, donating too much blood, injury or surgery.
- Not eating enough iron-rich foods such as eggs, meat, seafood, legumes, nuts and seeds, whole grains and certain vegetables (not so much spinach, despite their fame, as the iron they contain is hard to absorb).
- Problems absorbing iron from food due to digestive conditions such as celiac disease, Crohn’s disease or short gut syndrome.
- Other conditions such as genetic disorders and chronic inflammation.
Treatments for low iron levels
If your doctor diagnoses you with iron deficiency anemia, they may advise you to take iron supplements. Typically, it takes three to six months to replenish your iron stores.¹⁷ However, too much iron can damage organs and serve up some pretty nasty side gastrointestinal side effects, including flatulences, abdominal pain, nausea and difficult bowel movements.¹⁸
Because of this, it’s best to follow your healthcare professional’s guidance so you’re getting the amount of iron you need — not too little, not too much. Your doctor will likely order follow-up blood tests to monitor your iron levels as they increase to normal.
Depending on the specific reason for your iron deficiency, your doctor may recommend another treatment, medication, or dietary changes that help address the root cause.
Elevated ferritin levels
High serum ferritin levels may be caused by ingesting too much iron in your diet or excessive iron supplementation. But high ferritin is also associated with a number of health conditions, including infections, alcohol abuse, liver diseases, autoimmune conditions and some cancers, and getting to the root cause can take time. In these conditions, elevated ferritin doesn’t necessarily indicate high iron stores, so treatment would focus on determining the reason for abnormal results, as opposed to simply trying to reduce iron intake.
Symptoms of elevated ferritin levels
Symptoms of elevated ferritin and excess iron can include:¹⁹ ²⁰
- Joint pain
- Abdominal pain
- Lack of energy
- Weight loss
- Body hair loss
- Lack of sex drive
Causes of high ferritin levels
Below are just some of the medical conditions or conditions associated with high ferritin levels. Please note that for many of these conditions, you may need additional testing to confirm a diagnosis:²¹ ²² ²³ ²⁴ ²⁵
- Alcohol abuse
- Autoimmune diseases such as rheumatoid arthritis and Grave’s disease
- Certain cancers (leukemia, lymphoma, breast cancer)
- Hemochromatosis
- Hyperthyroidism
- Infections
- Liver disease
Treatments for high ferritin levels
There is no single treatment for high ferritin levels — what works depends on what’s causing the elevation in the first place.
Depending on your individual situation, your doctor may recommend changes to your diet or supplementation routine, or they may wish to explore reducing your iron stores with treatments like phlebotomy (having blood removed from your body) or chelation therapy (taking medicines to draw iron from the blood so it's released in the urine).²⁶
Summary
A ferritin blood test is a simple way to assess your iron levels, particularly if you think you have iron deficiency or iron deficiency anemia, which can often be treated with supplements and dietary changes. Abnormal ferritin test results may also indicate iron overload (caused by supplements or the rare condition hemochromatosis) or various underlying conditions such as liver disease and certain cancers. If your ferritin levels are low or high, be sure to share test results with your doctor so they can help you make sense of your results and determine the best course of action.
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