ASH Issues Guidance on Serum Ferritin Thresholds for Diagnosing Iron Deficiency

MONDAY, Oct. 5, 2026 (HealthDay News) — In guidelines issued by the American Society of Hematology and published online Sept. 16 in Blood Advances, recommendations are presented for the diagnosis of iron deficiency.

Jacquelyn M. Powers, M.D., from the Baylor College of Medicine in Houston, and colleagues established a multidisciplinary guideline panel to develop evidence-based guidelines relating to the diagnosis of iron deficiency.

The authors developed five recommendations. For children ages 9 months to 4 years, a serum ferritin threshold of ≤20 ng/mL is suggested instead of a threshold of ≤12 ng/mL for the diagnosis of iron deficiency; this threshold is for children without known or suspected inflammation. A serum ferritin threshold of ≤30 ng/mL is suggested instead of ≤15 ng/mL for the diagnosis of iron deficiency in the adult population who are not menstruating or pregnant; the threshold is for adults without known or suspected inflammation. For menstruating individuals, a serum ferritin threshold of ≤30 ng/mL is suggested, and there is a suggestion against use of a serum ferritin threshold of ≤15 ng/mL for the diagnosis of iron deficiency; a serum ferritin threshold of ≤50 ng/mL is appropriate for those with heavy menstrual bleeding or other forms of abnormal uterine bleeding. A serum ferritin threshold of ≤30 ng/mL is suggested for pregnant individuals, while there is a recommendation against a serum ferritin threshold of ≤15 ng/mL for diagnosing iron deficiency. Both serum ferritin and transferrin saturation are suggested rather than serum ferritin alone for evaluating iron deficiency in adults with anemia of inflammation.

“These updated ferritin thresholds provide clear guidance in an area where consensus has been lacking,” Powers said in a statement. “We hope these recommendations empower patients to better understand and ask for the testing they need and that health systems adopt these thresholds for diagnosis.”

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