Do you treat low ferritin (iron) levels, specifically iron deficiency?

From the Guidelines

Low ferritin levels should be treated, particularly when they fall below 45 mg/dL, as recommended by the American Gastroenterological Association guideline 1. The treatment approach should prioritize oral iron supplementation, typically with ferrous sulfate 325 mg taken 1-3 times daily between meals with vitamin C to enhance absorption. Alternative formulations include ferrous gluconate or ferrous fumarate if sulfate causes too much gastrointestinal distress. Some key points to consider when treating low ferritin levels include:

• Treatment should continue for 3-6 months to fully replenish iron stores, even after hemoglobin normalizes 1.
• For those who cannot tolerate oral iron due to side effects like constipation, nausea, or abdominal pain, intravenous iron formulations such as iron sucrose or ferric carboxymaltose may be necessary 1.
• Identifying and addressing the underlying cause of low ferritin levels is crucial, which may include blood loss, poor dietary intake, malabsorption, or increased iron requirements 1.
• Dietary changes to include iron-rich foods like red meat, spinach, and legumes can complement supplementation 1.
• Iron deficiency can lead to fatigue, weakness, and impaired cognitive function, making treatment essential to improve quality of life and decrease the risk of complications related to anemia 1. It's also important to note that iron supplementation in the presence of normal or even high ferritin values is not recommended and is potentially harmful 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment of Low Ferritin Levels

• Low ferritin levels can be treated with oral iron therapy, and in some cases, intravenous iron supplementation may be necessary 2, 3.
• The treatment of iron deficiency without anaemia is recommended, as iron is essential for optimal cognitive function and physical performance 2.
• A baseline set of blood tests, including serum ferritin levels, is important to monitor iron deficiency, and a ferritin cut-off of 30 µg/l is appropriate for healthy males and females aged >15 years 2.

Diagnosis of Iron Deficiency

• Serum or plasma ferritin concentration can be used as an index of iron deficiency and overload, but its levels can be elevated in inflammation and infection 4.
• The diagnostic accuracy of ferritin concentrations for detecting iron deficiency and risk of iron overload is generally low, and the use of ferritin as a diagnostic test should be interpreted with caution 4.

Effectiveness of Iron Supplementation

• Iron supplementation can effectively increase iron stores in iron-deficient individuals, and may enhance endurance capacity by facilitating erythropoiesis 3, 5.
• Oral iron therapy can increase hemoglobin and ferritin levels, and decrease soluble transferrin receptor levels, in nonanemic menstruating women with low ferritin 5.
• Ferric citrate may be more effective than ferrous sulfate in treating iron deficiency in patients with chronic kidney disease (CKD) 6.

Monitoring and Follow-up

• Patients with low ferritin levels should be monitored regularly, with basic blood tests repeated every 6 or 12 months to monitor iron stores 2.
• The success of treatment should be measured by repeating basic blood tests after 8 to 10 weeks, and patients with repeatedly low ferritin may benefit from intermittent oral substitution to preserve iron stores 2.