From the Guidelines
A significant drop in ferritin levels is most commonly caused by blood loss, which can be acute or chronic, and can be due to various factors such as surgery, trauma, gastrointestinal bleeding, or heavy menstrual periods. According to the most recent study 1, iron deficiency, even without anaemia, can have negative implications for aerobic performance, and postpubertal female players are at the highest risk of iron deficiency due to regular blood loss during menstrual bleeding.
Other factors that can contribute to a significant drop in ferritin levels include:
- Chronic conditions like celiac disease, inflammatory bowel disease, or H. pylori infection, which can reduce iron absorption in the intestines 1
- Inadequate dietary iron intake, particularly in vegetarians or those with restricted diets, which can gradually lower ferritin levels 1
- Pregnancy, which increases iron requirements and can deplete ferritin 1
- Certain medications like proton pump inhibitors, which can interfere with iron absorption 1
- Hemodialysis patients, who often experience iron loss during treatments 1
It is essential to consult a healthcare provider if you experience a significant ferritin drop, as they will likely order additional tests such as complete blood count, iron studies, and possibly endoscopy or colonoscopy depending on symptoms. Treatment typically addresses the underlying cause while supplementing with oral iron (typically ferrous sulfate 325mg 1-3 times daily) or, in severe cases, intravenous iron 1. The body stores iron primarily as ferritin, so levels reflect total body iron reserves, making it an important diagnostic marker for iron deficiency.
In cases of iron deficiency anaemia, there is a need for iron substitution, and a diet rich in iron, particularly red meat, is recommended to avoid the development of overt anaemia and make sure that other haem-containing proteins/enzymes can be maintained at a sufficient level 1. Additionally, a period of iron supplementation may be considered at levels above the RDA after consultation with qualified medical and dietetic practitioners. Parenteral (ie, intravenous) supplementation is usually not indicated, except in cases of pathologically impaired iron digestion from the gut (such as in coeliac disease) 1.
From the Research
Causes of Significant Ferritin Drop
- A significant drop in ferritin levels can be caused by various factors, including iron deficiency, inflammation, and certain medical conditions 2, 3.
- Iron deficiency is a common cause of low ferritin levels, and it can be due to inadequate iron intake, increased iron requirements, or iron loss 2, 4.
- Inflammation can also cause a drop in ferritin levels, as it can lead to an increase in hepcidin, a hormone that regulates iron metabolism 2, 3.
- Certain medical conditions, such as celiac disease, Crohn's disease, and ulcerative colitis, can also cause a significant drop in ferritin levels due to malabsorption of iron 2, 3.
Factors Affecting Ferritin Levels
- Ferritin levels can be affected by various factors, including age, sex, and menopausal status 5.
- In women, ferritin levels tend to be lower than in men, and they can also be affected by menopausal status, with postmenopausal women having higher median ferritin values than premenopausal women 5.
- Certain medications, such as erythropoietin, can also affect ferritin levels by stimulating red blood cell production and increasing iron requirements 3.
Diagnostic Thresholds for Ferritin
- The diagnostic threshold for ferritin varies depending on the population and the clinical context 2, 5.
- A ferritin level of less than 12 microg/L is generally considered indicative of absolute iron deficiency, while levels above 15 microg/L may still not be sufficient to meet erythropoietic demand 3.
- However, some studies suggest that the ferritin threshold for diagnosing iron deficiency should be revised upwards, with a cutoff of 24-25 microg/L proposed for adult women and men 5.