What is a normal ferritin level?

Normal Ferritin Levels

Normal ferritin levels are 50-100 μg/L as a target range for maintenance, though clinically acceptable ranges are <200 μg/L for women and <300 μg/L for men. 1

Gender-Specific Normal Ranges

• Men:

  • Mean normal level: 69 ng/mL (μg/L) 2
  • Clinically acceptable range: <300 μg/L 1

• Women:

  • Mean normal level: 35 ng/mL (μg/L) 2
  • Clinically acceptable range: <200 μg/L 1

Interpreting Ferritin Levels

Ferritin levels can be interpreted as follows:

Ferritin Level	Interpretation
<10 μg/L	Severe iron deficiency [2]
<30 μg/L	Iron deficiency in the absence of inflammation [3]
30-100 μg/L	Possible iron deficiency or anemia of chronic disease with inflammation [3]
50-100 μg/L	Target maintenance range for most patients [1]
>100 μg/L	Possible anemia of chronic disease or iron overload [3]
>1000 μg/L	High risk of cirrhosis (20-45%) [3]

Clinical Significance and Considerations

Iron Deficiency

• A ferritin level below 30 μg/L typically indicates iron deficiency in patients without inflammation 3, 4
• However, in patients with inflammatory conditions, iron deficiency may still be present with ferritin levels up to 100 μg/L 5
• A study showed that using 50 μg/L as a cutoff for iron deficiency had a positive predictive value of 100% but a negative predictive value of only 22% 5

Iron Overload

• Elevated ferritin (>200 μg/L in women, >300 μg/L in men) may indicate iron overload but can also be caused by:
  • Inflammatory conditions
  • Malignancy
  • Infections
  • Liver disease
  • Metabolic syndrome 3, 6

Important Caveats

• Inflammation effect: Ferritin is an acute phase reactant and can be elevated in inflammatory states even with iron deficiency 3, 5
• Gender differences: Women typically have lower ferritin levels than men 2
• Extremely high levels: Ferritin >1000 μg/L is most commonly associated with malignancy and iron overload syndromes rather than rheumatologic diseases 6
• Monitoring: During treatment for iron overload, ferritin should be monitored monthly during the induction phase and every 6 months during maintenance 1

Clinical Pitfalls to Avoid

1. Don't assume normal iron stores with ferritin >50 μg/L: Patients with inflammatory conditions may still be iron deficient with ferritin levels up to 100 μg/L 5

2. Don't ignore transferrin saturation: Even when ferritin is within target range, elevated transferrin saturation (>50%) may be associated with symptoms 1

3. Don't overlook other tests: In unclear cases, additional tests like soluble transferrin receptor (sTfR) or reticulocyte hemoglobin content (CHr) may help differentiate true iron deficiency from functional iron deficiency 3

4. Don't miss underlying causes: Markedly elevated ferritin levels warrant investigation for malignancy, infection, and other conditions 6