What does a ferritin level of 24 indicate and how is it treated?

Interpretation and Management of Ferritin Level of 24

A ferritin level of 24 μg/L indicates iron deficiency and should be treated with oral iron supplementation in most cases. 1, 2

Diagnostic Interpretation

What This Level Means

• A ferritin level of 24 μg/L falls below the threshold of 30 μg/L, which defines absolute iron deficiency in individuals without inflammation 2, 1
• This level is between 15-30 μg/L, suggesting depleted iron stores even though anemia may not yet be present 2, 3
• In the absence of inflammation, this level has high specificity (92%) for diagnosing iron deficiency 2

Additional Diagnostic Considerations

• To confirm the diagnosis, evaluate for inflammation using CRP, as inflammation can falsely elevate ferritin levels 2, 4
• Check transferrin saturation; a level <16% would further support iron deficiency diagnosis 2, 1
• Consider measuring hemoglobin to determine if iron deficiency has progressed to iron deficiency anemia 5
• For a complete picture, assess additional parameters such as mean cell volume (MCV), mean cell hemoglobin (MCH), and percentage of hypochromic erythrocytes 3

Treatment Approach

First-Line Treatment

• Oral iron supplementation with preparations containing 28-50 mg of elemental iron daily or on alternate days 3, 5
• Ferrous sulfate 325 mg daily is a common first-line therapy 5
• Consider alternate-day dosing to improve absorption and reduce gastrointestinal side effects 5

Dietary Recommendations

• Increase consumption of iron-rich foods, particularly heme iron sources (red meat, seafood) 2, 3
• Co-ingest vitamin C with non-heme iron sources to enhance absorption 2
• Avoid tea, coffee, and calcium-rich foods around iron-rich meals as they can impair iron absorption 2, 3

Monitoring Response

• Repeat basic blood tests (ferritin, hemoglobin, MCV, MCH) after 8-10 weeks of treatment 3
• Target ferritin level should be >30 μg/L in adults and >15-20 μg/L in children and adolescents 3
• Long-term follow-up every 6-12 months is recommended for patients with recurrent iron deficiency 3

Special Considerations

When to Consider IV Iron

• Intravenous iron may be indicated in cases of:
  • Oral iron intolerance 5
  • Impaired absorption (celiac disease, post-bariatric surgery) 5
  • Chronic inflammatory conditions (IBD, CKD, heart failure) 5
  • Ongoing blood loss 5
  • Pregnancy (second and third trimesters) 5

Further Evaluation Needed

• In postmenopausal women and men with iron deficiency anemia, bidirectional endoscopy is strongly recommended to rule out gastrointestinal causes 2
• Investigate potential causes of iron deficiency: menstrual bleeding, gastrointestinal blood loss, malabsorption, inadequate dietary intake, or pregnancy 5

Common Pitfalls to Avoid

• Don't assume a ferritin level >30 μg/L excludes iron deficiency in patients with inflammation; in these cases, iron deficiency may be present with ferritin up to 100 μg/L 2, 6
• Avoid excessive iron supplementation in patients with normal iron stores as it can cause side effects and potential harm 3
• Don't overlook the need to identify and treat the underlying cause of iron deficiency 2, 5