What are the normal ranges for hemoglobin, iron panel, and ferritin levels in men and women?

Normal Hemoglobin, Iron Panel, and Ferritin Levels in Men and Women

Hemoglobin Levels

For adult men, normal hemoglobin is ≥13.0 g/dL, and for adult non-pregnant women, normal hemoglobin is ≥12.0 g/dL. 1

• The World Health Organization defines anemia as hemoglobin <13.0 g/dL in men over 15 years and <12.0 g/dL in non-pregnant women over 15 years 1, 2
• Some guidelines use slightly different cutoffs: anemia is defined as hemoglobin <13.5 g/dL in adult males and <12.0 g/dL in adult females in certain chronic kidney disease populations 1
• For pregnant women, anemia is defined as hemoglobin <11.0 g/dL in the second and third trimester 1
• The lower limit of normal should align with your local laboratory's reference range, but these should not fall below the WHO-defined thresholds 1

Important Considerations for Hemoglobin Interpretation

• Age in men: While mean hemoglobin decreases with age in males (declining 1-1.5 g/dL between ages 50-75 years), this should NOT be considered normal aging—lower hemoglobin in older males often reflects underlying pathology and warrants investigation 1
• Age in women: Hemoglobin remains stable between ages 20-80 years in iron-replete women 1
• Altitude: Hemoglobin increases by approximately 0.6 g/dL in women and 0.9 g/dL in men for each 1,000 meters above sea level 1
• Ethnicity: Normal hemoglobin distribution varies with ethnicity, and this should be considered when interpreting results 1, 2

Iron Panel and Ferritin Levels

Serum Ferritin

Normal ferritin levels are typically ≥15-30 μg/L, with iron deficiency definitively indicated by ferritin <15 μg/L in the absence of inflammation. 1

• Ferritin <15 μg/L is highly specific (99%) for absent iron stores 1
• Ferritin <30 μg/L generally indicates low body iron stores 1, 3
• Ferritin <45 μg/L provides optimal sensitivity-specificity balance (92% specificity) for iron deficiency in clinical practice, particularly when inflammation may be present 1
• Ferritin >150 μg/L is unlikely to occur with absolute iron deficiency, even with concurrent inflammation 1

Critical Caveat About Ferritin

• Ferritin is an acute-phase reactant and can be falsely elevated in infection, inflammation, chronic disease, hepatitis, cirrhosis, neoplasia, or arthritis—masking true iron deficiency 1
• In inflammatory states, use the higher cutoff of 45 μg/L to avoid missing iron deficiency 1

Transferrin Saturation

Normal transferrin saturation is >20%, with values <20% indicating iron deficiency. 1

• Transferrin saturation <20% combined with ferritin <100 ng/mL indicates iron deficiency requiring treatment in patients with chronic kidney disease 1
• In perioperative settings, transferrin saturation <20% (along with ferritin <100 ng/mL) indicates iron deficiency anemia 1

Additional Iron Panel Parameters

• Mean corpuscular volume (MCV): Normal is typically ≥80 fL; values <80 fL suggest microcytosis, which occurs in iron deficiency 1
• Mean corpuscular hemoglobin (MCH): Normal is ≥27 g/dL; values <27 g/dL indicate hypochromia and may be more sensitive than MCV for detecting iron deficiency 1
• Total iron-binding capacity (TIBC): Elevated in iron deficiency 1
• Serum iron: Low in iron deficiency, but has high day-to-day variation and is less reliable than ferritin 1

Practical Diagnostic Thresholds

For Screening and Diagnosis

In clinical practice, use these combined criteria to diagnose iron deficiency anemia: 1

• Men: Hemoglobin <13 g/dL AND ferritin <45 ng/mL
• Non-pregnant women: Hemoglobin <12 g/dL AND ferritin <45 ng/mL
• Pregnant women: Hemoglobin <11 g/dL AND ferritin <30 ng/mL

When to Investigate More Urgently

• Men with hemoglobin <12 g/dL should be investigated more urgently for serious underlying disease 1
• Postmenopausal women with hemoglobin <10 g/dL warrant urgent investigation 1
• Any level of anemia in the presence of confirmed iron deficiency should prompt investigation, though the urgency increases with severity 1

Response to Iron Therapy as Diagnostic Tool

A hemoglobin rise ≥10 g/L within 2 weeks of iron supplementation is highly suggestive of absolute iron deficiency, even if initial iron studies were equivocal 1