Do You Have Iron Deficiency Anemia?
Yes, you have iron deficiency based on your laboratory values, though whether you have anemia depends on your hemoglobin level, which you haven't provided. Your ferritin of 27 ng/mL combined with a transferrin saturation of 24% indicates depleted iron stores that require investigation and treatment. 1, 2
Understanding Your Laboratory Results
Your iron panel reveals a clear pattern of iron deficiency:
Ferritin 27 ng/mL: This is below the critical threshold of 30 ng/mL, which indicates low body iron stores and generally warrants treatment. 1 While ferritin <15 ng/mL has 99% specificity for absolute iron deficiency, your level of 27 ng/mL still falls within the range (15-30 ng/mL) that indicates iron deficiency with depleted stores. 1
Transferrin saturation 24%: Calculated as (serum iron 65 ÷ TIBC 270) × 100 = 24%. While this is technically above the traditional threshold of <20% used to define iron deficiency 3, it is still in the lower range and, combined with your low ferritin, confirms inadequate iron availability for red blood cell production. 3
The dramatic drop in ferritin: Your ferritin has fallen from 119.7 to 27 ng/mL, representing a 77% decline. This substantial decrease indicates ongoing iron loss that must be investigated. 3
Critical Distinction: Iron Deficiency vs. Iron Deficiency Anemia
You definitively have iron deficiency. Whether you have iron deficiency anemia depends on your hemoglobin level, which you did not provide. 2, 4
Iron deficiency without anemia (Stage 1-2 iron deficiency) occurs when iron stores are depleted but hemoglobin remains normal. This still causes significant symptoms including fatigue, exercise intolerance, difficulty concentrating, and restless legs syndrome. 1, 2
Iron deficiency anemia is defined as hemoglobin <13 g/dL in men or <12 g/dL in non-pregnant women, combined with evidence of iron deficiency. 3, 4
Important Caveat: Rule Out Inflammation
Before finalizing this diagnosis, you must verify that inflammation is not present, as ferritin is an acute-phase reactant that rises during infection, inflammation, or tissue damage. 3, 1
Check inflammatory markers: Request C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR). 3
If CRP/ESR are normal, your diagnosis of absolute iron deficiency is confirmed. 3
If CRP/ESR are elevated, the diagnostic thresholds shift: ferritin <100 ng/mL would indicate iron deficiency in the presence of inflammation, and your level of 27 ng/mL would still confirm iron deficiency even with concurrent inflammation. 3, 1
Mandatory Investigation for the Cause
The most critical next step is identifying why your iron stores have dropped so dramatically. 3, 2
Gastrointestinal blood loss is the most common cause in adult men and postmenopausal women, and asymptomatic colon or gastric cancer may present with iron deficiency. 3
Menstrual blood loss is the most common cause in premenopausal women. 2, 4
Other causes include: malabsorption (celiac disease, atrophic gastritis, post-bariatric surgery), inadequate dietary intake, NSAID use, inflammatory bowel disease, or regular blood donation. 3, 2
Celiac disease screening with tissue transglutaminase (tTG) antibody should be performed at presentation. 3
Endoscopic evaluation (colonoscopy and upper endoscopy) is recommended, particularly if you are male or a postmenopausal woman, or if you are over age 50. 3, 4
Treatment Recommendations
Oral iron supplementation should be initiated immediately while the underlying cause is being investigated. 2
First-line therapy: Ferrous sulfate 325 mg daily or on alternate days. 2
Oral iron is appropriate unless you have malabsorption, intolerance to oral iron, ongoing significant blood loss, or chronic inflammatory conditions. 2
Intravenous iron is indicated if you have celiac disease, post-bariatric surgery anatomy, chronic kidney disease, heart failure, inflammatory bowel disease, cancer, or are in the second/third trimester of pregnancy. 2
Monitor response: Hemoglobin should increase by 1-2 g/dL within one month of starting oral iron. If it does not, consider malabsorption, continued bleeding, or non-compliance. 4
Long-Term Monitoring
- Once the underlying cause is identified and treated, and iron stores are repleted, you should be monitored every 6-12 months depending on risk factors, as recurrence of iron deficiency is common (>50% after 1 year). 3