Normal Serum Ferritin Range in Adult Females
The normal serum ferritin range in adult women is 20-200 μg/L according to the most recent ESPEN micronutrient guideline. 1
Standard Reference Intervals
The 2022 ESPEN guideline establishes the following reference intervals for serum ferritin in adults:
These ranges are based on various immunological methods of determining serum ferritin, and the guideline notes that variability in methods means laboratories should indicate their own specific reference ranges. 1
Alternative Reference Values from Other Sources
The 2011 AASLD hemochromatosis guideline provides slightly different normal ranges:
The CDC reports average serum ferritin values rather than ranges:
Critical Clinical Thresholds for Interpretation
Beyond the "normal range," specific ferritin thresholds have important diagnostic implications:
Iron Deficiency Thresholds
- Ferritin <15 μg/L has 99% specificity for absolute iron deficiency 1, 2
- Ferritin <30 μg/L generally indicates low body iron stores 2
- Ferritin <45 μg/L may justify gastrointestinal investigation, especially with chronic inflammation (specificity 0.92) 2
Upper Limit Considerations
- Values >150 μg/L rarely occur with absolute iron deficiency, even in the presence of inflammation 2
- Ferritin >1000 μg/L with elevated liver enzymes predicts cirrhosis in 80% of hemochromatosis patients 1
Important Caveats for Clinical Interpretation
Ferritin is an acute-phase protein that rises during inflammation, infection, or tissue damage, potentially masking depleted iron stores. 2 This is the most critical pitfall in ferritin interpretation.
Impact of Inflammation
- In inflammatory conditions (IBD, chronic kidney disease, heart failure), the threshold for iron deficiency shifts upward to ferritin <100 μg/L 2
- When inflammation is present, ferritin levels can be falsely elevated despite true iron deficiency 2
- Always check inflammatory markers (CRP, ESR) when ferritin is in the 30-100 μg/L range to determine if values are falsely elevated 2
Complementary Testing Required
Ferritin should never be interpreted in isolation—always evaluate alongside transferrin saturation and clinical context. 2 The relationship is direct: 1 μg/L of serum ferritin equals approximately 10 mg of stored iron. 2
Age and Menstrual Status Considerations
Serum ferritin levels in women remain low through their forties due to menstrual blood loss, then abruptly increase after age 50 (menopause). 3 This physiologic pattern means:
- Premenopausal women commonly have lower ferritin levels (often <30 μg/L) without pathology 3
- Post-menopausal women have ferritin levels approaching those of men 3
Methodological Quality Concerns
A 2024 systematic review found that published ferritin reference intervals are at high risk of bias, with 49% of studies failing to screen for iron deficiency risk and 52% not adhering to reference interval establishment guidelines. 4 This suggests that commonly reported lower limits of normal may contribute to structural underdiagnosis of iron deficiency. 4