What is the significance of a ferritin level of 40 in a 20-year-old male patient?

From the Guidelines

A ferritin level of 40 ng/mL in a 20-year-old male patient indicates iron deficiency, as the cut-off for diagnosis is a ferritin level of less than 45 ng/mL, according to the American Gastroenterological Association (AGA) recommendations 1. To address this, I recommend the following steps:

• Increase dietary iron intake through foods like lean red meat, beans, lentils, fortified cereals, and leafy green vegetables.
• Consider an over-the-counter iron supplement containing 18-38 mg of elemental iron daily, taken with vitamin C to enhance absorption and preferably between meals.
• Avoid taking iron supplements with calcium, dairy products, coffee, or tea as these can inhibit absorption.
• Monitor for side effects like constipation or stomach upset; if these occur, try taking the supplement with food or consider a different formulation. It is essential to note that the AGA recommends using a cut-off of 45 ng/mL when using ferritin to diagnose iron deficiency, and this patient's level is below that threshold 1. Additionally, the patient should be tested for celiac disease with serology first, and a small bowel biopsy should only be considered if serology is positive, as per the guidelines for patients with iron deficiency anemia 1. Given the patient's age and sex, it is crucial to investigate the cause of iron deficiency anemia, and bidirectional endoscopy may be considered, although the decision should be made on a case-by-case basis, taking into account the patient's preferences and values 1.

From the Research

Ferritin Levels in a 20-Year-Old Male Patient

• A ferritin level of 40 ng/mL in a 20-year-old male patient can be evaluated in the context of iron deficiency and iron overload diagnosis 2.
• According to the study published in The Cochrane database of systematic reviews, a ferritin cutoff of 30 μg/L is often used to diagnose iron deficiency, with a sensitivity of 79% and a specificity of 98% in non-healthy adults 2.
• The patient's ferritin level is above this cutoff, suggesting that iron deficiency is unlikely.
• However, it is essential to consider other factors, such as inflammation, which can affect ferritin levels 2.
• A study published in JAMA notes that iron deficiency can cause symptoms such as fatigue, exercise intolerance, and difficulty concentrating, even in the absence of anemia 3.
• Another study published in Nutrition journal found that supplementation with ferrous sulfate or iron bis-glycinate chelate can increase ferritin concentration in schoolchildren with low iron stores 4.
• The effects of iron therapy on serum ferritin levels have also been studied in adults with iron-deficiency anemia, with results showing that standard treatment does not cause a rise in serum ferritin until hemoglobin levels are normal 5.
• A comparative study of oral lactoferrin and ferrous sulfate supplementation found that lactoferrin had better effects on serum iron, ferritin, and hemoglobin concentration, but a reducing effect on fractional iron absorption and IL-6 levels 6.

Diagnostic Considerations

• The diagnosis of iron deficiency or iron overload should be based on a combination of clinical evaluation, laboratory tests, and medical history 3, 2.
• Ferritin levels should be interpreted in the context of other laboratory tests, such as hemoglobin and transferrin saturation, to determine the presence of iron deficiency or iron overload 3, 2.
• The patient's symptoms, medical history, and physical examination should also be taken into account when interpreting ferritin levels 3.