The American Society of Hematology has published new guidelines for diagnosing iron deficiency

The American Society of Hematology has published new recommendations for diagnosing iron deficiency. The document "American Society of Hematology 2026 guidelines for diagnosis of iron deficiency" introduces different ferritin thresholds for children, adults, pregnant women and patients with chronic inflammation.

The most important change concerns the way of thinking about the test result

A ferritin level of e.g. 25 ng/ml should not be automatically considered a normal result in an adult. According to new recommendations of the American Society of Hematology, it may already indicate iron deficiency - depending on age, symptoms, clinical situation and comorbidities.

These are not new "laboratory standards" that replace reference ranges overnight in all laboratories in Poland. These are the diagnostic thresholds proposed in American clinical guidelines. The result must always be related to the symptoms, morphology, disease history, possible inflammation and the doctor's assessment.

Threshold values indicated by the organization in its guidelines

Children 9 months to 4 years: 20 ng/ml or less

Adults, menstruating or pregnant: 30 ng/ml or less

High-risk groups, including people with heavy menstrual bleeding and pregnant women with anemia: 50 ng/ml or less

Adults with inflammation, including those with cancer, inflammatory bowel disease or infectious disease: serum ferritin concentration below 100 ng/ml or transferrin saturation (iron transport protein) below 20%.

Why doesn't the "result within the norm" always close the topic? Ferritin increases when there is inflammation

Elevated or apparently normal ferritin may occur, among others: during infections, chronic inflammatory diseases, non-specific inflammatory bowel diseases, cancer, chronic kidney disease and some liver diseases. In such situations, the ferritin result alone may mask iron deficiency.

Therefore, the American Society of Hematology recommends that in adults with inflammation, not only ferritin, but also transferrin iron saturation (TSAT) should be measured. Deficiency should be considered when:

ferritin below 100 ng/ml or

TSAT below 20 percent

Who is most at risk of iron deficiency?

The risk of iron deficiency is not evenly distributed in the population. Groups that require special attention - apart from patients with chronic inflammation - include: people with heavy or prolonged menstruation, pregnant and postpartum women, people donating blood, patients after bariatric surgery and other stomach and intestinal procedures, people with a diet low in iron, patients with absorption disorders, e.g. celiac disease, people with chronic kidney, heart or intestinal diseases or people taking certain medications, e.g. proton pump inhibitors if there are other risk factors.

If my result is low, should I buy iron straight away from the pharmacy?

It is not worth starting high-dose supplementation just because ferritin is near the lower end of the reference range. First, you need the correct interpretation of the result. Taking iron on your own may cause side effects, mainly gastrointestinal problems: nausea, abdominal pain, constipation or diarrhea. More importantly, without consultation, the cause of the deficiency may be missed, e.g. bleeding from the gastrointestinal tract.

If a deficiency is suspected, the doctor may order additional tests - depending on the situation - including: blood count with red blood cell parameters, TSAT, CRP, i.e. an inflammation index, reticulocytes or reticulocyte hemoglobin, vitamin B12 and folic acid, or tests aimed at the source of blood loss or absorption disorders.