{"product_id":"new-guidelines-for-diagnosing-iron-deficiency-what-patients-need-to-know","title":"New Guidelines for Diagnosing Iron Deficiency: What Patients Need to Know","description":"\u003cp\u003eNew 2026 guidelines from the American Society of Hematology (ASH) set specific blood test cutoffs for diagnosing iron deficiency in different groups of people. The guidelines recommend a serum ferritin threshold of 20 ng\/mL for children aged 9 months to 4 years. Serum ferritin is a blood test that measures stored iron. The guidelines recommend a serum ferritin threshold of 30 ng\/mL for most adults and for menstruating individuals. The guidelines recommend a serum ferritin threshold of 30 ng\/mL for pregnant individuals. For people with inflammation, the panel suggests checking both serum ferritin and transferrin saturation (TSAT, a measure of how much iron is carried in the blood) rather than ferritin alone. The guidelines aim to catch iron deficiency early, whether or not anemia is present.\u003c\/p\u003e\n\n\u003ch1\u003eNew Guidelines for Diagnosing Iron Deficiency: What Patients Need to Know\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Why These Guidelines Matter\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#methods\"\u003eHow the Guidelines Were Developed\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#strength\"\u003eUnderstanding Recommendation Strength\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#children\"\u003eDiagnosis in Infants and Children\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#adults\"\u003eDiagnosis in Adults (Excluding Menstruating and Pregnant Individuals)\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#menstruating\"\u003eDiagnosis in Menstruating Individuals\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#pregnancy\"\u003eDiagnosis in Pregnant Individuals\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#inflammation\"\u003eDiagnosis in Adults With Inflammation\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#symptoms\"\u003eSigns, Symptoms, and Risk Factors\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#outcomes\"\u003eOutcomes Affected by Timely Diagnosis\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#implications\"\u003eClinical Implications for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations and Research Gaps\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eWhat Patients Can Do\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eThe 2026 ASH guidelines set different serum ferritin cutoffs by group: 20 ng\/mL or less for children aged 9 months to 4 years, and 30 ng\/mL or less for most adults, menstruating individuals, and pregnant individuals.\u003c\/li\u003e\n\u003cli\u003eFor adults and menstruating individuals with symptoms, risk factors, heavy bleeding, upcoming surgery, or pregnancy planning, a ferritin threshold of 50 ng\/mL or less is appropriate.\u003c\/li\u003e\n\u003cli\u003eIn adults with anemia of inflammation, the panel suggests checking both serum ferritin and transferrin saturation rather than ferritin alone; transferrin saturation should be drawn fasting for 5 to 9 hours.\u003c\/li\u003e\n\u003cli\u003eIron deficiency should be diagnosed whether or not anemia is present, so a normal hemoglobin level does not rule it out.\u003c\/li\u003e\n\u003cli\u003eSeveral recommendations rest on low or very low certainty evidence, and the panel made no recommendations for children with inflammation because of a lack of data.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: Why These Guidelines Matter\u003c\/h2\u003e\n\u003cp\u003eIron deficiency is the most common micronutrient deficiency worldwide. When iron deficiency goes unrecognized and untreated, it progresses to iron deficiency anemia, the most common blood condition globally.\u003c\/p\u003e\n\n\u003cp\u003eIron is a critical nutrient that serves key functions throughout the body. These functions include erythropoiesis (the production of red blood cells), DNA replication, mitochondrial energy production, and neurotransmitter synthesis. Despite these countless roles, iron deficiency affects individuals across the entire lifespan in a variety of settings.\u003c\/p\u003e\n\n\u003cp\u003eIron deficiency can occur with or without anemia. People with iron deficiency experience symptoms including fatigue, pica (cravings for non-food items), irritability, poor concentration, headaches, and restless legs syndrome. The condition is also associated with poorer health-related quality of life and other important patient-reported outcomes.\u003c\/p\u003e\n\n\u003cp\u003eIron deficiency develops when there is a net negative balance between iron intake and absorption on one side, and iron demands and losses on the other. This imbalance may occur in several situations:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eInsufficient dietary iron\u003c\/li\u003e\n  \u003cli\u003eIncreased iron needs, such as during rapid growth or pregnancy\u003c\/li\u003e\n  \u003cli\u003eBlood loss, including menstrual blood loss or losses within the gastrointestinal tract\u003c\/li\u003e\n  \u003cli\u003eDecreased iron absorption, such as in inflammatory states\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe most affected populations include young children and menstruating individuals, largely adolescent girls and adult women, especially during pregnancy. People of lower socioeconomic status are disproportionately affected. Individuals with gastrointestinal conditions are also at risk, including celiac disease, inflammatory bowel disease, and those who have undergone bariatric surgery. People with dietary restrictions, blood loss, or other chronic conditions are at risk as well. These chronic conditions include heart failure, rheumatologic disease, and chronic kidney disease.\u003c\/p\u003e\n\n\u003cp\u003eIron deficiency is underrecognized for two main reasons. First, there is a lack of screening in high-risk populations. Second, laboratory reference ranges vary, and these ranges often include values within the deficient range. This variability leads to underdiagnosis and undertreatment.\u003c\/p\u003e\n\n\u003cp\u003eExisting guidance on the diagnostic criteria for iron deficiency has been limited and not evidence based. These new guidelines aim to fill that gap. The purpose is to provide evidence-based recommendations on the diagnosis of iron deficiency. The guidelines place the highest value on identifying individuals with iron deficiency, so that patients can get access to care and timely interventions.\u003c\/p\u003e\n\n\u003ch2 id=\"methods\"\u003eHow the Guidelines Were Developed\u003c\/h2\u003e\n\u003cp\u003eThe American Society of Hematology established a multidisciplinary guideline panel to create these recommendations. The panel included 1 patient representative. The panel was balanced to minimize potential bias from conflicts of interest.\u003c\/p\u003e\n\n\u003cp\u003eThe University of Kansas Health System supported the guideline-development process. This support included performing systematic evidence reviews on the prevalence of iron deficiency across populations. The team also reviewed studies to inform diagnostic thresholds, with evidence reviewed up to July 2025.\u003c\/p\u003e\n\n\u003cp\u003eThe panel prioritized clinical questions according to clinical impact and high-risk populations. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. This approach included GRADE Evidence-to-Decision frameworks to assess evidence and make recommendations. The recommendations were subsequently open for public comment.\u003c\/p\u003e\n\n\u003cp\u003eThe panel agreed on 5 recommendations in total. The recommendations take into consideration the values and preferences of affected populations. They also weigh cost and cost-effectiveness, resource requirements, impact on health equity, acceptability, and feasibility.\u003c\/p\u003e\n\n\u003cp\u003eThe target audience for these guidelines is broad. It includes hematologists, family physicians, pediatricians, obstetricians and gynecologists, internists, other clinicians, and health care providers such as advanced practice providers. The guidelines also address decision-makers and patients. The guidelines may be relevant to policymakers engaged in developing local, national, or international initiatives. Such initiatives may seek to enhance guidance on screening at-risk populations for iron deficiency. They may also aim to implement standardized clinical decision limits (CDLs) in laboratory reporting. The document may also serve as the basis for adaptation by local, regional, or national guideline panels.\u003c\/p\u003e\n\n\u003ch2 id=\"strength\"\u003eUnderstanding Recommendation Strength\u003c\/h2\u003e\n\u003cp\u003eThe guidelines express the strength of each recommendation in one of two ways. A strong recommendation is worded as \"the guideline panel recommends.\" A conditional recommendation is worded as \"the guideline panel suggests.\"\u003c\/p\u003e\n\n\u003cp\u003eFor a strong recommendation, most individuals in this situation would want the recommended course of action. Only a small proportion would not. Most individuals should follow the recommended course of action. Formal decision aids are not likely to be needed to help individual patients make decisions consistent with their values and preferences. The recommendation can be adopted as policy in most situations. Adherence to this recommendation could be used as a quality criterion or performance indicator.\u003c\/p\u003e\n\n\u003cp\u003eFor a conditional recommendation, most individuals in this situation would want the suggested course of action, but many would not. Decision aids may be useful in helping patients make decisions consistent with their individual risks, values, and preferences. Different choices will be appropriate for individual patients. Clinicians must help each patient arrive at a management decision consistent with the patient's values and preferences. Policymaking will require substantial debate and involvement of various stakeholders.\u003c\/p\u003e\n\n\u003cp\u003eThe guidelines also include good practice statements. These statements endorse interventions or practices that the guideline panel agreed have unequivocal net benefit. Such practices may not be widely recognized or used. Good practice statements in these guidelines are not based on a systematic review of available evidence. Nevertheless, they may be interpreted as strong recommendations.\u003c\/p\u003e\n\n\u003ch2 id=\"children\"\u003eDiagnosis in Infants and Children\u003c\/h2\u003e\n\u003cp\u003eFor infants and children aged 9 months to 4 years, the ASH guideline panel suggests using a serum ferritin threshold of ≤20 ng\/mL instead of a threshold of ≤12 ng\/mL. This is a conditional recommendation based on low certainty in the evidence about effects.\u003c\/p\u003e\n\n\u003cp\u003eThis threshold is for infants and children without known or suspected inflammation. A higher serum ferritin threshold may be required for children with inflammation.\u003c\/p\u003e\n\n\u003cp\u003eThe panel did not develop specific recommendations for children aged over 4 years until adolescence. The American Academy of Pediatrics defines adolescence as age ≥11 years. The panel also did not develop specific recommendations for nonmenstruating adolescents, because of a lack of direct evidence.\u003c\/p\u003e\n\n\u003cp\u003eFor children aged over 4 years until adolescence, a serum ferritin threshold of ≤20 ng\/mL is appropriate for the diagnosis of iron deficiency. This threshold comes from indirectly applying evidence for young children. For nonmenstruating adolescents, a serum ferritin threshold of ≤30 ng\/mL is appropriate. This threshold comes from indirectly applying evidence from menstruating adolescents and adult populations. For menstruating adolescents, the guidelines point to recommendation 3.\u003c\/p\u003e\n\n\u003ch2 id=\"adults\"\u003eDiagnosis in Adults (Excluding Menstruating and Pregnant Individuals)\u003c\/h2\u003e\n\u003cp\u003eFor the adult population, excluding menstruating or pregnant individuals, the ASH guideline panel suggests using a serum ferritin threshold of ≤30 ng\/mL instead of ≤15 ng\/mL. This is a conditional recommendation based on low certainty in the evidence about effects.\u003c\/p\u003e\n\n\u003cp\u003eFor people with signs or symptoms associated with iron deficiency, or with ongoing iron deficiency risk factors, a serum ferritin threshold of ≤50 ng\/mL is appropriate. This higher threshold helps diagnose iron deficiency and guide management decisions.\u003c\/p\u003e\n\n\u003cp\u003eThis threshold is for adults without known or suspected inflammation. The panel made a separate recommendation for adults with inflammation, which appears in recommendation 5.\u003c\/p\u003e\n\n\u003ch2 id=\"menstruating\"\u003eDiagnosis in Menstruating Individuals\u003c\/h2\u003e\n\u003cp\u003eFor menstruating individuals, the ASH guideline panel suggests using a serum ferritin threshold of ≤30 ng\/mL. The panel also suggests against using a serum ferritin threshold of ≤15 ng\/mL for the diagnosis of iron deficiency. This is a conditional recommendation based on low certainty in the evidence about effects.\u003c\/p\u003e\n\n\u003cp\u003eFor people with heavy menstrual bleeding (HMB) or other forms of abnormal uterine bleeding (AUB) that result in excessive blood loss, a serum ferritin threshold of ≤50 ng\/mL is appropriate. The same threshold applies to people with symptoms associated with iron deficiency, additional risk factors for iron deficiency, upcoming surgery, or planning pregnancy. This higher threshold helps diagnose iron deficiency and guide management decisions.\u003c\/p\u003e\n\n\u003cp\u003eThe guidelines include a good practice statement on menstrual history. A detailed menstrual history is necessary to facilitate the diagnosis of abnormal uterine bleeding, particularly heavy menstrual bleeding. It would be essential to address abnormal menstrual bleeding and\/or heavy menstrual bleeding, if identified.\u003c\/p\u003e\n\n\u003ch2 id=\"pregnancy\"\u003eDiagnosis in Pregnant Individuals\u003c\/h2\u003e\n\u003cp\u003eFor pregnant individuals, the ASH guideline panel suggests using a serum ferritin threshold of ≤30 ng\/mL. This is a conditional recommendation based on low certainty in the evidence about effects. The panel also recommends against using a serum ferritin threshold of ≤15 ng\/mL for the diagnosis of iron deficiency. This is a strong recommendation based on low certainty in the evidence about effects.\u003c\/p\u003e\n\n\u003cp\u003eFor pregnant individuals with anemia, with or without other iron deficiency risk factors and\/or symptoms associated with iron deficiency, a serum ferritin threshold of ≤50 ng\/mL may be appropriate. This higher threshold helps diagnose iron deficiency and guide management decisions.\u003c\/p\u003e\n\n\u003cp\u003eThe guidelines list pregnancy-specific risk factors associated with iron deficiency during the perinatal period (the time around pregnancy and birth). These risk factors are:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003ePreceding history of heavy menstrual bleeding\u003c\/li\u003e\n  \u003cli\u003eTeenage pregnancy\u003c\/li\u003e\n  \u003cli\u003eHyperemesis gravidarum (severe nausea and vomiting during pregnancy)\u003c\/li\u003e\n  \u003cli\u003eMultiple gestation (twins or more)\u003c\/li\u003e\n  \u003cli\u003eVaginal bleeding after the first trimester\u003c\/li\u003e\n  \u003cli\u003eAbnormal placentation, including placenta previa, placenta accreta spectrum, and placental abruption\u003c\/li\u003e\n  \u003cli\u003eShort interpregnancy interval, defined as less than 18 months between delivery and subsequent conception\u003c\/li\u003e\n  \u003cli\u003eMultiparity (having given birth more than once)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"inflammation\"\u003eDiagnosis in Adults With Inflammation\u003c\/h2\u003e\n\u003cp\u003eFor adults with anemia of inflammation, the ASH guideline panel suggests performing both serum ferritin and transferrin saturation (TSAT) rather than serum ferritin alone. This is a conditional recommendation based on very low certainty in the evidence about effects.\u003c\/p\u003e\n\n\u003cp\u003eInflammation is on a continuum, and establishing a serum ferritin threshold for the diagnosis of iron deficiency is challenging. However, in adults with anemia of inflammation, the diagnosis of iron deficiency may be considered in two situations. The first is when TSAT is \u0026lt;20%. The second is when serum ferritin is \u0026lt;100 ng\/mL.\u003c\/p\u003e\n\n\u003cp\u003eTSAT should be drawn in a fasting state. The fasting period is 5 to 9 hours, and it includes fasting from multivitamin or iron supplements. This fasting requirement exists because the test is susceptible to recent dietary intake.\u003c\/p\u003e\n\n\u003cp\u003eAnemia of inflammation may occur in individuals with several conditions. These conditions include inflammatory bowel disease, infectious diseases, cancer, chronic kidney disease, heart failure, rheumatologic disorders, and other inflammatory disorders.\u003c\/p\u003e\n\n\u003cp\u003eThe panel made no recommendations for children with inflammation. This decision reflects a lack of data on the diagnosis of iron deficiency in this population. Recommendation 1 covers the guidance for children.\u003c\/p\u003e\n\n\u003cp\u003eThe guidelines include a good practice statement for people with inflammation. Anemia of inflammation may be present at the same time as other causes of anemia. Consequently, for individuals with inflammation, serum ferritin and TSAT should be analyzed in the context of the full clinical picture. This full picture includes consideration of the history, physical exam, underlying disease process, and other existing management guidelines for chronic diseases. Such guidelines may consider higher serum ferritin and\/or TSAT thresholds for the diagnosis of iron deficiency.\u003c\/p\u003e\n\n\u003ch2 id=\"symptoms\"\u003eSigns, Symptoms, and Risk Factors\u003c\/h2\u003e\n\u003cp\u003eThe guidelines list signs and symptoms associated with iron deficiency in nonmenstruating, nonpregnant adults. Recognizing these can help patients and clinicians decide when to test.\u003c\/p\u003e\n\n\u003cp\u003eSigns include:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eTachycardia (fast heart rate) and murmur, in the presence of anemia\u003c\/li\u003e\n  \u003cli\u003eTongue depapillation (loss of the surface of the tongue) and cheilosis (cracking at the corners of the mouth)\u003c\/li\u003e\n  \u003cli\u003eKoilonychia (spoon-shaped nails)\u003c\/li\u003e\n  \u003cli\u003eDiffuse nonscarring scalp alopecia (hair loss)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eSymptoms include:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eFatigue and decreased quality of life\u003c\/li\u003e\n  \u003cli\u003eDecreased cognitive function\u003c\/li\u003e\n  \u003cli\u003eRestless legs syndrome\u003c\/li\u003e\n  \u003cli\u003ePica or pagophagia (ice craving)\u003c\/li\u003e\n  \u003cli\u003eDecreased exercise tolerance\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eRisk factors fall into several categories. Physiologic states include extreme exercise and blood loss. Gastrointestinal conditions include inflammatory bowel disease, peptic ulcer disease, and gastritis. Other gastrointestinal causes include gastric bypass surgery, gastrointestinal surgery, and malabsorption. Parasitic infection such as hookworm is also a risk factor. So are hereditary hemorrhagic telangiectasia (a disorder that causes abnormal blood vessel formation and bleeding) and chronic kidney disease.\u003c\/p\u003e\n\n\u003cp\u003eAdditional risk factors include low iron intake and a restricted diet, including vegan or vegetarian diets. Reduced absorption is another category. Causes of reduced absorption include gastric bypass surgery, gastrointestinal surgery, celiac disease, atrophic gastritis, Helicobacter pylori infection, long-term use of proton pump inhibitors or antacids, and bariatric surgical procedures.\u003c\/p\u003e\n\n\u003ch2 id=\"outcomes\"\u003eOutcomes Affected by Timely Diagnosis\u003c\/h2\u003e\n\u003cp\u003eThe panel considered which outcomes are affected by the timely diagnosis of iron deficiency. These outcomes were judged important for clinical decision-making across all the questions the panel addressed.\u003c\/p\u003e\n\n\u003cp\u003eFor all populations, the relevant outcomes include symptoms, cognitive function, fatigue, health-related quality of life, mental health and emotional lability, and physical activity and shortness of breath. The relevant outcomes also include cardiovascular health, restless legs syndrome and\/or periodic limb movement disorder, pica, and dermatologic health.\u003c\/p\u003e\n\n\u003cp\u003eFor treatment-related outcomes, the panel considered red cell transfusion and gastrointestinal adverse events from oral iron. The panel also considered infusion site reactions, infusion reactions that are not life-threatening, life-threatening infusion reactions, and systemic infection from intravenous (IV) iron.\u003c\/p\u003e\n\n\u003cp\u003eFor pregnant individuals, the panel considered maternal outcomes. These include postpartum hemorrhage and preterm delivery. The panel also considered fetal outcomes. These include fetal cognitive development, low birth weight, and premature birth.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eClinical Implications for Patients\u003c\/h2\u003e\n\u003cp\u003eThese recommendations place the highest value on identifying individuals with iron deficiency. The goal is to promote access to care and timely interventions. The recommendations also aim to improve the accurate identification of affected individuals and to minimize the harms of overdiagnosis.\u003c\/p\u003e\n\n\u003cp\u003eThe guidelines aim to improve provider and patient education using available evidence and evidence-based recommendations. Better education should result in better recognition of iron deficiency. Recognition, in turn, should lead to the identification and management of underlying causes where applicable. It should also lead to improved counseling of affected individuals and early initiation of iron therapy to improve iron status.\u003c\/p\u003e\n\n\u003cp\u003eManagement of iron deficiency includes administration of oral or IV iron replacement therapy. Management also includes steps to address the underlying cause. These steps may include dietary modifications and\/or therapy to control or minimize blood loss.\u003c\/p\u003e\n\n\u003cp\u003eFor patients, the key message is that the cutoff for a \"normal\" ferritin result depends on who you are. A ferritin level that is normal for one person may signal iron deficiency in another. The guidelines set different thresholds for young children, adults, menstruating individuals, pregnant individuals, and people with inflammation.\u003c\/p\u003e\n\n\u003cp\u003eThe guidelines also emphasize that iron deficiency should be diagnosed whether or not anemia is present. This means that a normal hemoglobin level does not rule out iron deficiency. Patients can have iron deficiency with a normal blood count.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations and Research Gaps\u003c\/h2\u003e\n\u003cp\u003eThe guidelines identify gaps in the literature and research priorities. Several recommendations rest on low or very low certainty in the evidence about effects. This means that further research could change the recommendations.\u003c\/p\u003e\n\n\u003cp\u003eOne gap concerns children. Because of a lack of direct evidence, the panel did not develop specific recommendations for children aged over 4 years until adolescence. The panel also did not develop specific recommendations for nonmenstruating adolescents. For these groups, the guidelines rely on indirectly applying evidence from other populations.\u003c\/p\u003e\n\n\u003cp\u003eAnother gap concerns children with inflammation. Because of a lack of data on the diagnosis of iron deficiency in children with inflammation, the panel made no recommendations for this population.\u003c\/p\u003e\n\n\u003cp\u003eA further challenge concerns inflammation in general. Inflammation is on a continuum, and establishing a serum ferritin threshold for the diagnosis of iron deficiency is challenging.\u003c\/p\u003e\n\n\u003cp\u003eSerum ferritin results may also vary based on the testing platforms used. However, the guidelines note that this variation is low at low serum ferritin values.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eWhat Patients Can Do\u003c\/h2\u003e\n\u003cp\u003ePatients can use these guidelines to have more informed conversations with their clinicians. The following steps may help.\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003eKnow your risk group. Young children, menstruating individuals, pregnant individuals, and people with chronic conditions are at higher risk of iron deficiency.\u003c\/li\u003e\n  \u003cli\u003eTrack symptoms. Fatigue, restless legs, ice cravings, hair loss, and decreased exercise tolerance are all associated with iron deficiency.\u003c\/li\u003e\n  \u003cli\u003eAsk about ferritin testing. A serum ferritin test measures stored iron and is central to the diagnosis.\u003c\/li\u003e\n  \u003cli\u003eDiscuss your menstrual history. A detailed menstrual history is necessary to identify abnormal uterine bleeding, particularly heavy menstrual bleeding.\u003c\/li\u003e\n  \u003cli\u003eTell your clinician about inflammation. If you have an inflammatory condition, both serum ferritin and transferrin saturation may be needed.\u003c\/li\u003e\n  \u003cli\u003eFast before a transferrin saturation test if asked. TSAT should be drawn in a fasting state of 5 to 9 hours, including fasting from multivitamin or iron supplements.\u003c\/li\u003e\n  \u003cli\u003eAsk about the cause. Management includes steps to address the underlying cause, which may include dietary changes or therapy to control blood loss.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003ePatients should remember that these guidelines are intended to support, not replace, individualized medical advice. Clinicians must help each patient arrive at a decision consistent with the patient's values and preferences.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat ferritin level means iron deficiency in young children?\u003c\/h3\u003e\n\u003cp\u003eFor infants and children aged 9 months to 4 years without known or suspected inflammation, the guideline panel suggests a serum ferritin threshold of 20 ng\/mL or less, instead of 12 ng\/mL or less. This is a conditional recommendation based on low certainty in the evidence. Children with inflammation may need a higher threshold.\u003c\/p\u003e\n\u003ch3\u003eWhat ferritin cutoff applies to most adults?\u003c\/h3\u003e\n\u003cp\u003eFor adults who are not menstruating or pregnant, and who do not have known or suspected inflammation, the panel suggests a serum ferritin threshold of 30 ng\/mL or less instead of 15 ng\/mL or less. This is a conditional recommendation based on low certainty in the evidence about effects.\u003c\/p\u003e\n\u003ch3\u003eI have heavy periods. Does a different ferritin number apply to me?\u003c\/h3\u003e\n\u003cp\u003eFor menstruating individuals, the panel suggests a threshold of 30 ng\/mL or less and suggests against using 15 ng\/mL or less. If you have heavy or abnormal uterine bleeding, symptoms, other risk factors, upcoming surgery, or are planning pregnancy, a threshold of 50 ng\/mL or less is appropriate. A detailed menstrual history is necessary.\u003c\/p\u003e\n\u003ch3\u003eI am pregnant. What ferritin level is used to diagnose iron deficiency?\u003c\/h3\u003e\n\u003cp\u003eFor pregnant individuals, the panel suggests a serum ferritin threshold of 30 ng\/mL or less, and recommends against using 15 ng\/mL or less. If you have anemia, with or without other risk factors or symptoms, a threshold of 50 ng\/mL or less may be appropriate. Pregnancy risk factors listed include teenage pregnancy, twins or more, and short intervals between pregnancies.\u003c\/p\u003e\n\u003ch3\u003eI have an inflammatory condition. Will ferritin alone be enough?\u003c\/h3\u003e\n\u003cp\u003eFor adults with anemia of inflammation, the panel suggests checking both serum ferritin and transferrin saturation rather than ferritin alone. Iron deficiency may be considered when transferrin saturation is under 20% or serum ferritin is under 100 ng\/mL. Transferrin saturation should be drawn fasting for 5 to 9 hours, including fasting from multivitamin or iron supplements.\u003c\/p\u003e\n\u003ch3\u003eCan I have iron deficiency if my blood count is normal?\u003c\/h3\u003e\n\u003cp\u003eYes. The guidelines aim to catch iron deficiency whether or not anemia is present, so a normal hemoglobin level does not rule out iron deficiency. People with iron deficiency may experience fatigue, pica or ice craving, irritability, poor concentration, headaches, and restless legs syndrome, and the condition is linked to poorer health-related quality of life.\u003c\/p\u003e\n\u003ch3\u003eWhat can I do at my appointment?\u003c\/h3\u003e\n\u003cp\u003eKnow your risk group, track symptoms such as fatigue, restless legs, ice cravings, hair loss, and decreased exercise tolerance, and ask about ferritin testing. Discuss your menstrual history and tell your clinician about any inflammatory condition. Ask about the underlying cause. These guidelines support, not replace, individualized medical advice from your clinician.\u003c\/p\u003e\n\u003ch3\u003eMy ferritin was called normal but I still have fatigue and ice cravings — when should I get a second opinion on iron deficiency?\u003c\/h3\u003e\n\u003cp\u003eThe ferritin cutoff for a normal result depends on who you are: 20 ng\/mL for children aged 9 months to 4 years, and 30 ng\/mL for most adults, menstruating individuals, and pregnant individuals. A level of 50 ng\/mL is appropriate with symptoms or risk factors, and with inflammation both ferritin and transferrin saturation are needed. A normal hemoglobin does not rule out iron deficiency. If your result was judged against a different cutoff, a second opinion can review whether your group's threshold applies. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e American Society of Hematology 2026 guidelines for diagnosis of iron deficiency.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Powers JM, Lim MY, Achebe MO, Akpan IJ, Auerbach M, Brown MC, Cardenas MP, Cromwell C, DeLoughery T, Fleming RE, Fraga M, Goshua G, James P, Lewkowitz A, May J, Nnadozie G, Ogunnaya F, Ruiz-Arguelles GJ, Sholzberg M, Van Doren L, Weyand AC, Zeller MP, Azzam M, Choaib A, Hamarsha Q, Kawtharany H, Khawandi J, Mustafa RA.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication details:\u003c\/strong\u003e Blood Advances, 10 November 2026, Volume 10, Number 21, pages 7353-7357. Submitted 22 May 2026; accepted 12 August 2026; prepublished online 16 September 2026. DOI: https:\/\/doi.org\/10.1182\/bloodadvances.2025015950. Published by Elsevier Inc. on behalf of the American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0).\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding and support:\u003c\/strong\u003e The University of Kansas Health System supported the guideline-development process, including systematic evidence reviews.\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eThis patient-friendly article is based on peer-reviewed research. It summarizes a clinical practice guideline and does not replace advice from your own health care provider.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":48392450769052,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0599\/5449\/5644\/files\/ddn-medical-article-new-guidelines-for-diagnosing-iron-deficiency-what-patients-need-to-know-hero.png?v=1794464271","url":"https:\/\/diagnosticdetectives.com\/products\/new-guidelines-for-diagnosing-iron-deficiency-what-patients-need-to-know","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}