What ferritin is and what to do if it's low

What a ferritin test shows

Most of the body’s iron goes into hemoglobin, which carries oxygen. Some iron is kept in reserve, mainly in the liver, spleen and bone marrow, and ferritin is what holds it there. A small amount of this protein is always present in the blood, so its level tells the doctor how much iron your body has stored.

When iron runs short, the body uses up its reserves first, and ferritin falls before hemoglobin does. That’s why your complete blood count can be normal while you already feel tired and get out of breath on the stairs.

Doctors often use this rough guide: in adults, a ferritin level under 30 µg/L (the same as ng/mL) usually points to iron deficiency. The reference range on your report depends on the lab, your age and your sex, so a doctor interprets the result alongside your other tests and symptoms.

Inflammation raises ferritin. In that case it can look normal even when you are short of iron, and your doctor may add other tests, such as C-reactive protein.

Why ferritin can be low

Most often, the body loses or uses iron faster than it gets it from food. This happens when:

• your periods are heavy or last longer than usual;
• there is unnoticed bleeding from the stomach or bowel, for example from an ulcer or polyps;
• you are pregnant or breastfeeding and need more iron;
• your diet has little meat or fish;
• iron is poorly absorbed, for example with celiac disease or after stomach surgery;
• you give blood often.

In men and in women after menopause, iron deficiency is rarely explained by diet alone. For them, the doctor looks for hidden blood loss first and may refer you to a gastroenterologist.

Iron deficiency shows up as tiredness, pale skin, shortness of breath during everyday activity, hair loss and brittle nails. Some people have no symptoms at all, and low ferritin turns up in a routine test.

How to raise low ferritin

The first step is to find the cause. Take your result to an internist or family doctor. They will ask about your diet, periods, digestion and medicines, order more tests and, if needed, refer you to a gynecologist or gastroenterologist.

Iron supplements are prescribed by a doctor, who decides whether you need them, in what form and dose, how long to take them and when to recheck your ferritin. Although they are sold without a prescription, taking iron without a doctor’s advice is risky. You might miss the bleeding or illness that is causing the deficiency. Too much iron is also harmful, because it builds up in the liver and other organs. An accidental overdose of iron tablets can be life-threatening for a child, so keep them out of children’s reach.

Food helps maintain your stores, but diet alone usually won’t correct a deficiency you already have. Iron from meat, poultry and fish is absorbed better than iron from plants. Legumes and leafy greens contain iron too, and foods with vitamin C in the same meal help you absorb it. Drink tea and coffee between meals, since with food they reduce iron absorption. Apples and pomegranate juice, often recommended “for hemoglobin”, contain very little iron.

See a doctor the same day if your weakness suddenly gets worse, or if you become short of breath at rest or very dizzy. Call an ambulance on 103 if you vomit blood, have black, tarry stools, heavy bleeding or chest pain, or if you have fainted.

What causes high ferritin

The most common cause of high ferritin is inflammation, including infections and chronic inflammatory diseases. Liver disease, such as fatty liver, and regular alcohol use also raise it. Iron overload, for example in hereditary hemochromatosis, is less common.

If your ferritin is high, see an internist or family doctor as well. They will look at it together with other tests, such as liver function tests and transferrin saturation, and tell you whether you need further tests.

How to get a ferritin test in Slavuta

Ferritin is measured in a blood sample from a vein. Blood is taken in the morning on an empty stomach: the lab recommends 12 hours without food, and water is fine. The day before, avoid alcohol and fatty food, and don’t smoke in the morning. A cold or other infection can raise ferritin for a while, so it’s best to have a routine test when you’re well. If you already take iron supplements, tell your doctor, who will say whether to pause them before the test.

You can have a ferritin test at Viva Clinic’s Diagnost-Lab laboratory at 32 Sobornosti St, 4th floor. Book by calling the lab or messaging it on Viber. If it’s hard for you to come in, blood can be taken at your home; ask about the terms by phone. You’ll get a Viber message when your result is ready, and if a Viva Clinic doctor is treating you, they will receive it directly.