What do iron studies showing low ferritin with normal haemoglobin typically indicate?

Name: What do iron studies showing low ferritin with normal haemoglobin typically indicate?
Published: 2026-05-12T03:28:48.507000

Key Points

IDWA is at least twice as common as iron deficiency anaemia globally
Ferritin <30 µg/L confirms iron deficiency (sensitivity ~92%, specificity ~98%); in chronic inflammation, use a threshold of <100 µg/L and check TSAT
Patients can be symptomatic despite normal Hb: fatigue, reduced cognition, impaired exercise tolerance, restless legs, hair loss
Treatment is indicated when identified; oral iron is first-line, target ferritin >100 µg/L
Cause should be investigated: menstrual loss, dietary insufficiency, malabsorption (coeliac disease), or GI blood loss (especially in men and postmenopausal women)

Low ferritin with normal haemoglobin indicates iron deficiency without anaemia (IDWA), also termed non-anaemic iron deficiency (NAID). This represents depleted iron stores before haemoglobin has been affected, essentially the earliest stage of iron deficiency.

Population	Common causes
Premenopausal women	Heavy menstrual bleeding, pregnancy, dietary insufficiency
Men / postmenopausal women	GI blood loss (warrants GI investigation including consideration of endoscopy), coeliac disease, malabsorption
All groups	Coeliac disease, vegetarian/vegan diet, frequent blood donation, PPI use reducing absorption

What do iron studies showing low ferritin with normal haemoglobin typically indicate?

Key Points

Stages of Iron Depletion

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What do iron studies showing low ferritin with normal haemoglobin typically indicate?

Key Points

Stages of Iron Depletion

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Key Diagnostic Points

Common Causes to Consider

Management