Iron Studies Interpretation Chart

How to use this tool

1. Pick the right context at the top of the tool. Ferritin cutoffs shift by demographic — a 22 ng/mL ferritin is iron deficient in any adult, but a 60 ng/mL is normal for a postmenopausal woman and "low for performance" for an endurance athlete. Pregnant patients have specific WHO/ACOG thresholds. If you have a known inflammatory condition (CKD, CHF, autoimmune disease) or your CRP is elevated, choose Inflammation present — ferritin is an acute-phase reactant and the bands shift to account for that.
2. Type your ferritin reading (the only required input — it's the single most useful iron-status marker). Add TSAT (transferrin saturation), hemoglobin, serum iron, TIBC, or CRP if your lab report includes them. More inputs = more pattern-specific guidance. Recompute is instant — there's no Calculate button.
3. Read the pattern call. The result card names one of five patterns: Normal, Iron Deficiency (no anemia yet), Iron Deficiency Anemia, Functional Iron Deficiency, Anemia of Chronic Disease, or Iron Overload. Each comes with a tier color (green / amber / orange / red), a one-line action ("Replenish stores," "Treat the underlying condition," "Stop iron — hemochromatosis workup"), and plain-English guidance.
4. Check the ferritin band chart below the result. The horizontal color bar shows where your ferritin falls across all of this context's bands, with a marker pointing to your number. It's the visual the SERP couldn't give you.
5. Save the result (or several results across visits) and export a clinician-ready PDF to bring back to your physician — particularly useful if you're tracking response to oral iron, or if you want a single page that shows the pattern call alongside your raw values.

What the five patterns mean

Normal iron studies

Ferritin within the demographic-appropriate normal band, TSAT 20–45%, hemoglobin at or above the normal cutoff for your context. No supplementation is indicated. The exception worth noting: if you're a premenopausal woman with heavy menses, a "normal" ferritin of 32 ng/mL is the edge of the cliff — you're not deficient today but you're one heavy cycle from being deficient. A daily multivitamin with 18 mg iron is reasonable maintenance even in the normal range.

Iron deficiency (no anemia yet)

Ferritin below 30 ng/mL but hemoglobin still normal. This is stage 1 of iron deficiency — your stores are depleted, but your bone marrow is still making enough red blood cells. Symptoms may include fatigue, exercise intolerance, restless legs, hair shedding, or pica (cravings for ice or starch) even before anemia develops. Replenishing now prevents progression. This is the stage where therapeutic oral iron works well — typically a 6–12 week course of ferrous sulfate or iron bisglycinate, ideally taken on alternate days for better absorption per Lancet Haematology 2017 data.

Iron deficiency anemia

Ferritin below 30 ng/mL AND hemoglobin below the normal cutoff for your context (13 g/dL for men, 12 for non-pregnant women, 11 for pregnancy 1st/3rd trimester). This is established iron deficiency anemia — the most common anemia worldwide, and the most common nutritional deficiency. Treatment is therapeutic iron PLUS investigation of the cause. In a premenopausal woman, heavy menses is the most likely explanation. In a postmenopausal woman or any adult man, new iron deficiency anemia warrants GI evaluation (colonoscopy, upper endoscopy) to rule out occult blood loss from a GI source.

Functional iron deficiency

Ferritin in the 30–100 range AND TSAT below 20% AND inflammation context. This pattern occurs when you have enough stored iron, but inflammation-induced hepcidin elevation prevents that iron from being mobilized into the bloodstream where erythropoiesis can use it. Common in chronic kidney disease, congestive heart failure, inflammatory bowel disease, and after major surgery. Oral iron is poorly absorbed in this state. IV iron is sometimes used; treating the underlying inflammation is the priority.

Anemia of chronic disease (anemia of inflammation)

High-normal or elevated ferritin (often above 100) WITH low TSAT (below 20%) and a normal-to-low TIBC, plus anemia. The mechanism is the same as functional iron deficiency — hepcidin sequesters iron — but the ferritin readout is higher because chronic inflammation has been present longer. Found in autoimmune disease, malignancy, chronic infection, and advanced CKD. Oral iron rarely helps because gut absorption is also hepcidin-suppressed. The right answer is treating the underlying condition; IV iron is sometimes considered, and a hematology consult is reasonable.

Iron overload pattern

Ferritin above the context-specific cutoff (300 for men, 200 for premenopausal women, 250 for postmenopausal women) AND/OR transferrin saturation above 45%. The most common cause is hereditary hemochromatosis — an autosomal recessive condition affecting roughly 1 in 200–300 people of Northern European descent. Untreated, iron accumulates in the liver, pancreas, heart, joints, and skin over decades. The first step after this pattern shows up is HFE gene testing (C282Y and H63D variants) and a hepatology referral. Stop any iron-containing supplements or multivitamins immediately. First-degree family members may also need screening.

Three real-world examples

Pregnancy iron deficiency

Priya, 32, is 18 weeks pregnant. Her OB ordered iron studies because she's been more fatigued than she expected. Ferritin 22 ng/mL, hemoglobin 11.4 g/dL. She drops the values into the tool, selects the Pregnancy context. The result: Iron deficiency (no anemia yet) — green-ish-amber tier. Her ferritin is below the WHO/ACOG threshold of 30, but her hemoglobin is still above the 1st/3rd trimester cutoff of 11. The tool's guidance points her toward starting a chelated prenatal with bisglycinate iron and re-checking labs in 6 weeks. Without the demographic-context shift, an adult-default tool would have shown her ferritin in the same color band — but her physician would have flagged the pregnancy cutoff anyway. The point is: the tool gets it right the first time, with the citation visible.

Hemochromatosis screening

Marcus, 47, has had elevated liver enzymes for six months. His PCP ordered iron studies as part of the workup. Ferritin 540 ng/mL, TSAT 62%. He enters the values, selects Adult man. The result: Iron overload pattern — red tier — with the escalation banner directing him to discuss HFE gene testing and a hepatology referral. His PCP had said "let's check iron studies" but didn't explain what the numbers meant. The tool turns three numbers and a citation into a plain-English action plan. Marcus stops taking the daily multivitamin with iron that he'd been on for years, gets the HFE test (homozygous C282Y), and starts therapeutic phlebotomy. His sister and adult son also get tested.

Anemia of chronic disease in CKD

Donna, 68, has stage 3 chronic kidney disease and persistent fatigue. Her nephrologist ordered iron studies: ferritin 210 ng/mL, TSAT 14%, hemoglobin 10.8 g/dL, CRP 8 mg/L. She enters the values; CRP greater than 5 auto-applies the inflammation context regardless of her selection, and the inflammation banner explains why. The result: Anemia of chronic disease pattern — amber tier — with the clinician note explaining that oral iron rarely helps this pattern and that the right step is a conversation with her nephrologist about IV iron and erythropoiesis-stimulating agents. She skips buying oral iron over-the-counter, brings the saved PDF to her next nephrology visit, and the team starts IV iron sucrose with a planned re-check in six weeks.

Why context shifts the thresholds

The single biggest gap on the rest of the iron-studies SERP is that they all use one ferritin cutoff. BMJ's 2017 review argues — and most current hematology guidance agrees — that 30 ng/mL is the right cutoff for iron deficiency. Below 30, you're depleted; above, you generally have stores. But that's the floor. The ceiling and the meaning of values in the middle change by who you are.

A premenopausal woman's "normal" upper-band for ferritin is around 200 ng/mL (or lower, depending on the assay). For an adult man it's 300. For a postmenopausal woman it climbs back toward 250 because the menstrual iron-loss faucet shut off. In pregnancy, the WHO and ACOG agree on a 30 ng/mL threshold but the hemoglobin cutoff drops — 11 g/dL in 1st/3rd trimester, 10.5 in 2nd — because plasma volume expansion dilutes the count. With active inflammation, ferritin can climb 5–10× its true value just from the acute-phase response, which is why TSAT becomes the more useful marker in those settings (and why CRP > 5 auto-applies that context in this tool).

For endurance athletes, sports-medicine literature treats a ferritin under 35–40 ng/mL as "low for performance" even without anemia — VO₂ max and time-to-exhaustion both improve with iron repletion in athletes whose ferritin sits in the 20–35 range. None of the SERP results help you reason about that. We do, in one click.

Frequently asked questions

What's the cutoff for iron deficiency on ferritin?

30 ng/mL is the modern cutoff — recommended by the BMJ 2017 review and most major hematology guidelines. Older labs may still print a reference range starting at 11 or 12 ng/mL, but those values reflect "below 12 is unambiguous deficiency" rather than "above 11 is fine." Anything below 30 is iron deficiency. In active inflammation, ferritin alone can be misleading and TSAT becomes a more reliable marker.

Is a ferritin of 30 enough during pregnancy?

Barely. The WHO and ACOG both treat 30 ng/mL as the floor below which pregnancy iron deficiency is diagnosed, but pregnancy iron requirements nearly double (to 27 mg daily) and fetal iron accretion accelerates in the third trimester. A ferritin at exactly 30 ng/mL in early pregnancy will typically drift downward without supplementation — most OBs recommend a prenatal with chelated iron through pregnancy and several months postpartum, with re-check labs at the standard prenatal screening points.

I take iron daily but my ferritin won't budge — what's going on?

Three common reasons. First, you may have an absorption problem — proton pump inhibitors, calcium, dairy, tea, and coffee all reduce iron absorption when taken with the supplement. Second, you may have a hidden source of ongoing loss (heavy menses, occult GI bleeding) that's matching your intake. Third, you may have inflammation suppressing absorption and mobilization — the functional iron deficiency or anemia-of-chronic-disease pattern. The first step is to separate iron from coffee/tea/dairy by at least two hours, take it with vitamin C, try every-other-day dosing (which improves fractional absorption per 2017 Lancet Haematology data), and re-check labs in 8 weeks. If still flat, your clinician should consider GI workup or IV iron.

Should I stop taking my multivitamin if my ferritin is high?

If your ferritin is above your context's overload cutoff (300 for men, 200 for premenopausal women, 250 for postmenopausal women) AND your TSAT is elevated above 45%, yes — stop any iron-containing multivitamin, prenatal, or supplement until your physician has worked up the cause. Hereditary hemochromatosis affects roughly 1 in 200 people of Northern European descent and the diagnosis matters: untreated, it damages liver, pancreas, heart, and joints over decades. Confirm with HFE gene testing.

Can I embed this tool on my own site?

Yes. Copy the embed snippet at the bottom of this page. The embedded variant is a stripped-down version designed for primary care offices, OB-GYN practices, anemia support communities, women's-health blogs, and patient-education portals. Required attribution is built in. There is no fee, no signup, no analytics attached to the embed.

Related tools

• Cholesterol Ratio Calculator — pair lipid markers with iron status when working up generalized fatigue or cardiometabolic risk.
• Blood Pressure Log — track BP alongside iron studies; iron deficiency anemia can mimic or worsen BP-related fatigue.
• Browse all free tools by Dr. Taylor →

Dr. Taylor's recommendations after an iron-studies review

If your pattern is iron deficiency (with or without anemia) and your clinician has confirmed there's no hidden loss source, these three product categories cover almost every supplementation scenario:

• Best Iron Supplements — ferrous sulfate at 65 mg elemental iron is first-line for confirmed deficiency. Iron bisglycinate is the gentler-on-the-gut alternative for patients who can't tolerate ferrous sulfate. Liquid Floradix and chewable gummies cover patients who can't swallow pills.
• Best Multivitamins for Women — for maintenance after deficiency correction, or for premenopausal women with borderline ferritin who want a daily preventive dose. Look for 18 mg iron in premenopausal formulas, iron-free in 50+ formulas.
• Best Prenatal Vitamins — for pregnancy or preconception, prioritize prenatals with chelated bisglycinate iron (gentler on first-trimester nausea), methylated folate, and at least 200 mg DHA.

If your pattern is anemia of chronic disease, functional iron deficiency, or iron overload — don't start over-the-counter iron. Bring the saved PDF to your clinician and have the conversation about what your specific pattern needs.

Sources & methodology

• BMJ — Interpreting iron studies (Kelly AU, 2017). Source for the modern 30 ng/mL ferritin cutoff and pattern-recognition framework.
• NIH Office of Dietary Supplements — Iron Fact Sheet. Source for TSAT, ferritin, serum iron, and TIBC reference ranges.
• WHO — Nutritional anaemias guidance (2017). Source for pregnancy ferritin cutoffs.
• ACOG — Anemia in Pregnancy Practice Bulletin. Source for pregnancy hemoglobin cutoffs.
• AASLD — Hereditary Hemochromatosis Practice Guideline. Source for TSAT > 45% as screening threshold and ferritin overload follow-up cutoffs.
• CDC — Recommendations to Prevent and Control Iron Deficiency in the United States. Source for adult hemoglobin cutoffs.
• Mayo Clinic Labs — Iron Studies reference. Confirmatory reference for assay-level variation.

This tool is reviewed annually for citation currency. About Dr. Taylor · Last reviewed May 28, 2026.

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