Blood WorkA ferritin test measures the protein that stores iron, which makes it the best single blood test for your body's iron reserves. Low ferritin means iron stores are running out, often before anemia shows up. High ferritin can come from inflammation, liver disease or iron overload. At Passion Health, ferritin is $15 on its own or part of the $119 Energy & Iron Panel.
What does a ferritin test measure?
Your body stores iron inside a protein called ferritin, mostly in the liver, spleen and bone marrow. The small amount of ferritin in the blood mirrors those stores, so a low result reliably means low iron.
Ferritin also rises with inflammation, infection and liver damage. That means a normal or high ferritin doesn't always rule out low iron, which is why we often check it with iron, transferrin saturation and C-reactive protein.
Who should get a ferritin test?
- Tiredness, shortness of breath with activity, hair shedding, restless legs or craving ice.
- Heavy periods, pregnancy or planning a pregnancy.
- Vegetarian or vegan eating, frequent blood donation, or gastric bypass surgery.
- Celiac disease or long-term use of acid-reducing medicines, which can reduce iron absorption.
- A family history of hemochromatosis (iron overload), or abnormal liver tests.
What do ferritin levels mean?
Ferritin is reported in ng/mL (the same as micrograms per liter). These are the thresholds guidelines use:
| Ferritin | What it means |
|---|---|
| Below 15 ng/mL | Iron stores are empty; iron deficiency is confirmed in otherwise healthy adults (WHO 2020) |
| Below 45 ng/mL with anemia | Iron deficiency is likely (AGA 2020) |
| Below 70 ng/mL with inflammation or infection | Iron deficiency may still be present (WHO 2020) |
| Above 150 ng/mL in women who still have periods, or above 200 ng/mL in men and in women after menopause | Possible iron overload in healthy adults; needs follow-up (WHO 2020) |
| Above 1,000 ng/mL | Needs prompt evaluation. In hemochromatosis, this level calls for checking the liver for scarring (AASLD, ACG 2019) |
Lab reference ranges are wide, so a ferritin in the 20s can be printed as normal even when your stores are low. Your clinician reads it with your symptoms and blood count.
Low ferritin: causes and treatment
Common causes are blood loss (heavy periods or slow bleeding in the gut), pregnancy, low iron intake, and poor absorption from celiac disease, gastric bypass, H. pylori infection or acid-reducing medicines.
Is low ferritin a sign of cancer? Low ferritin itself isn't cancer. But in men and in women after menopause, iron deficiency without an obvious cause can come from slow bleeding in the digestive tract, including colon cancer. That's why the American Gastroenterological Association recommends evaluating the gut in adults with iron deficiency anemia.
How to increase ferritin. Treat the cause, then rebuild stores. Iron from meat, poultry and fish is absorbed best. Iron from lentils, beans, spinach and fortified cereals is absorbed better with vitamin C and worse with tea or coffee at the same meal. Most people also need an iron supplement, which your clinician will dose. Some people need IV iron. Ferritin rises slowly, so we recheck after 8 to 12 weeks. Don't take iron for months without knowing why your ferritin was low.
High ferritin: causes and what we check
The most common causes are inflammation, infection, fatty liver disease, alcohol, and obesity or metabolic syndrome. Less often, high ferritin comes from hereditary hemochromatosis, repeated blood transfusions or, rarely, cancer.
We repeat ferritin together with iron, transferrin saturation, liver tests and CRP. A transferrin saturation of 45% or higher points toward iron overload and prompts genetic testing for hemochromatosis. When hemochromatosis is confirmed, treatment by removing blood usually starts when ferritin is above 300 ng/mL in men or 200 ng/mL in women.
How to prepare for a ferritin test
Ferritin alone doesn't require fasting. If we're also measuring iron and transferrin saturation, a morning draw before eating gives the most reliable result, and you should skip iron supplements for a day before the test unless your clinician says otherwise.
Ferritin test cost in Texas
Self-pay. $15, plus one $29 draw and clinician review fee per order. Or get the $119 Energy & Iron Panel, the standard first look at fatigue, where the fee is waived. It has 34 results: blood count, metabolic panel, thyroid, ferritin, iron and binding capacity, B12 and folate.
With insurance. If we're in network with your plan, we bill it when the test is covered. You pay cash for a test only after we tell you the price in writing, and Medicare patients sign an Advance Beneficiary Notice first.
Ferritin questions
What is a normal ferritin level?
It depends on the reason for testing. Below 15 ng/mL confirms iron deficiency in healthy adults, and below 45 ng/mL points to iron deficiency when anemia is present. Above about 150 ng/mL in women who still have periods, or 200 ng/mL in men and in women after menopause, needs follow-up for possible iron overload.
What is a dangerously low ferritin level?
Ferritin below 15 ng/mL means iron stores are essentially empty. What makes it urgent is severe anemia. Chest pain, fainting or shortness of breath at rest need same-day care; call 911 for chest pain.
What is a dangerously high ferritin level?
Above 1,000 ng/mL needs prompt evaluation; in hemochromatosis, it is the level at which the liver is checked for scarring. Very high ferritin can also come from serious inflammation or infection, so the cause matters more than the number.
Can you have low ferritin without anemia?
Yes. Iron stores run down before hemoglobin falls, so ferritin can be low while your blood count is still normal. That's the best time to find and fix the cause.
How long does it take to raise ferritin?
Hemoglobin usually improves within weeks of starting iron, but ferritin rises more slowly. We typically recheck after 8 to 12 weeks.
Sources
- American Gastroenterological Association: guideline on the gastrointestinal evaluation of iron deficiency anemia, 2020
- World Health Organization: guideline on use of ferritin concentrations to assess iron status, 2020
- American College of Gastroenterology: clinical guideline on hereditary hemochromatosis, 2019
- AASLD: deciphering the code of iron overload