Labs & Reports · Iron & anaemia

Ferritin test: normal range, what low and high levels mean, and when to test

Fifty-seven per cent of Indian women aged 15 to 49 are anaemic by the last national survey, and a quarter of men.¹ Those are haemoglobin numbers. Ferritin tells a different and earlier story: the iron a body has put aside, which runs down for months before haemoglobin moves at all. That is why a report can say "iron normal" and still be describing someone who is tired, shedding hair, and running on empty stores. This page explains what the number measures, what the thresholds are actually based on, and what to do with a result that is low, borderline or unexpectedly high.

A ferritin test measures serum ferritin, the protein that stores iron inside cells, and is the standard blood marker of the body's iron reserves. Low ferritin means stores are depleted, which happens before anaemia. High ferritin can mean iron overload, but far more often means inflammation, infection, liver disease or metabolic disease, because ferritin also rises as an acute-phase protein.

What a ferritin test measures Copy link

Iron in the body is either working or in storage. The working iron sits in haemoglobin inside red cells, in muscle, and in a long list of enzymes. The stored iron is held inside a hollow protein shell called ferritin, mostly in the liver, spleen and bone marrow, ready to be released when the working pool needs topping up. A small amount of ferritin leaks into the blood in proportion to how much is in storage, and that is what the serum ferritin test measures.²

So the number on your report is a proxy for reserves. It is not a measure of how much iron is circulating today, which is what serum iron reports, and it is not a measure of oxygen-carrying capacity, which is what haemoglobin reports. Those three answer different questions and can disagree with one another for months at a time. You can have a haemoglobin of 12.5, a serum iron in range, and a ferritin of 9, and all three can be true at once.

One thing to clear up before you compare your report with anyone else's, because it causes confusion in India: some labs print ferritin in ng/mL and some in µg/L. They are the same unit. A ferritin of 20 ng/mL is a ferritin of 20 µg/L. If your report and this page use different units, you can read them straight across.

Ferritin normal range, and where the cut-offs actually come from Copy link

Look at the range printed on your report. It is the laboratory's reference interval, usually derived from the assay manufacturer's data on a mostly Western population. It is not a health target and it was not designed to tell you whether your stores are adequate. This is why three major Indian chains can print lower limits of roughly 15, 18 and 22 ng/mL for the same test, and why an "adult" upper limit on one report can read 300 and on another 464.

The more useful reference points are the World Health Organization's cut-offs, which were re-issued as a formal guideline in 2020 and are the ones public health and most clinical guidance work from.²

Two things that table does not tell you, and both matter for how you read your own value.

First, the 15 cut-off is expert opinion from an earlier era of radiometric assays, and the WHO guideline itself grades much of its evidence as low certainty.² When researchers at the US Centers for Disease Control went back to population data and asked at what ferritin haemoglobin actually begins to fall and red-cell protoporphyrin begins to rise, the physiological answer with modern assays landed nearer 25 µg/L in women and 20 in young children.³ That is not yet a guideline. It is a reason not to treat your 16 as comfortably normal.

Second, the overload thresholds are for healthy people. In someone with a fever, a liver condition, obesity or a chronic inflammatory disease, ferritin above 200 is common and usually says nothing about iron. The guideline is explicit that ferritin should never be used alone to diagnose overload.²

Ferritin normal range by age and sex

Men run higher than women from puberty onward, because menstruation removes iron every month for three or four decades. After menopause, women's ferritin drifts up toward male values. Children run lower than adults, and the WHO cut-off under the age of five is 12. In pregnancy, ferritin falls through the second and third trimesters as plasma volume expands and iron is diverted to the fetus, so only a first-trimester value is interpreted against the usual threshold.² None of this changes the definition of deficiency. It changes what "typical" looks like for someone your age and sex, which is a different thing.

Reading your number Copy link

Use the bands below as a guide to interpretation, alongside your symptoms and alongside a CRP if one was run. Are they pass or fail lines? No. Treat them as a map of where a conversation with a doctor should start.

What does a ferritin of 12, 18 or 25 mean? Here it is directly. Twelve is below the deficiency line in any adult and warrants treatment and a search for the cause. Eighteen sits above the WHO line and below the physiological one, which is the zone where a report says normal and a person may not feel it. Twenty-five is at the edge of where haemoglobin begins to respond in population data; many people at 25 feel fine, some do not, and symptoms decide the next step.

Low ferritin: what it means, what it feels like, and why it happens Copy link

Low ferritin means the body has spent its reserve. What it does not yet mean is anaemia. Iron deficiency without anaemia, sometimes called iron depletion, is the stage where ferritin is low but haemoglobin has not moved, and it is far more common than the anaemia that follows it. The Comprehensive National Nutrition Survey measured ferritin in more than 33,000 Indian children and adolescents with a paired CRP to correct for inflammation. Iron deficiency came out at 31.9% in children aged one to four and 30.4% in adolescent girls, against 11 to 15% in boys and in five- to nine-year-olds.⁴ In the same survey, anaemia in adolescents ran at about 29%. Those two numbers overlap, but they do not describe the same children: a share of the anaemic ones were not iron deficient, and a share of the iron-deficient ones were not anaemic. Ferritin is the test that separates them.

Symptoms of low ferritin

Tiredness that sleep does not fix is the commonest complaint you will hear, with reduced exercise tolerance close behind: the stairs that used to be nothing. Diffuse hair shedding, brittle nails, restless legs at night, feeling the cold, and difficulty concentrating are all reported at low ferritin, sometimes before haemoglobin falls. A craving to chew ice, called pagophagia, is a specific and slightly strange symptom of iron deficiency that resolves with treatment. Breathlessness, palpitations and dizziness belong more to the anaemia stage.

The trouble with that list, as you would expect, is that every item on it has other causes, and low ferritin is common enough in India that it will frequently be present alongside a problem it is not causing. Thyroid disease produces the same fatigue and the same shedding, which is why you should ask for a ferritin alongside a thyroid panel and not on its own.

Causes of low ferritin

Iron goes out faster than it comes in. On the way out: menstruation, particularly heavy periods; pregnancy and breastfeeding; regular blood donation; and bleeding from the gut, which in an older adult or a man with no other explanation is the cause that must be excluded. On the way in: a diet low in absorbable iron, and conditions that block absorption, including coeliac disease, H. pylori infection, and surgery on the stomach or small bowel.

The diet part deserves a plain statement if you eat the way most of India eats. Iron from plant foods, called non-haem iron, is absorbed far less efficiently than iron from meat, and its absorption is further reduced by the phytates in whole grains and legumes and by the polyphenols in tea and coffee taken with meals. A vegetarian diet built around dal, roti and rice, with chai following the meal, delivers a great deal of iron on paper and rather little into the blood. That does not make your diet wrong. It makes your ferritin worth checking.

Why Indian ferritin is low in unexpected places Copy link

Two findings from the national survey run against intuition. Check them against your own assumptions about who gets deficient.

The first: iron deficiency was more prevalent in urban than rural children, and in the richer wealth quintiles than the poorer ones. Among one- to four-year-olds it was 44% in the richest quintile against 22% in the poorest.⁴ The authors proposed that infection and inflammation in poorer settings inflate ferritin and mask true deficiency, and that diets in better-off urban households may be low in absorbable iron in their own way. Either way, an educated, well-fed household like yours is not protected.

The second: because ferritin rises with inflammation, a population with a high background of infection reads as less iron deficient than it is. The survey corrected for this with a CRP. Most individual reports do not. If you had a viral fever, a dental infection or a flare of any inflammatory condition in the weeks before a "normal" ferritin, your number may have been flattered. Remember that when you look at the date on the report.

Ferritin and hair loss: what the evidence does and does not show Copy link

If shedding is what brought you here, the evidence deserves to be laid out with both sides showing.

Indian series consistently find lower ferritin in women with diffuse shedding. In Chennai, 50 women with telogen effluvium were compared with 50 controls; mean ferritin was 24.3 ng/mL in the shedding group against 44.8 in controls, and 28% of the shedding group were below 15 while none of the controls were.⁵ Earlier Hyderabad and other Indian series report low ferritin in the majority of women with diffuse hair loss. These are cross-sectional comparisons at a single point in time: they show that the two things travel together; whether one causes the other is a separate question.

The largest controlled study anywhere found something different. At Duke University, 381 women with pattern hair loss or chronic shedding were compared with 76 women without hair loss. Iron deficiency was common in all groups, and was not more common in the women losing hair than in the controls, at any of three ferritin definitions the authors tested.⁶ Their closing line is worth quoting in sense: until someone runs a controlled trial of iron replacement in women with hair loss, the relationship remains speculative. That trial has still not been done.

In practice, what a dermatologist does with this: test your ferritin anyway, because iron deficiency is so common in Indian women that finding and correcting it is worthwhile in its own right, and because the mechanism is plausible, iron being a cofactor for the enzyme that limits DNA synthesis in the rapidly dividing cells of the hair follicle. Correct a low value and give it six months before you judge. Do not expect iron to reverse pattern hair loss, which is driven by androgens and genetics, and do not accept ferritin targets of 70 or higher as though they came from a trial. They did not. Our guide to telogen effluvium explains the shedding itself, and the women's pattern hair loss page explains what ferritin cannot fix.

High ferritin: what it means in India Copy link

A raised ferritin frightens people because of iron overload. Should it frighten you? Rarely, because overload is the least likely explanation. Ferritin is an acute-phase protein: the liver makes more of it in response to inflammation, and the hormone hepcidin, which rises with inflammation, locks iron into storage where it registers as ferritin. So the number climbs with infection, with autoimmune disease, with tissue damage, and with the low-grade inflammation of obesity and fatty liver.⁷

In an Indian outpatient clinic the commonest reasons for a ferritin in the 300 to 800 range are, roughly in order: a recent or current infection; non-alcoholic fatty liver disease, often in someone with a raised SGPT and central weight; alcohol; type 2 diabetes and metabolic syndrome; and chronic inflammatory conditions. Hereditary haemochromatosis, the classic iron-overload disease, is rare in South Asian populations. Repeated blood transfusion, as in thalassaemia, is the important overload cause in India, and those patients already know it.

The test that separates inflammation from overload is transferrin saturation, which is part of an iron profile. If your saturation is normal and CRP or liver enzymes are up, iron is not your problem. If saturation is high alongside a high ferritin, overload is on the table and needs a specialist. A ferritin above 500 in someone who is unwell is the WHO's line for evaluation. It is not a cue to cut iron out of your diet.²

Ferritin in COVID-19 and other infections Copy link

Ferritin became a household word in 2020 because hospitals used it to grade COVID-19. A meta-analysis of 52 studies and more than 10,000 patients found ferritin substantially higher in severe than non-severe disease, and higher still in those who did not survive.⁸ The mechanism is the cytokine storm: an inflammatory surge that drives ferritin up as it drives up CRP and D-dimer.

Three things follow for you today. A high ferritin during or shortly after any significant infection, COVID or otherwise, is expected and should not be read as an iron result. A ferritin measured within a few weeks of a fever cannot be used to rule out iron deficiency, which is why the WHO threshold in that setting rises to 70.² And the ferritin used in an ICU is a severity marker; nobody needs a ferritin to manage a mild infection at home.

Getting tested: fasting, price and what to pair it with Copy link

The test is a standard blood draw. Ferritin itself does not need fasting; the reason most Indian labs ask for 8 to 12 hours is that it is usually bundled with serum iron, which swings through the day and after meals. If you are only having ferritin, a morning draw is convenient and no more than that. Tell the collector if you have had a fever in the last few weeks, and note it on your own copy of the report, take iron tablets, or have had a transfusion, because each of those changes the reading.

At the major national chains a stand-alone ferritin was listed at roughly ₹400 to ₹900 when checked in August 2026, with wide variation by city and by whether it is bought inside a package. Prices move; treat those as an order of magnitude and check the current figure before you book.

What to run with it depends on your question. For fatigue or shedding: a CBC for haemoglobin and red-cell size, a thyroid panel, and a vitamin D, since those three deficiencies cluster in Indian women and present the same way. For an unexplained high ferritin: a CRP, liver enzymes and transferrin saturation. For a low ferritin in a man or a post-menopausal woman: the CBC and a conversation about the gut. Most of these sit inside a routine full body checkup; the gap is that many packages include haemoglobin without ferritin, which is exactly the wrong way round for detecting deficiency early.

If you start iron, ask for the retest at around three months. Ferritin responds slowly and a value taken at four weeks tells you little.

Who should get a ferritin test Copy link

Any woman with heavy periods, any woman planning or in early pregnancy, and any adult with unexplained tiredness or diffuse hair shedding has a good reason. So do vegetarians and vegans, regular blood donors, adolescents through the growth spurt, endurance athletes, and anyone whose CBC has shown small or pale red cells. In a man or a post-menopausal woman, a low ferritin is a reason for a doctor to ask where the iron is going, and that question is more important than the tablet.

It is also the test to insist on if you have been told your haemoglobin is fine and you still do not feel fine. Plainly: ask for it by name. Haemoglobin is the last marker to fall. Ferritin is the first. Sapiens runs ferritin as part of its lab panels with physician interpretation; any accredited laboratory can run it, and the interpretation on this page applies either way.

When to see a doctor Copy link

Bring your report to a doctor with any ferritin below 15, or below 30 with symptoms; with a low ferritin if you are a man or past menopause; with a ferritin above 300, or above 150 if you are a menstruating woman, once a recent infection has been excluded; with black or bloody stools, unexplained weight loss, or fatigue that is worsening rather than stable; or if you are pregnant with a low value. Iron tablets are cheap and available without a prescription in India, and that is exactly why they are so often taken for the wrong reason, for the wrong duration, and without the cause ever being found. Take your result to someone who will ask why.