Emeka Patrick Chukwuka: Ferritin Falls First – Iron Deficiency Before Anaemia
Emeka Patrick Chukwuka, Hematologist and Clinical Pathologist at Maternity and Children Hospital, Al Mubarazshared, shared a post on LinkedIn:
“Ferritin Falls First: Iron Deficiency Before Anaemia
83.6% of iron-deficient young women have no anaemia.
We have been checking the wrong number first.
This figure comes from our computational haematology research, published this week.
The biology is well established. Iron depletion follows a fixed order. Ferritin falls first, while haemoglobin stays in range. By the time Hb drops, the patient has already been iron deficient for months, sometimes years.
Stage 1: Ferritin falls. Everything else normal. Most iron deficiency without anaemia (IDWA) lives here.
Stage 2: TSAT falls, sTfR rises, Ret-He begins to fall. Hb still in range.
Stage 3: Hb finally falls. Microcytosis. Hypochromia. RDW rises.
ASH 2026 has now raised the ferritin threshold to greater than 30 µg/L — doubling the WHO 2020 cut-off of 15 µg/L. The zone between 15–30 µg/L is now officially iron deficient.Most commercial laboratory assays report a lower reference limit of just 9 µg/L for women, so a ferritin of 12 µg/L is flagged ‘normal.’ It is not. The reference range is calibrated to a population that is itself iron deficient.
Fixing this means reforming laboratory practice, and in GCC and West African settings, where haemoglobinopathies and endemic inflammation complicate interpretation further, it becomes a computational problem.
Our 30-day open-data sprint is building inflammation-aware, trait-robust, LIS-ready tools to make ASH 2026 transportable to Saudi and Nigerian laboratories.
Iron deficiency begins when ferritin falls, months or years before haemoglobin does.”
Title 1: American Society of Hematology 2026 guidelines for diagnosis of iron deficiency
Authors: Jacquelyn M Powers, Ming Yeong Lim, Maureen O. Achebe, Imo J Akpan, Michael Auerbach, Megan C Brown, Maria Paula Cardenas, Caroline Cromwell, Thomas G. DeLoughery, Robert E. Fleming, Martina Fraga, George Goshua, Paula D. James, Adam K Lewkowitz, Jori Ellen May, Grace Nnadozie, Frances Ogunnaya, Guillermo J. Ruiz-Arguelles, Michelle Sholzberg, Layla Van Doren, Angela C. Weyand, Michelle Paula Zeller, Muayad Azzam, Ali Choaib, Qais Hamarsha, Hassan Kawtharany, Jana Khawandi, Reem A. Mustafa
Read the Full Article on Blood Advances
Title 2: Prevalence of Iron Deficiency and Iron-Deficiency Anemia in US Females Aged 12-21 Years
Authors: Angela C. Weyand, Alexander Chaitoff, Gary L. Freed, Michelle Sholzberg, Sung Won Choi, Patrick T. McGann
Read the Full Article on JAMA
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