Abdul Mannan: Low Ferritin Is a Clue, Not the Final Diagnosis
Abdul Mannan, Consultant Haematologist at Betsi Cadwaladr University Health Board shared a post on LinkedIn:
”IDA is common. The mistake is treating numbers without asking why iron fell.
When I teach trainees, I use one rule.
Find the cause, then treat the cause.
Here is what you need to know:
Underproduction with a low absolute reticulocyte count is the first signal in iron deficiency anaemia.
Ferritin thresholds are group specific: less than 20 in children, less than 25 in non-pregnant adults, less than 30 in pregnancy, and less than 100 with low transferrin saturation in inflammation.
Oral iron is first line (about 65 mg elemental iron/day in adults, 3 mg/kg/day in children).
No response should prompt a quick check of dose, adherence, and hidden blood loss source.
In menstruating adults with clear heavy bleeding, iron plus bleeding control often comes before extensive GI workup.
A practical pattern: reticulocytes rise in about a week, Hb starts improving by week 2, and clear gains appear around week 4.
Evidence check: this reflects the supplied teaching content and standard haematology practice for underproduction anaemia assessment.
What part of your current IDA pathway most often causes delay in clinic?”
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