Luis Oliverio Ambriz Garcia: Key Points From the ASH 2026 Guidelines on Iron Deficiency
Luis Oliverio Ambriz Garcia, Doctor, Specialist in Internal Medicine at HRAEB, Chief Executive Officer of Memodi, shared a post on X about a recent article by Jacquelyn M. Powers et al., published in Blood Advances, adding:
“Latest ASH guidelines (2026) on iron deficiency.
Key points:
- Adult: ferritin 30 ng/mL or less, deficiency. Sensitivity 67%, specificity 96%. The threshold applies even without anemia; the diagnosis does not depend on hemoglobin.
- With symptoms or persistent risk factor, the cutoff rises to 50 ng/mL or less. The cost is more false positives, so it’s best to use it in those with a real pretest probability.
- Inflammation: ferritin plus TSAT, never ferritin alone. Applies in heart failure, CKD, IBD, cancer, and rheumatic disease. Diagnosis is considered with TSAT less than 20% or ferritin less than 100 ng/mL. TSAT should be taken after fasting for 5 to 9 hours and without iron supplements.
- The lab’s ‘normal range’ is a problem. The lower limits for ferritin were set with a ‘seemingly healthy’ population that included people with deficiency. A ferritin of 18 marked as ‘normal’ on the report is still deficiency.
I’m going to finish reading them thoroughly to update the apps.”
Title: 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
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