Aya Qattan: When a Normal CBC Does Not Mean Normal Iron Status
Aya Qattan, Pediatric Resident at Children’s University Hospital – Damascus, shared a post on LinkedIn:
“A normal CBC should not automatically be interpreted as normal iron status
When iron deficiency is suspected, think beyond hemoglobin.
On September 16, 2026, the American Society of Hematology (ASH) released new evidence based guidelines for the diagnosis of iron deficiency, emphasizing that iron deficiency can exist even before anemia develops.
Key ferritin thresholds:
- Children 9 months to 4 years: low 20 ng mL
- Adults: low or equal 30 ng mL
- Pregnancy: low or equal 30 ng mL
- In selected higher risk patients, a threshold up to low or equal 50 ng mL may be considered.
In patients with inflammation, ferritin may appear normal or elevated. In these situations, ferritin low 100 ng mL or TSAT low 20 percent may support the diagnosis of iron deficiency.
High risk groups include:
- Young children
- Pregnant individuals
- People with heavy menstrual bleeding
- Patients with gastrointestinal blood loss
- Celiac disease or inflammatory bowel disease
- Previous bariatric surgery
- Dietary restriction or inadequate iron intake
- Chronic inflammatory conditions
Possible symptoms:
- Fatigue
- Weakness
- Dizziness
- Headache
- Difficulty concentrating
- Shortness of breath
- Palpitations
- Pallor
Importantly, these symptoms may appear before overt anemia develops.
Clinical takeaway:
When iron deficiency is suspected, consider:
Symptoms plus risk factors plus ferritin plus or minus transferrin saturation
Earlier recognition may help identify the underlying cause and prevent progression to iron deficiency anemia.”
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