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Danny Gaskin: Recognising Iron Deficiency Before Anaemia
Danny Gaskin/LinkedIn, Andrea Marshall/LinkedIn
Nov 11, 2026, 13:46

Danny Gaskin: Recognising Iron Deficiency Before Anaemia

Danny Gaskin, Lead Specialist at NHS Blood and Transplant, Coach at Accrington Stanley Women Football Club, shared Andrea Marshall‘s post on LinkedIn:

“I think laboratory reference ranges have an important part to play here.

I don’t think they’re sensitive enough in many laboratories, and aren’t particularly helpful in recognising iron deficiency.

I saw a pathology handbook yesterday with a female ferritin reference range of 11–310 µg/L. My local Trust uses 10–291 µg/L for females over 16.

We know reference ranges aren’t intended to be diagnostic thresholds, but I worry they provide false reassurance.

A woman with a ferritin of 12 µg/L, normal haemoglobin and symptoms consistent with iron deficiency can have the condition ruled out because the result is reported as ‘within range’.

Clinicians should of course understand the tests they request and how to interpret them. But realistically, given the pressures on healthcare services, can we expect every result to be scrutinised in detail, particularly when it’s reported as ‘within range’? I’m not sure.

That’s why I think how we report results matters. We shouldn’t be introducing a red herring by labelling results as ‘within range’ when they may still be clinically significant and warrant further investigation.

NICE guidance recognises ferritin below 30 µg/L as indicative of iron deficiency in relevant clinical contexts.

I also welcome the updated American Society of Hematology recommendations, which recognise a threshold of 30 µg/L for adults and menstruating or pregnant individuals, increasing to 50 µg/L for certain higher-risk groups, including those with heavy menstrual bleeding.

Of course, it’s not about treating numbers in isolation.

But are we inadvertently missing opportunities to recognise iron deficiency, replenish iron stores, relieve the burden of symptoms and investigate the underlying cause?”

 Andrea Marshall, Patient Blood Management Development Manager at NHS Blood and Transplant, shared a post on LinkedIn:

“Why are we waiting for iron deficiency  to tip into anaemia before looking for it, investigating it, and treating the cause?

Heavy menstrual bleeding and ID in women is constantly ignored, downgraded and normalised.

Iron deficiency causes symptoms that affect health and wellbeing, just ask the women!

If we are serious about the NHS plan, then why aren’t we looking at this? Because it affects more women than men?”

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