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Fikreab Tesfaye Tefera: 10 Practical Take-Home Points for Diagnosing Iron Deficiency Anemia
Fikreab Tesfaye Tefera/LinkedIn
Sep 21, 2026, 15:08

Fikreab Tesfaye Tefera: 10 Practical Take-Home Points for Diagnosing Iron Deficiency Anemia

Fikreab Tesfaye Tefera, Internal Medicine Resident at Adama Hospital Medical College, shared a post on LinkedIn:

”10 Practical Take-home points from the 2026 ASH Guideline on Diagnosing Iron Deficiency Anemia

1. Ferritin ≤30 ng/mL matters in adults

  • The traditional <15 ng/mL cutoff can miss iron deficiency. A ferritin ≤30 ng/mL supports iron deficiency in adults.

2. Children have a different threshold

  • For children 9 months–4 years, ferritin ≤20 ng/mL supports iron deficiency.

3. Pregnancy and menstruation need attention

  • In pregnant and menstruating individuals, ferritin ≤30 ng/mL indicates iron deficiency.

4. Think about ≤50 ng/mL in high risk settings

  • A higher threshold may be appropriate in situations such as heavymenstrual bleeding or pregnancy associated anemia.

5. Inflammation can hide iron deficiency

  • Ferritin rises with infection, inflammation, malignancy, and other inflammatory states—so a “normal” ferritin doesn’t always mean adequate iron stores.

6. Add TSAT when inflammation is present

  • When inflammation is suspected, interpret ferritin together with transferrin saturation (TSAT) rather than relying on ferritin alone.

7. In inflammatory states, ferritin <100 OR TSAT <20 percent can support deficiency

  • In adults with inflammation, either finding can indicate iron deficiency and should prompt clinical consideration.

8. Iron deficiency can exist without anemia

  • A patient can have normal hemoglobin but depleted iron stores. Iron deficiency often develops before anemia becomes apparent.

9. Don’t be reassured by the laboratory ‘normal range’

  • A ferritin of 20–30 ng/mL may be flagged as normal by some laboratories, but that does not necessarily mean the patient’s iron stores are adequate.

10. Finding iron deficiency is only the beginning

  • Once iron deficiency is identified, the next question is: ‘Why?’ Look for blood loss, inadequate intake, pregnancy, malabsorption, gastrointestinal disease, and other underlying causes.”

Fikreab Tesfaye Tefera: 10 Practical Take-Home Points for Diagnosing Iron Deficiency Anemia

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ASH Guideline Ferritin Fikreab Tesfaye Tefera Health Hematology Hemostasis Hemostasis News Hemostasis Today Iron-Deficiency Iron-Deficiency Anemia Medicine the 2026 ASH Guideline Transferrin Transferrin Saturation
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