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New guidance on iron deficiency: Why UAE doctors are focusing more on ferritin
Doctors warn tiredness, dizziness, headaches, feeling cold and difficulty concentrating can all be signs of depleted iron stores — even before anaemia develops
- PUBLISHED: Fri 25 Sept 2026, 6:00 AM
New clinical guidance on iron deficiency has placed renewed focus on ferritin levels and the symptoms that can appear even before a person develops anaemia.
The American Society of Hematology (ASH) issued new evidence-based guidance on September 16, recommending higher ferritin thresholds to help clinicians identify iron deficiency earlier and more accurately. Ferritin is a protein that stores iron and is commonly measured when doctors assess a person’s iron reserves.
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Under the guidance, a serum ferritin level of 30 nanograms per millilitre or lower is the recommended diagnostic threshold for adults, including menstruating and pregnant individuals. A threshold of 50ng/mL or lower applies to higher-risk groups, including people with heavy menstrual bleeding and pregnant patients with anaemia.
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For adults with inflammation, including those with cancer, inflammatory bowel disease or an infectious illness, the guidance recommends a ferritin level below 100ng/mL or transferrin saturation below 20 per cent. For children aged nine months to four years, the recommended ferritin threshold is 20ng/mL or lower.
Dr Malaz Yabrodi, Specialist in Internal Medicine at Medcare Shaikh Saqr Al Qasimi Hospital in Sharjah, said the medical understanding of iron deficiency had become more nuanced.
“Ferritin is commonly used as a marker of the body’s stored iron, but ferritin should not be interpreted on its own,” Dr Yabrodi said. “It needs to be considered alongside symptoms and other blood tests.”
In the past, a ferritin result that fell within a laboratory’s reference range might have been regarded as evidence of adequate iron stores. Clinicians now increasingly recognise that stores can become depleted before haemoglobin drops to the level associated with anaemia, the doctor explained.
“This means that symptoms and the wider clinical picture should not be overlooked simply because the haemoglobin level is still within the normal range,” Dr Yabrodi said.
Why a normal result may not tell the whole story
Laboratory reference ranges should not be treated as an ideal target for every person, according to Dr Yabrodi. Ferritin can be influenced by inflammation, infection and certain medical conditions, making clinical context important.
“Because inflammation and infection can raise ferritin levels, a normal result does not always rule out iron deficiency,” the doctor said.
The ASH guidance reflects this distinction by setting a higher ferritin threshold for adults with inflammation and allowing transferrin saturation a measure related to iron transport and availability to be considered in diagnosis.
Warning signs of depleted iron stores
Iron is essential for producing haemoglobin, which carries oxygen around the body. It also contributes to normal energy metabolism and supports physical and cognitive function, Dr Yabrodi said.
When iron stores become depleted, some people may experience symptoms before anaemia develops. Warning signs can include tiredness, reduced energy, difficulty concentrating, headaches, dizziness, feeling unusually cold and reduced exercise tolerance.
Shortness of breath is more commonly associated with iron-deficiency anaemia, particularly when haemoglobin is significantly reduced. Some people may also notice increased hair shedding or changes in their nails.
However, Dr Yabrodi cautioned that these symptoms are not specific to iron deficiency and can have several possible causes.
“They should not automatically be attributed to low iron,” the doctor said. “The important message is that both very low and excessively high iron levels can be problematic. The aim is not simply to have the highest possible ferritin level, but to maintain an appropriate level for your individual needs and health circumstances.”
A balanced diet is the starting point
For most people, maintaining healthy iron levels begins with a balanced and varied diet. Sources of iron include lean meat, poultry and seafood, as well as beans, lentils, tofu, dark green vegetables, nuts, seeds and iron-fortified foods.
Combining plant-based iron sources with foods rich in vitamin C can also help improve absorption, Dr Yabrodi said.
Diet is only one part of the picture. Low iron can be linked to insufficient intake, increased requirements, blood loss, heavy menstrual periods, pregnancy or problems with absorption.
“In adults, particularly when iron deficiency is unexplained or persistent, it is important to consider possible sources of blood loss and other underlying causes rather than assuming that diet alone is responsible,” Dr Yabrodi said.
Why people should not self-prescribe iron
People with persistent symptoms or blood tests showing low ferritin should discuss the results with a doctor. A healthcare professional can determine whether further tests are needed and whether dietary changes, iron supplementation or an investigation into an underlying cause is appropriate.
“Iron supplements are not something everyone needs, and taking them unnecessarily can also cause side effects and, in some circumstances, lead to excessive iron accumulation,” Dr Yabrodi said.
The new ASH recommendations are diagnostic thresholds rather than personal targets. The organisation said separate guidance on the treatment of iron deficiency is expected in 2027.
“Ultimately, maintaining healthy iron stores is about looking at the whole person rather than focusing on a single number,” Dr Yabrodi said. “Regular medical review, a balanced diet and addressing the underlying cause of any deficiency are the most sensible approach.”
Ruqayya Alqaydi is an associate editor with an endless curiosity to learn. Like a journalist on a caffeine overdrive, she is fuelled by passion and on a mission to uncover every gem in the UAE.