The American Society of Hematology recommends higher ferritin cut-offs to identify iron deficiency earlier in children, aiming to improve outcomes through timely diagnosis and intervention.
New guidance from the American Society of Hematology is pushing clinicians to rethink how iron deficiency is identified in children, with ferritin thresholds set higher to catch cases earlier. The move reflects growing concern that long-standing cut-offs may miss children whose iron stores are already running low, especially when testing practices vary and inflammation can obscure the picture. A study in Blood Red Cells & Iron supports that shift, suggesting that iron deficiency in children aged 5 to 14 begins at ferritin levels below 24 μg/L, rather than the lower level used in some current guidance.
The change matters because iron deficiency in children can be subtle at first, yet still affect energy, concentration and growth. Mayo Clinic has warned that some existing thresholds may be too low, which can delay diagnosis and treatment. That is particularly relevant in primary care and pharmacy settings, where children and caregivers may first raise concerns about fatigue, poor appetite or academic difficulties rather than obvious anaemia.
ASH says the revised approach is meant to improve recognition across groups, including children, adults, pregnant people and those with inflammation. Its updated guidance raises the ferritin cut-off to 20 ng/mL or lower for children aged nine months to four years, and to 30 ng/mL or lower for adults, menstruating and pregnant individuals. The society also advises looking at both ferritin and transferrin saturation in adults with inflammation-related anaemia, because ferritin alone can be misleading when inflammation is present.
Treatment remains a practical challenge, and Mayo Clinic notes that oral iron does not work well for every patient. Intravenous iron may be needed when absorption is poor, side effects limit adherence or a quicker response is required, which is one reason pharmacy teams are being asked to play a larger part in identifying appropriate patients and supporting treatment plans. In children, the broader message from specialists is that earlier detection should translate into earlier intervention, before iron deficiency becomes harder to reverse.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
