Ferritin in Pediatrics: Optimal Testing Recommendations

  • Order ferritin as an initial laboratory test for children with suspected iron deficiency.
  • Do not order a panel of iron tests (serum iron, TIBC, UIBC, transferrin).
  • Order ferritin measurement when the laboratory findings based on CBC are unclear.

Guidelines for Test Utilization

What does the test tell me?

Ferritin is the major storage protein for iron and is involved in iron uptake and accumulation. Iron is stored in all cells, but the majority is stored in hepatocytes, macrophages in bone marrow, and in the spleen. Ferritin concentrations reflect the iron storage in the body. French scientist Laufberger discovered ferritin in 1937, and it took another thirty seven years to show ferritin as a detectable serum marker for iron storage and iron deficiency. [back to top]

When should I order this test?

Order for pediatric patients at risk of iron deficiency.

Order when CBC results are indeterminate and to distinguish iron deficiency from other anemia. [back to top]

When should I NOT order this test?

Do not order ferritin in acute or chronic illnesses. Ferritin is an acute phase reactant and may be elevated in these conditions. [back to top]

How should I interpret the result?

Ferritin less than 12 mcg/L in children under 5 years of age or less than 15 mcg/L for children 5-12 years old is diagnostic of iron deficiency anemia. [back to top]

Is the test result diagnostic/confirmatory of the condition? If not, is there a diagnostic/confirmatory test?

Yes, low ferritin concentration is confirmatory of iron deficiency anemia.

Low hemoglobin and low mean corpuscular volume are characteristics of iron deficiency anemia. However, these findings do not exclude other forms of anemia. Ferritin can be used to clarify these results. [back to top]

Are there factors that can affect the lab result?

Ferritin concentrations may rise in acute or chronic illnesses.

Although measurement of C-reactive protein (CRP) may be used to rule out inflammation as a cause of elevated ferritin, the United States Preventive Services Task Force (USPSTF) does not recommend this practice. [back to top]

Are there considerations for special populations?

Pediatrics [back to top]

What other test(s) might be indicated?

Initial laboratory tests for anemia include CBC with platelet count, hemoglobin, hematocrit, mean corpuscular volume, and red blood cell distribution width. [back to top]

References

Wang W, Knovich MA, Coffman LG, Torti FM, Torti SV. Serum Ferritin: Past, present and Future. Biochimica et biophysica acta 2010; 1800: 760-9.

Vieth JT, Lane DR. Anemia. Hematology/oncology clinics of North America 2017, 31: 1045-60.

Powers JM, Mahoney DH. Iron deficiency in infants and children <12 years: Screening, prevention, clinical manifestations, and diagnosis 2018, UpToDate.

Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia 2016, 387: 907-14.

Siu Al, Force USPST. Screening for iron deficiency anemia in young children: USPSTF recommendation statement. Pediatrics 2015;136:746-52.s 2015; 136: 746-52.


Last reviewed: June 2020. The content for Optimal Testing: the Association for Diagnostics & Laboratory Medicine’s (ADLM) Guide to Lab Test Utilization has been developed and approved by the the Academy of Diagnostics & Laboratory Medicine and ADLM’s Science and Practice Core Committee.

As the fields of laboratory medicine and diagnostic testing continue to grow at an incredible rate, the knowledge and expertise of clinical laboratory professionals is essential to ensure that patients received the highest quality and most useful laboratory tests. ADLM’s Academy and Science and Practice Core Committee have developed a test utilization resource focusing on commonly misused tests in hospitals and clinics. Improper test utilization can result in poor patient outcomes and waste in the healthcare system. This important resource geared toward medical professionals recommends better tests and diagnostic practices. Always consult your laboratory director to make sure these recommendations are appropriate for your patient population.