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Low Iron Normal Ferritin

My son who is 13 years old was diagnosed with crohn's 2 years ago. In his most recent lab results his Iron was low but his Ferritin level was normal. I have been reading a bit about why people with chronic diseases can sometimes have low iron but normal ferritin and I find it a bit confusing. I am wondering what this might mean and if my son will need to take iron tablets again or get an iron infusion?

Any advice would be great!

Iron Level 46 Ref. range 67-175
Ferritin Level 43.4 Ref. range 10-110.0

Other labs

WBC 4.9 Ref. range 4.5-13.5
RBC 4.72 Ref. range 4.5-5.3
HGB 13.2 Ref. range 13.0-16.0
HCT 40.2 Ref. range 37.0-49.0
MCV 85.2 Ref. range 78.0-94.0
MCH 28.0 Ref. range 25.0-35.0
MCHC 32.8 Ref. range 31.0-37.0
RDW 11.5 Ref. range <=14.6
Platelet 317 Ref. range 135-466

Bilirubin 0.4 REf. range 0.1-1.1
Bili Direct <0.1 Ref. range 0.0-0.3
total Protein 7.2 Ref. range 6.4-8.6
Albumin 4.0 Ref. range 3.8-5.6
Globulin 3.2
A/G ratio 1 Ref. range 1-2
AST 18 Ref. range 10-36
ALT 21 Ref. range 24-68
Alk Phos 330 Ref. range 74-390
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On the ranges posted both iron and ferritin look low. Ferritin sometimes acts a marker of inflammation. Do you have any other iron numbers?
She mistyped the reference range. It is typically 12 to 300 in adult males. I expect the low end of this ref range may be between 10 and 20 making the ferritin result in the normal range.

Here's a fairly straightforward article about iron and iron tests. It talks about additional tests that measure the iron binding capacity and other aspects of iron transport and storage in the body. These tests may be run when the cause of anemia needs to be investigated.


The iron measured in the test is the iron in the blood (serum). Ferritin is a measure of the iron stored in the ferritin protein within the bone marrow.

It's my understanding that you can have a low iron and normal ferritin if the anemia is just starting and the serum level has dropped but not so much that the iron stores (ferritin) have been drawn down below normal. However there are probably other explanations as well. The article I linked discusses having iron tests done at a particular time of day and not using supplements before hand. Those factors may also be influencing the results.

Since his H&H are in the normal ranges he is not officially anemic.

You could ask your doctor if your son would benefit from an iron supplement. While his ferritin is in the normal range it is on the low side and, according to my son's doctor, it can't hurt for it to be a bit higher than that since it is iron stores. Iron is hard for the body to digest so if you start iron supplementation you might ask for tips on ways to maximize the absorption. Unfortunately it is hard on the intestines so there is a bit of a catch-22 when CDers need iron supplementation.

His levels are not as low as those I have seen when a child received an iron infusion so I don't think you need to worry about that.
Thank you Patricia for catching that!!

Should I give Johnny his iron supplement? We have some from the last time it was prescribed. I don't have any numbers from that time as our last hospital never emailed them to us. The GI office had to move his appointment so we wont see the GI for over a month yet. Johnny has been very fatigued lately and I would like to get a start on that since it can take months to correct.

Could puberty lower iron levels? Can you tell by the numbers if it could be Anemia of Chronic disease?


Sarah takes a iron supplement and her ferritin level is 32 ug/L. Her iron level has risen finally 12 umol/L from a low of 3.

You need the transferrin level to know whether he may be heading towards anemia of chronic disease.

The test is called iron studies in Australia, I believe you call it an iron panel.
I do think he is having his growth spurt right now. He has been growing above his normal rate for the last 5 months. I know they don't like to track height in increments smaller than a year because kids can sprout up for a few months of the year and then stay stagnant. But he is 13 years old and looks to be developmentally about where he should be for that growth to take off. No armpit hair yet but has a few other signs.

I suppose it could be catch up growth too, we are trying to get all the extra calories in him required for catch up growth but it feels almost impossible. He eats well though and makes pretty good choices. He has gained 20lbs since this time last year, it feels like a great success. That was all in the last 7 months, before that he was stagnant or losing weight.

Its very interesting to watch puberty play out among his friends. Kids seem to be all over the place at this age. He has a few boys that are earlier, some are starting now, and some look no where near starting. Throw in a chronic illness and it gets to be very difficult to know what is going on. I know you know exactly what I mean :)
Just got the Transferrin results (didn't know he ordered those)

238 Reference range 197-360

Does this mean it is not Anemia of chronic disease?
Never give iron supplements without first discussing it with your doctor.

Too much iron can be very harmful so you need to be careful with this particular supplement.

Hopefully this is something they could discuss with you over the phone. My guess is they will not want to supplement since the only thing that is low is the iron and that could be a fluke reading since the transferrin and ferritin are within the normal ranges.

On a practical level, everyone with Crohn's is likely to have varying levels of anemia of chronic disease. But treating it with iron without first having labs and doctor's guidance is unwise given the dangers of too much iron.

Encouraging him to eat iron rich foods is probably best for now unless your doc says otherwise. You could ask for follow up testing in a month or two if the fatigue continues.

It could also be Vit B deficiences making him tired. If that hasn't been checked recently you could also ask for that. Many kids with CD have Vit B deficiences along with Vit. D and zinc to name two.

Also kids who are entering puberty actually need more sleep than they did as pre-adolescents. It's not uncommon for an adolescent to need 12 hours of sleep. So he may just not be getting enough zzzz's.


Sorry, I should said in previous response never supplement iron without discussing with your medical professional first.

As it was explained to me the serum iron level is unreliable and need to read in conjunction with the ferritin and transferrin levels.

As the transferrin level and ferritin level is normal maybe retest in a couple of months for a clearer picture.

Transferrin level would be expected to be low with Anemia of chronic disease.
Thank you for the advice Catherine and Patricia. You are absolutely right that I shouldn't start the iron with out the GI asking us to.:ybatty:

Patricia, I found what you said about Alk phos really interesting so I looked up Johnny's lab results for the past year. His Alk phos has gone up steadily by about 10 every month until the end of June when it went up by 60. This was right when he really started to grow. It went up 5 more points from there at the next draw. It's like I can see puberty unfolding with the Alk phos numbers! It will be interesting to track from now on to see how closely things correlate. And if he stops growing (or slows) once they go back down.

Thanks for the support and info!!
I went home and looked at Jack's Alk phos last night after reading this post, they were low end of normal :( but you can bet I will be watching them. Next labs are early Dec.