Low ferritin is one of those health issues that quietly slips under the radar for many Indians. You may feel constantly tired, notice more hair on your pillow than usual, or struggle to focus, yet routine blood tests often come back ‘normal’. That is because haemoglobin, the number most people look at, does not always tell the full story. Ferritin, which reflects the body’s iron reserves, often drops much earlier.
“Ferritin is a protein that stores iron in the body. Think of it as the body’s iron bank. Haemoglobin tells us how much iron is currently being used to make red blood cells, while ferritin reflects iron reserves. A person can have normal haemoglobin but low ferritin, meaning iron stores are depleted and anaemia may develop later if not corrected. Low ferritin can cause symptoms even before anaemia appears, which is why it’s clinically important,” explains Dr Venkata Krishna Kumar Talluri, MBBS, DNB (internal medicine), MRCP (UK), consultant physician and diabetologist at Renova Century Hospitals, Banjara Hills.
And, according to Dr Srinath Bharadwaj, consultant medical oncologist at Apollo Hospitals, Jubilee Hills, “Most hematologists become concerned when ferritin drops below 30 ng/mL, even if haemoglobin is still within the normal range. A level under 15 ng/mL is considered diagnostic of iron deficiency. Some specialists say symptoms can appear even at 30 – 50 ng/mL in women, athletes and people with chronic illness. Ferritin is an early warning marker: once it falls, the body’s reserve is already depleted.”
Fatigue and hair fall are often the first signs, but low ferritin can also cause breathlessness on exertion, dizziness, headaches, palpitations, poor concentration and even restless legs at night. These symptoms are frequently brushed off as stress or a busy lifestyle, especially among young adults.
“Iron deficiency is highly prevalent in India due to multiple factors, including predominantly vegetarian diets, low intake of iron-rich foods and poor absorption from cereals and pulses. Menstrual blood loss, increased requirements during adolescence, pregnancy and lactation, chronic infections, frequent pregnancies, poor awareness, and stressful and erratic diets among young adults together worsen anaemia,” Dr Venkata points out.
Many people are surprised when their ferritin stays low despite taking iron tablets. Dr Srinath explains: “Persistent low ferritin despite supplements is common and usually points to an underlying issue. The most frequent reasons include poor absorption (such as in gut disorders, celiac disease or after gastric surgery), taking iron with tea, coffee or calcium that blocks absorption, irregular dosing, ongoing blood loss from heavy periods or the digestive tract, and inflammation that traps iron in storage. In some people, the dose is simply too small to replenish depleted stores.”
Modern iron infusions are generally safe when given under supervision, though mild side effects can occur. Once ferritin levels improve, doctors usually recheck them after a few months. “Oral iron is typically the first step when deficiency is mild and the patient can tolerate tablets. Intravenous (IV) iron is preferred when ferritin is very low, rapid correction is needed, absorption is poor, or tablets cause severe side effects. If ferritin fails to rise after a proper trial of treatment, doctors investigate hidden blood loss, often from the gut, using endoscopy, stool testing or gynaecological evaluation in women. The treatment decision balances severity, symptoms and the suspected cause,” Dr Srinath stresses.
Alongside treatment, diet matters the most. Green leafy vegetables, lentils, jaggery, dates, along with vitamin C-rich foods, can support recovery. Low ferritin may be hidden, but with timely testing and the right care, it does not have to be ignored.