Q: I am a 24 years old woman having ferritin level 8 for the last year. Since then I am taking iron medicine with Vitamin-C and even green vegetables. The level increased to 19 but now again it has dropped to 9. What should I do? What complications may occur due to the deficiency of ferritin? What diet and medicine should be taken for this? What is Ferritin? How is it important to our body? How much of it should be present in a normal human being, especially women?

A:The total iron in our body is stored within cells in the form of an iron-containing protein called ferritin. Its estimation in the blood is done to determine an individual’s total iron storage capacity. In conditions where available iron is not sufficient to meet the body’s iron needs, the level of ferritin falls in the blood. This may be due to inadequate intake of iron (lack of meat or green leafy vegetables in diet), its impaired absorption in the intestine (due to intestinal diseases), increased utilization of iron (as in growing children or pregnancy), or diseases causing chronic loss of blood from the body (menstrual disorders, piles etc). The normal levels are subject to variation due to a variety of conditions but the accepted reference range for adult males is 23 to 70 ng/ml and adult females 6 to 40 ng/ml.

Decreased level of ferritin in the blood is the first indication of impending iron deficiency. Its levels are increased in conditions where more iron is absorbed by the body. Ferritin levels may also be increased in conditions causing inflammation – infections, some cancers, liver disease, alcoholism, etc. and thus will be falsely high even if iron deficiency is present.

You are suffering from iron deficiency anemia and unless the underlying cause is treated, this will continue to happen, i.e. ferritin levels will start getting restored when you are on long-term iron therapy but will fall again when you stop taking the iron pills. Iron-deficiency may be caused by a) consuming diets low in iron (iron is obtained from foods in our diet but only 1 mg of iron is absorbed for every 10 to 20 mg of iron ingested. A person unable to have a balanced iron-rich diet may suffer from some degree of iron-deficiency anemia); b) body changes with an increased iron requirement (growth spurts in children or during pregnancy/lactation); c) gastrointestinal tract abnormalities (as iron is absorbed in the upper small intestine, any abnormalities in the gastrointestinal tract could alter iron absorption and result in iron-deficiency anemia) and d) blood loss (GI bleeding, kidney/bladder tumor, or injury).

Absorption of iron from food is influenced by multiple factors. One important factor is the form of the iron. Heme iron, found in animal sources, is highly available for absorption in contrast to non-heme iron found in vegetable sources. Vegetarians need more iron in their diets than non-vegetarians because the iron from plant foods is not as well absorbed as it is from animal foods. Vegetarians should choose several iron-rich plant foods daily. Grains, beans and lentils, vegetables (green-leafy ones, tomato, potato, green & red chillies etc), fruits, nuts and seeds are rich sources of non-heme iron. The absorption of non-heme iron can be improved when a source of heme iron meat/fish/poultry is consumed in the same meal or iron absorption enhancing foods like fruits/fruit juices are consumed. But coffee/tea and calcium if consumed along with a meal impair iron absorption.

Please consult a hematologist who can take a through history (regarding diet, blood loss etc.), and examine you before suggesting investigations followed by appropriate therapy.