Original Investigation

Ferritin Reference Curves and Optimal Curves in Preadolescent Children

JAMA Network Open 10.1001/jamanetworkopen.2026.13041

May 15, 2026 at 11:00 AM EDT

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What are the lower and upper limits of the ferritin reference curves for preadolescent children, and are these curves associated with physiologically based iron deficiency thresholds?In this cross-sectional study of 4935 children, the limits were highest in early infancy, declined at 1.5 years of age (lower limit, 5-6 ng/mL), then gradually increased at 9 to 10 years of age (lower limit, 15-17 ng/mL). From 3 months to 10 years of age, the lower limit of ferritin level was below the physiologically based threshold of 20 ng/mL or less.These findings suggest that reference curves, which provide lower and upper limits continuously across age, may improve clinical utility, despite the lower limits being below the proposed threshold for identifying iron deficiency in pediatrics.

Corresponding Author: Patricia C. Parkin, MD, The Hospital for Sick Children Research Institute, 686 Bay St, Toronto, ON M5G 0A4, Canada (patricia.parkin@sickkids.ca).

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