Summary
A study using NHANES data found that raising the diagnostic threshold for iron-deficiency anemia (IDA) from 15 ng/mL to 45 ng/mL would increase IDA prevalence by 3.3 million people, primarily among premenopausal women.
Another study using data from the Transfusion-Transmissible Infections Monitoring System (TTIMS) found that the prevalence of HIV, HBV, and HCV in the U.S. blood supply remained stable or decreased from 2015 to 2023.
Editor: Deborah Sesok-Pizzini, MD, MBA, adjunct professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Diagnostic serum ferritin thresholds and prevalence of iron-deficiency anemia
December 2025—The American Gastroenterological Association formalized, in 2020, iron-deficiency anemia recommendations for postmenopausal women and for men, which include esophagogastroduodenoscopy and colonoscopy, or bidirectional endoscopy. This guideline only conditionally recommended that bidirectional endoscopy be performed on premenopausal women, who are more likely to have iron-deficiency anemia (IDA) due to menorrhagia. The association also advised revising the World Health Organization’s recommended iron-deficiency diagnostic threshold of 15 ng/mL or lower ferritin to 45 ng/mL or lower. The authors used population-representative data from the National Health and Nutrition Examination Survey (NHANES) to assess the role of these recommendations in IDA prevalence estimates and management in the United States. For their study, the authors assessed ferritin and hemoglobin levels among nonpregnant adult NHANES participants to calculate IDA prevalence. Iron deficiency was evaluated based on the World Health Organization (WHO) recommendation of 15 ng/dL or lower, the American Gastroenterological Association (AGA) recommendation of 45 ng/mL or lower, and an intermediate level of 30 ng/mL or lower. Participants were classified as anemic using the WHO hemoglobin threshold of 12 g/dL or lower for women and 13 g/dL or lower for men. Data analyses were conducted from January to April 2025. The authors identified 7,357 nonpregnant adult NHANES participants, representing 213.7 million people in the United States. Of these participants, 27.2 percent were premenopausal women, 26.1 percent postmenopausal women, and 46.7 percent men. The median ages for these groups were 35, 63, and 46 years, respectively. The median ferritin levels were 43 (22–73) ng/mL for premenopausal women, 98 (60–152) ng/mL for postmenopausal women, and 145 (90–223) ng/mL for men. In evaluating the population at ferritin thresholds of 15 ng/mL or lower, 30 ng/mL or lower, and 45 ng/mL or lower, 5.9 (95 percent confidence interval [CI], 4.7–7.1) million, 8.3 (95 percent CI, 6.8–9.9) million, and 9.2 (95 percent CI, 7.6–10.7) million people, respectively, were classified as having IDA. Per the American Gastroenterological Association guidelines, 0.8 (95 percent CI, 0.6–2.3) million additional postmenopausal women and 0.7 (95 percent CI, 0.1–1.9) million additional men would be recommended to receive bidirectional endoscopy, and 1.8 (95 percent CI, 1.0–4.4) million additional premenopausal women would be conditionally recommended for the procedure. The authors found that changing the threshold to 45 ng/mL or lower increased the prevalence of IDA by 3.3 million people. Moreover, more than half of the study participants who were newly classified with IDA were premenopausal women. This may result in this population receiving bidirectional endoscopy with very low yield. The authors concluded that additional research is needed to establish the risks and benefits of changing the threshold for IDA ferritin levels and the risks of bidirectional endoscopy for premenopausal women with IDA, which could assist in the development of management guidelines stratified by the most likely origin of IDA.
Al Ta’ani O, Mayrer BM, Luche NM, et al. Diagnostic serum ferritin thresholds and prevalence of iron deficiency anemia. JAMA Intern Med. 2025. doi.org/10.1001/jamainternmed.2025.2311
Correspondence: Dr. Ravy K. Vajravelu at [email protected]
A study of the prevalence of HIV, HBV, and HCV in U.S. blood donations
The Transfusion-Transmissible Infections Monitoring System was established by the FDA; National Heart, Lung, and Blood Institute; and Health and Human Services’ Office of the Assistant Secretary for Health to provide a comprehensive national data set to report transfusion-transmissible infectious disease. Four major blood- collection organizations participated in the Transfusion-Transmissible Infections Monitoring System (TTIMS): the American Red Cross, New York Blood Center Enterprises, OneBlood, and Vitalent. These organizations collect approximately 60 percent of the U.S. blood supply. TTIMS tracks the frequency with which HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis are detected in the blood supply. TTIMS tracking is important due to donor regulation changes and blood donor screening updates. One recent change involved revising the deferral rates for donors with high-risk behaviors, such as injection drug users, men having sex with men (MSM), or those having sex in exchange for money or drugs, from indefinite to 12 months since last exposure for MSM (in effect from 2016–2020) and then from 12 months to three months for MSM and other high-risk behaviors (in effect from 2020–2023). Individual donor assessment was instituted in 2023. The authors conducted a study to assess the annual prevalence and overall trends for HIV, HBV, and HCV during eight years of TTIMS, extending from 2015 to 2023. They also evaluated and compared the prevalence rates for two periods of donor deferral—the period prior to implementing a three-month deferral in 2020 and the three-month deferral period. This corresponded to two time periods—approximately 2015 to 2020 and 2020 to 2023. HIV, HBV, and HCV prevalence per 100,000 donations (PHTD) were calculated based on serology and nucleic acid testing results. The authors also performed negative binomial regression to assess prevalence at one-year intervals. Fisher’s exact test was used to evaluate changes in prevalence between the two periods (α=0.05). The results showed that the annual HIV and HBV prevalence rates remained stable and changed only slightly from years one to eight (from 2.5 to 2.1 PHTD for HIV and from 6.3 to 6.6 PHTD for HBV). No notable sex-based differences in these trends were found. However, HCV prevalence declined (from 19.7 to 9.6 PHTD; p<.01) and was more pronounced among repeat female donors. In addition, overall HIV and HCV prevalence decreased (from 2.5 to 2.0 PHTD for HIV and from 18.4 to 9.8 PHTD for HCV) from the period prior to three-month deferral to the three-month deferral period (p<.01), while HBV prevalence was relatively stable (decreasing from 6.5 to 6.2 PHTD; p=.06). The authors noted that these results, although varying slightly by subgroup, suggest that the safety of the overall blood supply remains stable. The study showed that the eight-year prevalence of HIV, HBV, and HCV in the U.S. blood supply, as monitored by TTIMS, remained unchanged or decreased. Moreover, the three-month deferral policy did not negatively impact blood safety. However, the authors concluded that it is important to continue monitoring efforts to safeguard against transfusion-transmissible infectious disease and ensure that revised deferral policies continue to emphasize donor safety.
Huseynova E, Haynes J, Notari EP, et al. Prevalence of HIV, HBV, and HCV in United States blood donations, 2015–2023: The transfusion-transmissible infections monitoring system (TTIMS). Transfusion. 2025. doi.org/10.1111/trf.18424
Correspondence: Dr. Emilya Huseynova at [email protected]