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Iron studies

Evaluation of the body's iron depends on the results of three lab tests. To reach a diagnosis the three results should be interpreted together (see table below).

Serum iron

Serum iron measures the amount of iron in the blood.

  • Normal serum iron: 60-170 mcg/dl (10-30 ?mol/L)

Lower than normal levels may indicate:

  • chronic gastrointestinal blood loss
  • chronic heavy menstrual bleeding
  • inadequate absorption of iron
  • insufficient dietary iron
  • pregnancy
  • anemia of chronic disease

Higher than normal levels may indicate:

  • hemochromatosis
  • hemolysis
  • hemolytic anemias
  • hemosiderosis
  • hepatic (liver) necrosis (tissue death)
  • hepatitis
  • vitamin B-12 deficiency, vitamin B-6 deficiency
  • iron poisoning
  • multiple blood transfusions

Total iron binding capacity

A test that measures indirectly the transferrin level in the bloodstream. Transferrin is a protein that carries iron in the body.

Normal values are 240 to 450 mcg/dl.

Lower than normal TIBC may indicate:

  • Cirrhosis
  • Sickle cell anemia
  • Hypoproteinemia
  • Pernicious anemia
  • Hemolytic anemia

Greater than normal TIBC can be seen in:

  • Iron deficiency anemia
  • Late pregnancy
  • Polycythemia vera
  • The use of birth control pills can lead to increased TIBC measurements.

Ferritin

Serum ferritin measures the amount of ferritin in the blood. This is a better estimate of total body iron than the serum iron test.

Normal Values:

  • male: 12-300 ng/ml
  • female: 12-150 ng/ml

Lower than normal levels may indicate:

  • chronic gastrointestinal bleeding
  • heavy menstrual bleeding
  • iron deficiency anemia

Higher than normal levels may indicate:

  • alcoholic liver disease
  • hemochromatosis
  • hemolytic anemia
  • Hodgkin's lymphoma
  • megaloblastic anemia
  • Any inflammatory disorder can raise the ferritin level.
Disease Iron TIBC Ferritin
Iron deficiency anemia Decrease Increase Decrease
Anemia of chronic disease Decrease Decrease Increase
Hemochromatosis Increase Decrease / Normal Increase
Chronic hemolysis Increase Decrease Increase
Pregnancy Increase Increase Normal
Sideroblastic anemia Increase Normal Increase

Table 1: Interpretation of iron studies in various diseases.

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