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  2. Iron studies

What are Iron Studies? 

Iron is a mineral that is needed for the production of haemoglobin and red blood cells (RBCs). 

It is mostly obtained through diet and gets absorbed in the gut. This iron then binds to a protein called transferrin and gets transported throughout the body. Mostly, iron is used for the synthesis of (and is thus present in) haemoglobin (Hb), which is a protein that helps in the transport of oxygen to different parts of the body from the lungs. 

The remaining iron is either used to produce other proteins and enzymes or stored in various tissues in the form of ferritin. If you do not consume enough iron through food, your body will start using its iron reserves. If the levels of circulating and stored iron get depleted in your body, it may lead to iron-deficiency anaemia, indicated by low levels of Hb and smaller RBCs. 

On the other hand, excessive iron can be toxic. An excessive amount of iron intake and hence absorption in the body can cause iron build-up in tissues, which can lead to organ dysfunction or failure. Read more: Iron poisoning symptoms

An iron study includes the following tests:

  • Iron: An iron test checks for the amount of iron present in your blood.
  • Unsaturated total iron-binding capacity (UIBC): A UIBC test checks for the amount of transferrin that is not bound by iron - called reserve transferrin.
  • Total iron-binding capacity (TIBC): A total iron-binding capacity test is a blood test that checks how efficiently transferrin can carry iron in blood. It tells if your iron content is too low or too high. TIBC is a sum of UIBC and iron in the blood.
  • Percent (%) transferrin saturation (TS): This test determines the percentage of iron-binding proteins such as transferrin and others in your blood. It is calculated in the following manner: % TS = Iron/TIBC × 100
  • Ferritin: Iron is stored in the body in the form of ferritin. The ferritin test checks for the stored iron in your body. An increase in ferritin levels indicates excessive iron; whereas, a decrease in ferritin levels indicates decreased iron storage and iron deficiency anaemia.
  • Hb electrophoresis: This test determines the different types of Hb present in your blood. The common types are Hb A, Hb A2 and Hb F. However, there are more than 350 types of abnormal Hb, including Hb S and Hb C. Abnormal haemoglobin can cause anaemia and conditions like sickle cell disease. The process of electrophoresis uses an electric current to separate the different types of Hb in the blood. Read more: Haemoglobin electrophoresis test
  1. Why is Iron studies test performed?
  2. How do you prepare for Iron Studies test?
  3. How is the Iron Study performed?
  4. Iron Studies results and normal values

Why is Iron studies test performed?

This test is performed to check the levels of iron in your blood, the amount of stored iron and the capacity of your blood to transport iron. This test can also help in diagnosing the different causes of anaemia. The iron study panel results are read together to determine if you have iron deficiency, anaemia or iron overload.

Some of the symptoms of deficiency of iron are:

  • Delayed mental development in children
  • Acquiring infections frequently
  • Feeling cold 
  • Swollen tongue
  • Feeling weak and tired
  • Unable to keep up with everyday work

Some of the symptoms of excess iron are:

How do you prepare for Iron Studies test?

Before the iron, TIBC, UIBC, % TS and transferrin tests, you need to fast for 12 hours. Recently having a meal that is high in iron may affect the test results.

Patients with the haemolytic disease will have an artificially elevated iron content, and it will interfere with the test results of iron, TIBC, % TS, transferrin and ferritin. If you have had any recent blood transfusion, it may also affect the results of an iron study.

Make sure to tell your doctor if you are taking any medications, supplements or herbs.

The following drugs can increase the levels of iron in your body:

The following drugs can decrease your iron levels:

  • Colchicine
  • Methicillin
  • Chloramphenicol
  • Adrenocorticotropic hormone (ACTH)
  • Testosterone
  • Deferoxamine

Medication, including oral contraceptives and fluorides, can also increase the levels of TIBC; whereas, drugs such as chloramphenicol and ACTH can decrease the TIBC values. Your doctor may request you to stop taking these medicines before the test.

Women on their period may have a lower level of iron and ferritin.

Ferritin levels may be raised if you consume iron preparations. It may be falsely high in certain inflammatory conditions and Gaucher disease.

Wear a short-sleeved t-shirt or shirt for the test.

How is the Iron Study performed?

Iron study is performed on a blood sample. A technician will draw a few millilitres of blood from a vein in your arm using a sterile needle and a syringe. During or after the test, you may feel dizzy or faint and after the test, you may have a bruise at the needle insertion site; however, it will disappear over time. Tell your doctor if you see signs of infection - swelling and redness at the blood withdrawal site or fever.

Iron Studies results and normal values

Normal results:

The normal reference values for the tests are: 

  • Iron:

    • Male: 80-180 mcg/dL
    • Female: 60-160 mcg/dL
    • Child: 50-120 mcg/dL
    • Newborn: 100-250 mcg/dL
  • TIBC: 250-460 mcg/dL
  • Transferrin:
    • Male: 215-365 mg/dL
    • Female: 250-380 mg/dL
    • Child: 203-360 mg/dL
    • Newborn: 130-275 mg/dL
  • % TS: 
    • Male: 20%-50%
    • Female: 15%-50%
  • Ferritin:
    • Male: 12-300 ng/mL
    • Female: 10-150 ng/mL
    • Children of age between 6 months and 15 years: 7-142 ng/mL
    • Children of age between 2 and 5 months: 50-200 ng/mL
    • Children aged 1 month or less: 200-600 ng/mL
    • Newborn: 25-200 ng/mL
  • Hb electrophoresis: 
    • Hb A1: 96.5%-98.5% of total Hb
    • Hb A2: 1.5%-3.5% of total Hb
    • Hb F: 0%-1% of total Hb
    • Abnormal Hb: none
  • UIBC: 153-308 mcg/dL

Abnormal results:

Abnormal values in the iron study panel results may indicate various conditions as given below.

Increased iron levels may be due to one of the following:

  • Hepatitis
  • Haemolytic anaemia
  • Haemosiderosis
  • Hepatic necrosis
  • Haemochromatosis
  • Iron poisoning
  • Lead poisoning
  • Massive blood transfusion

Decreased iron levels could indicate the following:

  • Chronic blood loss
  • Insufficient dietary iron
  • Inadequate iron absorption
  • Iron deficiency anaemia
  • Pregnancy
  • Chronic gastrointestinal blood loss
  • Neoplasia
  • Chronic haematuria
  • Chronic heavy pathological or physiological menstrual bleeding

Increased TIBC or transferrin values could indicate the following:

Decreased TIBC or transferrin values can indicate the following:

  • Inflammatory diseases
  • Hypoproteinaemia
  • Cirrhosis
  • Pernicious anaemia
  • Haemolytic anaemia
  • Sickle-cell anaemia

Increased %TS values could indicate the following:

  • Haemolytic anaemia
  • Acute iron overdose
  • Haemosiderosis
  • Haemochromatosis 

Decreased %TS values could indicate the following:

  • Chronic illness like malignancy
  • Iron deficiency anaemia

Increased values of ferritin could mean the following:

  • Haemosiderosis
  • Haemochromatosis
  • Megaloblastic anaemia
  • Alcoholic or inflammatory hepatocellular disease
  • Haemolytic anaemia
  • Inflammatory disease
  • Advanced cancers
  • Collagen vascular diseases
  • Chronic illnesses such as cirrhosis and leukaemia 
  • Congenital and acquired sideroblastic anaemia
  • Haemophagocytic syndromes

Low ferritin levels occur due to the following conditions:

Abnormal results in Hb electrophoresis could be due to: 

  • Higher levels of Hb A2 and Hb F could indicate mild thalassemia; whereas, very low Hb A and high Hb F could indicate severe thalassemia.
  • Increased levels of Hb F could mean hereditary persistence of foetal Hb.
  • Low levels of Hb E and Hb C could be a sign of Hb E trait and Hb C trait, respectively, and higher levels indicate Hb E disease and Hb C disease, respectively.
  • The sickle-cell trait could be due to moderate levels of Hb S, and sickle-cell disease could be due to higher levels of Hb S.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Harmening D. Clinical Hematology and Fundamentals of Hemostasis, Fifth Edition, F.A. Davis Company, Philadelphia, 2009, pp 122-127.
  2. Greer J, Foerster J, Rodgers G, Paraskevas F, Glader B, Arber D, Means R, eds. Wintrobe's Clinical Hematology. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins.
  3. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Iron and Total Iron-Binding Capacity
  4. Nader Rifai. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th edition, Elsevier Health Sciences; 2017. Pg 742.
  5. UCSF health: University of California [internet]. US; Total iron binding capacity
  6. Pagana KD, et al. Mosby’s Diagnostic and Laboratory Test Reference. 14th ed. Missouri: Elsevier. 2019.
  7. Michigan Medicine: University of Michigan [internet]. US; Hemoglobin Electrophoresis
  8. Nemours Children’s Health System [Internet]. Jacksonville (FL): The Nemours Foundation; c2017; Blood Test: Hemoglobin Electrophoresis
  9. National Health Service [internet]. UK; Blood Tests
  10. Better health channel. Department of Health and Human Services [internet]. State government of Victoria; Iron deficiency - adults
  11. Legacy Health [Internet]. Portland (Ore). U.S.A.; Iron Binding Capacity, Unsaturated (UIBC)
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