From the Guidelines
Low transferrin levels, while other parameters are normal, suggest a potential issue with protein synthesis or nutrition, and I recommend consulting with a healthcare provider for a thorough evaluation. This evaluation may include additional tests like serum iron, total iron binding capacity (TIBC), and ferritin to assess iron status comprehensively, as suggested by the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1. In the meantime, focusing on consuming a balanced diet rich in proteins from sources like lean meats, fish, eggs, dairy, legumes, and nuts is advisable. Transferrin is a protein made by the liver that transports iron in the blood, and low levels can occur due to liver disease, malnutrition, inflammation, protein-losing conditions, or genetic factors.
Some key points to consider include:
- The sensitivity and specificity of low transferrin saturation for iron deficiency, as noted in the recommendations to prevent and control iron deficiency in the United States by the Centers for Disease Control and Prevention 1.
- The potential for chronic inflammatory states, such as those present in chronic heart failure (CHF), to lead to increased hepcidin release by the liver, resulting in reduced iron absorption/mobilisation, as discussed in the British Society of Gastroenterology guidelines 1.
- The importance of identifying the underlying cause of low transferrin levels, as this will inform the appropriate management strategy, which may include protein supplementation or other interventions.
Given the potential for low transferrin levels to be associated with reduced functional capacity, impaired quality of life, and poorer prognosis in certain conditions, such as CHF, it is essential to prioritize a thorough evaluation and management plan, as outlined in the British Society of Gastroenterology guidelines 1. A healthcare provider should be consulted to determine the best course of action, which may include further testing, dietary modifications, and potentially intravenous iron replacement therapy (IRT) if iron deficiency is confirmed.
From the Research
Low Transferrin Levels
- Transferrin is a protein that binds to iron in the blood, and low levels of transferrin can indicate iron deficiency or other conditions 2, 3.
- In patients with chronic liver disease, low transferrin levels can be challenging to interpret due to the liver's role in producing transferrin and the potential for iron deficiency anemia 2.
- Serum soluble transferrin receptor (sTfR) levels can be used to diagnose iron deficiency in patients with chronic liver disease, with a sensitivity of 91.6% and specificity of 84.6% 3.
Potential Causes
- Iron deficiency anemia is a frequent complication of advanced liver disease, often due to chronic hemorrhage into the gastrointestinal tract 2.
- Hemochromatosis, a genetic disorder characterized by iron overload, can also affect transferrin levels and should be evaluated before initiating iron therapy 4.
- Other conditions, such as hypotransferrinemia and hypohepcidinemia, can also impact iron metabolism in chronic liver diseases 5.
Diagnostic Considerations
- Laboratory tests, including serum iron, ferritin, transferrin saturation, and mean corpuscular volume, can be affected by liver disease and may not accurately reflect iron status 2.
- Additional testing, such as red blood cell ferritin, serum transferrin receptor test, and hepcidin, may be necessary to diagnose iron deficiency in patients with chronic liver disease 2, 3.