From the Guidelines
Management of very high transferrin levels involves addressing the underlying cause, which is often iron deficiency, and the primary approach is iron supplementation, typically with oral ferrous sulfate 325 mg taken 1-2 times daily between meals with vitamin C to enhance absorption, as recommended by recent guidelines 1. The goal of treatment is to replenish iron stores and normalize hemoglobin levels. According to the expert consensus guidelines published in the American Journal of Hematology in 2024 1, the frequency of administration and duration of benefit of intravenous iron depends on the underlying etiology of the iron deficiency.
- For patients with ongoing losses, such as heavy menstrual bleeding or inflammatory bowel disease, multiple administrations of intravenous iron may be necessary.
- Laboratory evaluation following IV iron should include a CBC and iron parameters, such as ferritin and percent transferrin saturation, 4 to 8 weeks after the last infusion 1.
- The goal ferritin level is 50 ng/mL, regardless of sex at birth, and a transferrin saturation <20% has high sensitivity for diagnosing absolute or functional iron deficiency 1.
- Regular monitoring of iron studies is essential to track progress, and dietary modifications to increase iron intake are also beneficial, focusing on red meat, leafy greens, beans, and fortified cereals.
- Patients should be evaluated for underlying causes of iron deficiency, such as blood loss, malabsorption, or increased iron requirements, and treatment should be tailored to the individual patient's needs, as suggested by the British Society of Gastroenterology guidelines published in Gut in 2021 1.
From the Research
Transferrin Management
- Transferrin saturation is a key diagnostic criterion for iron deficiency, and its use in addition to ferritin can improve diagnosis, especially in patients with chronic inflammatory diseases 2.
- Soluble transferrin receptor (sTfR) is another important marker for iron deficiency, and its levels can reflect tissue iron status and erythropoietic activity 3.
- The diagnosis of iron deficiency is typically made by measuring serum ferritin and transferrin saturation, with a transferrin saturation of less than 20% indicating iron deficiency 4.
Iron Deficiency Treatment
- Oral iron supplementation is typically the first-line treatment for iron deficiency, with ferrous sulfate being a common choice 4.
- However, intravenous iron may be necessary for patients who do not tolerate oral iron, have impaired absorption, or have certain chronic inflammatory conditions such as inflammatory bowel disease (IBD) 5.
- Alternative iron supplements, such as iron-enriched Aspergillus oryzae, may have fewer gastrointestinal side effects and be a safer option for treating iron deficiency anemia 6.
Iron Deficiency Prevalence
- Iron deficiency is a common condition that affects approximately 2 billion people worldwide, with 14% of adults in the US being affected 4.
- Certain populations, such as pregnant women, individuals with chronic kidney disease, and those with inflammatory bowel disease, are at higher risk of developing iron deficiency 4, 5.