What is the significance of elevated Iron and Total Iron-Binding Capacity (TIBC) levels with low Iron Saturation in a 62-year-old female?

From the Guidelines

The patient's lab results indicate iron overload, which requires prompt evaluation and management to prevent complications, and I strongly recommend scheduling an appointment with a healthcare provider within 1-2 weeks for further assessment, including additional testing such as ferritin levels and MRI to confirm iron overload and quantify tissue iron concentrations. The lab results show fluctuating iron levels over time, with the most recent value (205 mcg/dL) being significantly elevated above the normal range of 37-145 mcg/dL, as noted in the patient's records from 7 days ago (5/6/25), 6 months ago (11/14/24), 2 years ago (11/1/22), and 2 years ago (8/9/22) 1. Iron saturation is currently at the upper limit of normal at 50%, while previous measurements showed low saturation. Total iron binding capacity (TIBC) has been consistently elevated in past measurements but is now within normal range at 410 mcg/dL. These findings suggest iron overload, which can be caused by various factors including hemochromatosis, excessive iron supplementation, multiple blood transfusions, or certain liver conditions.

The recent study by the European Association for the Study of the Liver (EASL) provides guidance on the diagnosis and management of haemochromatosis, a condition characterized by iron overload 1. According to this study, serum iron parameters alone are often insufficient to ascertain iron overload, and non-invasive assessment of tissue iron overload by MRI is recommended to determine the degree of iron overload and predict organ damage. The study also notes that MRI can be used to quantify iron in the liver, spleen, pancreas, and heart, and that hepatic MRI R2* quantification can act as a surrogate of total body iron stores.

Some key points to consider in the management of iron overload include:

• Avoiding iron supplements and vitamin C supplements, which can enhance iron absorption
• Limiting consumption of iron-rich foods like red meat and iron-fortified cereals
• Monitoring for symptoms of iron overload, such as fatigue, joint pain, abdominal pain, or skin darkening, and seeking medical attention if these symptoms occur
• Considering additional testing, such as ferritin levels and MRI, to confirm iron overload and quantify tissue iron concentrations

It is also important to note that the distinction between absolute and functional iron deficiency is crucial in understanding what constitutes adequate transferrin saturation (TSAT) and serum ferritin levels, as discussed in the study by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) 1. However, this study is older and less relevant to the current patient's situation, and the more recent EASL study provides more up-to-date guidance on the diagnosis and management of iron overload.

In terms of specific management, I recommend that the patient undergo MRI to quantify tissue iron concentrations and guide diagnosis and management, as recommended by the EASL study. This will help to determine the degree of iron overload and predict organ damage, and will inform the development of a treatment plan to reduce iron levels and prevent complications.

From the Research

Iron Overload and Chelation Therapy

• Iron overload is characterized by excessive iron deposition and consequent injury and dysfunction of various organs, including the heart, liver, and joints 2.
• Chelation therapy is used to treat iron overload, with the goal of preventing or managing complications such as cardiac failure, liver damage, and joint problems 2, 3.

Laboratory Results and Iron Overload

• The provided laboratory results show elevated iron levels, with a value of 205 mcg/dL, which is above the reference range of 37-145 mcg/dL.
• The total iron-binding capacity (TIBC) is also elevated, with a value of 410 mcg/dL, which is above the reference range of 228-428 mcg/dL.
• Iron saturation is 50%, which is within the reference range of 20-55% 3.

Treatment Options for Iron Overload

• Deferasirox is an oral iron chelator that has been shown to be effective in reducing iron overload in patients with hemodialysis and hereditary hemochromatosis 3, 4.
• Other iron chelators, such as deferoxamine and deferiprone, have also been used to treat iron overload in patients with thalassemia and other conditions 5, 6.

Management of Iron Overload

• The management of iron overload involves reducing iron levels to prevent complications such as cardiac failure, liver damage, and joint problems 5.
• The goal of chelation therapy is to maintain labile iron and total body iron levels within a normal range, if possible, to prevent long-term complications of iron overload 5.