From the Guidelines
Iron panel analysis should include a complete blood count with reticulocyte count, ferritin, serum iron, transferrin, transferrin saturation, and total iron binding capacity to accurately assess iron status in the body. When interpreting results, it is essential to consider the various markers and their implications. For instance, low serum iron with high total iron binding capacity and low transferrin saturation typically indicates iron deficiency, while high serum iron with high transferrin saturation may suggest iron overload conditions like hemochromatosis 1. Ferritin serves as the best indicator of iron stores but can be elevated in inflammatory conditions independent of iron status, as noted in a study published in the journal Gut 1.
Key Markers and Their Implications
- Serum iron: normal values are approximately 60-170 μg/dL
- Total iron binding capacity (TIBC): normal values are approximately 240-450 μg/dL
- Transferrin saturation: normal values are approximately 20-50%
- Ferritin: normal values are approximately 20-250 ng/mL, but can be elevated in inflammatory conditions
- Mean cell Hb (MCH) and mean cell volume (MCV) can also be useful markers, with MCH being a more reliable indicator of iron deficiency 1
Special Considerations
- Patients should fast for 12 hours before testing and avoid iron supplements for 24 hours prior to ensure accurate results
- Patients should inform their provider about any medications that might affect results
- Athletes with restrictive diets or high-risk activities should consult a sports dietitian to optimize their daily nutrition plans for iron intake, as iron deficiency is common in female athletes, with estimates ranging from 15 to 35% 1
- A full iron panel is essential for diagnosing conditions ranging from iron deficiency anemia to iron overload disorders and guiding appropriate treatment decisions, with ferritin being a key indicator of iron stores 1
From the Research
Iron Panel Analysis
Iron panel analysis is a diagnostic tool used to evaluate iron deficiency and iron overload. The following points highlight the key aspects of iron panel analysis:
- Iron deficiency is the most common nutritional disorder worldwide, accounting for approximately one-half of anemia cases 2.
- The diagnosis of iron deficiency anemia is confirmed by the findings of low iron stores and a hemoglobin level two standard deviations below normal 2.
- Iron deficiency can be caused by malnutrition and blood loss, and its differential diagnosis includes iron-refractory iron deficiency anemia (IRIDA) and anemia of chronic disease 3.
- Biochemical measures, such as serum iron and ferritin, are essential for detecting iron depletion and iron deficiency anemia, as hemoglobin and hematocrit levels may not be reliable indicators 4.
Diagnostic Evaluation
The diagnostic evaluation of iron deficiency and iron overload involves:
- Measurement of hemoglobin and hematocrit levels, as well as biochemical measures such as serum iron and ferritin 4.
- Imaging studies and specific mutation analyses may be necessary for diagnosing iron overload due to congenital disturbances of iron metabolism 3.
- A complete blood count (CBC) test should be accompanied by other tests of iron status to pinpoint true iron deficiency 4.
Treatment and Management
The treatment and management of iron deficiency involve:
- Oral iron therapy as the first line of treatment in most cases 5, 6.
- Parenteral iron formulations may be used in patients who cannot tolerate or absorb oral preparations 5, 6.
- Treatment of the underlying cause of iron deficiency, such as gastrointestinal endoscopy to exclude bleeding lesions in men and postmenopausal women 2, 5.