What does elevated ferritin (Ferritin) and iron with low Total Iron-Binding Capacity (TIBC) indicate?

From the Guidelines

Elevated ferritin and iron levels with low Total Iron-Binding Capacity (TIBC) typically indicate iron overload conditions, with hemochromatosis being the most common cause, and require prompt evaluation and treatment to prevent serious complications. This pattern suggests that the body has excessive iron stores and reduced capacity to bind additional iron in the bloodstream. According to the most recent guidelines, patients with these lab findings should consult a healthcare provider promptly for further evaluation, which typically includes genetic testing for hereditary hemochromatosis, particularly for the HFE gene mutations (C282Y and H63D) 1.

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

• The use of serum iron parameters, including transferrin saturation and serum ferritin, as surrogates of body iron status 1
• The role of MRI in non-invasive quantification of liver, spleen, pancreas, and cardiac iron, and its use in guiding diagnosis and management 1
• The importance of assessing the stage of liver fibrosis and other end-organ damage at diagnosis, as these determine disease management 1
• The use of therapeutic phlebotomy as the primary treatment for hemochromatosis, with targets of ferritin <50 µg/L during the induction phase and <100 µg/L during the maintenance phase 1

Treatment often involves therapeutic phlebotomy (blood removal) performed regularly until iron levels normalize, then maintenance phlebotomies as needed. For severe cases, iron chelation therapy with medications like deferoxamine, deferasirox, or deferiprone may be necessary. This lab pattern requires attention because untreated iron overload can lead to serious complications including liver cirrhosis, diabetes, heart problems, and joint damage as excess iron deposits in organs and tissues. Secondary causes of this pattern include alcoholic liver disease, hepatitis, and multiple blood transfusions, which should also be investigated during evaluation.

From the Research

Elevated Ferritin and Iron with Low TIBC

Elevated ferritin and iron levels with low Total Iron-Binding Capacity (TIBC) can indicate iron overload, a condition where the body absorbs too much iron from food, supplements, or other sources. This can lead to tissue damage and various health problems.

• Iron Overload: High ferritin levels are a common indicator of iron overload, as ferritin is a protein that stores iron in the body 2. Low TIBC levels also suggest iron overload, as TIBC measures the amount of transferrin available to bind to iron, and low levels indicate that most of the transferrin is already bound to iron.
• Causes of Iron Overload: Iron overload can be caused by genetic disorders such as hereditary hemochromatosis, or by repeated blood transfusions, which can lead to an accumulation of iron in the body 3, 4.
• Consequences of Iron Overload: Iron overload can lead to tissue damage, liver disease, heart problems, and other health issues 5, 6. It is essential to monitor and manage iron levels to prevent these complications.
• Treatment Options: Treatment for iron overload typically involves reducing iron levels through phlebotomy (blood removal) or chelation therapy, which uses medications to remove excess iron from the body 5, 3, 4.

Diagnostic Considerations

When interpreting ferritin and iron levels, it is essential to consider other factors that may influence these values, such as inflammation or infection, which can cause ferritin levels to rise 2. A comprehensive diagnostic evaluation, including medical history, physical examination, and laboratory tests, is necessary to determine the underlying cause of elevated ferritin and iron levels with low TIBC.