What does a ferritin level of 30, low iron of 8.7, and a transferrin saturation of 15% indicate, and how is it treated?

Iron Deficiency Anemia Diagnosis and Treatment

Your lab results (ferritin 30, iron 8.7, transferrin saturation 15%) indicate iron deficiency anemia that requires oral iron supplementation as first-line treatment.

Interpretation of Your Lab Results

Your laboratory values show:

• Ferritin: 30 ng/mL (borderline low)
• Serum iron: 8.7 (low)
• Transferrin saturation: 15% (low)

These values are consistent with iron deficiency anemia. According to diagnostic criteria:

• Transferrin saturation below 16-20% indicates insufficient iron available for erythropoiesis 1
• Serum ferritin at 30 ng/mL is at the lower threshold of normal, but when combined with low transferrin saturation, still suggests iron deficiency 1
• In the absence of inflammation, ferritin <30 μg/L is diagnostic of iron deficiency 2

Treatment Recommendations

First-Line Treatment: Oral Iron

1. Oral iron supplementation:

   • Ferrous sulfate 325 mg (65 mg elemental iron) 2-3 times daily 1
   • Take on an empty stomach with 500 mg vitamin C to enhance absorption 1
   • Alternative formulations (ferrous gluconate or ferrous fumarate) can be considered if intolerance occurs 1

2. Duration of treatment:

   • Continue for 3 months after normalization of hemoglobin to replenish iron stores 1
   • Target ferritin level is 50-100 μg/L 1

3. Monitoring response:

   • Check hemoglobin, ferritin, and transferrin saturation after 8-10 weeks of treatment 1
   • A hemoglobin increase of less than 1.0 g/dL at day 14 suggests poor response 1

When to Consider Intravenous Iron

Consider switching to intravenous iron if:

1. Poor response to oral iron despite compliance (hemoglobin increase <1 g/dL after 2 weeks) 1
2. Intolerance to oral iron (gastrointestinal side effects) 1
3. Presence of inflammatory conditions that may impair oral iron absorption 2
4. Hemoglobin below 10 g/dL (severe anemia) 1

Intravenous iron options include:

• Ferric carboxymaltose (Injectafer) 3
• Iron sucrose (Venofer) 4

Special Considerations

Inflammation and Iron Deficiency

If you have an underlying inflammatory condition:

• Higher ferritin cutoffs (up to 100 μg/L) may be used to diagnose iron deficiency 1
• Serum ferritin up to 100 μg/L may still be consistent with iron deficiency in the presence of inflammation 2
• Intravenous iron may be more effective than oral iron in inflammatory conditions 1

Causes to Investigate

Common causes of iron deficiency that should be investigated include:

• Gastrointestinal blood loss
• Menstrual blood loss in women
• Malabsorption disorders
• Dietary insufficiency
• H. pylori infection 1

Pitfalls to Avoid

1. Underdiagnosis: Using only ferritin as a diagnostic marker can lead to underdiagnosis, especially in inflammatory states. A combination of transferrin saturation and ferritin provides better diagnostic accuracy 1, 5

2. Inadequate treatment duration: Stopping iron supplementation too early before stores are replenished can lead to recurrence 1

3. Excessive supplementation: Avoid long-term daily supplementation once ferritin is normal, as excessive iron can be harmful 1

4. Missing underlying causes: Treating the iron deficiency without investigating and addressing the underlying cause can lead to recurrence 1

By following these recommendations, your iron deficiency anemia should improve with appropriate treatment and monitoring.