From the Guidelines
Low TIBC, high ferritin, and low transferrin levels are indicative of iron overload, and the most appropriate course of action is to consult a healthcare provider for further evaluation and potential treatment with therapeutic phlebotomy, as recommended by the EASL clinical practice guidelines on haemochromatosis 1.
Key Considerations
- The combination of low TIBC, high ferritin, and low transferrin suggests iron overload, which can be due to conditions like hemochromatosis or chronic inflammatory states.
- The EASL guidelines recommend a target serum ferritin level of 50 lg/L during the induction phase and 50-100 lg/L during the maintenance phase for patients with HFE-haemochromatosis 1.
- Therapeutic phlebotomy is the primary treatment for hemochromatosis, with initial sessions weekly until iron levels normalize, then maintenance sessions every 2-4 months.
- It is essential to monitor serum haemoglobin levels during phlebotomy and adjust the frequency and volume of blood removal as needed to avoid iron deficiency and other complications 1.
- Additional tests, such as serum iron levels, transferrin saturation, and genetic testing for hereditary hemochromatosis, may be ordered to confirm the diagnosis and guide treatment.
Treatment and Management
- The goal of treatment is to reduce iron stores and prevent complications associated with iron overload.
- Phlebotomy is typically performed weekly or every 2 weeks during the induction phase, with a target volume of 400-500 ml per session 1.
- During the maintenance phase, phlebotomy is performed every 1-4 months, depending on the patient's iron status and serum ferritin levels 1.
- It is crucial to monitor serum ferritin levels regularly to ensure that the target range is maintained and to avoid overtreatment or undertreatment 1.
From the Research
Laboratory Results
- Low TIBC (Total Iron Binding Capacity)
- High ferritin
- Low transferrin
Possible Interpretations
- According to the study 2, low TIBC and high ferritin may indicate iron overload, as TIBC measures the ability of transferrin to bind iron, and low TIBC can be a sign of excess iron in the body.
- The study 3 suggests that high ferritin and low transferrin can be indicative of hemochromatosis, a genetic disorder that affects iron regulation and can lead to iron overload.
- The study 4 found that elevated transferrin saturation (which can be calculated using TIBC and serum iron) is an early indicator of parenchymal iron overload, and that measuring serum ferritin concentration can help confirm the diagnosis of iron overload.
Diagnostic Considerations
- The combination of low TIBC, high ferritin, and low transferrin may suggest iron overload or hemochromatosis, and further testing such as serum iron measurement, transferrin saturation calculation, and genetic testing may be necessary to confirm the diagnosis.
- The study 2 suggests that measuring transferrin or TIBC alone may be a cost-effective approach to diagnosing iron deficiency, but in this case, the results suggest iron overload rather than deficiency.
- The study 4 highlights the importance of considering other causes of hyperferritinemia, such as liver disease or metabolic disorders, when interpreting laboratory results.