From the Guidelines
These lab results indicate iron deficiency, as evidenced by elevated total iron binding capacity (TIBC) and unsaturated iron binding capacity (UIBC), low iron saturation, and low serum iron level. The TIBC is elevated at 473 μg/dL (normal 250-450), and the UIBC is also high at 421 μg/dL (normal 118-369), which is consistent with the body's increased capacity to bind iron in the setting of iron deficiency 1. While the serum iron level is at the lower end of the normal range at 52 μg/dL (normal 27-139), the iron saturation is low at 11% (normal 15-55%), further supporting the diagnosis of iron deficiency.
According to the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults, serum markers of iron deficiency include low ferritin, low transferrin saturation, low iron, raised total iron-binding capacity, and raised red cell zinc protoporphyrin 1. In this case, the elevated TIBC and low iron saturation are consistent with iron deficiency.
The underlying cause of iron deficiency should be investigated, including potential sources of blood loss (menstrual, gastrointestinal), malabsorption, or inadequate dietary intake. Treatment typically involves oral iron supplementation, such as ferrous sulfate 325 mg daily or twice daily, taken with vitamin C to enhance absorption and between meals to maximize effectiveness. Follow-up testing in 2-3 months is recommended to assess response to therapy, with the goal of normalizing iron saturation and eventually TIBC levels. It is also important to note that serum ferritin (SF) is the most specific test for iron deficiency in the absence of inflammation, and an SF level of <15 μg/L is indicative of absent iron stores 1.
Key points to consider in the management of iron deficiency include:
- Investigating the underlying cause of iron deficiency
- Initiating oral iron supplementation
- Monitoring response to therapy with follow-up testing
- Considering the role of serum ferritin in diagnosing iron deficiency
- Being aware of the potential for inflammation to affect serum ferritin levels, as noted in the guidelines 1.
From the Research
Lab Results Interpretation
The provided lab results show the following values:
- Iron Bind.Cap.(TIBC): 473 H (ug/dL) - higher than the normal range of 250-450 (ug/dL)
- UIBC: 421 H (ug/dL) - higher than the normal range of 118-369 (ug/dL)
- Iron: 52 (ug/dL) - lower than the normal range of 27-139 (ug/dL)
- Iron Saturation: 11 L (%) - lower than the normal range of 15-55 (%)
Iron Deficiency Indicators
These results indicate iron deficiency, as evidenced by low iron levels and high TIBC and UIBC levels 2, 3. Iron deficiency can be caused by various factors, including bleeding, impaired iron absorption, inadequate dietary iron intake, and pregnancy.
Diagnosis and Treatment
Diagnosis of iron deficiency is typically made by measuring serum ferritin and transferrin saturation levels 2. Treatment usually involves oral iron supplementation, with ferrous sulfate being a common first-line therapy 2, 4. However, some patients may not tolerate oral iron or may have impaired absorption, in which case intravenous iron may be necessary 2, 5.
Key Findings
- Low iron saturation and high TIBC and UIBC levels are indicative of iron deficiency 2, 3
- Oral iron supplementation is typically the first-line treatment for iron deficiency 2, 4
- Intravenous iron may be necessary for patients who do not tolerate or have impaired absorption of oral iron 2, 5
- Newer oral iron formulations, such as Sucrosomial iron, may offer improved gastrointestinal tolerance and efficacy compared to traditional oral iron salts 6