What is the diagnosis for a patient with elevated TIBC, low percent saturation, and low-normal ferritin?

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Normal Iron Studies - No Iron Deficiency Present

Based on your laboratory values (total iron 122 µg/dL, TIBC 331 µg/dL, transferrin saturation 37%, ferritin 48 ng/mL), you do not have iron deficiency. These results fall within normal ranges and do not warrant iron supplementation.

Interpretation of Your Iron Parameters

Your iron studies demonstrate adequate iron status:

  • Transferrin saturation of 37% is well above the diagnostic threshold for iron deficiency (which is <16-20%), indicating sufficient iron availability for red blood cell production 1

  • Ferritin of 48 ng/mL exceeds the cutoff for absolute iron deficiency (<30 ng/mL in the absence of inflammation, or <15 µg/L in some guidelines), confirming adequate iron stores 1, 2

  • TIBC of 331 µg/dL is within normal range (typically 250-450 µg/dL), and elevated TIBC would be expected with true iron deficiency as the body attempts to capture more circulating iron 3, 4

  • Total iron of 122 µg/dL is normal (typical range 60-170 µg/dL for men, 50-150 µg/dL for women), further supporting adequate iron availability 5

Why This Is Not Iron Deficiency

The pattern you present is distinctly different from iron deficiency:

  • Iron deficiency typically shows transferrin saturation <20%, not 37% as in your case 1

  • True iron deficiency without inflammation requires ferritin <30 ng/mL, and your ferritin of 48 ng/mL indicates preserved iron stores 2

  • The combination of normal-to-high transferrin saturation with normal ferritin excludes both absolute and functional iron deficiency 1, 3

Clinical Implications

No iron supplementation is needed:

  • Iron therapy is indicated only when transferrin saturation is <20% and/or ferritin is <30 ng/mL in non-inflammatory conditions 1, 2

  • Your values do not meet criteria for oral or intravenous iron replacement 1

  • Unnecessary iron supplementation can lead to iron overload, particularly when baseline iron parameters are normal 1

If Symptoms Are Present

If you have fatigue, weakness, or other symptoms that prompted these tests:

  • Investigate alternative causes beyond iron deficiency, as your iron status is adequate 2

  • Consider evaluation for vitamin B12 deficiency, folate deficiency, thyroid dysfunction, sleep disorders, or other causes of fatigue 1

  • Anemia from causes other than iron deficiency (chronic disease, hemolysis, bone marrow disorders) should be considered if hemoglobin is low 4

Monitoring Recommendations

Routine follow-up of iron studies is not necessary with these normal values:

  • Repeat iron studies only if new symptoms develop or if there are risk factors for iron loss (heavy menstrual bleeding, gastrointestinal bleeding, malabsorption) 1, 2

  • Annual monitoring may be appropriate if you have chronic conditions associated with iron deficiency (inflammatory bowel disease, chronic kidney disease, heart failure), but your current values are reassuring 1, 2

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Management of Iron Deficiency Anemia with Normal Ferritin

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Research

Iron deficiency anemia.

American family physician, 2007

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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