What is the diagnosis and treatment for a patient with low iron saturation, elevated TIBC (Total Iron Binding Capacity), and ferritin level of 85?

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Interpretation: Normal Iron Studies – No Iron Deficiency

Your iron studies are completely normal and do not indicate iron deficiency or any pathological condition requiring treatment. 1

Laboratory Values Analysis

Your results fall within normal reference ranges across all parameters:

  • TIBC 246 mg/dL: Normal range is typically 240-450 mg/dL 1
  • Iron saturation 30%: Well above the threshold for iron deficiency (>20% rules out deficiency) 1
  • Ferritin 85 ng/mL: Comfortably above all diagnostic thresholds for iron deficiency 1

Why This is Not Iron Deficiency

Iron deficiency is definitively excluded by your ferritin level. In the absence of inflammation, iron deficiency requires ferritin <30 μg/L 1. Your ferritin of 85 ng/mL is nearly three times this threshold. 1

Even in the presence of chronic inflammation (where ferritin can be falsely elevated as an acute phase reactant), iron deficiency is only considered when ferritin is <100 μg/L 1. Your value sits right at this boundary, but your transferrin saturation of 30% clearly excludes functional iron deficiency, which requires TSAT <16-20% 1.

The combination of ferritin >30 μg/L AND transferrin saturation >20% definitively rules out both absolute and functional iron deficiency. 1

Clinical Context Matters

The interpretation would only differ if you have specific inflammatory conditions:

  • Without inflammation: Ferritin >30 μg/L excludes iron deficiency 1
  • With chronic inflammation (IBD, chronic kidney disease, heart failure): Ferritin up to 100 μg/L might still indicate deficiency, BUT only if TSAT is <16-20% 1
  • Anemia of chronic disease: Diagnosed when ferritin >100 μg/L AND TSAT <20% 1

Your TSAT of 30% excludes all these scenarios. 1

No Treatment Indicated

No iron supplementation is needed or recommended. 1, 2

Iron therapy is only indicated when:

  • Ferritin <30 μg/L in non-inflammatory states, OR 1
  • Ferritin <100 μg/L with TSAT <16-20% in inflammatory conditions 1

Neither criterion applies to your case. Unnecessary iron supplementation can lead to iron overload, oxidative stress, and gastrointestinal side effects. 2, 3

Common Pitfall to Avoid

Do not misinterpret a TIBC of 246 mg/dL as "low." While this sits at the lower end of the reference range, TIBC must be interpreted alongside transferrin saturation and ferritin. 1, 3 A slightly lower TIBC with normal-to-high iron saturation and adequate ferritin indicates sufficient iron stores with appropriate iron utilization—not deficiency. 3

In iron deficiency, you would expect TIBC to be elevated (>450 mg/dL) as the body attempts to capture more circulating iron, combined with low TSAT (<16%) and low ferritin (<30 μg/L). 1, 3 Your pattern shows the opposite.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Iron deficiency anemia: evaluation and management.

American family physician, 2013

Research

Diagnosis and management of iron-deficiency anaemia.

Best practice & research. Clinical haematology, 2005

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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