From the Guidelines
Low ferritin with high Total Iron Binding Capacity (TIBC) indicates iron deficiency, and treatment typically involves oral iron supplementation, with ferrous sulfate 325 mg taken 1-3 times daily being the most common option, as recommended by recent guidelines 1. This condition occurs when your body's iron stores are depleted, causing ferritin levels to drop below normal (typically under 30 ng/mL) while TIBC rises above normal range (usually over 400 μg/dL) 1. Some key points to consider when treating iron deficiency include:
- Take iron supplements on an empty stomach with vitamin C (like orange juice) to enhance absorption, but avoid taking with calcium, dairy, coffee, tea, or antacids which can reduce absorption 1.
- Side effects may include constipation, nausea, and black stools.
- For severe cases or those who cannot tolerate oral supplements, intravenous iron may be necessary, with recent data suggesting better iron resorption and possibly fewer adverse effects with alternate day dosing 1.
- While supplementing, address the underlying cause of iron deficiency, which could be blood loss (menstruation, gastrointestinal bleeding), poor dietary intake, or malabsorption issues.
- Dietary changes to include iron-rich foods like red meat, spinach, beans, and fortified cereals can help maintain iron levels.
- Follow up with your healthcare provider to monitor your response to treatment with repeat blood tests after 2-3 months of supplementation, and consider laboratory evaluation following IV iron, including a CBC and iron parameters (ferritin, percent transferrin saturation (TSAT) calculated by dividing the serum iron by the total iron binding capacity (TIBC)) 4 to 8 weeks after the last infusion 1.
From the Research
Low Ferritin and High Total Iron Binding Capacity (TIBC)
- Low ferritin levels indicate depleted iron stores, while high TIBC suggests that the body is attempting to capture more iron from the diet 2.
- This combination can be seen in iron deficiency anemia, which affects approximately 1.2 billion people worldwide, including 10 million in the US 2.
- Causes of iron deficiency include bleeding, impaired iron absorption, inadequate dietary iron intake, and pregnancy 2.
Diagnosis and Treatment
- Iron deficiency is diagnosed by low serum ferritin (typically <30 ng/mL) in individuals without inflammatory conditions or by transferrin saturation (iron/total iron binding capacity × 100) less than 20% 2.
- Oral iron (ferrous sulfate 325 mg/d or on alternate days) is typically first-line therapy, while intravenous iron is indicated for patients with oral iron intolerance, poor absorption, or certain chronic inflammatory conditions 2.
- Other iron supplements, such as ferrous bisglycinate, may have better bioavailability and fewer gastrointestinal side effects compared to iron salts 3, 4, 5.
Management and Prevention
- Identifying and treating the underlying cause of iron deficiency is crucial, and prevention strategies should focus on addressing risk factors such as heavy menstrual bleeding, pregnancy, and inadequate dietary iron intake 2.
- Vitamin C supplementation may not be essential for patients with iron deficiency anemia, as oral iron supplements alone have been shown to be equivalent to oral iron supplements plus vitamin C in improving hemoglobin recovery and iron absorption 6.