From the Guidelines
High ferritin, low UIBC, low TIBC, and normal iron levels typically suggest a condition called iron overload or hemochromatosis, which requires prompt evaluation and treatment to prevent organ damage. This pattern indicates that your body has excess iron stores (high ferritin) while maintaining normal circulating iron levels. The low UIBC and TIBC values mean your body has little remaining capacity to bind additional iron, suggesting your iron transport system is already heavily saturated.
According to the most recent study 1, the goal ferritin is 50 ng/mL, regardless of sex at birth, and a TSAT <20% has high sensitivity for diagnosing absolute or functional iron deficiency. However, in the presence of inflammation, the lower limit of ferritin consistent with normal iron stores should be increased to 100 μg/L, as stated in study 1.
The laboratory pattern of high ferritin, low UIBC, low TIBC, and normal iron levels is concerning because excessive iron accumulation can damage organs like the liver, heart, and pancreas over time. You should consult with a healthcare provider promptly for further evaluation, which may include genetic testing for hereditary hemochromatosis, the most common inherited cause of iron overload. Other potential causes include certain liver diseases, inflammatory conditions, or repeated blood transfusions.
Treatment typically involves therapeutic phlebotomy (blood removal) to reduce iron levels if hemochromatosis is confirmed. The frequency of phlebotomy depends on the severity of iron overload, starting possibly weekly until iron levels normalize, then maintenance sessions several times per year, as recommended in study 1. Early diagnosis and treatment are important to prevent complications like cirrhosis, diabetes, heart problems, and joint pain.
Some key points to consider:
- High ferritin levels can indicate iron overload, but can also be elevated in inflammatory conditions, as noted in study 1.
- Low UIBC and TIBC values indicate a low capacity to bind additional iron, suggesting iron overload.
- Normal iron levels do not rule out iron overload, as the body may have excess iron stores despite normal circulating iron levels.
- Prompt evaluation and treatment are necessary to prevent organ damage and complications.
In terms of management, study 1 recommends laboratory evaluation following IV iron, including a CBC and iron parameters, 4 to 8 weeks after the last infusion. Additionally, reticulocyte Hb content can be a useful test for detecting iron deficiency and the need for iron replacement, as stated in study 1.
Overall, the key takeaways are:
- High ferritin, low UIBC, low TIBC, and normal iron levels suggest iron overload or hemochromatosis.
- Prompt evaluation and treatment are necessary to prevent organ damage and complications.
- Therapeutic phlebotomy is the typical treatment for hemochromatosis.
- Laboratory evaluation, including CBC and iron parameters, should be performed 4 to 8 weeks after IV iron infusion.