From the Guidelines
Low transferrin levels should be evaluated for hypotransferrinemia, particularly in patients with unexplained hypochromic microcytic anemia, and mutation analysis of the TF gene is recommended if low iron binding capacity and increased ferritin concentrations are present. To address low transferrin, it is crucial to consider the potential underlying causes, including genetic disorders of iron metabolism or heme synthesis, as outlined in the practice guidelines for the diagnosis and management of microcytic anemias due to these disorders 1. The clinical presentation and diagnostics of hypotransferrinemia involve evaluating patients with unexplained hypochromic microcytic anemia, low iron binding capacity (low serum transferrin concentrations), and increased ferritin concentrations.
Some key points to consider in the evaluation and management of low transferrin include:
- Evaluating for hypotransferrinemia due to a TF defect in case of a homozygous or compound heterozygous TF defect
- Considering mutation analysis of the TF gene in patients with low iron binding capacity and increased ferritin concentrations
- Assessing dietary iron intake and considering supplementation if necessary, while also evaluating for underlying conditions that may be contributing to low transferrin levels, such as liver disease, protein malnutrition, inflammation, or chronic illness, as these conditions can impact iron metabolism and transferrin levels 1.
In terms of treatment, the focus should be on addressing the underlying cause of the low transferrin levels, which may involve iron supplementation, treatment of underlying medical conditions, and ongoing monitoring of transferrin levels and iron studies to ensure effective management and prevent potential complications, such as anemia, which can result from impaired iron transport due to low transferrin levels.
From the Research
Low Transferrin Levels
Low transferrin levels can be an indicator of iron deficiency or other underlying health conditions. The following points highlight the relationship between transferrin and iron deficiency:
- Transferrin saturation is a useful diagnostic criterion for iron deficiency, particularly when used in conjunction with ferritin levels 2.
- Hepatic transferrin plays a crucial role in maintaining systemic iron homeostasis and preventing liver ferroptosis 3.
- Soluble transferrin receptors (sTfR) can be used as a surrogate marker for bone marrow iron stores, improving the diagnosis of iron deficiency anemia, especially in patients with coexisting chronic diseases 4.
Treatment and Management
Various treatment options are available for managing low transferrin levels and iron deficiency:
- Ferric citrate has been shown to be effective in increasing transferrin saturation and ferritin levels in patients with iron deficiency and chronic kidney disease (CKD) 5.
- Lactoferrin supplementation has been found to have better effects on serum iron, ferritin, and hemoglobin levels compared to ferrous sulfate, with fewer gastrointestinal side effects 6.
- Ferrous sulfate is a commonly used iron supplement, but it can cause gastrointestinal side effects, highlighting the need for alternative treatment options 5, 6.
Diagnostic Considerations
When diagnosing and managing low transferrin levels, the following factors should be considered:
- Transferrin saturation and ferritin levels should be used in conjunction to diagnose iron deficiency 2.
- Soluble transferrin receptors (sTfR) can be used to evaluate iron stores, particularly in patients with coexisting chronic diseases 4.
- Liver function and iron metabolism should be assessed, as hepatic transferrin plays a crucial role in maintaining systemic iron homeostasis 3.