From the Guidelines
High ferritin levels combined with low Total Iron Binding Capacity (TIBC) typically indicate iron overload, and the most effective treatment is therapeutic phlebotomy, as recommended by the 2022 EASL clinical practice guidelines on haemochromatosis 1. This pattern suggests conditions like hemochromatosis, chronic inflammation, liver disease, or certain types of anemia. Ferritin is a protein that stores iron, so elevated levels mean excess iron storage, while low TIBC indicates that transferrin (the protein that binds and transports iron) is already highly saturated with iron. Some key points to consider in the management of iron overload include:
- The use of MRI for non-invasive quantification of iron in the liver, spleen, pancreas, heart, and brain, as recommended by the 2022 EASL guidelines 1
- The importance of assessing tissue iron concentrations, which can be done non-invasively by MRI, where specific relaxation sequences have been adopted to reliably quantify iron 1
- The role of therapeutic phlebotomy in reducing iron stores and improving outcomes, as outlined in the 2011 practice guideline by the American Association for the Study of Liver Diseases 1
- The need for regular monitoring of serum ferritin levels and other iron parameters to guide treatment and prevent complications, as recommended by both the 2011 and 2022 guidelines 1
- The potential benefits of therapeutic phlebotomy, including improved survival, reduced risk of cirrhosis and diabetes, and improved quality of life, as outlined in the 2011 guideline 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Ferritin High and TIBC Low
- High ferritin levels can indicate iron overload, which can be caused by various factors including genetic disorders, frequent blood transfusions, or certain hematological diseases 2.
- Total Iron-Binding Capacity (TIBC) is a measure of all proteins available for binding mobile iron, including both transferrin and other proteins 3.
- A low TIBC level can indicate iron overload, as transferrin becomes saturated with iron and is no longer available to bind additional iron 3.
- Studies have shown that high ferritin and low TIBC levels can be predictive of all-cause mortality in patients with end-stage chronic kidney disease during the first 3 years of hemodialysis 4.
- In patients with hereditary hemochromatosis, elevated serum ferritin and transferrin saturation are common, but TIBC levels may be low or normal 5, 3.
- It is essential to consider the clinical context and rule out secondary causes of iron overload when interpreting ferritin and TIBC levels 3.