Iron

Anemia

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Fasting Required

Details

Measures circulating iron in blood; useful for anemia or iron overload diagnosis.

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Iron Test Information Guide

Why is it done?
- Measures the amount of iron in the blood to assess iron metabolism and storage status
- Diagnose iron deficiency anemia or iron overload disorders such as hemochromatosis
- Evaluate symptoms of fatigue, weakness, shortness of breath, or pale skin suggesting anemia
- Monitor patients with chronic diseases, malabsorption disorders, or heavy menstrual bleeding
- Screen for hereditary conditions affecting iron absorption and metabolism
- Follow-up testing after abnormal complete blood count (CBC) results
Normal Range
- Adult Males: 60-170 mcg/dL (10.7-30.4 µmol/L)
- Adult Females: 50-170 mcg/dL (9.0-30.4 µmol/L)
- Children: 50-120 mcg/dL (9.0-21.5 µmol/L) depending on age
- Interpretation Guidelines:
- Normal (Within Range): Indicates adequate iron levels for normal blood cell production and oxygen transport
- Low Iron (Below Range): May indicate iron deficiency, poor nutrition, blood loss, or malabsorption
- High Iron (Above Range): May suggest hemochromatosis, multiple transfusions, liver disease, or certain anemias
- Unit of Measurement: micrograms per deciliter (mcg/dL) or micromoles per liter (µmol/L)
- Note: Reference ranges may vary by laboratory and should always be compared with the specific lab's reference values
Interpretation
- Low Serum Iron (<50 mcg/dL):
  - Iron deficiency anemia (early stage or chronic)
  - Chronic bleeding (gastrointestinal, menstrual, or other sources)
  - Malabsorption disorders (celiac disease, inflammatory bowel disease)
  - Inadequate dietary iron intake or vegetarian/vegan diet without adequate supplementation
  - Pregnancy and lactation with increased iron demands
- High Serum Iron (>170 mcg/dL):
  - Hemochromatosis (hereditary iron overload disorder)
  - Multiple blood transfusions or chronic transfusion therapy
  - Liver disease or cirrhosis affecting iron metabolism
  - Certain types of anemia (hemolytic, sideroblastic, or vitamin B12 deficiency)
  - Excessive iron supplementation or iron toxicity
  - Acute hepatitis or kidney disease
- Factors Affecting Results:
  - Diurnal variation: Iron levels fluctuate throughout the day (highest in morning)
  - Recent iron supplementation or medication containing iron
  - Inflammation or infection can temporarily increase serum iron
  - Menstrual cycle phase in women (may affect results)
  - Recent blood transfusion or phlebotomy
  - Estrogen therapy or hormonal contraceptives
- Clinical Significance:
  - Serum iron alone is not diagnostic; must be interpreted with ferritin, transferrin saturation, and TIBC
  - Iron panel results require correlation with clinical symptoms and CBC findings
  - Chronic iron deficiency can lead to anemia, fatigue, cognitive impairment, and reduced work capacity
  - Chronic iron overload can damage liver, heart, pancreas, and joints
Associated Organs
- Primary Organ Systems Involved:
  - Hematologic System: Iron is essential for hemoglobin synthesis in red blood cells; deficiency leads to anemia
  - Gastrointestinal System: Primary site of iron absorption (duodenum and proximal jejunum); bleeding leads to iron loss
  - Hepatic System: Stores iron (ferritin) and produces transferrin; iron overload causes cirrhosis and fibrosis
  - Cardiac System: Iron deficiency causes reduced oxygen transport; iron overload causes cardiomyopathy and arrhythmias
  - Endocrine System: Iron overload damages pancreas, causing diabetes; affects hormone production
- Common Conditions Associated with Abnormal Results:
  - Iron Deficiency Conditions:
    - Iron deficiency anemia (IDA)
    - Celiac disease and gluten sensitivity
    - Crohn's disease and ulcerative colitis
    - Gastric bypass surgery
    - Chronic kidney disease
  - Iron Overload Conditions:
    - Hereditary hemochromatosis
    - Secondary hemochromatosis from chronic transfusions
    - Sideroblastic anemia
    - Thalassemia major
    - Cirrhosis and end-stage liver disease
- Potential Complications:
  - From Iron Deficiency:
    - Severe anemia with heart failure or syncope
    - Developmental delays in children
    - Cognitive impairment and poor academic performance
    - Impaired immune function
    - Pica (compulsive eating of non-food items)
  - From Iron Overload:
    - Cirrhosis and hepatocellular carcinoma
    - Dilated cardiomyopathy and cardiac arrhythmias
    - Diabetes mellitus
    - Arthritis and joint damage (pseudogout)
    - Hypogonadism and infertility
Follow-up Tests
- Complementary Iron Panel Tests:
  - Serum Ferritin: Assesses total body iron stores; most important indicator of iron deficiency or overload
  - Total Iron-Binding Capacity (TIBC): Measures capacity of transferrin to carry iron; elevated in iron deficiency
  - Transferrin Saturation: Percentage of transferrin occupied by iron; useful screening for hemochromatosis
- Complete Blood Count (CBC):
  - Essential for evaluating hemoglobin, hematocrit, and red blood cell indices (MCV, MCH, MCHC)
  - Detects presence and severity of anemia
  - Identifies microcytic vs. macrocytic anemia patterns
- Additional Investigations for Iron Deficiency:
  - Peripheral Blood Smear: Visualizes red blood cell morphology; shows hypochromia and microcytosis
  - Soluble Transferrin Receptor (sTfR): More specific for iron-depleted erythropoiesis; useful when ferritin is elevated
  - B12 and Folate Levels: Rule out concurrent deficiencies in vitamin B12 and folate causing mixed anemia
  - Gastrointestinal Workup: Upper and lower endoscopy to identify bleeding sources in unexplained iron deficiency
  - Celiac Serology: Tissue transglutaminase (tTG-IgA) antibodies to screen for celiac disease
- Additional Investigations for Iron Overload:
  - HFE Gene Testing: Genetic testing for hereditary hemochromatosis mutations (C282Y, H63D)
  - Liver Function Tests (LFTs): Assess hepatic damage from chronic iron deposition
  - Magnetic Resonance Imaging (MRI): T2-weighted MRI quantifies tissue iron deposition in liver and cardiac tissue
  - Cardiac Evaluation: EKG and echocardiography to assess cardiac complications
  - Liver Biopsy: May be performed to assess cirrhosis and quantify iron accumulation
- Monitoring Frequency:
  - Iron Deficiency Anemia: Recheck iron studies and CBC 4-6 weeks after starting supplementation; repeat every 3-6 months during treatment
  - Hemochromatosis: Monitor iron studies and ferritin every 3 months during phlebotomy therapy; then annually after maintenance phase
  - Post-Treatment: After iron stores normalized, periodic monitoring annually or as clinically indicated
Fasting Required?
- Fasting Status: YES - Fasting is required for accurate iron test results
- Fasting Duration:
  - 12 hours minimum overnight fasting preferred
  - Some labs require 8-10 hours minimum
- Fasting Instructions:
  - No food or drink except water for the fasting period
  - Water intake is permitted and encouraged during fasting
  - Avoid coffee, tea, juice, milk, or any beverages other than water
- Timing of Draw:
  - Morning blood draw (between 7-10 AM) is preferred for most accurate results
  - Iron levels show diurnal variation with highest levels in early morning
- Medications to Avoid:
  - Iron Supplements: Hold iron supplements for 24 hours before blood draw (consult physician for guidance)
  - Chelation Agents: Delay deferoxamine or other iron chelators until after blood draw
  - Multivitamins: Avoid multivitamins containing iron for 24 hours before testing
  - Corticosteroids: May continue routine corticosteroid use unless specifically instructed otherwise
- Additional Patient Preparation:
  - Notify laboratory if taking medications that may interfere with results (consult with healthcare provider)
  - Bring insurance card and photo ID to blood draw
  - Wear loose-fitting sleeves for easy blood draw access
  - Stay hydrated with water prior to blood draw
  - Inform phlebotomist of any history of vasovagal response or difficulty with blood draws

How our test process works!