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Iron Studies (for Anemia Screening)

Anemia

5 parameters

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Details

Serum iron, TIBC, Transferring Saturation/Serum, UIBC

₹599₹1,460

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Parameters

  • List of Tests
    • Iron
    • TIBC
    • Transferrin Saturation
    • UIBC
    • Transferrin - Serum

Iron Studies (for Anemia Screening)

  • Why is it done?
    • The Iron Studies panel comprehensively evaluates iron metabolism and storage status in the body to diagnose and differentiate types of anemia
    • Serum Iron measures the amount of iron circulating in the blood, reflecting current iron availability for hemoglobin synthesis
    • TIBC (Total Iron Binding Capacity) assesses the blood's capacity to bind and transport iron, indicating the body's iron-carrying protein availability
    • Transferrin Saturation calculates the percentage of transferrin proteins bound to iron, revealing whether iron transport is adequate
    • UIBC (Unsaturated Iron Binding Capacity) measures the unbound iron-binding capacity, indicating reserve binding sites available on transferrin
    • Serum Transferrin quantifies the iron-transport protein directly, reflecting the body's iron transport capacity and storage status
    • Ordered for patients presenting with fatigue, weakness, shortness of breath, or suspected anemia of various etiologies
    • Used to differentiate iron-deficiency anemia from anemia of chronic disease and hemochromatosis
    • Recommended for screening individuals with chronic bleeding, malabsorption disorders, dietary insufficiency, or hereditary iron metabolism disorders
    • Essential for monitoring iron supplementation therapy effectiveness and assessing iron overload risk
    • Individual tests work synergistically: Serum Iron and TIBC establish baseline iron levels; Transferrin Saturation and UIBC reveal iron distribution; Serum Transferrin quantifies transport protein capacity
    • Together, these tests identify iron-deficiency anemia (low iron, high TIBC, low saturation), iron overload (high iron, low TIBC, high saturation), and anemia of chronic disease (low iron, low TIBC, normal saturation)
  • Normal Range
    • Serum Iron: 60-170 mcg/dL (10.7-30.4 μmol/L) for men; 50-170 mcg/dL (8.9-30.4 μmol/L) for women. Normal range indicates adequate circulating iron for red blood cell production
    • TIBC (Total Iron Binding Capacity): 250-425 mcg/dL (45-76 μmol/L). Normal range reflects adequate transferrin protein availability for iron transport and storage
    • Transferrin Saturation: 20-50% (percentage of transferrin molecules carrying iron). Normal range indicates balanced iron binding and utilization
    • UIBC (Unsaturated Iron Binding Capacity): 150-375 mcg/dL (27-67 μmol/L). Normal range shows adequate unbound iron-binding sites available on transferrin
    • Serum Transferrin: 200-360 mg/dL (2.0-3.6 g/L) or 2.0-3.5 g/L. Normal range reflects appropriate iron-transport protein production and adequate iron transport capacity
    • Interpretation of normal results: Patient has adequate iron stores, appropriate iron transport, and balanced iron metabolism without iron deficiency or overload
    • Low values indicate iron deficiency or impaired iron metabolism; elevated values suggest iron overload or hemochromatosis
    • Reference ranges may vary slightly between laboratories depending on methodology and patient demographic factors (age, sex)
  • Interpretation
    • Serum Iron Low (<60 mcg/dL): Indicates iron deficiency, chronic bleeding, malabsorption, inadequate dietary intake, or anemia of chronic disease. Clinical concern for impaired hemoglobin synthesis
    • Serum Iron High (>170 mcg/dL): Suggests iron overload, hemochromatosis, excessive supplementation, repeated blood transfusions, or hemolysis. Risk for tissue damage from iron accumulation
    • Serum Iron Diurnal variation: Iron levels naturally fluctuate throughout the day, peaking in morning; testing should ideally occur in morning for consistency
    • TIBC Low (<250 mcg/dL): Indicates iron overload, hemochromatosis, anemia of chronic disease, liver disease, malnutrition, or protein deficiency. Reduced transferrin production
    • TIBC High (>425 mcg/dL): Suggests iron deficiency anemia, pregnancy, estrogen use, or increased transferrin production response to iron loss. Body attempting to maximize iron transport
    • Transferrin Saturation Low (<20%): Classic finding in iron-deficiency anemia; indicates insufficient iron binding despite adequate transferrin availability
    • Transferrin Saturation High (>50%): Suggests iron overload, hemochromatosis, or impaired iron regulation. Increased risk of free radical formation and tissue oxidation damage
    • Transferrin Saturation >60%: Significant concern for hemochromatosis; warrants genetic testing for HFE mutations and liver function evaluation
    • UIBC Low: Correlates with elevated serum iron and indicates available transferrin binding sites are becoming saturated with iron
    • UIBC High: Indicates few iron atoms bound to transferrin, suggesting iron deficiency or malnutrition with compensatory transferrin increase
    • Serum Transferrin Low: Indicates reduced iron-transport protein production from liver disease, malnutrition, nephrotic syndrome, or chronic inflammation
    • Serum Transferrin High: Reflects increased transferrin synthesis in response to iron deficiency or pregnancy; body attempting to maximize iron transport capacity
    • Iron-Deficiency Anemia Pattern: Low iron, high TIBC, low transferrin saturation (<20%), high UIBC, high transferrin
    • Iron Overload/Hemochromatosis Pattern: High iron, low TIBC, high transferrin saturation (>50%), low UIBC, normal or low transferrin
    • Anemia of Chronic Disease Pattern: Low iron, low TIBC, normal to low transferrin saturation, normal UIBC, low transferrin
    • Results affected by time of collection (iron shows diurnal variation), recent transfusions, hemolysis, medications (iron supplements, contraceptives), and inflammatory states
  • Associated Organs
    • Serum Iron: Evaluates bone marrow function and red blood cell production capacity. Low values affect erythropoiesis and hemoglobin synthesis
    • Serum Iron: Related to gastrointestinal absorption via duodenal and proximal jejunal epithelial cells. Low iron may indicate malabsorption or chronic GI bleeding
    • TIBC: Primarily evaluated by liver function since transferrin is synthesized hepatically. Low TIBC indicates liver disease or malnutrition
    • TIBC: Reflects kidney function indirectly; nephrotic syndrome causes transferrin loss in urine, reducing TIBC despite iron deficiency
    • Transferrin Saturation: Indicates iron status in tissues including bone marrow, spleen, and liver. High saturation risks oxidative damage from iron accumulation in these organs
    • UIBC: Reflects overall iron-transport capacity of blood; evaluates bone marrow's ability to receive iron for hemoglobin synthesis
    • Serum Transferrin: Produced by liver; low levels indicate hepatic dysfunction, malnutrition, or nephrotic syndrome
    • Iron deficiency complications: Impaired oxygen delivery (fatigue, dyspnea), weakened immune function, poor wound healing, cognitive impairment, restless leg syndrome
    • Iron overload complications: Hepatic cirrhosis, fibrosis, hepatocellular carcinoma from iron-mediated oxidative damage
    • Iron overload complications: Cardiac arrhythmias, congestive heart failure, myocarditis from myocardial iron deposition
    • Iron overload complications: Pancreatic dysfunction including diabetes mellitus, endocrine disorders from pituitary iron accumulation
    • Iron overload complications: Testicular atrophy and hypogonadism from iron deposition affecting gonadal function
    • Chronic bleeding sites evaluation: Gastrointestinal tract bleeding (peptic ulcer, gastritis, malignancy), gynecologic bleeding, respiratory tract bleeding
    • Malabsorption assessment: Evaluates celiac disease, Crohn's disease, surgical small bowel resection, or H. pylori gastritis affecting iron absorption
  • Follow-up Tests
    • If Low Serum Iron: Complete Blood Count (CBC) to assess hemoglobin, hematocrit, and red cell indices; reticulocyte count to evaluate bone marrow response
    • If Low Serum Iron: Serum ferritin to assess total body iron stores; abnormally low ferritin (<30 ng/mL) confirms iron deficiency
    • If Low Serum Iron: Fecal occult blood test to detect gastrointestinal bleeding; colonoscopy or upper endoscopy if positive
    • If Low Serum Iron with Malabsorption Suspicion: Tissue transglutaminase (tTG) and endomysial antibodies for celiac disease screening
    • If Low Serum Iron in Women: Gynecologic evaluation to assess for abnormal uterine bleeding as iron deficiency source
    • If High Serum Iron: HFE genetic mutation testing for hereditary hemochromatosis (C282Y and H63D mutations)
    • If High Serum Iron: Serum ferritin level to quantify total body iron burden and assess cirrhosis risk
    • If High Serum Iron: Liver function tests (ALT, AST, albumin, bilirubin) to detect hepatic dysfunction from iron overload
    • If High Serum Iron: Abdominal ultrasound or MRI to assess hepatic iron content, steatosis, and screen for hepatocellular carcinoma
    • If High Serum Iron: Cardiac evaluation including ECG and echocardiography to assess iron-related cardiomyopathy
    • If High Transferrin Saturation (>50%): Additional imaging and genetic testing urgently recommended to confirm hemochromatosis diagnosis
    • If Abnormal TIBC: Liver function tests to assess hepatic synthetic capacity and nutritional status evaluation
    • If Low Transferrin: Serum albumin and total protein to evaluate nutritional and protein synthetic status
    • Repeat Iron Studies: Recommended 6-8 weeks after starting iron supplementation to assess treatment response
    • Repeat Iron Studies: Every 3-6 months for iron overload patients undergoing phlebotomy or chelation therapy monitoring
    • Repeat Iron Studies: Annually for stable patients with documented iron-deficiency anemia to assess adequacy of replacement therapy
    • Complementary Tests: Inflammatory markers (CRP, ESR) to differentiate anemia of chronic disease; serum soluble transferrin receptor for specific iron deficiency confirmation
  • Fasting Required?
    • Fasting: Not strictly required, but a 12-hour overnight fast is preferred to minimize postprandial fluctuations in serum iron levels
    • Morning collection: Serum iron exhibits strong diurnal variation with peak levels in early morning (6-8 AM); testing should be scheduled early morning for optimal consistency and interpretation
    • Iron-containing medications: Discontinue iron supplements, multivitamins containing iron, and iron-fortified cereals for 24 hours before testing if medically safe
    • Medications affecting results: Inform healthcare provider of estrogen therapy, oral contraceptives (increase TIBC), corticosteroids, and NSAIDs (may affect results)
    • Avoid alcohol: Minimize alcohol consumption for 24 hours prior to testing as it may affect iron metabolism and liver function
    • Fluid intake: Drink adequate water; dehydration can artificially elevate iron and other analyte concentrations
    • Recent transfusions: Inform laboratory if patient received blood transfusion within past 3 months, as this significantly elevates serum iron artificially
    • Recent phlebotomy: Iron studies should be drawn at least 2-3 days after phlebotomy to allow iron equilibration in blood
    • Hemolysis prevention: Request proper venipuncture technique; hemolysis releases iron from red blood cells, falsely elevating serum iron
    • Infection/inflammation status: Acute infection, inflammation, or fever temporarily decrease serum iron; defer testing until patient recovers if possible
    • Specimen collection: Use EDTA-free tube (serum separator tube) for iron studies; EDTA contamination can cause falsely elevated results
    • Stress level: Minimize physical and emotional stress 24 hours before testing as stress may temporarily affect iron metabolism and hematologic parameters

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