Healthwise: Iron Tests

Wednesday 9 October 2019

Iron Tests

Iron tests evaluate the amount of iron in the body by measuring several substances in the blood.

This article was last reviewed on

July 22, 2017.

This article waslast modified on September 23, 2019.

Why Get Tested?

To evaluate your body's current level of iron; to help diagnose iron deficiency or iron overload

When To Get Tested?

When you have low hemoglobin and hematocrit on a complete blood count (CBC); when your healthcare practitioner suspects that you may have too little iron (deficiency) or too much iron (overload) in your body

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

You may be instructed to have your blood drawn in the morning and/or fast for 12 hours before the test; in this case, only water is allowed. Follow any instructions from your healthcare practitioner and/or from the laboratory performing the test.

What is being tested?

Iron is an essential nutrient that, among other functions, is needed in small quantities to help form normal red blood cells (RBCs). It is a critical part of hemoglobin, the protein in RBCs that binds oxygen in the lungs and releases it as blood circulates to other parts of the body. The body cannot produce iron and must absorb it from the foods we eat or from supplements.

Iron tests evaluate the amount of iron in the body by measuring several substances in the blood. These tests are often ordered at the same time and the results interpreted together to help diagnose and/or monitor iron deficiency or iron overload.

Serum iron test—measures the level of iron in the liquid portion of the blood.
Transferrin test—directly measures the level of transferrin in the blood. Transferrin is the protein that transports iron around in the body. Under normal conditions, transferrin is typically one-third saturated with iron. This means that about two-thirds of its capacity is held in reserve.
TIBC (total iron-binding capacity)—measures the total amount of iron that can be bound by proteins in the blood. Since transferrin is the primary iron-binding protein, the TIBC test is a good indirect measurement of transferrin availability.
UIBC (unsaturated iron-binding capacity)—The UIBC test determines the reserve capacity of transferrin, i.e., the portion of transferrin that has not yet been saturated with iron. UIBC also reflects transferrin levels.
Transferrin saturation—a calculation that reflects the percentage of transferrin that is saturated with iron (100 x serum iron/TIBC).
Serum ferritin—reflects the amount of stored iron in the body.

Iron is normally absorbed from food in the small intestine and transported throughout the body by binding to transferrin, a protein produced by the liver. In healthy people, most of the iron transported is incorporated into the production of red blood cell hemoglobin. The remainder is stored in the tissues as ferritin or , with additional small amounts used to produce other proteins such as myoglobin and some .

When the level of iron is insufficient to meet the body's needs, the level of iron in the blood drops and iron stores are depleted. This may occur because:

There is an increased need for iron, for example during pregnancy or childhood, or due to a condition that causes chronic blood loss (e.g., peptic ulcer, colon cancer)
Not enough iron is consumed (either foods or supplements)
The body is unable to absorb iron from the foods eaten in conditions such as celiac disease

Insufficient levels of circulating and stored iron may eventually lead to iron-deficiency anemia (decreased hemoglobin and hematocrit, smaller and paler red cells). In the early stage of iron deficiency, no physical effects are usually seen and the amount of iron stored may be significantly depleted before any signs or symptoms of iron deficiency develop. If a person is otherwise healthy and anemia develops over a long period of time, symptoms seldom appear before the hemoglobin in the blood drops below the lower limit of normal.

However, as the iron deficiency progresses, symptoms eventually begin to appear. The most common symptoms of anemia include fatigue, weakness, dizziness, headaches and pale skin. Read the article on Anemia to learn more.

Conversely, too much iron can be toxic to the body. Iron storage and ferritin levels increase when more iron is absorbed than the body needs. Absorbing too much iron over time can lead to the progressive buildup of iron compounds in organs and may eventually cause their dysfunction and failure. An example of this is hemochromatosis, a rare genetic disease in which the body absorbs and builds up too much iron, even on a normal diet. Additionally, iron overdose can occur when someone consumes more than the recommended amount of iron.

Common Questions

How is it used?

Iron tests are used to assess the amount of iron circulating in the blood, the total capacity of the blood to transport iron, and the amount of stored iron in the body. Testing may also help differentiate various causes of anemia.

Iron tests are often ordered together, and the results of each can help identify iron deficiency, iron deficiency anemia, or too much iron in the body (overload).

When is it ordered?

Iron tests may be ordered when results from a routine complete blood count (CBC) show that a person's hemoglobin and hematocrit are low and their red blood cells are smaller and paler than normal (microcytic and hypochromic), suggesting iron deficiency anemia even though other clinical symptoms may not have developed yet.

Iron tests may be ordered when a person develops and of anemia, such as:

Chronic fatigue/tiredness
Dizziness
Weakness
Headaches
Pale skin (pallor)

Iron tests may be ordered when iron overload is suspected. Signs and symptoms of iron overload will vary from person to person and tend to worsen over time. They are due to iron accumulation in the blood and tissues. These may include:

Joint pain
Fatigue, weakness
Lack of energy
Abdominal pain
Loss of sex drive
Organ damage, such as in the heart and/or liver

When a child is suspected to have ingested an excessive amount of iron tablets, a serum iron test is ordered to detect and help assess the severity of the poisoning.

What does the test result mean?

A summary of the changes in iron tests seen in various diseases of iron status is shown in the table below.

Disease	Iron	TIBC/Trans ferrin	UIBC	% Transferrin Saturation	Ferritin
Iron Deficiency	Low	High	High	Low	Low
Hemochroma tosis/ Hemosiderosis	High	Low	Low	High	High
Chronic Illness	Low	Low/Normal	Low/ Normal	Low/Normal	Normal/ High
Hemolytic Anemia	High	Normal/Low	Low/ Normal	High	High
Sideroblastic Anemia	Normal/ High	Normal/Low	Low/ Normal	High	High
Iron Poisoning	High	Normal	Low	High	Normal

Iron deficiency

The early stage of iron deficiency is the slow depletion of iron stores. This means there is still enough iron to make red cells, but the stores are being used up without adequate replacement. The serum iron level may be normal in this stage, but the ferritin level will be low.

As iron deficiency continues, all the stored iron is used and the body tries to compensate by producing more transferrin to increase iron transport. The serum iron level continues to decrease and transferrin and TIBC and UIBC increase. As this stage progresses, fewer and smaller red blood cells are produced, eventually resulting in iron deficiency anemia.

Iron overload

If the iron level is high, the TIBC, UIBC and ferritin are normal and the person has a clinical history consistent with iron overdose, then it is likely that the person has iron poisoning. Iron poisoning occurs when a large dose of iron is taken all at once or over a short period of time. Iron poisoning in children is almost always acute, occurring in children who ingest their parents' iron supplements. In some cases, acute iron poisoning can be fatal.

A person who has mutations in the HFE gene is diagnosed with hereditary hemochromatosis. However, while many people who have hemochromatosis will have no symptoms for their entire life, others will start to develop symptoms such as joint pain, abdominal pain, and weakness in their 30's or 40's. Men are affected more often than women because women lose blood during their reproductive years through menstruation.

Iron overload may also occur in people who have hemosiderosis and in those who have had repeated transfusions. This may occur with sickle cell anemia, thalassemia major, or other forms of anemia. The iron from each transfused unit of blood stays in the body, eventually causing a large buildup in the tissues. Some people with alcoholism and with chronic liver disease also develop iron overload.

Is there anything else I should know?

Recent consumption of iron-rich foods or iron supplements can affect test results, as can recent blood transfusions.

Normal iron levels are maintained by a balance between the amount of iron taken into the body and the amount of iron lost. Normally, a small amount of iron is lost each day, so if too little iron is taken in, a deficiency will eventually develop. Unless a person has a poor diet, there is usually enough iron to prevent iron deficiency and/or iron deficiency anemia in healthy people.

In certain situations, there is an increased need for iron. Persons with chronic bleeding from the digestive tract (usually from ulcers or tumors such as colorectal cancer) or women with heavy menstrual periods will lose more iron than normal and can develop iron deficiency. Women who are pregnant or breast feeding lose iron to their baby and can develop iron deficiency if not enough extra iron is taken in. Children, especially during times of rapid growth, may need extra iron and can develop iron deficiency. Iron deficiency can also be seen in malabsorption diseases such as celiac disease.

Low serum iron can also occur in states where the body cannot mobilize and use storage iron properly. In many chronic inflammatory conditions, especially in cancers, autoimmune diseases, and with chronic inflammations or chronic infections (including AIDS), the body cannot properly use iron to make more red cells. Under these conditions, production of transferrin decreases, and serum iron is low because little iron is being absorbed from the gut and storage iron can't get mobilized, and ferritin increases.

Do all people with iron deficiency have anemia? What are the symptoms?

Iron deficiency refers to a decrease in the amount of iron stored in the body, while iron deficiency anemia refers to a drop in the number of red blood cells (RBCs), hemoglobin and hematocrit caused by not having enough stored iron (there are many other causes of anemia). It typically takes several weeks after iron stores are depleted for the level of hemoglobin and production of RBCs to be affected and for anemia to develop. There usually are few symptoms early in iron deficiency, but as the condition worsens and blood levels of hemoglobin and RBCs decrease, then ongoing weakness and fatigue can eventually develop.

As your iron continues to be depleted, you may have shortness of breath and dizziness. If the anemia is severe, chest pain, headaches, and leg pains may occur. Children may develop learning (cognitive) disabilities. Besides the general symptoms of anemia, there are certain symptoms that are characteristic of iron deficiency. These include dysphagia, pica (cravings for specific substances, such as ice, corn starch, licorice, chalk, dirt, or clay), a burning sensation in the tongue or a smooth tongue, sores at the corners of the mouth, and spoon-shaped fingernails and toenails.