Iron: The Test 1/22/10 12:39 AM

Iron
Also known as: Serum Iron; Serum Fe
Formal name: Iron, serum
Related tests: Ferritin; TIBC & UIBC, Transferrin; Hemoglobin; Hematocrit; CBC; Zinc protoporphyrin; Iron Tests

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The Test
How is it used?
When is it ordered?
What does the test result mean?
Is there anything else I should know?

How is it used?
Serum iron and a total iron-binding capacity (TIBC), or sometimes a UIBC (unsaturated iron-binding capacity) or transferrin test,
are ordered together, and a transferrin saturation calculated to determine how much iron is being carried in the blood. A ferritin
test may also be ordered to evaluate a person's current iron stores.

These tests are used together to detect and help diagnose iron deficiency or iron overload. In people with anemia, these tests can
help determine whether the condition is due to iron deficiency or another cause, such as chronic illness. Iron tests are also ordered
if a doctor suspects that a person has iron poisoning and to screen for hereditary hemochromatosis, an inherited condition
associated with excessive iron storage.

When is it ordered?
Serum iron tests are not ordered routinely. They are typically ordered as follow-up tests when abnormal results are found on
routine tests such as a CBC, hemoglobin, and hematocrit. They may also be ordered when iron deficiency or iron overload is
suspected.

Early iron deficiency usually causes no concerns at all. If a person is otherwise healthy, symptoms seldom appear before the
hemoglobin in the blood drops below a certain level (about 10 g per deciliter). As iron stores continue to be depleted, signs that
your body is low in iron may develop. As your condition progresses and anemia begins to develop, some of the signs and
symptoms that appear may include:

Chronic fatigue/tiredness

Dizziness

Weakness

Headaches

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If the iron-deficiency anemia is severe, shortness of breath, dizziness, 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 pica (cravings for specific substances, such as 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 finger- and toe-nails.

A serum iron and other iron tests may be ordered when iron overload (hemochromatosis) is suspected. Symptoms of high iron
levels will vary from person to person and tend to worsen over time. They are associated with iron accumulation and can be similar
to those seen with other conditions. Symptoms may include:

Joint pain

Fatigue, weakness

Lack of energy

Abdominal pain

Loss of sex drive

Heart problems

When a child is suspected to have ingested iron tablets, a serum iron test is ordered to detect and help assess the severity of the
poisoning. Iron tests may also be ordered periodically when iron deficiency or overload is being treated to evaluate the
effectiveness of treatment.

What does the test result mean?

Serum iron levels are often evaluated in conjunction with other iron tests. A summary of
the changes in iron tests seen in various diseases of iron status is shown in the table
below.

Disease Iron TIBC/Transferrin UIBC Ferritin

%Transferrin

Saturation

Iron Deficiency Low High High Low Low

Hemochromatosis High Low Low High High

Chronic Illness Low Low Low/Normal Low 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

A low iron with a high transferrin or TIBC is usually due to iron deficiency. In chronic diseases, both iron and transferrin or TIBC
are typically low. Iron deficiency is usually due to long-term or heavy bleeding. However, it can also be due to increased iron
requirements (in pregnancy), rapid growth (in children), poor diet, and problems with absorption (stomach or intestinal disease).

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requirements (in pregnancy), rapid growth (in children), poor diet, and problems with absorption (stomach or intestinal disease).

High levels of serum iron can occur as the result of multiple blood transfusions, iron injections into muscle, lead poisoning, liver
disease, or kidney disease. It can also be due to the genetic disease, hemochromatosis.

Is there anything else I should know?

Recent consumption of iron-rich foods, or of iron pills or tablets, can affect test results, as can recent blood transfusions. Alcohol
and drugs, such as oral contraceptives and methotrexate, can increase iron test levels, while testosterone, large doses of aspirin,
metformin, and ACTH (adrenocorticotropic hormone) can decrease them.

Stress and sleep deprivation can temporarily decrease serum iron levels.

This article was last reviewed on October 27, 2009. | This page was last modified on January 19, 2010.

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