This is how to use an iron panel, serum
ferritin, and transferrin in order to
assess your iron status.
Hi, I'm Dr. Chris Masterjohn of
chrismasterjohnphd.com. This is
Chris Masterjohn Lite,
where the name of the game is
"Details? Shmeetails. Just tell me what works!"
And today we're going to talk
about blood work for managing iron status.
There's a whole lot to unpack in
the topic of iron that I'm not talking
about today, and that includes anemia, and
that includes many medical disorders.
What I want to talk about today is how
to make sure that you're not suffering
from iron overload using these iron
tests, and in particular why it's
important to look at ferritin and
transferrin on top of the iron panel
when looking at this. If you look on the
screen, you'll see the list of iron tests
that I got for my most recent blood
analysis. We'll look at the numbers in
the next video.
We have iron and TIBC. TIBC means
total iron-binding capacity, and that
breaks down into TIBC, UIBC, which is
unbound iron-binding capacity, iron, and
iron saturation. Then as separate tests,
I have added on here serum ferritin and
serum transferrin. The things that we're
really interested with these tests are
serum ferritin, which is a marker of your
long-term iron storage, and transferrin
saturation, which is not the same as
serum transferrin. It's the number of
transferrin molecules in your blood that
have their iron binding sites bound to
iron. Transferrin is your short-term
store of iron, distinct from ferritin,
which is your long-term store of iron,
and together serum ferritin and
transferrin saturation give a good
picture of your short- and long-term iron
status. When you are subject to iron
overload, what happens early on is
transferrin saturation increases above
what it normally would increase to
before ferritin kicks in. Normally you eat
iron, your serum transferrin saturation
goes up, that kicks in ferritin to take some
of that iron and put it in long-term
storage. When you have iron overload
conditions because of a genetic
predisposition, the transferrin
saturation goes up, and it doesn't kick
iron over into ferritin until much later.
If you have a late-stage iron overload
condition, you will see ferritin rise,
and you can see it rise very, very high.
In the iron binding panel, what we're
looking at is measures of iron
saturation, and this is a cheaper
estimate of transferrin saturation. What
they do here is they say, "You know, it's
mostly transferrin in the blood that's
binding iron, so let's just throw iron at
the blood and see how much sticks."
By doing that, you can estimate the total
iron-binding capacity of the blood, that's
how much can stick when the iron is
removed; the unbound iron-binding
capacity, that's how much sticks when you
don't remove the natural iron present in
the blood; and then how much iron is in
the blood, and you can use all this to
estimate the iron saturation, all as a
means of getting a cheaper estimate of
transferrin saturation, which is what
we're really interested in. What we want
is for the transferrin saturation to be
between 30% and 40%. The range that
they give for iron saturation is bigger
than that, 15% to 55%, but when we're
looking for an optimal range, 30% to 40% is the
optimal range. In the case of serum
ferritin, the ranges are controversial,
and the ranges vary from laboratory to
laboratory and over time. In my opinion,
we generally want to keep serum ferritin
between 60 and 150. In cases where
someone has a long experience of being
subject to iron overload, it might make
sense to go under 60, maybe even go
down to 20 or 30. But in cases
where someone's predisposed to anemia,
that's a good reason for trying to keep
it above 60 and maybe even get
towards 100 to 150. Because in one case,
you're trying to drain iron that's been
overloaded out of the body, and in the other
case, you're trying to replete iron
stores, and so it makes sense to be on
the higher or lower end of that
accordingly. For transferrin saturation,
the way that we estimate—the way that
we calculate this when we've measured
transferrin is to take this serum iron,
divide it by the serum transferrin, and
multiply it by 0.79.
Now, you might ask, "Why should you bother with
that if you have already estimated it
with the iron saturation?" And the reason
is that there are other things in the
blood besides transferrin that bind to iron.
Albumin, for example, is the most
prevalent protein in the blood, and it
can bind to iron. And there are studies
suggesting that in some people with iron
overload, iron saturation is often an
underestimate of the transferrin
saturation. And it's the transferrin
saturation that you want between 30% and 40%.
So here's what I would
suggest. Given the fact that measuring
serum transferrin is more expensive than
the iron panel, it does make sense to be
conservative about ordering the test
when you don't need to. But you don't
know if you need to until you order the
test at least once. So what I would do is
at least once or maybe three times, get
all of these measured and compare the
transferrin saturation when calculated
as serum iron divided by serum
transferrin times 0.79
to the iron saturation. If they diverge
consistently, then you probably want to
continue measuring your transferrin
saturation by getting transferrin and
making the calculation as long as you
continue to have iron-related issues
that you believe need to be managed.
If, on the other hand, your transferrin
saturation as calculated that way always
looks like your iron saturation, then I
think you can conclude from that that
iron saturation is a good enough proxy
to use going forward, and going forward,
you can limit this to the iron panel and
to the ferritin.
You can find more details on managing
and monitoring iron status in my e-book,
Testing Nutritional Status: The Ultimate Cheat Sheet.
The audio of this episode was enhanced
and post-processed by Bob Davodian
of Taurean Mixing. You can find more
of his work at taureanonlinemixing.com.
This episode is brought to you by
Testing Nutritional Status: The Ultimate Cheat Sheet.
Everything you could ever need to know
about optimizing your nutrition all in one place.
Easier to find and use than ever before.
Get your copy at chrismasterjohnphd.com/cheatsheet.
Use the code LITE5,
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LITE5 to get $5 off.
All right, I hope you found this useful.
Signing off, this is Chris Masterjohn of
chrismasterjohnphd.com.
This has been Chris Masterjohn Lite.
And I will see you in the next episode.
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