Reference Range

The amount of circulating iron bound to transferrin is reflected by the serum

iron level.
The serum iron reference range is 55–160 µg/dL in men and 40–155 µg/dL in
women. [1]
Interpretation
Increases in serum iron level are associated with the following: [1, 2, 3]
 Idiopathic hemochromatosis
 Liver necrosis (viral hepatitis)
 Hemosiderosis caused by excessive iron intake (eg, multiple
transfusions, excess iron administration)
 Acute iron poisoning (children)
 Hemolytic anemia
 Pernicious anemia
 Aplastic or hypoplastic anemia
 Lead poisoning
 Thalassemia
 Vitamin B6 deficiency
 Estrogens
 Ethanol
 Oral contraceptive
Decreases in the serum iron level are associated with the following: [1, 2, 3]
 Iron deficiency anemia
 Nephrotic syndrome(loss of iron-binding proteins)
 Iron deficiency
 Chronic renal failure
 Many infections
 Active hematopoiesis
 Remission of pernicious anemia
 Hypothyroidism
 Malignancy (carcinoma)
 Postoperative state
 Kwashiorkor
Collection and Panels
Collection - Tiger-top or red-top tube
Panel - Iron panel
Background
Description
The metabolism of all living organisms requires iron. Iron is a part of heme,
which is the active site of peroxidases that protect cells from oxidative injury
by reducing peroxides to water. Heme is also the active site of electron
transport in cytochromes. [3] When iron levels are insufficient, proliferation of
bacteria or nucleated cells stops. [3]
Iron deficiency anemia may cause pallor, stomatitis, glossitis (smooth red
tongue), angular cheilitis, and koilonychias. Patients with Plummer-Vinson
syndrome may experience esophageal webs, dysphagia, and iron deficiency
anemia. [4] Retinal hemorrhages and exudates may also be observed,
especially in individuals with severe anemia. Although rare, splenomegaly in
individuals with iron deficiency anemia likely results from other causes. [5, 3, 6]
The following is observed in patients with severe uncomplicated iron
deficiency anemia
 RBCs are hypochromic and microcytic.
 The plasma iron concentration is decreased.
 The iron-binding capacity is increased.
 The serum ferritin concentration decreases.
 The serum transferrin receptor and erythrocyte zinc protoporphyrin
concentrations are increased.
 The bone marrow is depleted of stainable iron.
The classic combination of these laboratory findings is observed only in
severe and uncomplicated iron deficiency anemia that presents in patients
without infection or malignancy who are not receiving blood transfusions or
iron therapy. [3] Serum iron levels are often low in untreated iron deficiency
anemia; however, levels may be normal. [7, 8]
If patients with iron deficiency anemia receive iron medication before blood is
drawn, normal or high concentrations are typically noted. Even multivitamins
with low (18 mg) elemental iron may produce this result. Thus, 24 hours
before a blood draw for serum iron, all oral iron mediation should be stopped.
Parenteral injection of iron dextran may result in high serum iron levels (eg,
500-1000 µg/dL) for several weeks. [9] Infusion of sodium ferric gluconate or
iron sucrose causes increases in iron levels that last much shorter; [10, 11] these
infusions are unlikely to interfere with serum iron testing. [10, 11, 3]
Deterministic factors for plasma iron concentration include the following: [3]
 Absorption from the intestine
 Storage in the intestine, liver, spleen, bone marrow
 Rate of breakdown or loss of hemoglobin
 Rate of synthesis of new hemoglobin
When screening for hereditary hemochromatosis, serum iron, iron-binding
capacity, and transferrin saturation may be helpful.
Recent transfusions influence test findings.
The amount of circulating iron bound to transferrin is the serum iron level. The
circulating transferrin is indirectly measured by the total iron-binding capacity
(TIBC). Transferrin saturation in excess of 50% suggests a disproportionate
amount of iron bound to transferrin is being delivered to nonerythroid tissues.
If this continues for an extended time, tissue iron overload may be
observed. [12]
Indications/Applications
Serum iron testing is indicated for the following:
 Diagnosis of blood loss
 Differential diagnosis of anemia
 Diagnosis of hemosiderosis and hemochromatosis
 Evaluation of iron deficiency
 Diagnosis of acute iron toxicity particularly in children
 Evaluation of thalassemia and sideroblastic anemia
 Monitoring the response to therapy of anemia [2]

Considerations
Serum iron testing does not reliably determine iron deficiency or identify
hemochromatosis or other iron overload states. TIBC, transferrin saturation
percentage, and ferritin levels are recommended measurements in these
settings. Oral contraceptives increase the iron level. Iron dextran elevates
serum iron levels several weeks. Ingestion of even small amounts of iron may
transiently increase serum iron levels. Patients undergoing iron chelation
therapy (deferoxamine) may have inaccurate serum iron test results.
Diurnal variation is observed with serum iron testing; normal values are found
in the mid-morning, low values are found in mid-afternoon, and even lower
values are found near midnight. Diurnal variation disappears at values below
45 µg/dL.