Pernicious Anaemia Society
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Seeking help with iron blood test results

Hi everyone. I’m a newbie here, diagnosed a few days ago with B12 deficiency and hypothyroidism. I’ve learned so much since – and have a lot more to learn – about each condition, and want to thank every single person who has taken the time to share their experiences and knowledge, which have helped me begin to understand these conditions.

One of the first things I learned was to ask for a print-out of my blood test results. I’m quite confused about the iron levels and would be grateful for any guidance. Basically, my transferrin saturation index is high, though my ferritin levels are (I think) lower than optimal. Should I be worried about haemochromotosis, which I understand can be linked to hypothyroidism, or is this a known pattern to do with untreated B12 and/or hypothyroidism?

I’m female, 49 years old and still menstruating regularly. I wasn’t on any sort of supplements when these bloods were taken, though I was just recovering from an inner ear infection which might have skewed some results. I’d be very grateful for any insight.

Transferrin saturation index: 46% (range 16.00-50.00%)

Serum transferrin: 2.18 (range 1.80-3.60)

Serum iron level: 22.1 (range 11.00-30.00)

Serum ferritin: 40.8 (range 10.00-200.00)

In case it's directly relevant, my B12 level is 158.

8 Replies

My transferrin was over 50 when I was first diagnosed as B12 deficient, but ferritin was high too. I think transferrin becomes saturated with iron when iron is not being used effectively in the body. In your case, you are at the lower end of normal range for other iron study results so you are bordering on becoming iron deficient. My transferrin saturation reduced to within normal limits after B12 supplementation, as did my ferritin. My blood count also increased, although I had a good level of haemoglobin to start with and was never anaemic. I think this shows I was better able to use the iron stores when I had more B12. After B12 supplementation, I would recommend getting your iron study rechecked. Your iron requirement will increase with the added B12, especially if you are anaemic, and you may become iron deficient.


Transferrin is a binding protein that moves iron around. Think of it like the chairs on a ski-lift. Iron are the skiers that get onto the lift. When there are not many skiers the chairs are mostly empty, which means there is plenty of capacity for more skiers to get on the lift. Normally, your transferrin levels increase when your iron decreases and vice versa. If your iron levels dip too much, you'll become iron deficient which would result in anemia. In hemochromatosis, both the transferrin and the ferritin levels become too high. That doesn't look like a danger for you.

This webpage explains how some of the iron tests relate to each other:


I think I fundamentally misunderstood the way the saturation index worked - I thought it was precisely the opposite, and your chair lift analogy really helped me to get my head around it.

When trying to understand such a high saturation index reading I read that ferritin levels were low in the early stages of haemochromatosis, and guess I spiralled myself into a bit of a panic!! Thank you so much for taking the time to answer. :)


Thank you so much for taking the time to answer, Secondchance. I could see I was on the low end of all the ranges, but the saturation index being so high absolutely threw me. I now get how it works! :)


No problem

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Hi, my ferritin has always been at the low end of the range, but doc has always insisted it has had no bearing on my health (15 years of M.E symptoms!). The breathlessness, dizziness, general ill feeling, cystitis got pretty unbearable before Christmas and my ferritin was found to be 12 with the range being 23-300. I presumed iron was always being tested in the past by having a full blood count, but reading all the info from the extremely knowledgable people on here has taught me otherwise! They've suggested getting ferritin reading at least between 70-90 for the thyroid to work efficiently, so can see that yours is just half of that. Also, ferritin levels can apparently read higher than they actually are if you have inflammation or infection, so perhaps having just got over an ear infection there could be a possibility the result was higher than it actually would normally be. In a not very scientific explanation, I think the bacteria feeds on iron, so our clever bodies work hard at temporarily putting it into storage as ferritin, to stop the bugs from using it.

I'm trying hard to increase mine and hope it will improve a lot of symptoms. I was also recommended on here to have a vitamin d test (cost £28) if doc won't do it, don't know if you've had that, but have read it is commonly low with thyroid symptoms and again needs to be in midrange. Mine came back quite low, so was worth checking! At least if you can get levels of these nutrients up it gives your thyroid and body the best chance of performing well I guess.

As much as you don't want these conditions, at least it is incredibly encouraging to have some printed results in front of you that explain why you are feeling so rotten and that you can start to treat. The people on here are incredibly helpful and so willing to share and help. Hope you notice a difference as you get the help you need, am sure you will...Jo

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Jo, I'm sorry to be so late in replying to you - I've been too exhausted to sit at the PC this week, pathetic as that sounds. :) Thank you so much for this detailed answer; I didn't know that about Vitamin D and I'm going to see if my doctor will test me for it. If not, I think it's worth going the paid test route just to get as much information as I can on what's going on with my body.

Your answer has also helped me to understand better just why my ferritin level needs to be up - I'm definitely going to talk to the doctor about it. If she doesn't think it's a cause for concern, I guess it'll be a case of taking iron supplements off my own bat, and seeing if I can get my iron levels tested a bit further down the line to monitor their effect.

I'm sorry to hear you've been having such awful symptoms for so long and am keeping my fingers crossed that raising your ferritin levels will make life very much easier for you. Surely it has to make some difference - your level sounds incredibly low.


Hi Impala, just a quick reply, teat time calls again! Thanks for your reply, don't apologise, just sorry to hear you've had a rough week and hope this one is better one...exhaustion is so frustrating, when you know what you want to do, but it seems to take days to complete! I ordered the test via Better you, it was a pinprick test and they were very quick with results, if your doc doesn't test.

I guess you've found both the Thyroid and B12 Healthunlocked sites, so much helpful information...thanks for your good wishes and hope you soon start having some better days...:) Jo


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