Why is iron over-range yet TIBC shows a need ro take more please?

[Jo5454]

I'm wondering if the following could be explained please?In past ferritin has been 48 ug/L & obv considered normal by Dr. On doing private iron profile results like the following have come up,on more than one occasion.

Iron 24.19 (6,6,-22)

Tibc 115.49 (41-77)

Transferrin saturation 20.95% (20-55)

Kind folk on here have told me I need to take iron. I'm just wondering why iron goes overhangs, yet isn't used if TIBC is displaying a need for more iron please?

No Dr as of yet will test iron profile, I usually do.pinpricjs, but for some reason countless attempts with 3 companies has resulted in haemolysing everytime frustratingly.

Ferritin is now back to 48,even though I've been taking iron, just finishing loading dose today & aware I need to have adequate iron/ folate to ensure maximum use of b12. Mch over range.

Many thanks ...

[FlipperTD]

Oh dear... [Scientist, not medic.]

One of many causes of frustration in labs is the receipt of haemolysed samples. Why does this happen? Well, temperature abuse is one possibility. Frantic shaking of the sample in the tube will do it. Prolonged storage is another. Bad sampling technique is yet another. Squirting blood through a needle into a sample vial will do it with ease.

Finger prick collection is another problem. Not every time, but it happens. Excess squeezing of the finger to get enough blood is often suspected to be the cause. Red cells are sensitive little girls and boys, and need treating with care. A well-taken sample by a competent phlebotomist who knows how to handle the sample reduces the risk of this happening, and ideally it's best done in the place where the lab is based too. I realise this isn't always possible, but you get better quality results by shortening the distance and the time from vein to lab.

Good luck!

[helvella in reply to FlipperTD]

I'll point out that my personal experience was better when pretty much all blood draws were done at the phlebotomy unit in the local hospital. At least nine out of ten were extremely proficient.

Then someone realised GP surgeries were receiving some recompense for blood draws they were not doing!

GP surgeries trained receptionists (and cleaners, handymen, and anyone who paused for a few seconds) to do phlebotomy. Unfortunately, many just were not cut out to be proficient at the role.

And instituted appointment systems rather than turn up and wait (which I preferred).

Now the local hospital is not an option. (I have moved area so things might always have been different here.)

Blood can remain for hours before getting to the lab. I have no idea of any cooling or other precautions. When it could have been minutes when done at the hospital.

An unplanned and poorly implemented change to implement requirements of the accountants.

Not sure if anyone has actually done a formal investigation into the impact on individual patients and particular samples?

[FlipperTD in reply to helvella]

Organising a hospital-based phlebotomy service is [or can be] an absolute nightmare. Ideally a walk-in-and-queue service, like we used to have with GP visits, was a sure fire way of getting what was needed. Phlebotomists are one of the lowest paid groups of staff.

Needless to say, if you turned up with a form from the GP, and your visit happened to coincide with a Warfarin Anticoagulant clinic, friction was likely. [Our biggest one was Thursday morning, when we'd have upwards of 100 patients to bleed, test and dose]. Some patients would arrive before 7am, when the clinic didn't start until 9am, to be 'first in the queue'. This made any attempt to audit the transit time through the clinic fairly pointless. Arrive at 7am, get seen at 9am; arrive at 8:45, get seen at 9:10... [been there, done it.]

Phlebotomy is one of the most crucial bits of lab service, and is grossly undervalued by many. It's an easily learned skill providing you have the right mindset, and done well, it's a huge benefit to the service. However, the folks doing it need the right training and education. [I could ramble on about this, but I'll spare you the details, other than to mention the experienced phlebotomist who 'developed a needle phobia'.]

[helvella in reply to FlipperTD]

Personal experience was that the warfarin people had appointments which left gaps into which 'others' could be slotted.

But I was always accepting of the wait because I could see that things were being done as fast as they could.

I guess new-gen DOACs have helped reduce the Warfarin load!

[FlipperTD in reply to helvella]

Oh, the new DOACs are a marvel. But there's still a lot of Rat Poison used, although it no longer kills rats!

[Jo5454 in reply to FlipperTD]

Thank you for your detailed explanation.! I was just wondering if something had changed in the testing of iron profile over the last year or so as its always worked perfectly pinprick wise up.until then,seems odd it's failed so many times. Also.other tests taken from same pinprick sample have worked ok?

Can I pick your brains further please, as u carefully explained the TIBC/UIBC is over range because it hasn't enoughnferritin to transport, but why has it used up.what there is of the 48, and why is the actual iron over range please? Many thanks...

[FlipperTD]

Argh! This gets more complex, and there isn't always a simple answer, or sometimes any answer at all.

It's always easier if all the tests are done by the same folks, on the same sample, in the same lab, but I accept that isn't always the case. In my lab, we performed IFAb for lots of other hospitals, and likewise, Epo levels. If the lab in use has changed methods or instrumentation for some of the tests, then that could explain why somethings do alter, and others don't.

TIBC is UIBC plus Iron. So, that's what's in transport. Ferritin is a measure of storage iron, and inflammatory conditions can cause the ferritin level to rise quite a bit. It will then come back down once the inflammatory crisis is over, but these things probably won't alter the Serum Iron and TIBC. But I'm well outside my comfort zone here. In iron deficiency, the TIBC does actually increase overall.

Iron is eventually stored in tissue. It gets stored in the bone marrow for instance, in the form of haemosiderin. It is also stored in other tissues. If there's excess iron to store, it can be deposited in skin and other organs. We don't have an effective method for excreting excess iron, and this probably comes down to iron being an important trace element that's quite scarce in nature. The only really effective ways of losing excess iron come down to blood loss. [There are pharmaceutical products that can help us excrete excess iron, but that's another story.]

Good luck!

[Jo5454 in reply to FlipperTD]

Thanks oodles! So it def seems like iron deficiency is an issue,even tho iron is bit too high. Thank you for jumping out of your comfort zone & explaining,muchly appreciated and I'll prob try another tibc test,by private nurse if it has to.come to that...I've a sinking feeling I need to be very well armed & as we all do want to give everything best chance to work!