Who knows about ferritin/ iron tests? Confused here! Do I need to do something? Help please!

[TaraJR]

I get confused with ferritin and iron results, as I can't remember how they work together. Ferritin is low, but haemoglobin is ok? My GP marked everything 'normal'. I'd be grateful for some explanation and advice on what to do please!

I have felt more tired. In fact absolutely exhausted a couple of times. And often SO cold. My thyroid levels are optimal, and last vitamin D was good, at around 100.

Recent GP and Medichecks tests were done within a few days of each other.

GP levels:

Total white blood count 5.3 10*9/L [4.0 - 10.0]

Red blood cell count 5.30 10*12/L [3.8 - 4.8] Above high reference limit

Haemoglobin concentration 138 g/L [120.0 - 150.0]

Haematocrit 0.421 [0.36 - 0.46]

Mean cell volume 79 fL [83.0 - 101.0] Below low reference limit

Mean cell haemoglobin level 26.1 pg [27.0 - 32.0] Below low reference limit

Platelet count - observation 243 10*9/L [150.0 - 410.0]

Neutrophil count 2.86 10*9/L [2.0 - 7.0]

Lymphocyte count 1.80 10*9/L [1.0 - 3.0]

Monocyte count - observation 0.42 10*9/L [0.2 - 1.0]

Eosinophil count - observation 0.22 10*9/L [0.02 - 0.5]

Basophil count 0.01 10*9/L [0.0 - 0.1]

Nucleated red blood cell count 0.00 10*9/L [0.0 - 0.1]

Serum creatinine level 73 umol/L [45.0 - 84.0]

eGFR using creatinine (CKD-EPI) per 1.73 square metres 72 mL/min/1.73m^2

Serum ferritin level 40 ug/L [23.0 - 300.0]

Medichecks results:

Iron 15.7 umol/L (5.8 - 34.5)

TIBC 45.4 umol/L (45 - 81)

UIBC 29.7 umol/L (24.2 - 70.1)

Transferrin Saturation 34.5 % (20 - 50)

Ferritin 54.9 ug/L (13 - 150)

CRP HS 3.25 mg/L (0 - 5)

[radd]

TaraJR,

Iron 15.7 umol/L (5.8 - 34.5). = 32%

TIBC 45.4 umol/L (45 - 81)

UIBC 29.7 umol/L (24.2 - 70.1)

Transferrin Saturation 34.5 % (20 - 50)

Ferritin 54.9 ug/L (13 - 150). = 30%

CRP HS 3.25 mg/L (0 - 5)

In your previous post we discussed how a FBC may indicate iron deficiency, and where humanbean also gave you an excellent detailed response.

Serum iron is 32% and ferritin 30%. However, your iron labs are unusual because both TIBC and UIBC are low so indicating elevated iron levels. I have read this can happen with certain anemias. Equally, iron binding capacity may decrease with liver issues common in hypothyroidism as transferrin is synthesised by the liver. There are also things that can influence test results. Transferrin saturation % is skewed by having both low TIBC & UIBC. (The TIBC equals UIBC + serum iron. T/S% is calculated by dividing the S/I by TIBC, x 100.)

Iron binding studies are important for the diagnosis of iron deficiency but given your previously discussed RBC results I would lean towards the low iron status defined by serum iron & ferritin levels. Also you are symptomatic and low iron can be both an effect but also a cause of hypothyroidism by encouraging higher levels of RT3, so decreasing levels of T3. This would mean your circulating 'frees' might show as adequate in test results but then be metabolised to inactive forms instead of active, thereby making you hypothyroid on a cellular level.

Low iron as well as low thyroid hormones levels (or thyroid hormones not working effectively) also effects thermogenesis and thermoregulatory functions, ie making you feel the cold more easily. In his book Dr P says another cause for anaemia in hypothyroidism is the generally low body temperature because for bone marrow to manufacture new blood cells it need to be at the correct temperature.

On the other side of the coin is effectively working thyroid hormones that boost metabolism enough to result in an increased need for iron due to increased stimulation of the whole erythropoiesis processes, ie RBC,s haemoglobin, etc. In this scenario catching iron levels up should eventually encourage the mechanisms driving erythropoiesis to level RBC markers out.

If I were you I wouldn’t supplement iron yet on those results because they don’t wholly make sense. If you have gut issues and low gastric acid, Betaine HCL + pepsin will replace, & help iron absorption (but don't take with PPI's or stomach ulcers.) Like wise drinking orange juice (or alcohol) with iron rich meals. Raising iron slowly will encourage better raising of transferrin as mechanisms renormalise.