My dad has just collected his latest iron studies prior to call from GP at some point today.
Would you mind taking a look and interpreting please. Have tried to use the Polish calculator to work out percentages but there’s an error and I can’t use it.
23/11/22
CRP <4 (0 - 9)
Ferritin 46.2 (22 - 322)
Iron 17.3 (11.6 - 31.3)
Transferrin 2.59 (2.15 - 3.65)
% iron saturation 29% (16 - 50)
2/09/22
CRP <4 (0 -6) ref change
Ferritin 23 (22 - 322)
Iron 22.5 (14 - 31.3) ref change
Transferrin 2.53 (2.15 - 3.65)
% iron saturation 39 (16 - 50)
Would appreciate if anyone could comment quite soon as call between now and 1pm.
Would’ve posted results
sooner but he was unable to see them till this morning.
Thank you.
Does anyone have a different % calculator they can share please? Not the one that just does thyroid function though.
Thanks again.
Forgot to say he’s supplementing daily with Thorne iron 26mg.
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musicaljune
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Optimal iron panel levels according to rt3-adrenals.org/Iron_test_... are (but don't expect GP to agree, they just want to see a number within a range):
Serum iron
• 55 to 70% of the range
• higher end for men
TIBC (total iron binding capacity) or Transferrin
• Low in range indicates lack of capacity for additional iron
• High in range indicates body's need for supplemental iron
Saturation
• optimal is 35 to 45%
• higher end for men
Ferritin
• Low level virtually always indicates need for iron supplementation
• High level with low serum iron/low saturation indicates inflammation
or infection
• High level with high serum iron and low TIBC indicates excess iron
• Over range with saturation above 45% suggests hemochromatosis
Forgot to say he’s supplementing daily with Thorne iron 26mg.
Was this left off for 7 days before the test, and was test done after a 12 hour fast?
Interesting what you say as GP recommended he doubles his iron even though he’s low in transferrin.
I'm not an expert on iron, it's very complicated. However, if I was looking at an iron panel I would take more notice of serum iron and saturation, I'm not saying I'm right, just that it's what I would do.
Any comments on why, when his ferritin is rising, iron saturation and iron are falling?
Ferritin can rise with inflammation. CRP is an inflammation marker and to put the result as <4 isn't at all helpful. It could be really nice and low as 0.something but it could be as high as 3.9 and and that would be a big difference with the 3.9 showing that there is some inflammation compared with a much lower result, but if they don't show the actual result it isn't helping you understand the ferritin result.
Thank you SeasideSusie, I hadn’t thought about CRP like that and although ferritin rise IS most likely due to now consistently taking his iron (and I say that because it’s roughly commensurate with what you’d expect it to be given the length of time and the quantity of supplementation) what you say is a very good point which means he can’t be certain inflammation isn’t responsible for ferritin rising and if inflammation IS the cause, what’s the cause of the inflammation???
He has FBC result too, is that worth posting? Is there an admin whose “subject” is iron because could it be that increasing his dose is the wrong thing to do?
Had a thought He was really unwell with his Covid booster. If he did have some inflammation, could a Covid booster cause it?
Just my thoughts, but if his ferritin is rising as a result of taking iron, then I would expect to see a rise in his serum iron and saturation too as a result of the iron supplement.
if inflammation IS the cause, what’s the cause of the inflammation???
Unfortunatey CRP is a non-specific inflammation marker so there's no way of knowing.
He has FBC result too, is that worth posting?
Is anything out of range or drastically different from previous FBC?
White blood cells elevated can indicate infection which would also be a possible cause of inflammation, so have any of the WBC results gone from his normal level to high?
Is there an admin whose “subject” is iron because could it be that increasing his dose is the wrong thing to do?
No, we're all just patients with our own experiences which might differ from someone else's.
I don't think increasing his iron tablets is the wrong thing to do because his serum iron and saturation have dropped which, to me, suggests he should carry on and possibly increase dose, but it's important to keep a regular check on his levels.
If humanbean is around she might comment.
Had a thought He was really unwell with his Covid booster. If he did have some inflammation, could a Covid booster cause it?
I think too much is unknown about the Covid jabs and what effects they might have, certainly some people have been affected by them in one way or another so maybe it's a possibility, who knows?
SeasideSusie, thanks. Will look more closely at his FBC.
I think it’s a good idea to keep supplementing iron in the relatively low dose by doubling his Thorne bisglycinate as GP recommended because since he became consistent in taking it he’s no longer breathless on minimal exertion and returned to the gym yesterday.
I don't think you have enough time to make use of it, but my vade mecum has a section on various calculators available (without charge) across the internet.
You would have to look round to find the best for your purposes. Maybe allow you to prepare fopr the next test(s)?
helvella - Vade Mecum for Thyroid
The term vade mecum means:
1. A referential book such as a handbook or manual.
2. A useful object, constantly carried on one’s person.
Please don't get put off by the number of pages!
Nor by the fact it is targeted at people interested in thyroid issues. Much of its contents could be of use to many involved in health issues. Things like abbreviations, lists, general reference information, an Appendix of links to many useful websites.
And do keep up to date. I edit it frequently- sometimes trivially, sometimes extensively. If your copy is more than a few weeks old, please download it again. (You must download - not just view in a browser- for the Table of Contents to work.)
In particular, it is not intended that you sit and read the document. Just that you download it and know you can look things up.
If there is anything you'd like me to add, let me know.
Iron 22.5 (14 - 31.3) ref change 49.13% through range
Transferrin 2.59 (2.15 - 3.65) 29.33% through range
Transferrin 2.53 (2.15 - 3.65) 25.33% through range
% iron saturation 29% (16 - 50)
% iron saturation 39% (16 - 50)
.
This reply is going to be too late to be helpful with your father's GP but it might be useful for something... I'll probably end up repeating a lot of what SeasideSusie has written already.
I'll be using this link as my guide to what are optimal results for most of the results :
CRP - I notice that the reference range has increased for CRP. Since CRP is a measure of inflammation (which doesn't tell you where the inflammation is) I'm suspicious about the fact that the reference range has been widened. Patients are never told whether this is due to the lab using a new analyser or whether the medical profession has decided that they don't need to pay attention to inflammation numbers that are 9 or under rather than 6 or under. In other words I wonder if the change in reference range is to save money and hassle for doctors and labs.
When I first started looking at CRP numbers some years ago the range was 0 - 5 and optimal was considered to be a result less than 1 i.e. the smaller the better. Whatever the truth, a result smaller than the lab machine can measure suggests that inflammation is unlikely to be a major issue if it is within range, but also suggests that the lab who did the test doesn't have a very good test machine since they can't give very accurate results at the low end of the range.
Ferritin
When inflammation is high it will affect the level of ferritin in the blood. High inflammation leads to the body storing more of the body's available iron in ferritin, and I believe it may also reduce the body's absorption of iron as well.
To find out more info about what ferritin is used for in the body see this link - it's old but a useful read :
Forgot to say he’s supplementing daily with Thorne iron 26mg.
Your father's ferritin has increased from bottom of range to a higher - but still dreadful - level in 9 weeks. If he can tolerate more iron he might want to try taking one iron tablet twice a day. It must be taken four hours away from any thyroid hormones.
There are far more iron supplements available than people realise. As a rule of thumb the higher the dose of iron per tablet the fewer people can tolerate it. Ignore the stuff about pregnancy in the next link.
As regards ferritin, men generally are "allowed" a higher level of ferritin and iron than women, until women are in their 60s or over when the ranges are the same as for men.
I would suggest that people with thyroid disease should be aiming for 50% - 70% through the range. Note that NICE now recommends that ferritin should be a minimum of 30, so the range for your father's ferritin test is out-of-date.
A serum ferritin level of less than 30 micrograms/L confirms iron deficiency.
50% of 30 - 322 = 176
70% of 30 - 322 = 204, suggesting that optimal for your father is 176 - 204.
Serum iron - Your dad's result has dropped from roughly 49% down to 29%.
Optimal for serum iron is 55% - 70% - higher end for men, so 60% - 70% sounds reasonable i.e. 24.32 - 25.39
Given that ferritin has risen slightly and serum iron has dropped quite a bit this would suggest that your father might have some inflammation or infection after all, despite the negative CRP result, and he may have developed Anaemia of Chronic Disease. Or has he changed his diet or been ill in the last 9 weeks or had a Covid jab? Does your dad lose a lot of blood thanks to piles? Could he be losing blood in his poo? (I don't need to know the answers to these questions myself - they are just something for you to consider. ) Illness e.g. a cold or flu or Covid will reduce Iron and increase Ferritin.
Transferrin - I always assume optimal for this is roughly mid-range based on this from the optimal results link :
TIBC (total iron binding capacity) or Transferrin
• Low in range indicates lack of capacity for additional iron
• High in range indicates body's need for supplemental iron
Your father's low in range result could also suggest that he has Anaemia of Chronic Disease.
Having said that, though, my own Transferrin and TIBC have always been low (well below mid range or even below bottom of range) no matter how good or bad my iron and ferritin are.
I've seen other members show Transferrin (or TIBC) results that suggest the body has plenty of iron when clearly the other results suggest there is too little iron.
Please note for future reference that very low iron/ferritin can cause chest pain. Obviously heart attack must be ruled out if that happens, but if no heart attack is discovered then it could be the iron issue and/or undiscovered bleeding.
• minimum saturation of 30% required to successfully treat with T3
• Low, beginning doses of T3 can be started with saturation at 25%
Your father's results were closer to optimal before he started taking iron supplements, at least for serum iron, transferrin and iron saturation percentage.
Your father could continue to take one or two tablets per day of the iron supplement he is already taking for, say, a couple of months, then. What I suspect might happen is that ferritin will rise, serum iron will fall, transferrin or TIBC will fall, iron saturation percentage might fall.
So this is a conundrum that happens to many people. They need more iron, but taking more just pushes more iron into ferritin and lowers the other results.
I think it might be worth asking your father to continue taking one or two tablets a day of the iron supplement he's taking for another two months, see if my prediction comes true, and then stop the iron if it does. If he starts to feel ill, then stop them.
The other possibilities I can think of are that your father could have an iron infusion - but there could well be an age limit on this (although I can't find evidence of one), and I'm dubious about the suggestion myself. The older someone is the more likely they are to have hidden cancers or infections somewhere in the body - and iron feeds cancer and viruses and bacteria.
Can’t say enough about how helpful this is, humanbean. I’ll need to read it a few more times to fully understand.
It’s a tad disappointing that iron and saturation have fallen further and added to the conundrum but I think you’re right, continuing and increasing the dose for a short period of time and then retesting might give an indication of what’s going on.
He had the covid booster prior to the test and was extremely unwell. So much so that we were saying he might just as well have foregone the booster and risked a dose of covid! I realise that’s a flippant thing to say but it’s quite possible that if he DOES have any inflammation then covid COULD be responsible. No way of knowing at the moment.
PS are you able to explain how to use the bold/italic/underline function?
He had the covid booster prior to the test and was extremely unwell.
Snap! I got Covid a year ago, before getting any jabs. Horrendous experience. I have had three jabs since. The first caused no real problems, but the second and third were just like having Covid again, although for a shorter time. The last one made me seriously unwell for about a week. I won't be having another one, and I'll just hope for the best.
...
As for bold, italic, and underline, when you write a Post or a Reply, at the bottom you'll see B, I, U ( for Bold, Italic, Underline) When you want to start typing in Bold you can just press the B and anything you type will come out bold. When you want the Bold to stop you just press the B again. Alternatively, you can just type normally, and then highlight the word(s) you want to put in bold (as you would if you were going to copy something) then press the B. The same instructions apply to I and U. You can also use B, I and U together on the same words.
Bold alone, Italic alone, Underline alone.
Bold + Italic, Bold + Underline, Italic and Underline
Bold, italic, and underline
...
It might be worth searching for lists of iron-rich foods and including them in the diet. (Particularly heme-iron. Iron supplements contain non-heme iron)) Liver is an obvious one, as is black pudding, but there are many foods which contain iron.
There are also foods which actually reduce iron absorption e.g. coffee, so they might need to be avoided when eating iron-rich foods - perhaps eat/drink them a few hours apart.
Also vitamin C helps the body to absorb iron.
You might find this website has some useful tips :
I wonder how many are now avoiding the booster? I’ve had 3 in total but haven’t had a fourth because I’m nervous about doing so.
I was unaware that coffee affects absorption so my dad definitely won’t know and he drinks heavy duty espresso!
Thanks also for the helvella article, really informative but one thing I’ve never understood is why manufacturers don’t state on the product how much of the quoted iron content is actually elemental. Thorne bisglycinate 25mg for instance, how much of that 25 is elemental and is elemental the important portion of the product and if so what’s the rest of the it?
In helvella’s chart below, 200mg ferrous sulphate is 65mg elemental, what’s the remaining 135mg and what use is it?!!
helvella’s chart:
200 mg Ferrous sulphate 65 mg elemental iron
300 mg Ferrous gluconate 35 mg elemental iron
210 mg Ferrous fumarate 65-70 mg elemental iron
75 mg Ferrous bisglycinate 15 mg elemental iron
Thank you for this very useful info helvella.
Thank you also humanbean for the BIU instructions. It works!
Pure ferrous fumarate has an iron content of 32.87%, therefore one tablet of 300 mg iron fumarate will contain 98.6 mg of iron (548% Daily Value based on 18 mg RDI)
The elemental iron levels in any iron supplement tells you how much pure iron there is in each tablet. Nobody really needs to know about the other constituents, but can look it up if they are interested.
...
I just wanted to point out that if your father suffers with gut problems when taking iron supplements the most easily tolerated for most people are ferrous bisglycinate and ferrous fumarate. I could never tolerate ferrous sulfate, which is very common.
But I did tolerate ferrous fumarate 210mg which I bought in packets of 84 from pharmacies (without prescription). Each tablet contained 69mg of elemental iron.
The official maximum dose for that according to the BNF is 1 tablet, three times a day, but few people need to take that much to raise their iron. However you have some people who struggle to absorb iron at all. It took me nearly two years to get my very low in range ferritin up to mid-range. Even then my serum iron was still very low in range (having been under range).
I've probably given you this reply about iron supplements available in the UK before :
I've probably given you this reply about iron supplements available in the UK before
I don’t remember if you specifically gave it to me or remember what was in it but I’ve seen it before. Reading it again just now I found it a very interesting post.
Thank you for all of that but I really just wanted to know if the rest was any use because if the manufacturers don’t state the amount of elemental iron in the product the buyer doesn’t know how much useful stuff they’re getting.
My dad tolerates iron bisglycinate and if the figures are to be believed and if it isn't inflammation causing ferritin to rise then he’s absorbing it just fine but we don’t know if has any inflammation and if he did we wouldn’t know what was causing it.
I think if he just doubles his dose for now, in a couple of months we might get a better picture.
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