Help sought with iron panel, please

[Thalia56]

I took an Advanced Thyroid panel with Medichecks on 9th February, and my ferritin came back much lower than optimal, to the point where their GP commented that it could be increased:

Ferritin 51.4 (30-264) 9.15% through range

I followed the advice I've seen posted here over the years and took a (Blue Horizon) iron panel test before supplementing. Date of test 28th February:

Iron 17.7 (5.8-34.5)

UIBC 29.3 (24.2-70.1)

TIBC 47 (45-81)

Transferrin saturation 37.6% (20-50%)

Ferritin 46.80 (13-150) [24.67% through range]

I'm a little surprised how different my ferritin results are between tests. Blood was drawn (fingerprick test in both cases) at the same time of day, though Google tells me that ferritin levels can change by up to 27% day to day in women.

I don't understand iron panels, despite trying to read up on them, and would be very grateful for help as to whether

(a) it's advisable for me to take iron supplements to raise my ferritin (even if the latter test is accurate, it's still below optimal, I believe).

(b) anything else jumps out.

I was very confused as to why my TIBC is so low in range with a fairly low ferritin, but Google tells me that low protein levels in blood can cause low TIBC, and my protein levels are below range. If I've got this wrong, I'd be very grateful for a steer in the right direction.

Thanks so much for any help.

[FallingInReverse]

Have you had any cold/flu/any other infection recently?

And what time of day were each test taken?

[Thalia56 in reply to FallingInReverse]

Thanks so much for answering. Both tests were taken at 7.30am. As for an infection, I’m housebound and don’t see anyone, so I can’t have caught anything. The only thing I’ve had going on lately is something very strange with my mouth - my gums feel sore, my mouth dry, and I had a swollen lip a few days ago. REALLY annoyingly, I can’t remember if this had started when I had the first test done.

[FallingInReverse in reply to Thalia56]

Quick reply - inflammation increases Ferritin. That’s why a full iron panel tests CRP as a measure of inflammation… did you get that tested here?

Since you have consistency with timing likely that’s not a factor in the variance. Ferritin varies WITHIN a day, don’t think it varies day to day. Another reason for variance is the margin of error for any test.

And to your point, in either case it’s too low.

Most important along with the ferritin is the iron. Which shows a little less than half way through range if my mental math is right. Which means you have room to supplement iron but not a lot and not for long. You want to target 55-70% or thereabouts and no higher.

I’m guessing you don’t know how you might respond to iron supplements - fast or slow, so start conservative if you do and depending on what you decide test no later than 6-12 weeks after starting. Top/above range iron is toxic, regardless of your other deficient ferritin etc.

Your saturation number is fine - it tells you you have just enough iron for your T3 to do its job. Which is another indicator that your overall iron is not too low but could be a little higher.

All in all your iron is not dire, meaning you should supplement cautiously, and monitor frequently.

And therefor you - like many of us - have low Ferritin that needs to mainly be addressed by eating an iron rich diet, vitamin C to help it absorb, avoiding eating those iron food with iron blockers like calcium, coffee, etc.

[Thalia56 in reply to FallingInReverse]

Thank you for such a wonderfully helpful and detailed reply.

Unfortunately, this iron panel didn't include CRP. When I re-test after six plus weeks, I'll ensure I order one that includes CRP so I can see if the ferritin might be related to inflammation.

Thanks too for explaining about the saturation figure and the T3 link. I managed after a while to get my head around thyroid tests, but the iron panel remains a mystery to me! I'll do some cautious supplementation and see what happens.

Thanks again.

[FallingInReverse in reply to Thalia56]

Please let us know your supplement plan, we can help on type and dosage too.

[Thalia56 in reply to FallingInReverse]

You're very kind - thank you! The tablets I have are 34mg iron, which the back of the packet says is from 103mg ferrous fumarate.

[FallingInReverse in reply to Thalia56]

Everyone absorbs iron differently, so the important thing now is for you to start tracking/understanding for yourself.

So, Feb 28 Iron was 17.7

Was that having taken that 34 mg ferrous fumate, and for how long?

Does it agree with you? Any stomach upset ?

Also - have you been aware of any foods you eat around when you take the iron pill such as coffee/tea or calcium-rich, or eggs? Do you take with vitamin c ( like a cup of juice)? And how consistent have you been?

[Thalia56 in reply to FallingInReverse]

I had taken the 34g iron tablets, one per day, for four days prior to the Feb 28th test. I then read further and realised I should do an iron panel before supplementing, so I took no iron for the three days immediately before the test.

No stomach upset; no constipation. Thankful for both!

I take it with a glass of grapefruit juice, hoping that provides some Vitamin C, and usually have a slice of toast, butter and marmite and coffee about half an hour later, so I'll need to look into that.

[FallingInReverse in reply to Thalia56]

Just a reminder that I’m not a doctor : ) I will also say I am more conservative in my approach to iron. I’d rather start lower and test earlier to see how I absorb, vs starting high. I can see it both ways, but I do lean conservative.

Do you plan to talk to your doctor and see what he recommends?

There are two things that I’ll comment on. You’re not rock bottom deficient like some of us, you have some room to supplement. Iron moves more quickly than ferritin, the latter can takes months/years. Iron is your usable iron, ferritin is like your storage cabinets.

Consider that our bodies shed 2-4 mgs of iron a day… and we only absorb about 10% of those pills. So at 34 mgs a day, you can do the math but it’s just enough to maintain if you absorb efficiently, but not enough to break through the anemia.

I found this article to be excellent:

ncbi.nlm.nih.gov/pmc/articl...

Here’s a clip from the article:

A common generic approach for iron deficiency in adults consists of a daily dose of 150-200 mg of elemental iron. This approach entails prescribing one ferrous sulfate tablet 3 times daily since each tablet contains approximately 60 mg of elemental iron. Assuming that 10% of the iron is absorbed, the hemoglobin concentration may fully correct after 4 weeks in patients with moderate, uncomplicated iron deficiency… To further replenish iron stores, some recommend continuation of this regimen for several additional months. Unfortunately, this approach often fails. Up to 20 percent of patients experience some type of gastrointestinal discomfort while taking 180 mg of elemental iron per day using this regimen, and 30 per cent of some patient groups may self discontinue the medication.

re iron blockers:

there are other articles, but this one is good to show foods to keep away from iron.

livestrong.com/article/2843...

[Thalia56 in reply to FallingInReverse]

Thank you so much for all your help. I understand you're not a doctor, but you've helped me so much in my understanding and in linking me to further reading. I hadn't realised that one 34mg tablet is unlikely to do very much - it's rather important to know that!

I will be seeing my doctor in a couple of weeks, so will check that they're happy with the regimen I'm on.

Thanks again for all your time helping me with this.