Iron ranges changed

[Batty1]

Has anyone noticed Iron Levels changed? Mine went from range 30-100 to Range 13-100. My recent ferritin was

Curious

[FallingInReverse]

Iron is like that. Measured in the blood and can change based on an iron rich meal and I’ve seen it jump equal amounts below range and above range in 4-5 weeks periods.

How stable is the test of your iron panel results?

[helvella Administrator]

Don't know if you have noticed me posting this:

NICE

Clinical Knowledge Summary > Anaemia - iron deficiency

Last revised in September 2023

Serum ferritin level is the biochemical test that most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

cks.nice.org.uk/topics/anae...

Obviously, with NICE being a UK organisation, this applies only in the UK.

But we currently still have labs which have ferritin reference intervals starting much lower - like 10 or 15.

Thus we have utter inconsistency between labs.

And this seems to be true around the world.

If the lab uses the same units for ferritin (micrograms/L) then 20 is dreadful and it matters not whether the lab says 1, 20 or 30 - they are all dreadful.

It is even worse when you consider that ferritin rises when you have inflammation. Therefore, if you have current inflammation, that 20 is already misleadingly high due to inflammation and your level without inflammation would be expected to be even lower.

[Batty1 in reply to helvella]

I know Im anemic based on everything I read …. However my doctors says Im not because my level is above 13.

Are you saying Im actually more anemic because of my high inflammation?

sorry helvella haven’t been here much last couple of weeks.

[csj113 in reply to Batty1]

If you have low ferritin but normal haemoglobin then the Dr is correct, you are not “anaemic” (in this context anaemia is low haemoglobin).

Your ferritin on the other hand, IS extremely deficient at 20 and your GP needs to look at the latest guidelines.

You can have ferritin deficiency without anaemia.

Treatment is same as for anaemia though - oral or infused iron.

[Pray4health in reply to helvella]

That is very interesting to know helvella, that Ferritin rises with inflammation. I reached levels of 10 and under in the past but often am under 20 and it has been disregarded. This can explain how often people are misdiagnosed with illneses for example chronic fatigue. Is there an article about it? I would like to read a bit more about it. Thank you!

[helvella Administrator in reply to Pray4health]

I don't have any good links to hand.

This includes a paragraph but most of the paper is behind a paywall:

What is the next investigation?

Interpreting raised serum ferritin levels

BMJ 2015; 351 doi: doi.org/10.1136/bmj.h3692 (Published 03 August 2015) Cite this as: BMJ 2015;351:h3692

Ferritin is an intracellular iron storage protein and a marker of iron stores. Normal serum ferritin levels vary between laboratories but generally concentrations >300 µg/L in men and postmenopausal women and >200 µg/L in premenopausal women are regarded as elevated.1 Low ferritin values provide absolute evidence of iron deficiency.2 Raised levels often indicate iron overload, but they are not specific, as ferritin is an acute phase protein and is also released from damaged hepatocytes; thus levels are elevated in inflammatory disorders, liver disease, alcohol excess, or malignancy.3 4 Raised ferritin levels therefore require further investigation in primary care to determine if they truly represent iron overload. It is critical …

bmj.com/content/351/bmj.h3692

The common term is "acute phase reactant".

[FallingInReverse]

Batty, do you have any other iron related test results? You’ve asked about how iron can behave, but obviously just that one number - or any single number - can’t tell you about your iron status.

Let us know more info if you have it.

[Batty1 in reply to FallingInReverse]

No this is the other issue she did not do a complete iron panel this time only Ferritin and Iron …. Ferritin was 20 and Iron was 53 both in the range…. In January she did a complete iron panel Ferritin 17.8 and Iron 70 (37-145) Im not sure why Iron level would drop.

[FallingInReverse in reply to Batty1]

That all makes sense, but of course is missing half the picture. Are these the only 2 iron related results you e ever had.

Are you trying to determine a course of action? Or just curious why iron jumps up and down?

[Batty1 in reply to FallingInReverse]

In January she did the complete iron panel … This time only Ferritin and Iron I did have a test with my rheumy back in Jan 2 weeks after my regular doctors test and her test revealed low blood clotting levels ( which I believe) I get cut even a small scratch leaves me bleeding for 15 mins … for context last week I went to restroom pulled up my pants scratched my leg and I started to feel liquid running down my leg when I looked at my feet area (confused) I had a puddle of blood (not kidding) on the floor It took 15 minutes for it to stop bleeding … simple surface scratch thats all it was… My recent blood draw also bleed for 15 mins a lot for a needle prick…. Something seems off.

[FallingInReverse in reply to Batty1]

Agree the bleeding/clotting is something to look into , I have no experience there!

But your iron and ferritin can easily be explained, although would need other parts of the iron panel for a full understanding.

[helvella Administrator in reply to Batty1]

I suggest you at least have a look at this paper - though there other resources it is a reasonable first step:

Haematologica. 2020 Aug; 105(8): 2032–2037.

Prepublished online 2020 Jun 18. doi: 10.3324/haematol.2020.255117

PMCID: PMC7395262

PMID: 32554559

Acquired von Willebrand syndrome: focused for hematologists

Massimo Franchini1 and Pier Mannuccio Mannucci2

In patients with hypothyroidism, the syndrome is caused by the decreased synthesis of an otherwise qualitatively normal vWF, and this can be reversed by l-thyroxine therapy.

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

[humanbean]

I'm writing this from a UK perspective. Some of the links I give may be unavailable outside the UK.

The guidelines in the UK say that a ferritin level below 30 micrograms/litre is indicative of iron deficiency.

1) cks.nice.org.uk/topics/anae...

Quote from the above link :

Serum ferritin level is the biochemical test that most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency. However:

Ferritin levels are difficult to interpret if infection or inflammation is present, as levels can be high even in the presence of iron deficiency.

Ferritin levels may be less reliable in pregnancy.

People can be iron deficient with or without anemia. If someone is not anemic but is iron deficient the deficiency should be treated. Making patients wait until they are anemic before treating iron deficiency is sadistic, particularly since iron supplements are not usually expensive and don't need a prescription, and so cost shouldn't be a deciding factor.

How is anemia defined? In the UK doctors look at hemoglobin to diagnose anemia. If haemoglobin is under range then the patient is anemic. The World Health Organisation also defines anemia - see page 3 in this document :

2) iris.who.int/bitstream/hand...

Note underneath the table in the link above that it says (about "mild" anaemia) :

"Mild" is a misnomer: iron deficiency is already advanced by the time anaemia is detected. The deficiency has consequences even when no anaemia is clinically apparent.

Some other links on iron deficiency without anemia :

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

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

Links on how anaemia and/or iron deficiency affects people who are hypothyroid :

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

jstage.jst.go.jp/article/en...