Medichecks ferritin results and ranges

[KBird01]

Hi all.

I don't have a thyroid issue (this has been ruled out), but someone on the PAS forum suggested I post a query on here to see if anyone could shed light on this issue.

Having accessed my GP records late last year I discovered I had a long-standing ferritin deficiency, as defined by NICE guidelines (Below 30ug/l).

I hadn't picked this up, as my Medichecks results consistently showed readings almost double my NHS ones, even when taken within a short time period of each other. (See chart attached)

I see on here that I'm not the only person who has experienced this and wondered if anyone has any further info to share.

I asked them these questions below, but have just received the info contained on this web link in reply, which doesn't really answer any of these.

Medichecks results are consistently higher than NHS results, even when taken within a short time frame.

All tests were taken fasting, first thing on a morning.

No vitamin/iron supplements were taken for at least 3 days before a blood test.

The new Medichecks range is significantly different from the previous one. How do I now calculate results based on previous readings?

support.medichecks.com/hc/e...

My main concern is that Medichecks say they have revised their range with a lower range of 30 to align with NICE guidelines. Whilst my last test shows a higher figure of 89.2ug/l [30-264], their adjustment on my online tracker shows this at roughly the same level as my first test with them. This was in the same week I had a reading of 24 with the NHS. (See image attached in reply below)

I'd appreciate any thoughts on how to make sense of this and also how I monitor my ferritin levels moving forwards.

[KBird01]

Medichecks tracker as per post above...

Blood test results

[SlowDragon Administrator in reply to KBird01]

Your iron is very low

Have you had CRP tested

This is test for inflammation

High CRP can falsely raise ferritin

What are your actual thyroid results

ALWAYS test early morning, ideally before 9am and only drink water between waking and test

You need TSH, Ft4 and Ft3 plus vitamin D, folate and B12 testing too

[KBird01 in reply to SlowDragon]

Thanks  SlowDragon . Yes, I had CRP tested as part of the iron panel. This has never read as high. Here's the tracker and the last reading. I note again though, that Medichecks have changed the range from 0-5 to <3 for the last 2 tests.

According to my NHS results above, I've had low ferritin for quite some time, but Medichecks results consistently show as almost double those of my NHS results, hence my enquiry to them.

Sorry, the questions I posed to medichecks didn't show up on the image as I'd thought. I asked them:

Medichecks results are consistently higher than NHS results, even when taken within a short time frame.

All tests were taken fasting, first thing on a morning.

No vitamin/iron supplements were taken for at least 3 days before a blood test.

The new Medichecks range is significantly different from the previous one. How do I now calculate results based on previous readings?

All they replied, was with the link attached in my post above, which didn't answer any of those questions directly.

I've been supplementing with iron for around 6 months, but think my levels took a nosedive after a particularly active/strenuous walking holiday in early May. I've now upped my iron intake until I get on an even keel. I'm a vegetarian, so don't have sufficient in my diet. I'm also self-injecting B12 and taking a general multivit, including folate.

Re: thyroid - I had some tests around 18 months ago, which I posted on here, following advice on when to have the test, etc. I recall the general consensus was that I didn't have any obvious thyroid issues at that time.

Other than continuing with the supplementing for now, I'm not sure where to go for ferritin/iron panel tests in future, as Medichecks have consistently read as significantly over the 30ug/l stated in the NICE guidelines, even when my NHS results were around half this. Any advice on where to get a more consistent test would be appreciated.

[humanbean]

Could you possibly have Anaemia of Chronic Disease (or Anaemia of Chronic Inflammation - same condition just a slightly different name)?

irondisorders.org/anemia-of...

en.wikipedia.org/wiki/Anemi...

...

Doctors look at haemoglobin to decide whether a patient is anaemic - if it is under range then the patient is diagnosed as anaemic. But people can be iron deficient long before they become anaemic, and those in such a situation need to fix their iron deficiency.

See page 3 in this document from the World Health Organisation :

iris.who.int/bitstream/hand...

Note that the level of haemoglobin required to be declared not anaemic in adult women (aged 15+) is 120 g/L or higher.

The NHS used to use this level for the bottom of the range for haemoglobin. But, presumably to cut costs, they now declare that adult women are only anaemic if their haemoglobin drops below 115 g/L

...

There are various kinds of anaemia, and they aren't all determined by being iron deficient. See this link :

irondisorders.org/wp-conten...

Note that the table at the bottom refers to MCV (Mean Cell Volume) in the last column. This tells you the average size of your red blood cells. Neither big or small are desirable.

In iron and/or ferritin deficiency MCV is low, i.e. red blood cells are small (microcytosis)

In B12 and/or folate deficiency MCV is high i.e. red blood cells are large. (macrocytosis)

But what happens if someone is, for example, low in iron AND low in B12. In this case MCV might appear to be "normal". Another problem is that if someone has low B12 and low folate, red blood cells will appear large. If that person then supplements folate their red blood cells will shrink even though B12 is low. So MCV can be useful, but it shouldn't be taken as being a perfect answer to the questions "Am I short of iron or B12 or folate, and am I anaemic"

[KBird01 in reply to humanbean]

Thanks for your reply  humanbean . Since I obtained my records from my GP I have discovered my ferritin has been between 17 - 27 for the last 4 years. Their range is 10-150, so I was told 'in range'. It wasn't tested before and as you say, although I had full bloods my haemoglobin was always well in range (~130+), so they looked no further.

Bearing in mind the GP/NHS results, it appeared I was more likely lacking in iron than having too much. I've been a vegetarian for 30 years and have been supplementing iron, B12 (injections) and folate along with a multivit for the last year, since I found out about the low ferritin. Hence me sending for regular blood tests. I think my iron has nosedived on this last occasion following a very strenuous walking holiday early May.

Apologies, as I didn't add the questions I asked Medichecks, (Now added to original post) but my concern is, as you can see from my spreadsheet at the top, my Medichecks results are consistently almost double those of my NHS ones, even when taken a short space apart. As these read well over the 30ug/l stated as the lower ferritin limit for NICE, I didn't think I had an iron deficiency until I saw my GP records. I know from other posts on here that I'm not the only one who's had this discrepancy.

I've now upped my iron supplements, and am already starting to feel somewhat better, but am concerned about where I can obtain a reliable iron test that will show whether or not my levels are within the NICE (and other) guidelines. And as per your links, avoid iron overload. As this matter has been discussed on here before, I wondered if anyone had made any progress on getting some clarity?

[SlowDragon Administrator in reply to KBird01]

Very difficult to maintain GOOD iron and ferritin on vegetarian diet

Plant based iron is much harder to absorb

How old are you

Female?

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

Serum ferritin level is the biochemical test, which 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.

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.

It’s possible to have low ferritin but high iron

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

Stop iron supplements 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

Look at increasing iron rich foods in diet

Eating iron rich foods like pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

healthunlocked.com/thyroidu...

Posts discussing Three Arrows as very effective supplement. This is derived from meat so not suitable for vegetarians

Great replies from @FallingInReverse

re ferritin and Three arrows

healthunlocked.com/thyroidu......

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great reply by @fallinginreverse

healthunlocked.com/thyroidu...

Iron patches

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good iron but low ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Iron deficiency without anaemia

healthunlocked.com/thyroidu...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary

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

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

Really interesting talk on YouTube, link in reply by Humanbean discussing both iron deficiency and towards end how inflammation can also be an issue

healthunlocked.com/thyroidu...

Inflammation affecting ferritin

healthunlocked.com/thyroidu...

Updated reference ranges for top of ferritin range depending upon age

healthunlocked.com/thyroidu...

Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:

Females 18 ≤ age < 40. 30 to 180

Females 40 ≤ age < 50. 30 to 207

Females 50 ≤ age < 60. 30 to 264l

Females Age ≥ 60. 30 to 332

Males 18 ≤ age < 40 30 to 442

Males Age ≥ 40 30 to 518

The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.

[KBird01]

Thanks for your detailed reply and all the info SlowDragon . I'll take some time to read through this.