Serum ferritin, iron and transferrin levels in a large group of patients

Abstract

Serum levels of ferritin, iron and transferrin were measured in 1000 consecutive patients when serum was sent for assessment of iron status. Normal levels for these parameters were established in a separate group of volunteers without clinical or haematological evidence of iron deficiency who had not acted as blood donors in recent years. The great majority of the ferritin, iron and transferrin values could be allotted to one of 7 patterns. Characteristic profiles were seen in (a) normal subjects, (b) established iron deficiency, (c) latent (or early) iron deficiency, (d) iron overload, (e) states of increased erythropoiesis, (f) conditions with depressed erythropoiesis, and (g) chronic disease of various types. The study has shed light on the relative usefulness of the individual investigations. The serum iron and serum ferritin levels gave similar information in most cases except in various types of chronic disease and also in states of increased erythropoiesis. In the case of sufferers from the various chronic, inflammatory or infectious disease states, the high serum ferritin levels reliably indicate adequate iron stores while the associated low serum iron levels can be misleading. The transferrin level was a little more variable and less reliable in providing information on iron status than the serum iron level. The single most useful investigation in the diagnosis of low iron stores and thus the need for iron therapy was clearly the serum ferritin level. It is believed that the recognition of these different patterns will be of use in the analysis of clinical disorders of iron metabolism.