The Biomarker Handbook is a curated series that seeks to provide readers with insights on each biomarker we cover in our blood test packages and its relation to our body.
In almost all living things, from bacteria to humans, iron is an important bioelement in the body. The amount of circulating iron can give a good indication of the oxygen carrying capacity in your blood. Iron deficiency is one of the most common mineral deficiencies, especially in women, which can affect normal day to day activities.
Iron Levels and Forms in the Body
Iron is elemental for our respiratory (carrying oxygen and carbon dioxide, production of haemoglobin), metabolic (conversion of sugar to energy), immune (white cells’ ability to defend against pathogens), and enzymatic systems (production of enzymes) to function normally.
Iron in the body can exist in different forms. Inside the cells, it is stored in a protein called ferritin while in the blood it is carried as a part of an iron-binding glycoprotein, transferrin. When iron levels are inadequate, your doctor may track these biomarkers (ferritin and transferrin) to further evaluate the depletion of iron stores. Adequate levels of iron in the blood are necessary to avoid both an anaemic condition and hemochromatosis.
The recommended daily intake of iron varies for each age group:
- For adult men is 8mg
- For adult women is 18mg
- For pregnant women is 27mg, and those lactating is 9mg
- For postmenopausal women is 8mg
The Importance of Tracking Serum Iron Levels
According to statistics from the WHO, 25% of the world population will suffer from anaemia sometime in their life. That is well over 1.6 billion people. The commonest form of anaemia is iron deficiency anaemia, affecting over 1 billion people in this world.
Appropriate levels of iron in the body assist in the oxygen carrying function of red blood cells. A deficiency in iron can cause low levels of haemoglobin in the blood which results in a state of an iron-deficiency anemia. Lack of iron in the body can be multifactorial; excessive blood loss, pregnancy, heavy menstrual flow and a lack of dietary iron can all cause low iron levels. Menstruating or pregnant women, newborn, children and those with chronic illness are more prone to iron deficiency anaemia (IDA).
On the other hand, an excess of iron in the blood can have toxic effect. Iron toxicity can cause the production of increased free radicals in the body that can damage cellular components. A chronic state of iron overload (usually genetic) is called hemochromatosis and can cause joint pain and weakness.
Serum iron testing and panels are therefore important to ensure adequate circulating levels of iron are present in the body. The amount of iron in the blood can be detected by different biomarkers. Serum iron tests (iron in our blood), transferrin saturation and total iron binding capacity (your body’s ability to transport iron in the blood), ferritin (your body’s total iron storage capacity), haemoglobin levels and the hematocrit can all indicate the level of iron in the blood.
- The normal serum iron range is 55 – 160 micrograms/dL in men and 40 – 155 micrograms/dL in women.
- The normal transferrin saturation in the adult is 25 – 35%.
- The normal total iron binding capacity in an adult is 240 – 450 mcg/dL.
- A normal hematocrit range is 38.8 – 50% in men and 34.9 – 44.5% in women.
- Normal hemoglobin levels are 13.5 – 17.5 g/dL in men and 12 – 15.5 g/dL in women.
Signs and Symptoms of Abnormal Serum Iron Levels
Anaemia goes undetected in many people and symptoms can be minor. The symptoms can be related to an underlying cause or the anaemia itself.
Low levels of iron in the blood cause classic signs of iron-deficiency anaemia: fatigue, shortness of breath, pallor of the skin, hands and conjunctiva, chest pain, tachycardia, anorexia and cold feet. Severe symptoms may include mood changes, inflammation and ulcers in the mouth (Plummer-Vinson syndrome), brittle nails and compulsion to consume nonfood items like dirt or ice chips, and poor appetite in children.
Higher than normal levels of iron in the blood can cause symptoms and signs such as painful joints and/or abdomen, bronzing of the skin, fatigue, heart disease, changes in libido, muscle weakness and anorexia.
Consequences of Abnormal Serum Iron Levels
If low levels of iron persist, various health consequences may potentially occur. In pregnancy, untreated anaemia increases mortality in both mother and newborn (may also cause developmental problems in newborn). Reduced oxygen carrying capacity means that the heart needs to work harder than usual to pump more blood to compensate, potentially leading to heart failure. Along with worsening of the haemoglobin level, there is also a risk of concurrent thrombocytosis (elevated platelet count).
An iron overload left untreated can progress and cause cirrhosis of the liver (fibrosis or scarring that is irreversible), diabetes and even testicular failure. Patients over the age of 40 are at a greater risk of developing cirrhosis associated with iron toxicity. An excess of iron can also increase the chances of a hepatocellular carcinoma (cancer of the liver).
Maintaining a Normal Serum Iron Count in the Blood through Diet
Lifestyle modifications and dietary changes can help reduce the risk of an iron-deficiency anaemia especially those that are only mildly anaemic (no symptoms but abnormally low haemoglobin). Severe anaemia is when symptoms are present and along with medical intervention you will also benefit from lifestyle and dietary changes according to your clinician’s advice.
Iron-rich foods that can help combat anemia include red meat, seafood, beans, green leafy vegetables, beetroot, spinach, dried raisins and apricots and iron-fortified foods. Vitamin C rich foods can also help to maintain normal iron levels by increasing the absorption of this mineral from the intestine. Some examples of vitamin C rich food are citrus fruits and broccoli.
Medically Accurate Ways to Treat Abnormal Iron Levels
People that have low iron in the body can benefit from consuming iron tablets/supplements to meet their daily intake. These tablets work best on an empty stomach and should not be taken simultaneously with antacids or calcium tablets since they affect each others absorption. Take any of these two chemicals 1 to 2 hours apart from the iron supplement. And if already given iron injections, then your clinician will need to closely monitor your oral intake as this can cause overloading. In cases of severe iron deficiency, blood transfusion may become a necessity. Iron storage levels (ferritin), iron transport capacity (ferriting, total iron binding capacity) and serum iron levels need to be repeated to monitor treatment effectiveness and adjust intake of iron.
Just as important as managing the low haemoglobin level, your clinician will also treat the underlying cause of the anaemia. This may include surgery to remove an internally bleeding tumour or fibroid, medications to reduce heavy menstrual flow, and antibiotics to treat stomach ulcers.
In people with an excess of iron, routine phlebotomies (blood-letting) may be required. The frequency of these scheduled phlebotomies decrease as the iron level approaches the normal range.
Additional Tests for Iron-Deficiency
Along with the basic diagnostic tests, your doctor may perform additional tests to rule out ailments associated with abnormal iron levels in the body. These tests include an endoscopy, a colonoscopy and/or an ultrasound. These procedures are done to check for any underlying internal bleeding that may be the cause of iron deficiency.
Iron forms an essential component in the blood and plays a major role in metabolism. Inadequate levels of iron in the blood or an excess of it can cause distressing symptoms that may require a proper medical treatment. Identifying these signs early on and taking measures to improve serum iron levels can prevent the condition from worsening.
If you want to find out more about iron serum and how you can balance abnormal iron levels, take a look at our lifestyle article here!
Interested in other biomarkers? Check out the rest of The Biomarker Handbook.
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