An iron deficiency occurs in stages, as the attached infographic shows. But you might not see these stages developing, as people don't often get regular blood tests, so we more likely see that they are well into anaemia and iron deficiency symptoms when they see us and we analyse their results.

However these stages and resulting changes in iron studies biomarkers are not always the same as in the infographic, as there are other factors which can affect the iron-related markers, especially of Ferritin. As a result, Ferritin isn't always the first biomarker to show the signs of a possible iron deficiency.

Hence the 4 stage progression, assuming no infection or inflammation or tissue damage, should be:

Stage 1 – the iron stores as Ferritin, starts showing as low
Stage 2 - the iron being available to be transported, being the Transferrin Saturation %, starts showing as low
Stage 3 – Haemoglobin, the oxygen transport protein in the red blood cells, starts showing as low due to the reduced iron
Stage 4 – MCV is usually the last of these biomarkers to show low iron, in our experience.

More often we would actually see that Transferrin Saturation starts showing as low first, and before low ferritin shows as low!

Also, a reminder to never just test for Ferritin on its own, or interpret iron levels from this one biomarker! In so many cases, we have seen low Ferritin in early to advanced stages of iron overload conditions (such as Haemochromatosis)! We have seen doctors and other practitioners recommending iron infusions and/or iron supplements in these cases of low Ferritin, when all other iron-related biomarkers are showing as very high iron overload situation.

Pathology analysis is an art and a science!

Learn more about pathology analysis on our website (including EOFY special deals on now!) from the IIFP training courses for practitioners!

This article is a reminder for health practitioners who check blood test results, including GPs, doctors, Nutritionists, Naturopaths, Dietitians, Allied Health practitioners, and others. This information and advice is especially related to the Iron Studies test and its biomarkers.

Please remember this – you CANNOT determine if a patient has an iron deficiency or overload just from checking the Serum Ferritin test result!

Despite what you may have been taught in college, university, or from other sources, Ferritin is NOT the main or best test for a patient’s iron status. The full Iron Studies test MUST be done (ie, serum iron, TIBC and/or Transferrin, Transferrin Saturation and Ferritin), and ALL of the Iron Studies test results must be checked and interpreted TOGETHER!

Too many times we have seen practitioners, including doctors/GPs and others, suggesting that a patient has an iron deficiency or overload issue just from Ferritin alone, but all the other iron results indicate the opposite diagnosis. If the wrong diagnosis is made, such as an iron deficiency when in fact the patient has all the signs of an iron overload but with low Ferritin, the prescribed treatment of iron supplements and/or iron infusions can make the patient’s symptoms much worse. 

If your practitioner is only testing for Serum Ferritin, or diagnosing either an iron deficiency or even an iron overload issue from Ferritin only, then send them the link to this page!.

The full article, with detailed explanations of three real case studies of recent patients being incorrectly diagnosed and treated, based on their Ferritin results, complete with references to published studies, is attached here as a PDF file to download for your reference.
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