Unraveling the Secrets of Anemia: Insights into Iron, Ferritin, TIBC, and Transferrin Testing in Clinical Chemistry

Anemia, characterized by a deficiency in healthy red blood cells and hemoglobin, remains a significant global health concern affecting millions of people of all ages.

The W.H.O. estimates that approximately one-quarter of the global population can be defined as anemic, and as such is one of the most common abnormalities identified in routine diagnostic testing/wellness screening (1,2). Iron deficiency, due to inadequate intake or excessive loss, is suspected to be the underlying cause in 50% of all cases (3).

The Clinical Chemistry Laboratory plays a crucial role in identifying, diagnosing, and managing anemia. This requires a comprehensive analysis of biomarkers involved in iron metabolism, including iron, ferritin, total iron-binding capacity (TIBC), and transferrin. Timely and accurate diagnosis is instrumental in improving the quality of life for individuals affected by anemia, making these tests indispensable tools in combating this pervasive health condition.

Iron – An Integral Component of Hemoglobin Synthesis

Iron, the building block of hemoglobin and an essential trace element plays a central role in hemoglobin synthesis and oxygen transport. In the context of anemia evaluation, quantifying serum iron levels is crucial for assessing an individual’s iron status. Low serum iron levels are indicative of iron-deficiency anemia, a prevalent form of anemia worldwide. Conversely, elevated iron levels may point to conditions like hemochromatosis or sideroblastic anemia.

Ferritin – An Indicator of Iron Storage and Body Iron Reserves

Ferritin is a key indicator of Iron storage, an intracellular protein responsible for storing iron and releasing it in a controlled manner according to the body’s iron requirements. Assessing serum ferritin levels is pivotal in diagnosing anemia as it directly reflects the body’s iron stores. A decrease in ferritin levels is often an early sign of iron deficiency, even in the absence of anemia, making it a valuable biomarker for early detection and preventive measures.

Total Iron-Binding Capacity (TIBC) – Evaluating Iron Transport Capacity

Total iron-binding capacity (TIBC) quantifies the maximum amount of iron that transferrin, a plasma glycoprotein responsible for transporting iron in the blood, can bind. In the assessment of anemia, TIBC serves as a critical parameter, offering insights into the body’s capacity to transport iron. Reduced TIBC levels may indicate iron overload or chronic inflammation, while elevated TIBC values often accompany iron-deficiency anemia.

Transferrin – Assessing Iron Transport Efficiency

Transferrin is a crucial glycoprotein responsible for mediating the transport of iron to bone marrow and other tissues, ensuring adequate erythropoiesis. Consequently, transferrin is an essential biomarker in anemia diagnosis. Transferrin levels fluctuate with iron status, with increased levels in iron-deficient individuals and decreased levels in cases of iron overload.

Transferrin Saturation (TSAT)

With serum Iron and TIBC or Transferrin, Transferrin Saturation (TSAT) can be calculated. The results of first-line Iron studies including all three parameters have the benefit of providing a more complete picture than Ferritin only. Performing Fe and TIBC or Transferrin at the same time also avoids inconveniencing the patient with additional blood collections and further costs in some settings (Table 1).

Comprehensive testing panel for Iron studies 

VitalScientific offers a comprehensive testing panel for Iron studies and the accurate assessment of anemia including all key analytes: Iron, Ferritin, TIBC, and Transferrin. All reagents are ready-to-use liquid stable and optimized for the Selectra Family from semi-automated to fully automated benchtop chemistry analyzers. The assays are calibrated using dedicated calibrators traceable to international reference material such as ERM-DA470K/IFCC or WHO-NIBSC code 94/572.

For consistent, accurate, and reliable results on VitalScientific’s Selectra Family of instruments, Selectra System Reagents, Calibrators, and Controls are recommended. For more information, please visit our reagents page or contact us.

In conclusion, let us continue to pursue cutting-edge research, innovation, and cooperation in clinical chemistry to combat anemia effectively and create a brighter future for millions of individuals impacted by this condition.


1. World Health Organization. Iron deficiency anemia: assessment prevention and control. 2001. [cited 2021 Aug 12].

2. S. Numen & K. Kaluza, Systematic review of guidelines for the diagnosis and treatment of iron deficiency anemia using intravenous iron across multiple indications

3. Api O, Breyman C, Cetiner M, et al. Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: iron deficiency anemia working group consensus report. TJOD. 2015;12(3):173–181.

4. Adapted from the Royal College of Pathologists of Australasia

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