Q. Can you help me understand my blood results?

Answered by
Dr. Prakash H. Muddegowda
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 16, 2016 and last reviewed on: Mar 04, 2020

Hi doctor,

I was diagnosed with anemia due to heavy periods. I was told to double up my Iron supplements. My iron is already high and ferritin is low. My binding is not even registering. My results are as follows. Ferritin 8.0 ng/mL, iron 333 ug/dL, iron binding capacity and transferrin saturation not calculated due to unsaturated iron binding capacity of less than 55 ug/dL. Can you help me understand my results? Thank you.



Welcome to

Based on your query my opinion is as follows:

  • The values are very rare. However, I will try to help you to the best of my knowledge.
  • Ferritin is the storage form of iron. Serum iron is high, as you are on iron supplements.
  • The body will take longer period of time, usually up to three to six months for storing iron in the form of ferritin, hence ferritin is low.
  • Body usually regulates serum iron by reducing absorption of iron, however, if infusion is taken, iron can be high in serum.
  • If oral intake during the initial phase then increased serum iron maybe found as more receptors are activated to absorb iron in the view of severe iron deficiency.
  • The unsaturated iron binding capacity is total iron binding capacity (TIBC) minus serum iron. As the serum iron is high, the unsaturated iron binding capacity falls and hence it cannot be calculated.
  • Transferrin transports circulating ferrous molecules (Fe3). Normally only about one third of iron-binding sites are occupied; the remainder is called unsaturated iron-binding capacity.
  • Serum transferrin saturation is obtained by dividing serum iron by TIBC. This also could not be calculated as it is dependent on unsaturated iron binding capacity.
  • MCV (mean corpuscular volume), MCH (mean corpuscular hemoglobin) and MCHC (mean corpuscular hemoglobin concentration) should be low with increased RDW (red cell distribution width) to make a diagnosis of anemia on complete blood counts. These values are usually secondary to iron deficiency.
  • A better indicator of your body responding to improving iron status is reticulocyte count. It will start increasing within two weeks of start of therapy.
  • Due to increased serum iron and its importance in calculation of other results, other data was not calculated. Do continue with iron supplements, as the iron storage (ferritin) needs to be filled. Once serum ferritin is normal, you can reduce iron supplements to regular dose.

Treatment plan:

1. Continue iron supplements, until ferritin becomes normal.
2. Repeat biochemical tests after three months. If early tests needed, reticulocyte count will be more helpful.

Regarding follow up:

Revert back after three months to a hematologist online.--->

Thank you doctor,

I have attached the rest of my blood work. My blood work has never been this strange compared to my other test over the years. I am suffering with anemia for the last 16 years after birth of daughter. I just started treatment before six years after it had got extremely bad.



Welcome back to

Based on your query and attached reports (attachment removed to protect patient identity), my opinion is as follows:

  • The hemoglobin is mildly reduced and all others do not signify iron deficiency in any way. I can think of two possible explanations based on data available.
  1. In partially treated iron deficiency anemia, serum ferritin remains low when hemoglobin and serum iron have returned to normal. Ferritin returns to normal when iron stores get repleted with further iron therapy.
  2. Besides iron deficiency, there are two other conditions that are associated with low serum ferritin. One is hypothyroidism and the other is scurvy.
  • Always serum ferritin falls first, then serum iron. The correction also occurs, first in serum iron and then ferritin. Serum iron goes up following ingestion of iron-containing foods; but serum ferritin does not. It will take time.
  • If you are not having any fatigue, cold sensitivity, constipation, dry skin and unexplained weight gain then probably no hypothyroidism. Thyroid hormone profile can confirm.
  • Vitamin C deficiency causes scurvy and gum bleeding or small red spots in skin are usual findings.
  • If both are not present then it is getting corrected. Do continue with supplements.
  • The attached report is almost normal. Serum ferritin will get corrected, as hemoglobin returns to normal and serum iron will go to storage at that point.
  • Maintaining hemoglobin within the normal range will improve the quality of life and is essential. Continue the same, as of now.

Investigations to be done:

If necessary then get thyroid hormone profile.

Treatment plan:

1. Doubling the dose may not be necessary. Continuing the same dose should be adequate.
2. Repeat complete blood count after three months along with serum ferritin.

Regarding follow up:

Revert back after three months to a hematologist online.--->

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