What does it mean when serum iron is high but ferritin is low?

This question comes up all the time. Patients are baffled when their serum iron levels come back elevated and their ferritin levels come back low even though they have all of the symptoms of iron depletion.

What’s going on?

Often doctors or even patients who see this think ‘oh no we better stop taking iron support’ or ‘iron isn’t the issue’ because they see the high serum iron.

However, usually, this is a misunderstanding of what serum iron is testing and what elevated levels mean versus what low ferritin levels mean.

Out of the gate, it is paramount that we test the same way consistently in order to get consistent results.

How to test for iron

Optimally you want to complete the blood draw in the morning in a fasted state. Patients should also not take any iron supplement within 12 hours of a blood draw.

In a non-fasting state you can get significant swings in transferrin levels especially in iron deficient patients. 

Serum iron concentration is also a poor measure of iron status in the body as levels fluctuate significantly due to diurnal variation and fasting status. Even when both morning and fasting blood draws are completed, accuracy is still hampered by the fact that iron is an acute phase reactant and could be falsely low in the case of acute inflammation. 

Specific tests to order: CBC, Ferritin, TIBC, Iron (Transferrin) Saturation and Serum Iron levels checked at the same time. 

What does your iron test mean

If you have high serum iron levels and low ferritin, you may want to check for underlying infections, oral contraceptive use, thyroid disorders and consider testing based on history for heavy metals (especially lead). 

The use of cast iron skillets can be another reason for elevated levels of serum iron, especially if used in the hours before a blood draw.  The initial dosing of iron supplementation can also cause serum iron to rise to the top end of normal or even over while ferritin is slower to reach normal levels. 

As iron deficiency is improved ferritin will rise and serum iron will normalize. 

When ferritin levels drop below 25, the liver will often compensate by synthesizing more transferrin which leads to a pooling of iron in the blood and increased serum iron levels in the face of iron deficiency. This occurs when there’s an iron deficiency or in patients with high estrogen levels such as in pregnancy or with oral contraceptive use.

Ferritin levels of less than 75 can have effects like fatigue and an increased risk of miscarriage.  This is why it is paramount we test patients and ensure they have optimal iron levels and not just a ferritin within the normal range. If you’re a woman who has had a difficult time raising her ferritin levels, check out this post for considerations and tips to achieve healthy iron levels.

Have you had low ferritin levels and tried supplementing with iron? I’d love to hear about your experience in the comments below.

319 thoughts on “What does it mean when serum iron is high but ferritin is low?

  1. Sandra Feldberg

    my Ferritin was 3.3 and my Iron was 15 started taking iron and three weeks later Ferritin is 10.1 and Iron is 45 two weeks later Ferritin is 9.2 and Iron is 190. Going to specialist on Feb 9.

    1. rose

      Be sure to get your iron saturation checked and when getting labs done make sure they are fasting and in the morning.

      High iron essentially means high transferrin, so your body because of very low iron previously is shuttling iron around as fast as it can to make up for lost time. This will keep the ferritin low while iron (transferrin) is rising. Check out http://www.optimizeiron.com for more details.

      1. Angelica

        Hi! I am a bit confused with this article because it seems that having high iron levels and low ferritin to be ok.
        In my case I have always trying to figure out why I I had LOW iron levels while ferritin was also low but in range. At the present moment I am showing a huge increase in my iron levels but out of range and the ferritin while you d in range is still not optimal. My concern is that the Iron saturation is also high out of range. I am not sure where to go from here, should I stop eating iron reach foods like leafy greens and lean red meat or should get a therapeutic blood removal as some literature suggest? I mean, I would of course check a professional guidance but I would appreciate if you can help me out with some recommendations.
        Here is my recent lab test results:
        Reference Range: 3.80-5.10 Million/uL
        HEMOGLOBIN 15.4
        Reference Range: 11.7-15.5 g/dL
        HEMATOCRIT 47.1 H
        Reference Range: 35.0-45.0 %
        IRON, TOTAL 224 H
        Reference Range: 45-160 mcg/dL
        Reference Range: 250-450 mcg/dL (calc)
        % SATURATION 72 H
        Reference Range: 16-45 % (calc)

        1. haleigh

          I have the same thing going on… hematologist is wanting to get me tested for hemochromatosis but that would mean I would have a high ferritin. Did you find any answers?

          1. Chloe

            Hi ☺️
            I have the same thing! I am pregnant and my iron results came back low levels of ferritin but Iron saturation at 84%. I recently got tested for a hemochromatosis and my results was that I had two of the C282Y genes, which means I have it.
            I just wanna find out why my ferritin levels are dangerously low. Worried something is wrong with my thyroid.

          2. Dee Williams

            In early stages of hemochromatosis you can have normal ranges of ferritin. Maybe ask to be tested for the HFE gene which is genetic.

          3. Charlotte

            I have hereditary hemochromatosis (c282y/c282y)

            My ferritin was 45 transferrin saturation was 61%
            Serum iron was 26.7
            And transferrin 1.74
            So you don’t always have high ferritin whilst loading. Probably due to our periods.

        2. Blake

          Hi, did you ever find answers to your high iron saturation? I have the same results, dangerously high iron saturation (83%) and serum iron levels (224) but optimal ferritin (102). All other related parameters are normal. So confused by this.

          1. DAWN M DEPEEL

            if you have hemochromotosis that ferritin is not low it should be 50 and under i bet you have it to they say you can be as high as 247 but no you cant it damages your organs i have it and it is worse for men because they dont have periods

          2. Justin

            Hi Blake,
            I have similar blood results. High iron saturation (81 percent) and serum iron level (242) and normal ferritin (222). Have you been able to find out anything further which might explain this?

        3. DAWN M DEPEEL

          have you been checked for hemochromotosis it is high iron which damages your organ alot of people dont even know they have it and also have them check your thyroid.

        4. DAWN M DEPEEL

          hematocrit just means your dehydrogenated it really sounds like hemo to me i have it and thats what mine read until i get a blood draw to get the excess iron out. what is your ferritin levels at?

    2. Angela

      Just received ny results and have been dealing with exhaustion, joint pain, hair loss, heart palpitations, brain fog. I am deficient in vitamin D and take prescription strength for that deficiency. Please help me interrupt my iron labs.
      Iron = 51ug/dl
      Transferrin = 247mg/dl
      Ferrtin = 345 ng/ml
      TIBC = 346 ug/dl
      Iron Saturation = 15%
      Not sure if I need added labs…. Thank you.

      1. Dr. Matt

        It looks like your body is inflamed given your ferritin being high and iron sat being low. Definitely want to look into inflammatory lab tests.

        1. Isaac

          Hi dr Matt, I feel a little bit disoriented and little loss of short term memory. Have difficult to concentrate. Also my back hurts in the place of kidneys.
          I decided to test my blood, all values are ok except:
          hematocrit 50% (35.4%-49.4%)
          Serum Iron 214micrograms/dL (60-150)
          Transferrin saturation 71.17% (20-50)
          Ferritin 50.20 ng/ml (23.9 – 336.2)
          Total bilirubin 1.61 mg/dL. (0.22 – 1.04)
          Direct bilirubin 0.53mg/dL (0.12 – 0.42)
          Indirect bilirubin 1.08 mg/dL (0.09 – 0.65)
          Is the second time that this values of serum Iron and transferrin appear in a year. The first time that appeared took around 2 months to drop down and that values returned to normal but there are again now.
          It could be a type of secondary hemochromatosis or what do you think it’s happening there?
          My doctor suggested me to lower iron intake.
          I have a strange sensation of fatigue and lack of mental concentration.
          I will really appreciate your help.

          1. Erica PA

            I’m a PA. It doesn’t really look like an iron issue to me. I would recommend abdominal ultrasound to assess gallbladder/liver disease. After addressing that retest iron panel.

          2. Dr. Matt

            Check for blood clots, liver function tests, imaging of liver/GB. Really looks like your liver is at issue.

            Labs: GGT, AST, ALT, LDH

            Let us know how it goes.

          3. John

            Hi Isaac, your bilirubin is high. If other liver markers are ok you may have Gilbert’s Syndrome. Worth checking perhaps?

          4. D

            Isaac, as a follow up to this a year later, did you ever receive any insights into your condition/symptoms?

        2. Seanie

          Serum Iron 11.3
          Transferrin 3.15
          Transferrin Sat. 14.3
          MCH 32.6
          Alk. Phosphatase 44

          Symptoms of dizziness faintness low energy and extremely fatigue chest pain SOB sore glassy eyes headaches heart palpitations happens to me once a month

        3. Gina

          Hi Dr matt, could you help me interpret my iron results ?

          I’m so confused.
          My total iron is 180
          Binding capacity 316
          But my ferritin is low 18
          And my saturation is high 57

          I can barely stay awake, brain fog and overall feel horrible. The ferritin makes sense but the high saturation doesn’t?

          1. Kristen

            Mine are similar too with similar symptoms.
            Iron: 247
            Iron sat: 51%
            Tibc 486
            Ferritin 12

            I’m so 7 months pregnant and feel somewhat brushed off by dr. Looking for answers. Seeing a different dr today!

          2. Meg

            Hi I have similar issue right now and my numbers are almost identical! Did you ever hear about what caused this?

        4. Leah Cheatham

          Hey Dr. Matt,
          I’ve been told I was low in iron. I was told I have inflammation somewhere but the Dr.s arent really doing a deep dive into what is causing the inflammation. I was also told last year that I do have non-alcoholic fatty liver. I’m also curious of thyroid issues.
          Here are my most recent labs:
          Ferritin 29 ng/mL
          Iron-Saturation 58.6 %
          Iron-Serum 236 ug/dL
          Iron TIBC 403 ug/dL

          1. April Polichette

            My results are similar. Did you ever find out an answer? Do you supplement with iron?

          2. Dr. Matt

            Definitely would get full thyroid panel, vitamin, A, ceruloplasmin, copper levels checked given your high iron saturation. Make sure you have a 48 hour wash out period before your iron tests.

        5. Beth

          Hi! I’ve been trying to understand my levels & can’t come across any solid answers!!

          Ferritin 18 ng/ml
          Transferrin 325 mg/dl
          Transferrin Saturation 43%
          TIBC 518 ug/dl
          Iron 221 ug/dl

        6. Iliana

          Hi! It would be of very big help if you replied to me, because I’ve been to a ton of doctors already, and everyone seems to brush my issue off. My ferritin was at 4.75ng/mL and iron at 69 μg/dL in January, so I started taking iron supplements around March (a little late). I checked for my levels again a few days ago (so June), and although my iron has gone up, at 132, my ferritin is only at 14.69, and I still have all the symptoms. My hair had stopped falling, but recently it started again. The doctor gave me different supplements, but I’m scared they won’t work again and I’ll just have to be constipated for 3 more months for no reason. What should I do? :/

      2. Brian

        Taking the supplement ip6 is a very very effective iron chelating and anti-cancer supplement. That means it removes excess iron from the body. It works with several mechanisms to increase the production of natural killer cells that supports our bodies natural anti-cancer fighting ability. It also reduces oxidative stress in the body by removing excess iron from the body. It has a variety of life extending mechanisms that it triggers or enhances in the body. Men in the United States quite frequently build up toxic levels of iron over a Lifetime by about the age of 40 to 50 to the point where iron levels become so high in the body that they are triggering Cascades of excessive oxidation on various mechanisms. High levels of iron can certainly increase the chances of cancer development through its assault of oxidation on the body, and iron is needed by cancer cells to multiply. Having the right amount around is good but too much begins to work against your long-term health. We don’t have a biological way to remove iron from our body except through the ip6 that we get a tiny amounts in some fibers in a few commercially available foods. Other things that reduce iron is menstruation, or an injury where you bleed, and or giving blood several times to reduce your high iron levels. So many Americans have toxically high iron levels due to so many processed food products fortified with iron as well as from a diet with high red meat for an extended time in the past or present

      3. DAWN M DEPEEL

        omg you are high in your levels of ferritin go to hematologist and have them check you for hemochromotosis right away.

    3. Anna

      Hello! I had a blood test taken due to a number of intense symptoms, and have found that while before I thought I might be anemic the opposite might be the case, but I’m not sure.
      % Saturation: 67
      Ferritin: 38
      Iron binding capacity: 281
      Iron total: 187
      Transferrin: 206

    4. Kaitlyn Maish

      Hey! I have a history of past anemia, Pregnant currently with my second, with my first I had an issue with fully passing out, this time I get extremely dizzy, I’ve fallen a few times but not completely passed out. I’m constantly freezing, chest pains, exhausted (before/during/after my pregnancies) my results for labs came back as:
      Iron: 74 mcg/dL
      TIBC: 411 mcg/dL
      Iron % Sat: 18%
      Ferritin: 10 no/mL

      Finally my PCP did a test but so far OBs have completely brushed me off as normal pregnancy but I feel like something may be off

    5. Rochelle

      Hi Dr. Matt ! Can you help me interpret my iron results? My ferritin was low at a 14 and my iron serum was 100 and saturation 30%. So I started taking iron to up my ferritin, tested again about 6 weeks later, my ferritin went to 32 but my iron serum shot up to 150 and saturation to 42%. So I stopped taking the iron not wanting my iron and saturation to keep increasing. Retested about 10 days later and my ferritin went back down to 20, iron at 183, and saturation now at a 51%! Help please! I have a Doctor appt tomorrow but she seemed confused and not worried about my low ferritin even tho I have tons of symptoms when my ferritin was low. And when it went up to 32 my symptoms were going away! Now they’re coming back.

    6. Vicky Ridley

      Hi I have been diagnosed with periodic limb movement disorder (PLMD) which disrupts my sleep cycles & appear to have had it for around 30 years with only a definite diagnosis recently. I have been told by my sleep disorder consultant that ferritin needs to be at least 100 ug/L but was 27 ug/L 3 months ago, after which I supplemented with ferrous fumarate & have just had a retest & it has gone down to 19 ug/l..
      This also happened about 12 years ago when i was tested.
      My other test results:
      B12 272 ng/L
      Serum iron 12.9
      Transferrin 2.63 g/L
      Transferrin saturation 20%
      Haemoglobin 140g/L
      The sleep consultant requested i was referred to a haematologist, which my GP refused to do until I’d done a three month iron supplementation & here we are.
      Any advice on how to increase ferritin without iron overload in my serum greatly received! Enough stores of ferritin & it could be all i need to control the PLMD & avoid strong drugs.
      Many thanks

    7. Alexis Cathcart

      I’m a 14 year old girl and my iron is about 80 over the normal range. I’ve had a ton of fatigue and one of my aunts has hemochromatosis but my ferritin levels are lower in the healthy range. I’m so confused, any advice?

  2. JMO

    Can you please help me understand by Iron test results? I actually thought I may be Anemic, but it looks like the total opposite here? I’m so confused after just receiving my results.

    Total iron high (235), % Saturation high (73) but IBC normal, Ferretin normal, RBC Iron normal.

    I did not fast prior to my test and I took an iron supplement 2 days prior, for the first time. Could the supplement be responsible for the super high numbers here? I have stopped it since seeing these numbers. Thank you!

    1. Dr. Matt

      Yes, your labs would suggest sufficient iron levels and iron stores. Curious what your ferritin level was?

      1. Jordan

        Hey Dr Matt,

        Just wondering what you would make of these tests. Feel tired, brain fog, low energy. My tests came back as normal ferritin and high transferrin saturation. I am a 35 yr old male. Results are below. Thanks!

        Iron Plasma: 27 umol/L (7-29)
        TIBC: 49 umol/L (45-77)
        Transferrin Saturation: 0.55 (.20-.50)
        Ferritin: 181 ug/L (24-453)

        1. Catharine

          Hi! Could you help me to understand if I have anemia, please?
          I’ve been taking iron supplements since February/22 because my iron was 40 and ferritin 66. I rechecked in May, and iron went up to 89 but ferritin dropped to 55. I don’t think supplementing with iron is really helping, because ferritin keep dropping. I did test again in August with the following results:

          RBC: 3.77 L
          Hemoglobin: 11.6L
          Hematocrit: 34.6L
          Total Iron: 158
          Iron Binding Capacity: 398
          Saturation: 40%
          Ferritin: 34
          B12: 910

    2. jen

      My iron is and saturation are also very HIGH. What did you find out?
      I also thought maybe i was anemic before testing.

    3. Mike

      Good afternoon. Just got back my labs and hoping to better understand the results. I currently take 325 Iron FE in morning and then another pill in evening as my doctor thought I was low on Iron several months ago. After on this regime for 3 months and fasting, below were my results. I’m wondering if I should go back to only 1 pill/day.
      Ferritin: 54
      TIBC: 339
      Iron: 203
      Saturation: 60%

  3. Marla

    Have diagnoses of multiple myeloma (2-1/2 yrs. treatment, not having achieved remission) and Hashimoto’s thyroiditis (diagnosed 4 yrs. ago; stable though thyroid peroxidase antibody remains nearly 600 with serum iodine 70; T4 0.9; TSH 2.60; on 225 micrograms of iodine twice weekly); recently found to have ferritin of 8, total iron 73; TBIC 445, T-SAT 16). Oral iron supplements raised total iron and TBIC, but with little effect on ferritin. Now oncologist wants to initiate IV iron infusions… ??!! Is this simple iron deficiency anemia or something more complex due to multiple myeloma and/or Hashimoto’s?

    1. Dr. Matt

      Unlikely to be more complex as far as your ferritin goes. I would ask your oncologist if you can try Blood Vitality 2 capsules per day and see if that doesn’t change your ferritin. If you have had treatment for MM it can effect digestion capacity so having an extremely absorbable iron is crucial. Also make sure are taking vitamin D to support iron metabolism. I am also hesitant with the iron infusions since they putting a bolus of iron directly into your blood with no carrier, which increases oxidation something you are trying to avoid with MM and Hashimoto’s. Would love to hear how it goes,

      1. Lilit

        High ! I’m confused about results too as a 34yo woman.

        Total iron 176mcg/dl
        Iron binding capacity: 310 mcg/dl
        % saturation: 57%
        Transferrin 240ng/ml
        Ferritin: 20 Ng/mL ( range 16-154)
        Hemoglobin a1c 4,6% (range is <5.7)
        Hemoglobin 13.3g/dl ( range: 11.7-15.5)

  4. Alex

    Hi, I would greatly appreciate your opinion on my iron levels. Not sure if this is good or not? My blood test when fasted was:

    Iron 27umol/L
    Transferrin 2.67g/L
    Transferrin Saturation 41%
    Ferritin 52ug/L

    Should I take Ferritin, or lactoferrin supplements? Or am I all good? The reason why I ask is because my genetic report said that my genotype for ITLN1 expression was reduced and it recommended lactoferrin to help combat pathogens and reduce inflammation.

    Thanks in advance,

    1. Dr. Matt

      Hi Alex,

      Your labs would suggest you have sufficient iron. A ferritin of 70-100 often is most desired for people living very active lifestyles so depending on your activity level you may want to add 15mg of elemental iron (Blood Vitality is my preference). Lactoferrin is great for immunity and for use in times of infection but will unlikely bring your ferritin up.

      Let us know how it goes.

  5. Peter

    I have hemochromatosis diagnosed Nov 2019 with Ferritin of 479.
    My current numbers below.
    Looking back through my history since treatment Ferritin lowers but Serum Iron won’t budge. It has risen from within range to now 198.
    My Doctor wasn’t able to give me an answer on this.
    I took a vegan diet last year for 4 months and the doc gave me phlebotomy with ferritin of 33.
    Combined it looks like that has caused the rise according to what you’ve written.
    I am a bit worried as I feel more symptoms since it’s become higher and don’t see how it will ever lower.
    Doctors are only interested in Ferritin level. Is high serum Iron not problematic at all?

    Ferritin: 18.7
    Serum Iron: 198
    TIBC: 266
    TSAT%: 74

    1. Dr. Matt

      As long as you are not getting iron deposits in organ tissue you don’t necessarily need to keep giving blood. Not all hereditary hemochromatosis is the organ damaging type.

    2. Elizabeth Rogers

      Can you help me to understand this? I have severe fatigue and body pain. My serum iron came back high — 217 and iron saturation also high at 65 percent. My uibc was low — 119; but ferritin (33) and tibc (336) are normal. Should I try supplementing?

        1. Wendy

          I too experience nonstop fatigue & body pain. I’ve ruled out most other root causes & nothing has helped. I too have high iron, low ferritin, and high Transferrin Saturation %. Hmm…after reading your comments, I wonder if iron imbalance is the elusive culprit behind me feeling like I’m triple my age?

      1. April Polichette

        I have similar results with serum iron at the top of the range, satiation over the range, ferritin 84 and 92 each time I checked. Did you get an answer?

    3. Maru

      I am 33 weeks pregnant and I had a routine blood test where my iron was low: 9.7 (10.4-32.2). We repeated the test THREE days later and got very high levels of iron: 49.8 (10.4-32.2).
      None of these tests were fasting though. I am on 200 mg of iron daily because of mild anemia. I didn’t take my iron tablets on the mornings of the blood draws. The only thing i did is that I switched to ferrous fumarate from iron(III)-hydroxypolymaltose complex. Should I go back to my old tablets? Isn’t this level of iron dangerous for my baby?

  6. kiki

    Hello. Can you please help me understand my lab results? My ferritin has been consistently on the low end for the past few years. I carry the gene for Hemochromatosis but it doesn’t seem to be an issue at this point. Would you recommend taking Ferritin or would that raise my already high Iron totals/sat? I’ve tried to research what these levels mean but can’t really find an answer. Many thanks in advance!

    Iron total: 215
    % Sat: 57
    TIBC: 374
    Ferritin: 21

    1. Dr. Matt

      Many people the hereditary hemochromatosis gene profile do not manifest it. If you don’t have any symptoms of iron deficiency then you might want to look into something like lactoferrin. You situation can also be that the body has a higher iron and so is mobilizing a lot of iron which keeps iron total and sat up even though iron stores are low. This would mean you actually do need more iron. Correlation with symptoms and blood results over time is crucial in your situation.

      1. Kiki

        Thank you so much for your response. This was the first time that my Iron and Sat were high. I had been cooking in cast iron quite a bit prior to the test, so maybe that could have skewed it.

      2. Jamie

        Suffered PEs and DVTs as result of the vid. Put on Eloquis and follow up blood work found High Cardiolipin IgM antibodies 3 months after illness. Hematologist thinks it is also result of the vid but wants to keep me on blood thinner a year to be safe and if repeat still shows antibodies, then for life. She put me on iron as result of low hemoglobin and hematocrit (been low for years). They are back in range, but now iron is through the roof. Still waiting on repeat Cardiolipin results. Don’t feel comfortable continuing the iron at this point. Thoughts?

        Serum Iron high 246
        TIBC high 389
        Transferrin Saturation high 63%
        Ferritin in range 28.3 ng/ml
        WBC high 12.93
        Hemoglobin in range 12.6
        Hematocrit in range 39.5

        1. rose

          Low iron can increase susceptibility to all manner of body dysfunction. Taking physiological doses of iron should only serve to help your body heal. This another reason I am big on using Blood Vitality with patients, to not only get the iron in a whole food like manner but also having the supportive minerals and vitamins for optimal red blood cell metabolism.

      3. Haleigh

        This is fascinating. I have very similar lab results, all high with a low ferritin. Hematologists are thinking it’s hemochromatosis but wouldn’t that mean my ferritin would be high?

  7. Melissa Lipka

    Hi! This is the first post I have fund regarding high iron and low ferritin. I’m so delighted as I was at a loss of what to do. I have hypothyroidism and I’m struggling getting my free T3 up. I’m wondering if I need to supplement iron. Can you give me any advice? I was worried because my total iron was high but now I’m thinking I DO need iron.
    % Saturation : 44 (16-45)
    Ferritin: 30 (16-232)
    Iron Binding CA: 441 (250-450)
    Iron, Total: 196 (40-190)
    Thank you so much!!!!

    1. Dr. Matt

      Consider D3/K2, riboflavin, lipothiamine, magnesium, Active form B12/folate.

      Get zinc and copper checked.

      All effect iron metabolism and utilization.

      MCV is high could be low B’s, thyroid, mouth breathing.


      Antidepressants? Birth control?

  8. Sarah BC

    Hi! Thanks for your post. It is so hard to find anything about this combination of results. I’d love to hear your thoughts on mine as I have heard fears of iron overload to suspicion of anemia from different doctors, but no recommendations to do anything. I’ve had high serum iron and percent saturation with low-normal ferritin for several years that I know of, but no tests for these prior to 2018 to know what was going on prior.
    Serum iron has ranged from 186mcg/cl (192 mcg/dl most recent) to 218mcg/dl,
    TIBC range has been from 292mcg/dl (336 mcg/dl most recent) to 430 mcg/dl,
    % saturation from 52% to 74% (57% most recent),
    ferritin from 28 ng/ml (most recent) to 52 ng/ml.
    HGB has ranged from 14 to 15.2 and HCT from 42 to 44.1, both above range, and high MCV from 93.1 to 94.

    Any thoughts/advice you might have is much appreciated!

    1. Dr. Matt

      Consider D3/K2, riboflavin, lipothiamine, magnesium, Active form B12/folate.

      Get zinc and copper checked.

      All effect iron metabolism and utilization.

      MCV is high could be low B’s, thyroid, mouth breathing. Consider mouth taping.


      Antidepressants? Birth control?

  9. Anisha P

    Hello, I just came across your article. Long story short my hair has been thinning and falling out, the thickness of my hair has halved (which is stressful). After doing a little research I decided to get blood work done. My iron levels and vitamin D seem high, but ferritin is really low. My doctors response to all my lab work was “all labs look normal. Iron is a little elevated but there are some natural fluctuations. For Iron you can purchase SlowFe over the counter. For vitamin D and calcium I suggest 400-800 IU/day. To maximize calcium absorption, calcium should be taken in divided doses of 500mg or less at one time.” I understand Ferritin needs to be over 100 for hair health (mine is at 17), vitamin D optimal range is 70-80 ng/mL (mine is at 34), but my iron is high.

    Here are my lab results:
    – Iron levels: 197 ug/dL, iron binding 352 ug/dL, Iron % saturation 56
    – Ferritin: 17 ng/mL
    – Thyroid (TSH) w/ reflex free T4: 2.0 uIU/mL
    – Vitamin D: 34 ng/mL
    – Vitamin B12: 704 pg/mL
    – Folic Acid: 30.7 ng/mL

    In terms of vitamins I take this everyday:
    – zinc 50mg, vitamin D 25 mcg, b-12 1000 mcg, two multi vitamins, omega 3 690 mg, biotin 10000 mcg
    (I am also on birth control Blisovi Fe 1mg/0.02 mg)

    I don’t know what to do or why my ferretin is low and iron is high, and am confused by the advice of my doctor. I’d really really appreciate any help or tips you have. Thanks so much!

    1. Dr. Matt

      That is a lot of zinc to take on a regular basis. May want to decrease.

      I would used D3/K2 instead of D3 by itself. Ideally get D levels over 50.

      Iron is likely high with ferritin low because of OCP use. Given thinning hair and Ferritin is likely you are iron deficient.

      Blood Vitality is my favorite way to get iron levels up efficiently without all the inflammatory side effects of standard iron.


      1. Anisha P

        Thanks for your response! You said “Iron is likely high with ferritin low because of OCP use.” What is OCP use?

        Given my iron levels are high and low ferritin, is it okay to take iron supplements?

        I took a look at the blood vitality supplement facts and I’m getting all those in the multi vitamin I take, but the multivitamin has higher levels of each.

        1. rose

          OCP = oral contraceptive (birth control)

          This is a common iron panel when a woman is on birth control.

          You can’t no for sure without stopping birth control where the numbers are at but yes you are likely low in iron.

          The main thing about iron supplementation is minimizing side effects and maximizing utilization. Neither are possible with a standard multivitamin.

    2. Sara

      I was on the same birth control with similar numbers to you. Can’t help with the iron, but get the biopsy for scarring hair loss at the dermatologist… I had the gene that was sensitive to androgens in the birth control and that is what was causing the hair loss (which you don’t want!!). Every doctor told me I was crazy and that it was stress from caring for a sick parent since was probably 25-27 at the time and looked young and healthy. Best of luck babes!

  10. Laura

    Your article is the first resource that has given me ANY insight into what I am dealing with, so thank you for that! But I still unsure how to move forward.

    Lab results:
    Iron: 258 UG/DL
    Ferritin: 13.9 NG/ML
    Vitamin D: 26.4 NG/ML
    Folate: 23.6 NG/ML
    B-12: 409 PG/ML

    To give some background, I have been experiencing intense hair loss (diffused but especially on top of scalp), dizziness, fatigue, brittle nails, irritability, easy bruising (all symptoms of ferritin deficiency!). All my thyroid labs were normal. However, I realize the other day, that my ferritin was extremely low (as is vitamin D, but the doctor has me on a supplement for that), even though it is in the “normal” range, but my iron was extremely high. My doctor informed me my labs are normal, and I should not supplement iron—to avoid toxicity.

    At the point, I feel I know the issue is ferritin (along with other deficiencies like vitamin D), but I do not know how to raise it without taking iron supplements.

    There is very few resources discussing low ferritin but high iron.

    What would you suggest I do to raise my ferritin levels? I am desperate, and doctors have literally been no help to me.

    1. Laura

      And to give a little more insight, I am currently breastfeeding.

      Back in the 2009-2011 time frame (I cannot remember specifically), I tried to donate blood but they could not accept it because my levels indicated I was anemic.

      Additionally, this last week I was on my menstrual cycle (which returned 3 mont postpartum while exclusively breastfeeding), & all my symptoms became exponentially worse; which to me is further indication I have an iron deficiency.

      But all my doctors want to focus on is that my iron is extremely high, despite the fact that I have most of the symptoms of ferritin/iron deficiency. So frustrating.

    2. Laura

      Your article is the first resource that has given me ANY insight into what I am dealing with, so thank you for that! But I still unsure how to move forward.

      Lab results:
      Iron: 258 UG/DL
      Ferritin: 13.9 NG/ML
      Vitamin D: 26.4 NG/ML
      Folate: 23.6 NG/ML
      B-12: 409 PG/ML

      To give some background, I have been experiencing intense hair loss (diffused but especially on top of scalp), dizziness, fatigue, brittle nails, irritability, easy bruising, heart palpitations, feeling cold (all symptoms of ferritin deficiency!). All my thyroid labs were normal. However, I realize the other day, that my ferritin was extremely low (as is vitamin D, but the doctor has me on a supplement for that), even though it is in the “normal” range, but my iron was extremely high. My doctor informed me my labs are normal, and I should not supplement iron—to avoid toxicity.

      At the point, I feel I know the issue is ferritin (along with other deficiencies like vitamin D), but I do not know how to raise it without taking iron supplements.

      There is very few resources discussing low ferritin but high iron.

      What would you suggest I do to raise my ferritin levels? I am desperate, and doctors have literally been no help to me.

      To give a little more insight, I am currently breastfeeding.

      Back in the 2009-2011 time frame (I cannot remember specifically), I tried to donate blood but they would not accept it because my bloodwork indicated I was anemic.

      Additionally, this last week I was on my menstrual cycle, & all my symptoms became exponentially worse; which to me is further indication I have an iron deficiency.

      1. Dr. Matt

        I would also check your TIBC and transferrin/iron saturation. It does sounnd like you have insufficient iron stores which could be why there is so much in circulation.

        You can test all your levels and then recheck after taking a highly absorbable not digestion inflaming iron like Blood Vitality.


        Definitely want to get your D levels up into 50-70 range. https://drwholeness.myshopify.com/collections/nutritional-supplements/products/vitamin-d3-k2-liquid

        Alps consider taking vitamin A 5000-10000IU for a while to make sure you are sufficient as vitamin A is very important just like vitamin D for iron utilization.

        Also birth control is an issue and will mess up lab results.

  11. Elle

    Hi Dr. Matt!
    I am so thankful I found your website and post on this topic. I have been dealing with fatigue, hair thinning, hair loss, severe anxiety, dizziness, feeling unwell, and possible perimenopausal symptoms.
    Over the last month I had several things checked and of course my doctor says it all looks “normal” so no worries. Well I still don’t feel optimal so there must be something I am lacking. Can you offer me some insight?
    The only prescription medication I take is 25 mg Metoprolol for pvcs/pacs
    Folate – 11.5
    Vitamin B12 – 698
    Iron Bind TIBC – 325
    UIBC – 175
    Iron – 150
    Iron Saturation 46
    Ferritin – 41
    Transferrin – 276
    Vitamin D – 33
    TSH – 0.62
    Free Thyroxine (Ft4) – 1
    Sodium 138 mmol/L
    Potassium 4.8 mmol/L
    Chloride 104 mmol/L
    Carbon Dioxide (CO2) 26 mmol/L
    Anion Gap 8
    Glucose 89 mg/dL
    Blood Urea Nitrogen (BUN) 10 mg/dL
    Creatinine 0.77 mg/dL
    GFR Non African American 98 mL
    Calcium 9.5 mg/dL
    Protein Total 6.8 g/dL
    Albumin 4.2 g/dL
    Globulin 2.6 g/dL
    Albumin/Globulin Ratio 1.6
    Alkaline Phosphatase 58 U/L
    Aspartate Aminotransferase (AST) 17 U/L
    Alanine Aminotransferase (ALT) 16 U/L
    Bilirubin Total 2.0 mg/dL

    1. Dr. Matt

      Might want to check progesterone, estradiol, estrone, free T3, testosterone.

      Given your overall iron picture it sounds like hormonal imbalance unless your iron has been low and has recently come up to its current level.

  12. Marcella

    Thank you so much for taking the time to answer our questions!
    I have type 2 diabetes which I control with eating, currently my A1c is 5.3. Because my cholesterol started to climb (all that meat in lieu of carbs, I suppose) and reached 200, I backed down on meat, but my ferritin took a dive within two months. My saturation thee months ago was high (400 something), along with transferrin, but TIBC was normal, and my ferritin was 22. Now, two months later:

    Saturation: 23 (normal)
    Ferritin: 8 (very low)
    Binding Cap: 370 (normal)
    Iron Total: 87 (normal)
    Transferrin: 311 (normal/high-ish)

    After the blood draw, I came out with barely feeling my legs and arms and a bit dizzy, and two days later my arms and legs are still a bit funny (tingling/filled sensation). Shall I take iron tablets? When I did 60mg yesterday, I almost felt worse, but I’m really worried about my low ferritin, which after ten vials of blood draw is probably even lower. Blood count/RBW and platelets were normal. I have tingling in my hands often, which is why I went to get lab work done to begin with, but not as bad as now. I know it could be related to my diabetes in theory, but then my sugar level is really under control: I never go over 140 and my fasting sugar is in the low 90s. And, that heavy feeling in my arms and legs only started with the blood draw (not stiff, painful or weak, rather as if I have worked out too hard). Again, thank you for the advice.

    1. Dr. Matt

      Definitely sounds like you need some iron. I would check out Blood Vitality so much of iron absorption and utilization is Locke up the lack of synergistic nutrients. http://Www.optimizeiron.com

      Your A1c suggests your diabetes is well controlled so it would be unlikely blood sugar is causing your symptom.

      1. Marcella

        I received Blood Vitality and started taking it, thank you! Only I’m not sure if I should take on or two pills, given that while my ferritin is very low (it was 8 even before the 10 vials of blood draw, I think it is worse now), yet my serum iron levels are not particularly low. I’m worried about “overdosing” on iron because I know excessive iron is not healthy. I also found that other iron supplements (not Blood Vitality, which I’ve just started), give me acid reflux, even night sweats (or perhaps it’s the acid reflux that give me night sweats). Please advise on dosage and whether I should take Blood Vitality in the morning or at night, with food or without food – thank you.

        1. Dr. Matt

          2 capsules per day taken together is my general recommendation.

          Also, it is most preferable to consume away from food.

          If your ferritin was 8 then you are nowhere close to iron overload.

          It is good to recheck your ferritin in 4-6 weeks to make sure dose is sufficient bringing your levels up.

          Keep us posted.

    2. Sue

      Check your B12 blood level. Tingling, pins and needles, numbness were among my many B12 deficiency symptoms. Most people feel there best with their B12 blood level at 800. Mine was 220 when I was diagnosed. B12 injections bring your levels up quickly.

  13. Sarah

    After months and months of fatigue, Inhad blood work and my iron labs were way off. I’m not anemic but have been told it seems i have a storage problem.
    Ferritin was 7
    Iron 103
    Transferrin 303
    Total binding 424

    I’ve completely changed my diet, taking iron, vitamin c and b every other day. I also suffer for very heavy periods which last a full 5 days- of bleeding. But why is my body have such a hard time?

    1. Dr. Matt

      The heavy periods are the likely cause. You may want to see about utilizing a more efficient iron system though like Blood Vitality. This way you can take iron daily and get your ferritin levels up more efficiently. https://optimizeiron.com/

  14. Kimberly P

    Hi Matt thank you so much for your article! I have been trying to understand my test results and symptoms for awhile now. I am 8 months postpartum and not breastfeeding anymore. During pregnancy I was mildly anemic and took supplements to help eventually my symptoms of palpations and lightnessness went away by the end of pregnancy and I stopped taking the iron at 3 months pp but now all the symptoms have came back and plus some. Muscle weakness palpations exhausted feeling always hungry and sometimes flu like symptoms. I started taking my iron supplement of 65mg 2x daily again about 3 weeks ago and hoping for some relief soon. Also got checked for diabetes etc all good there!
    Below are some of my recent labs
    Any advice?

    Ferritin 27
    Hgb 14.2
    RBC 4.9
    Hct 42.9
    UIBC 298
    Transferrin 18
    Vit B12 704

    1. Dr. Matt

      I like to shoot for a ferritin of 50 at least, then depending on symptoms may push up to 100.

      Taking 65mg 2x per day ends up putting unnecessary stress on the body and will increase hepicidin production greatly decreasing your ability to uptake iron.

      I would consider a more efficient route of iron supplementation like Blood Vitality. http://Www.optimizeiron.com

      This way you can increase your ferritin but create excess oxidation and inflammation. Most women will do great on just 30mg of elemental iron through the Blood Vitality system.

      Let us know how it goes.

      1. Kimberly P

        Thanks so much for your reply! I just ordered BV and can’t wait to try them out. How many pills should I take a day?

  15. Eddy

    Hi, finally something on high iron in blood but low ferritin. There is not enough content on that topic on the internet. Thanks for that. Would really appreciate your opinion on my results and as I have high Iron but way to low ferritin

    Iron: 206 (33-193µg)
    UIBC: 154 (125-345µg)
    TIBC: 360 (250 – 450µg)
    Iron Saturaion: 57% (15-50%)
    Ferretin: 25.9 (30 – 300ng/ml)

    Phosphor, Calcium, Mangesium, Sodium, Potassium in normal Range
    Kidney: GFR 87.4 (> 90 mL/min/1.73m)
    HDL Cholesterol: 35 (40-60mg/dL)
    LDL Cholesterol: 142 (<100mg/dL

    1. Dr. Matt

      Do you have symptoms of iron deficiency?

      Meat, vegetables, fruit and a resistance training program would go a long ways in helping your HDL level.

      Thyroid issue. Birth control?

      1. Eddy

        Hello, thank you for the reply.

        My symptoms are: Fatique, Palpilations when walking. Hard time breathing when on the laying on the side.

        I do workout 3x per week in the gym, I have a normal BMI. I am male, so not on birth control.

        Also forgot to include hemoglobin levels which maybe not working properly in transporting oxygen?

        Maybe have to check thyroid have not checked it for a long time.

        Hgb: 17.5 (14-18 g/dL)

        Really not sure what is going on

  16. Missy

    I just had a blood panel ran and for the first time I am being told that I have high iron and low ferritin. My doctor suggested I stop taking any iron supplements for four weeks and then have my levels rechecked. I do not take any iron supplements, and here are my results. I am also a pescatarian so fish is the only meat in my diet, and I do not take any OCP as I am menopausal.
    Ferritin – 24.8
    Iron – 170
    Folate – 16.70
    Vitamin D – 65.6
    B12 – 619
    I am being treated for hypothyroidism and my doctor just adjusted my medication dosage as my levels came back as
    TSH – 0.02
    Free T4 – 1.43
    Free T3 – 5.47

  17. Josh P


    Please could you let me know your thoughts on my labs?

    Ferritin – 10 ug/L
    Iron – 17.7 umol/L
    Transferrin – 2.7 g/L
    Total binding – 68 umo/L
    B12 – 358 ng/L (Hydroxocobalamin 1mg/1ml every 12 weeks)
    Folate – 3.7 ug/L

    Many Thanks

    1. Dr. matt angove

      These results suggest you have low iron, B12, and folate. Get those levels up and you should feel like a new human 🙂

      Check out
      Www. optimizeiron.com for help.

  18. Josh P

    Hi Dr. Matt

    Please could you let me know your thoughts on my labs?

    Symptoms are:
    – Fatigue
    – Poor Memory
    – Unable to concentrate
    – Increased resting HR
    – Dizziness
    – Tinnitus
    – Restless Leg

    Have tried all ferritin supplements but all effect gastro so unable to tolerate.

    Ferritin – 10 ug/L
    Iron – 17.7 umol/L
    Transferrin – 2.7 g/L
    Total binding – 68 umo/L
    B12 – 358 ng/L (Hydroxocobalamin 1mg/1ml every 12 weeks)
    Folate – 3.7 ug/L

    Many Thanks

  19. Dr. matt angove

    Have you tried Blood Vitality? It is only one I use in practice as I have not seen side effects with it and it raises levels extremely efficiently.

    1. Nikki

      IBCU- 255
      Transferrin saturation- 360
      Ferritin -17
      Vitamin D -24
      High ANA,Positive Anti ssb,low wbc and lymphocytes,joint pain, bad heart palpitations/ bradycardia and tachycardia, fatigue, shortnessof breath, confused at times, bruise easily, blacked out twice, and down almost 30 lbs in a month. Also I’m a 39 year old female, no birth control due to tubal ligation. Any idea what’s going on and if I should get supplements? Please any advice to feel better would be very appreciated 🙏

  20. Jared

    Hey Dr Matt, thank you for sharing your expertise–very informative! I also posted this on one of your youtube videos… I’ve consistently checked low in ferritin the last few yrs. (hovering around 29) but having apparently normal iron levels otherwise. I’ve also been borderline hypothyroid with an elevated TSH and I’ve heard low ferritin can cause/exacerbate low thyroid. A few questions:

    1. Is ferritin truly the gold standard for the need for iron supplementation? Are there any instances/conditions where this is not the case?

    2. What do you think of bovine spleen to raise ferritin? I’ve tried iron supplements in the past (they were supposed to be the “safe” natural kind) and got weird symptoms–not gastro–but feeling spacey and depth perception/visual disturbances.

    3. I’ve read that for a man to have low ferritin is rare and internal bleeding should be ruled out. What’s your take–what would cause iron deficiency in a 34 yr old man? FYI, I do have chronic health issues, particularly lyme disease (diagnosed at 19) and pectus excavatum (rib cage compressing heart and lungs). I also struggle with persistent fungal skin infections and likely digestive as well (distended abdomen).

    Thank you for your time!

    1. Dr. Matt

      1) in inflammed state ferritin can be high and yet a person be in significant need for iron.
      2) spleen is a reasonable source….Blood Vitality http://www.optimizeiron.com is also a very unique source for iron.

      3) chronic lyme can cause all manner of issues. Fungal infections if present suggest imbalance of flora generally, which can effect iron absorption. may want to look into getting that taken care of first, since you can readily notice it between the bloating and skin infections.

  21. Michael


    I received the following blood results recently. I had done bloods a year previous, so I have points of comparison. I’m struck by the increase in my iron and transferrin saturation levels (72% seems way too high), but my ferritin is low. Could this be early-stage haemochromatosis? I’m Irish, a high-risk population, and I know my brother is a carrier with one gene, so it seems possible I could have two. Or is it more likely to be something else in my case?

    Iron: 47.2 umol/L (up from 18.4 a year previous)
    Transferrin: 2.63 g/L (down from 2.9)
    Transferrin saturation: 72% (up from 25%)
    TIBC: 66 umol/L (down from 73)
    Serum folate: 4.8 ng/mL (down from 9.9)
    Serum ferritin: 36 ng/mL (down from 46)

    Thank you.

    1. Dr. Matt

      Hi Michael, potentially but also could be a sign of increased iron utilization.

      This is why iron and iron saturation aren’t reliable markers of total body iron status as they can change fairly quickly with supplements, iron skillets, exercise, meals, whereas ferritin outside of acute inflammation is very consistent related to iron levels.

      I would recheck, fasting in the morning. Maybe get a hsCRP reading as well.

  22. Kim

    I have had iron issues for some time. This last time my iron bloodwork has come back a lot different than other times. I have asked my DR to retake my iron after fasting and he says that it is not beneficial to do that. Everything I read online suggests that iron bloodwork should be done in the morning after fasting. What reasons could there be for the following results of my iron bloodwork? I have now been referred to a gastroenterologist with no explanation as to why.
    Ferritin 5
    Transferrin Sat 60%
    Total Iron 277
    Total Iron Bind – 463
    Thank you for taking the time to look at my question. It is greatly appreciated.

    1. Matt

      Did you supplement with iron or eat high iron meal in the hours before blood draw? Looks like you are iron deficient and the body is transferring high amounts of iron to tissues in need.

  23. Aaron

    Hello Dr, Matt
    Recently had CBC with Diff and discovered my iron levels are odd and never been like this before. 45 year old male pretty well in shape although i did suffer a broken femur which required a blood transfusion do to loss of blood. The surgery was over 6 months ago. Ever sense then Iron, Ferritin, RDW, Bilirubin have gone off the charts a bit.
    Bilirubin = 1.6
    RDW = 15.3
    Iron total = 246
    Ferritin = 22

    Should i just go donate blood to reduce the high Iron levels? Any other recommendations to correct the Bilirubin RDW factored as well? Thank you for your time

    1. Dr. Matt

      You may want to look into Delayed Hemolytic Transfusion Reaction if these levels were all normal previously and then changed and remained post transfusion. Donating blood is unlikely to fix this.

  24. taryn

    like the others, i was so confused to get my results. i read through the whole thread but I’m still not feeling like its clear. thryoid and CBCs all came back normal. I’m not on birth control, I don’t use a cast iron skillet and I fasted for about 16 hours before labs.

    iron profile:
    IRON PLASMA 219 high
    TIBC 385
    FERRITIN 10 low

    other abnormal results:
    LDL 144 high
    TBIL 1.42 high
    BUN 7 low
    UA PH 8.5 high

    1. Dr. Matt

      You need more protein in your diet to start, given your low BUN.

      And more Whole Foods, less processed sugars, fats and flours to get that LDL right.

  25. Jessica Adams

    Hi Dr. Matt,
    My son just turned 7 and he has been off with his iron.

    Results from June 2021
    iron, total 125
    iron binding capacity 360
    % saturation 35
    ferritin 10
    Thyroid levels normal
    hemoglobin 14.6
    hematocrit 43.2

    Results from December 2021
    iron, total 178
    iron binding 391
    % saturation 46
    ferritin 9
    hemoglobin 14.3
    hematocrit 41.9

    I have not given him any otc supplements for this and he was fasting for both tests. All his other labs are normal. We do use an iron skillet maybe 2-3 times a week. Any insight would be so appreciated.

  26. Danielle

    Hi Dr. Matt,
    I am a 44yo female and have been struggling for some time with low energy/ fatigue, cold hands/feet, brain fog, and hair loss. I have tried many different supplements and dietary shifts etc. with little improvement. I assumed it was stress and hormones. recently my acupuncturist recommended I get my Ferritin levels checked and low and behold my iron labs came back a little off. My provider suggested I may have a condition called genetic Hemochromatosis–but that doesn’t really resonate with me as I do not have anyone in my family with the disorder and my 23and me came back negative for the genes tested for this disorder. I plan to have my a redraw on my iron labs, thyroid and have a CBC done. But can you interpret my Labs? From your article I took away that I am most likely iron deficient. If this is the case can you recommend a supplement?
    TSH– .930
    FT4— .65

    Lipid Panel:
    CMP–All normal range

    INSULIN- 7.0

  27. Danielle

    Hi Dr. Matt,
    Thank you fr this article it has been very helpful it is hard to find information on high iron and low ferritin. I have been struggling for quite some time with low energy, fatigue, low motivation mood issues, hair loss and cold hands and feet. I have tried many different avenues–supplements, dietary changes etc. I assumed it was all stress and hormone related. However, this past fall my acupuncturist recommended I have my Ferritin levels checked. Low and behold my iron labs came back a bit off. My thyroid and cholesterol are a little off as well which has not been the case historically. My provider has shared that she thinks I may have Genetic Hemochromatosis– however this does not resonate with me. I do not have anyone in my family with this disorder and my 23 and me id negative for the gene/s tested for this. I am wondering if you could help interpret my labs? I plan to have my iron labs redrawn as well as have a CBC done. My take away from your article is that I most likely am iron deficient. If this is the case would you recommend the blood vitality supplement?
    Fasting LABS:
    FESAT%– 57.79
    TSH– .930
    FT4– .65
    CMP–All normal range
    LIPID panel
    Trig– 135
    LDLC– 134
    HDL– 62
    Any insight would be greatly appreciated! Thank you!

  28. Kristin

    Hi Dr. Matt! My recent labs are showing low-normal ferritin and high iron/% Saturation). My doctor wants to re-test in a fasting state in 2 months. In the meantime, can you please help me interpret these results?

    Iron = 176 mcg/dL
    Transferrin 254 mg/dL
    TIBC, Calc = 318 mcg/dL
    % Saturation Calc = 55%

    Ferritin was 14 while on multivitamins with iron. In the last year, Ferritin has been 12 and 22 while on iron and 8 while not on iron.

    All other blood work was normal or low-normal. RBD = low normal 3.75, Hemoglobin = low normal 12 g/dL, TSH Sensitive = .85 ulU/mL

    I’m a woman, no birth control, low use of cast iron, age 45, normal BMI. My doctor thought this might be hereditary hemochromatosis? Any other hypotheses or suggestions?

    Thanks so much!

      1. Kristin Illingworth

        I do have symptoms of iron deficiency including fatigue (biggest concern), being cold and thinning hair. I do not feel better when I take iron and I’ve tried several types in pill form (including yours!) and liquid form.

  29. Anna

    Hi, I recently got a blood test at an endocrinologist w some abnormal results. I’m a 20-year-old female and I have some chronic conditions such as POTS. I am a vegetarian and I exercise regularly.
    Iron 230 H 30-170 (ug/dL)
    UIBC 191 112-347 (ug/dL)
    TIBC 421 H 225-390 (mcg/dL)
    % Transferrin Saturation 54.6 H 14-50 (Percent)
    Ferritin 12.3 L 13-150 (ng/mL)
    Transferrin 350 200-360 (mg/dL)

    The ferritin is pretty low while the iron is very high. The endocrinologist also said I have slight Hashimotos:
    Thyroid Peroxidase Ab 9.2 H < 9 (IU/mL)

    This was the only abnormal thyroid result. I have been experiencing extreme fatigue for a long time as well. Any insight? A reply would be much appreciated!

  30. Lauren

    I would appreciate any insight into some symptoms. Right now, I’m being monitored for potential lymphoma due to other symptoms such as drenching night sweats, enlarged lymph nodes, etc. However, I have become increasingly fatigued and found out my iron levels are 168 ug/dL and my ferritin is <5. What could be a cause for normal (somewhat high) iron levels and a very low ferritin? Could this be related to other symptoms of night sweats and persistent cold? Thank you. I brought it up to my PCP but they do not think that my low ferritin is even making me fatigued.

  31. Alexis

    Hi Dr. Matt,
    Can you help me understand these results?
    Not on birth control, get my thyroid tested annually and it’s always been fine…
    Ferratin 25 ng/mL
    Iron 141 ug/dL
    Transferrin saturation 54%

  32. Sarah

    Hi Dr. Matt,
    Can you help me understand these results? Am I iron deficient or is my iron too high?
    Iron binding capacity – 282mcg/dl
    Ferratin – 29ng/mL
    Iron – 210mcg/dl
    Iron saturation – 72%

  33. Theresa

    hi Dr. Matt,
    can you please help me understand my results, i don’t know what else to do. i am a 24 year old female who has a history of kidney stones. I have severe symptoms and its beginning to get in the way of my daily life; I’m exhausted (completed fatigued all the time), I can’t stay awake for more than 4 hours at a time, i’m constantly out of breath after doing anything remotely physical, dizziness when standing, paler than I’ve been before, high blood pressure, zero tolerance to cold, ringing in ears, sharp pain in ears, constant headaches, joint pain and back pain, hair loss, mood issues, nausea.
    Ferritin – 19 ug/L
    Vitamin B12 – 231 pmol/L
    Iron – 38 umol/L
    Transferrin Sat – 54%
    Transferrin – 2.79 g/L
    TIBC – 70 umol/L

  34. Sue

    Hi Dr. Matt,

    I am heterozygous for Hemachromatosis for the C282Y mutation. The last blood test was: SI: 105, transferrin sat 31, TIBC 343, Ferritin 34 (prior numbers in years past were 37, 27,40…and those were when I was on a multivitamin with iron and other numbers were high). I instead take a multivitamin without iron now…. But even on that the ferritin was never normal. Hemoglobin hovers around 12.7-14.1. My RBC’s hover around 4.5, WBC’s 3.4-5.3. I usually am borderline neutropenia, around 1.6-1.8 for absolute neutrophils, all else normal. My cholesterol is always high, over 200, but other numbers balance it out. Cardiologist not worried. I do have irregular heartbeat, on flecainide and metoprolol low dose. I eat healthy, but do have breast cancer, on arimidex, Vit D, (was low before) Calcium, prolia due to resultant osteopenia. I have had a hysterectomy. Had acute thyroiditis about 20y ago but that has normalized. Seeing endocrinologist soon. Thoughts? Recommendations? Much thanks!

    1. Dr. Matt

      Vitamin K2 want to have it on board with BC as well as anytime you are taking D3 and calcium.

      Also look into thiamine theory and nutrient depletion from arimidex.

      May want to go to cardiologist and get a better understanding as to what is going on with the cardiac irregularity and if there is anyway around being on both of those meds. Given they plan on you being on those for life unless you say otherwise or ask them to think outside the box.


  35. Chris s

    Hi Dr Matt,
    I enjoyed your article, well written. Looking for some guidance on my labs. 49 yo male, 6 months post gastric sleeve. I am asymptomatic. I also am on Testopel for Idiopathic low T due to primary hypogonadal failure diagnosed 8 years ago. I have sleep apnea treated with Bi-pap. I have not been taking my vitamin supplement like I should, but will be starting after my lab results. Is my high serum iron due to late onset Haemochromatosis or vitamin deficiency or occasional alcohol use? My labs were fasting, and I had not taken any supplements. I infrequently use a cast iron skillet.

    2 years ago my labs were almost identical, but my tsat was 17% and my serum iron was 66. What changed in 2 years:
    1. Gastric Sleeve
    2. Consistent testoerone replacement with pellets, was non compliant with gel
    3. Compliant with bi-pap, was non compliant with c-pap.

    Serum iron: 223
    TIBC: 393
    TSAT: 57%
    Transferrin: 264
    Ferritin: 148
    B12: 323 (ref range: (211-911)
    Vit D: 21.8 (ref: 30-100)
    Folate: 11.81 ng/ml
    Hgb/hct 17.5/49.1 high due to testosterone therapy
    All other rec/wbc labs wnl
    AST/alt: 10/11
    Asp: 62
    Bilirubin total: 1.1
    Albumin 4.4
    Total protein: 7.1
    Scr:. 0.81
    BUN 18
    A1C: 5.1
    Chol: 162
    HDL: 46
    LDL: 101
    TG: 77

  36. Allison

    I’ve been trying to conceive for over a year, and my acupuncturist says I need to have ferritin over 70ng and I cannot seem to get over 30ng. My iron labs are:
    Iron 171 ugh/dL
    TIBC 347 ug/dL
    Transferrin Saturation 49%

    I do have Hashimoto’s and my current thyroid lab is 1.060, I cannot seem to move the needle on the ferritin and fear that is causing implantation issues. I’ve been taking iron supplements (OptiFerin-C from Pure), two capsules a day. Any advice to increase ferritin levels?

    1. Dr. Matt

      Might want to try Blood Vitality (www.optimizeiron.com) as it has all the cofactors and supportive minerals packaged uniquely to build ferritin. Also look at using thiamine. Are you ovulating?

      I wouldn’t say you need a ferritin over 70 to conceive or carry a pregnancy though.

  37. Adam

    I know this is old, but I have low ferritin but high iron and saturation. Iron is at 385 sat is 97% ferritin was 25. I have hemochromatosis. I’ve never seen ferritin be low when my iron was high. It’s happened the last 2 labs I’ve had drawn. :/

    1. Shawn

      I have the same issue, Adam. I was diagnosed with Hereditary Hemochromatosis a few years ago (both mutated genes and a ferritin of 1180) I’ve gotten the ferritin back into normal ranges through phlebotomy, and for a while ferritin was the only test that was done. The last two times, they’ve done the other iron tests, and my ferritin was good at 90.6, but my iron was slightly high at 177ug/dl and my iron sat was quite high at 57%. I’m not sure what to make of that. I was fasted and had no meds or supplements that day.
      The HH has really taken its toll–I have type 2 diabetes, go into a-fib fairly regularly, and have some vision and memory problems. I also had a lot of joint pain and fatigue. That got better with the treatments, but those two have recently come back with a vengeance, and I’m wondering if the high test values might be an indication of why. Have you gained anymore insight into the issue?

  38. Maria Elise

    Hi doctor Matt,
    Today I got to know my ferritin level is at 8 (doctor said it should be more than 15). After one year on iron supplementation, he said it has not worked and I should now go for intravenous iron. Any thoughts about it, is it really helpful or with side effects? My husband and I are trying to conceive for 1 and a half year with no result. I have also had bad morning allergies since childhood (sneezing, watery eyes, sinus pressure) which cause is unknown. Could the low ferritin and allergies be a result of chronic inflammation? If so, any advice on where to start? I am losing faith 🙁

    1. rose

      Have you tried blood vitality?www.optimizeiron.com

      Inositol is great to support conception.

      I don’t think iron infusions are the answer. There is a reason you are having the sinus, eye thing work with a doctor to figure it out or go on your own study. Likely some environmental or food that is an issue. immunocap blood panel can help with this. Also get A, D, copper, zinc, B12, folate levels Checked.

  39. Kim

    Hi Dr. Matt,

    I’ve been struggling with low ferritin and in and out of bouts of anemia for over four years now. My ferritin has fluctuated between 2 ng/mL and 22 ng/mL over the course of four years. A year ago my total iron was high, but with ferritin at 20 ng/mL after taking Floravital liquid iron for a year (my ferritin actually went down over the course of the year taking liquid iron almost daily). My doctor advised me to stop taking the supplement, and now my ferritin is down to 4, but I am not anemic. Could this be an absorption issue? I’ve had symptoms of anemia for the full four+ years, and doctors have not been very knowledgable about the issue.

    My most recent blood CBC and Ferritin results:
    White blood cell count 6.8 Thousand/uL
    Red blood cell count 4.45 Million/uL
    Hemoglobin 13.0 g/dL
    Hematocrit 38.8 %
    Mean corpuscular volume 87.2 fL
    Mean corpuscular hemoglobin 29.2 pg
    Mean corpuscular hemoglobin concentration 33.5 g/dL
    Red blood cell distribution width 12.9 %
    Platelet count 266.0 Thousand/uL
    Mean platelet volume 10.4 fL
    Ferritin 5.0 ng/mL

  40. Pat Arsenault

    Hey dr Matt
    This is a long shot as I don’t usually ask on these websites I’ve been very sick over the last year I’ve had idiopathic pancreatitis ever since had gastritis acid reflux that won’t go away a few months later I was diagnosed with genetic hemochromatosis and small blood cloths in iv sites, I’ve been giving phlebotomys ands it’s worked a few times but now my iron is 47
    My saturation is 92%
    But my ferretin is at 42
    And my tibc is always low
    I’m extremely sick with chronic stomach pains burning swollen tongue I’ve been trying to treat it with Percocet 5mg but it’s not helping anymore am I able to give blood with low or normal ferretin but high iron?
    Thank you

  41. Heather

    My 15 y/o son has low ferritin but his iron is at the top of the range. How do I get his ferritin raised without pushing his iron over the top? Thank you!

  42. Lee

    Hi, I’m iron deficient with anemia and have been on slow release iron supplements for a while. Last blood work with new GP showed Total iron 323 mcg/dL, % Sat 90, and Ferratin 7 ng/mL. I’ve called four times to discuss my blood work and no one is calling back. It’s been 2 mo. I can see a specialist without a referral, so thinking maybe I should just go see a hematologist. Thank you.

  43. Natalia

    I’m so happy I found your article, dr. I’ve always been anemic and recently went to high elevation area. I felt like a train went over me. So, I figured my iron was out of wack. I started taking iron supplements and had my iron test a month later.
    The nurse called me and told me to stop talking iron because my levels are nigh. The first time ever. She didn’t mention my low ferritin though.
    I was takung bcp for a month.
    Test results
    Iron total 216
    IBC 503
    Saturation 43
    Ferritin 13
    Thanks in advance!

    1. Dr. Matt

      A TIBC of 503 definitely suggests your body is craving iron. Also, your ferritin of 13 suggests your iron stores are insufficient.
      The iron total and iron saturation can often be high if a person supplements with iron within 24 hours of a blood draw. This doesn’t mean you have excess iron, it means the body is readily putting the iron to work and you will need more.

      1. Natalia

        I’m so happy I found your article, dr. I’ve always been anemic and recently went to high elevation area. I felt like a train went over me. So, I figured my iron was out of wack. I started taking iron supplements and had my iron test a month later.
        The nurse called me and told me to stop talking iron because my levels are nigh. The first time ever. She didn’t mention my low ferritin though.
        I was takung bcp for a month.
        Test results
        Iron total 216
        IBC 503
        Saturation 43
        Ferritin 13
        Thanks in advance!

  44. Molly


    In June 2021 my ferritin was 30. I’d read from a different integrative/functional med doc that it should ideally be between 100-200 for women. I started taking iron supplements about 6 months ago and just did bloodwork last week.

    Total iron 164 (high)
    % saturation 52 (high)

    Unfortunately there was a mixup with the ferritin request and the lab never got it. Doc offered to run again but I’m overwhelmed with other health issues so skipped it for now.

    She said to STOP taking the iron supps as that likely spiked my iron readings (they’ve always been normal). I’m not so sure but have stopped for now.

    Curious to see what you make of this. I 53, perimenopausal, have thyroid nodules, and also just got low proten and low globulin results (never had those before either). I HAVE had slightly elevated bilirubin but it’s resolved. Also low in Vit D (I supp 5,000ius) and high cortisol (although better this year at 23.5 vs. 26.5 last year).

    Thank you! – Molly

    1. Dr. Matt

      If you were supplementing with iron then your total iron and iron saturation may be high because of utilization of the iron you are consuming. If patients come back with high iron or iron saturation, I recommend they not take iron within 24 hours, sometimes 48 hours of getting the blood draw. Also, get blood draw first thing in morning, fasting and not just after exercise.
      Really need a ferritin value though.

  45. Kathy mcccabe

    I am extremely fatigue. My blood test show low ferritin 29 ng/ml ,my iron is high 174 mcg/dL ,iron binding capacity is 391 ,%saturation /16-45%,mine is 45 .I would appreciate your input and comments

  46. Kathy mccabe

    I am extremely fatigue. My blood test show low ferritin 29 ng/ml ,my iron is high 174 mcg/dL ,iron binding capacity is 391 ,%saturation /16-45%,mine is 45 .I would appreciate your input and comments

  47. Carla

    Hi Dr Matt,

    First useful article on the article I have found, thank you.

    S-Ferritin 7.3
    Iron 46.2
    Trans Ferritin 3.42

    Struggling also to understand if the course my Dr. is recommending is correct. Intravenous iron?

    Please can you help.

  48. Victoria

    Hi Dr. Matt,

    53 year old female, athletic, vegetarian (had not been supplementing iron and was trying to get it from diet) and perimenopausal (irregular periods, thinning of hair, etc). I practice intermittent fasting and my energy levels have been good.
    Recent iron panel showed the following:
    Ferritin 17 (16-232)
    Iron Total 94 (45-160)
    Iron Binding Capacity 372 (256-450)
    % Saturation 25 (16-45)
    Sex hormones have not been tested yet. I realize that dropping/erratic estrogen levels play a role in hair thinning but with ferritin at low end of range, am I correct to assume that could be playing a part too? So a supplement like Blood Vitality will allow me to get the ferritin level up without the other numbers going too high/out of range? When do you recommend rechecking levels after being on it (3 months, 6 months, etc.,)?
    Thank you!

  49. Ramy Aly

    Dear sir,
    My son is two years old , making routine blood test shows the following result
    CBC values : Hb 12.9 –
    HCT 38.4 –
    Red blood cell count 5.6 –
    MCV 68.6 –
    MCH 23 –
    MCHC 33.6 –
    RDW 13.4
    and normal TLC .
    The results is Normal HB , moderate microcytosis and hypochromia .

    The iron profile as follows:
    Fe 124 –
    TIBC 438 –
    Ferritin 22.6

    I am worried , could you tell me your opinion please .
    Thanks in advance

  50. Ramy

    Dear sir,
    Thanks you for your blog. My son has 2 years old , after performing some routine blood tests we found the following results.
    – Hb 12.9 g/dl
    – Hct 38.4 %
    – Red cell count 5.6
    – MCV 68.6 fl
    – MCH 23 pg
    – MCHC 33.6 g/dl
    – RDW 13.4
    – WBCs are within normal range.
    Iron profile ;
    – Iron 124 ug/dl
    – TIBC 438 ug/dl
    – Ferritin 22.6 ug/dl
    – Ca total 12 mg/dl
    – Ca Ionized 5.5 mg/dl
    – Mg 2.4 mg/dl
    – 25 (OH) Vitamin D 56.6 mg/ml
    i do not know why his MCV and MCH is lower than normal limits , are this is the case for iron deficiency , but his serum iron and TIBC is high
    Please tell me your opinion ,

    1. Ramy

      Hi Dr. Matt
      The pediatrician has reviewed the tests and he prescribed folic acid 400mcg daily for three months to improve red blood cells . He said , this case is not iron deficiency and he has enough iron and more iron could be harmful.
      What is your opinion.

  51. Essie

    Hi!! This was a great read! Thank you 😊 I am hoping you can help make sense of my labs. I have seen similar results for over a year and have not been feeling well for a while.

    Iron, total – 26 mcg/dL
    Iron binding capacity – 490 mcg/dL
    % saturation – 5
    WBC – 5.4 thousand/uL
    RBC count – 5.27 million/uL
    Hemoglobin – 10.7 g/dL
    Hematocrit – 36.6%
    MCV – 69.4 fL
    MCH – 20.3 pg
    MCHC – 29.2 g/dL
    RDW – 15.6 %
    Ferritin – 2.0 ng/mL

  52. Patricia


    I am getting a bit confused with recent labs and hoping you can shed some light. Iron came back slightly high but ferritin low, and slightly low MCHC.

    Iron: 155 mcg/ dl
    Ferritin: 18 ng/ ml
    MCHC: 31.4 g/ dl
    Iron Saturation: 42
    Iron Binding Capacity: 365

    Factor II, V, and VIII all came back slightly high. Everything else was within normal range. If I have iron deficiency anemia which I think I do, is the serum iron superficially elevated but I am still in need of iron? I received a round of iron infusions last year and went from a ferritin of close to 200 to 18 this year. Wondering why I’m not able to hold and store iron properly. Colonoscopy and endoscopy were normal. Thanks for your feedback.

    Habitually tired but grateful,

  53. Rhonda Taylor

    Hi Dr. Matt! So grateful for this article and your willingness to help explain iron labs. 4 mos ago I had bloodwork and had a total iron of 242 which surprised the heck out of me. I don’t eat red meat, don’t take iron supplements but I was using my cast iron skillet daily. I stopped using it and just re tested. I’m 56 yrs old . Here are my results :

    TIBC. 321
    UIBC. 156
    Iron. 165
    Iron saturation. 51
    Ferritin. 14

    I did not fast for this last test. Perhaps I should do the lab again after fasting? I do have fatigue, some brain fog, muscle aches at times. Thank you so much for your help!!

    1. kenia a Zingale

      Hi Taylor, just wondering if you wereable tofigure out your iron labs? Mine came in today.
      total iron 178
      IBC 318
      Saturation 56
      Ferritin 14
      Its similar to yours and don’t know what it all means. Would appreciate any help in understanding. Thanks Kenia

  54. Pamela Ruiz

    Dr. Matt,

    I would like assistance. 34YOF, normal BMI.

    -Symptoms: hair thinning, joint pain, weakness.
    -Chronically with elevated vitamin B12 (>2000) for more than 5 years, normal folic acid (multiple times).
    -Not on birth control, not anemic (CBC/hemoglobin always wnl), no thyroid issues, not on any supplements.
    -chronically on Atomoxetine (60mg), low dose Vyvance (20mg)
    -recent history of on and off elevated ALT (40), normal T. Bili. Normal GGT.
    -recent iron studies:
    -ferritin 32
    -serum iron 174 (H)
    -iron sat 56% (H)

    Why are my serum iron and iron saturation high?

  55. HLW

    In Jan:
    Iron 62
    TIBC 289
    Percent Saturation: 21%
    Ferritin 40
    Started Iron Supplement and rested in April:
    Iron 91
    TIBC 378
    Percent Sat 24%
    Ferritin 23

    Is this moving in the right or wrong direction?

  56. Yoko

    Does anyone know what it means if my serum iron levels are high (254 ug/dl), but my ferritin is normal (87 ng/ml), also transferrin saturation is high at 72%. UIBC, TIBC, transferrin were all within normal range. Also my ALT was slightly elevated at 40 U/L. I was told this isn’t anything to worry about, that the numbers need to be much higher to be worried about hemochromatosis or liver issues. But I’m having a lot of liver related symptoms such as fatigue, depression, chemical and food sensitivities, alcohol intolerance, dark circles). Should I be concerned?

  57. Paula

    I have compound heterozygous hfe on a genetic report w symptoms of bradycardia, joint pain, fatigue, early menopause with no hormones at 43 years old. brain fog, mch of 32.

    My ferritin was 26. (16-232)
    Total iron 243 (45-160)
    Iron binding capacity 355. (250-450)
    Percent saturation 68 (16-45).

    I’m confused because this shows high iron but ferritin is low end of normal. Can you help me understand this? Thank you!!

  58. Deidre

    36 y/o fe here. No hx of abnormal labs prior to January. B12 and Vitamin D and TSH all Normal. No hx of IBS IBD. Hospitalized in January 2022 with Covid gastritis and Ileus. NG tube for 4 days. No other complications. I now have these labs. I take no supplements and was fasting each time. Also to add was not menses at these times.
    Feb 14 2022 serum iron 65 % sat 19
    Feb 28 2022 serum iron 271 % sat 75
    March 10 2022 “”. 87 % sat 24
    April 26 2022. “”. 260 % sat 74
    Iron binding on each occasion 345-360 normal.
    Ferritin 10 on each occasion.
    My doctor seems to think it’s fine. Normal CMP and CBC literally in middle for all. I do have Gilbert’s syndrome but normal billi only elevated when sick or tired at most 1.7.
    Any advice would be wonderful.

  59. Nikki

    Here are some of my labs and background
    IBCU- 255
    Transferrin saturation- 360
    Ferritin -17
    Vitamin D -24
    MCHC -low
    Hematocrit and MCV -high
    AST,ALT, and Alkaline phosphatase- low
    High ANA,Positive Anti ssb,low wbc and lymphocytes,joint pain, bad heart palpitations/ bradycardia and tachycardia, fatigue, shortnessof breath, confused at times, bruise easily, blacked out twice, and down almost 30 lbs in a month. Also I’m a 39 year old female, no birth control due to tubal ligation. Any idea what’s going on and if I should get supplements? Please any advice to feel better would be very appreciated 🙏

  60. John

    This was a very informative article. My iron was 178 and my ferritin is 28. From your article, it sounds like I may need to do iron supplementation. Is that a correct interpretation? I have been dealing with exhaustion over the last few months.

  61. Brittney Hock

    Hi, I recently had a bunch of bloodwork done:
    Ferritin – 26 ng,mL
    HB 13.7
    HCT 40%
    Iron 132
    TIBC – 316

    I am 53 year old woman who had a hysterectomy a year ago and have Hashimoto’s. My doc wants to put me on iron supplement for 3 months to bring the Ferritin level up a bit, but I don’t really want to take another supplement and these levels don’t seem to bad to me. Would love your thoughts. Thank you.

  62. Nikki

    IBCU- 255
    Transferrin saturation- 360
    Ferritin -17
    Vitamin D -24
    High ANA,Positive Anti ssb,low wbc and lymphocytes,joint pain, bad heart palpitations/ bradycardia and tachycardia, fatigue, shortnessof breath, confused at times, bruise easily, blacked out twice, and down almost 30 lbs in a month. Also I’m a 39 year old female, no birth control due to tubal ligation. Any idea what’s going on and if I should get supplements? Please any advice to feel better would be very appreciated 🙏

  63. Sara T.

    Hi Dr. Matt! I can’t believe I found this site. I’ve been searching over two hours to figure out an answer. I had my blood tested just for a “check-up” and to improve my health generally. I’ve been told in the past I was iron deficient, but I stopped taking iron pills about a month to two months ago. About a week ago, I had my blood tested after a 12 hours fast. I’m concerned because my TS is abnormally high (according to the results):
    Ferritin (ng/mL): 16
    Hemoglobin (g/dL): 11.8
    Iron (ug/dL): 159
    TIBC (ug/dL): 291
    TS: 55%

    Any insight you could give me would be GREATLY appreciated!! Thank you!!!

  64. Elsy

    Hello! Thank you for the great information. I would like to know your thoughts on my Iron lab results. I’m a 44yold female. I’m not sure if I should increase iron or not…. Here are my results”

    Ferritin (ng/mL) 38
    Hemoglobin (g/dL) 14.6
    Iron (ug/dL) 138
    TIBC (ug/dL) 295
    TS (%) 47
    Red blood cells (x10E6/μL) 4.7
    Hematocrit (%) 42.8
    MCV (fL) 91.5
    MCH (pg) 31.2
    MCHC (g/dL) 34.1
    RDW (%) 12
    Platelets (thousands/uL) 190
    MPV (fL) 12.4

    Thank you again!

    1. Elsy

      Just to note: I did fast, I do not take iron supplement, I’m 80% vegetarian and I do use the cast iron pan about 2-3 times a month.

  65. Catarina

    Hi! Thank you for your website and for your help with this article.
    I would like to hear your opinion.

    My values are as follows – blood draw first thing in morning and fasting:

    Ferritin: 12 ng/mL
    Transferrin: 256 mg/dL
    Serum iron: 141 µg/dL
    Transferrin saturation: 44 %
    Iron Binding Capacity: 320 µg/dL

    Hemoglobine: 13.2 g/dL – All other blood count elements are within the normal values.
    B12 is 867 pg/mL

    I don’t have any symptoms but don’t understand why my ferritin is so low and why I can’t increase it.

    Appreciate your help!

  66. Heidi

    Hi dr Matt
    My ferritin is 20 or less on average – iron saturation 57 – iron 193 – total thyrodectomy after cancer – one gene of hemochromatosis – no iron supplements – always take labs while fasting – enlarged liver and spleen – why such a continued contrast between ferritin and storage ? I appreciate any insight!

  67. Annmarie

    Hi there! I’m so happy I stumbled upon your site. The information has been great.

    Mini back story – my ferritin has not gone past 16 in 6 years almost. It’s currently 11.24 and I feel horrible. This past week extremely out of breath, racy heart, RLS, exhaustion constantly, weak, and more.

    These are my labs
    Iron 126 ug/dl
    TIBC 403 ug/dl
    Hgb 13.8 g/dl
    T-SAT 31.6
    Ferritin 11.24 ng/ml
    Vitamin D 41 ng/ml

    Do you have any suggestions? I’ve started iron supplements and vitamin c along with a vitamin supplement. How long does it typically take to see a change? Could I benefit more or quicker from infusions?

    Thanks so much for any input!

    1. rose

      I would try Blood Vitality. Most efficient with least side effect iron I have used in 13 years of practice.

  68. Cathy

    Can you interpret my iron levels (female, 65 yes old):
    (started taking SloFe Iron several months ago. Every day for 2 weeks, and then 2x a week for several weeks, and now 1x a week – when I remember)

    Ferritin 16.29
    Iron 117
    Iron TIBC sat ratio 29.66
    Total Iron binding cap TIBC 394.48
    Transferrin 284

    Ferritin 8
    % saturation 33
    Iron Binding 366
    total iron 119

    GFR usually low – 59 to 65
    Bilirubin usually high 1.5 to 2.0

  69. Natalie Coren

    A friend of mine shared with me this link and I am so happy I was able to find information on high iron, saturation and low ferritin. I spent so much time researching on internet and in my books and with not much luck. Thank you Dr Matt for this resource and your time. My question is suddenly i got very high iron level and high iron saturation. My ferritin was always kind of low but now it got even lower. I do have symptoms of my wrist aches. (I was thinking this is food intolerance like gluten) not on any medication or birth control. These results came abnormal. Everything else is optimal.
    TS – 53% (6 months ago 29%)
    Iron 170 (6 months ago 91
    Iron building capacity 321
    Ferritin 18
    B12 389
    VitD 45
    MPV 11.9
    Eosinophils 8.6%

    I am worry of this sudden iron markers that came off. Appreciate you help me to interpret my results! Many thanks in advance.

    1. rose

      Your B12 is pretty low, I aim for 1000.

      Are you taking iron currently? If menstruating, were both tests taken at the same time of your cycle?

  70. jrborenz

    Last year my iron was 130, transferrin 273, iron saturation 48%, and ferritin 47. I have hypothyroidism that caused heavy cycles for the past 5 months while I was adjusting my dose. I rechecked ferritin and it was 19. I took 25mg iron 3 X week and avoided coffee/tea near meals. I rechecked iron 5 weeks later and iron was 48, transferrin 273, iron saturation 18%, and ferritin 34. I’ve bumped iron up to 50mg per day for the next 4 weeks and then recheck. Is this too much per day? I suffer terrible weakness and fatigue.

  71. Heather

    Can someone help interpret my results. 34 yr old female. I take one a day vitamin every morning, and red rice yeast. Wake up almost every morning at the same time, heart pounding, feel of anxiousness, and the river to jump out of bed and pace the house. Thought it was glucose related but glucose looks in range.

    Results – ferritin 4 no/ml
    TIBC 227 mcg/dl

  72. Melissa

    Hi my doctors are stumped. Could you please help me? My serum iron is 207 (fasting) and has been elevated over the past 6 months. My ferritin is in the 20s usually but was 36 this last test when my serum iron was 207. % sat is high at 48 and TIBC high at 428. I think I am iron deficient despite my high serum iron levels. But also think I have heavy metal toxicity. I tested and my blood cadmium came back high at 1.8 (upper range is 1.2). I am doing a heavy metal urine test next. But can you please help me interpret my iron values and what I should do? Thanks so much Dr Matt!

  73. Bailee

    Hi Dr. Matt. My iron was high (200mcg/dL iron, 58% saturation, 21.90ng/ml ferritin), they thought I might have hemochromatosis so I had a liver MRI and it was determined I do not have it (just iron overload), and was told to donate blood to lower iron. I donated blood twice and iron fell to 56 with 14% saturation 3 months later. I was on OCP at the time. 1 year later: after donating blood once more and being off OCP for 6 months, my iron is now at 40 with 11% saturation. My cholesterol is also high (232). I had low energy and fatigue when my iron was high, and I still have it now that it is low. Any thoughts? Thank you.

  74. Olga

    Dr. Mark I am a little worried I had I the past iron deficit and I have some iron infusions and I take iron supplements.
    My resent blood test show this results And I don’t know how to interpret this
    .Cal%Iron Sat 68 ref range 20-50%
    .Iron Serum 247 ref range 37-145 (UG/DL).
    Ferritin 32 ref range 13-200(NG/ML
    What I need to do?
    My cholesterol is 228 <200
    My calc ldl chol 142 <100
    Thanks for your help and advice

  75. Olga

    Dr. Mark I am a little worried I had I the past iron deficit and I have some iron infusions and I take iron supplements.
    My resent blood test show this results And I don’t know how to interpret this
    .Cal%Iron Sat 68 ref range 20-50%
    .Iron Serum 247 ref range 37-145 (UG/DL).
    Ferritin 32 ref range 13-200(NG/ML
    What I need to do?
    My cholesterol is 228 <200
    My calc ldl chol 142 <100
    Thanks for your help and advice

  76. SD

    Dr. Matt!
    My ferritin is 18 ng/mL (ref range 7.3-270.7)
    Iron is 96 ug/dL (ref range 50-170)
    Transferrin is 310 mg/dL (ref range 215-365)
    TIBC is 372 ug/dL (ref range 250-425)
    Iron/Transferrin % saturation is 26 (ref range 15-50)

    My PCP want’s me on IV iron infusions. I feel great, high energy, active with no symptoms. I’m 34. Do you think my iron levels are normal?

  77. Colleen C

    I’d appreciate your advice with my labs. My whole life I’ve been anemic and iron deficient (I’ve been on iron supplements since I was a kid but nothing really seemed to help). However today my serum iron level came back 195! Saturation was 52% & Total iron binding capacity was 374. Ferritin is low at 19. Hemoglobin was 9.4 (when previously it was 11.7). Hematocrit =28.9, Erythrocytes = 3.06, MCV = 94.4, RBC Distribution width = 27.4. I haven’t taken any iron medication for 2 months! What could cause this? I’m a 30 year old female not on oral contraceptives. My thyroid has been removed due to papillary thyroid cancer so I take levothyroxine. My TSH is 58 and T4 1 (my doctor has increased my dose). I have deficiencies in vitamin A. Vitamin C, E, K, D, & B12 are low normal range. Potassium, calcium, & magnesium are all normal. Liver was tested a month ago – values were all normal (they were – Billirubin = 0.3, Bilirubin total = 1, AST = 31, ALT = 11, Alkaline Phosphatase = 96, Albumin = 4.4, & Protein = 6.5). I have 2 genetic disorders – Factor V Leiden (d- dimer was checked to rule out clots – was normal at 233) & Ehler Danlos Syndrome Hyper mobility type 3. Thank you for any help. My doctors are stuck! (They are thinking a bleeding ulcer for the drop in hemoglobin but can explain the high iron).

  78. Margaret F

    There is a study published on pubmed that indicates that turmeric supplementation can inhibit iron absorption by 20-90%. I have ulcerative colitis which can cause anemia. I am normally responsive to iron supplementation, but now I have high iron serum levels but very low ferritin levels. However, I have been supplementing turmeric. I am now taking a ferritin (only) supplement made by Flora, along with vitamin C, to raise my ferritin levels without raising my already high iron levels.

  79. Preyanka

    Hello! I could use some help analyzing my lab results. I was given a full panel test and these are the results that came up as flagged. Other vitamins/results came back as normal.

    IRON, TOTAL: 226 H Reference (Range: 40-190 mcg/dL)
    IRON BINDING CAPACITY: 393 (Reference Range: 250-450 mcg/dL (calc))
    % SATURATION :58 H (Reference Range: 16-45 % (calc))
    FERRITIN: 13 L (Reference Range: 16-154 ng/mL)
    VITAMIN D, 25-OH: TOTAL 24 L (Reference Range: 30-100 ng/mL)
    PARATHYROID HORMONE, INTACT 19 (Reference Range: 16-77 pg/mL)
    Interpretive Guide; Intact PTH; Calcium
    —————— ———- ——-
    Normal Parathyroid: Normal (Intact PTH); Normal (Calc)
    Hypoparathyroidism: Low or Low Normal (Intact PTH); Low (Calc)
    Primary: Normal or High: High
    Secondary: High: Normal or Low
    Tertiary: High; High
    Non-Parathyroid Hypercalcemia: Low or Low Normal; High

    ANA TITER: 1:80 H
    ANA PATTERN: Nuclear, Dense Fine
    ANA TITER: 1:40 H
    ANA PATTERN: Nuclear, Discrete Nuclear

  80. Paul Kutton

    Hello Dr Matt,
    Can someone help me with my results:
    B12: 167 pmol/L (>177)
    Active B12 67 pmol/L (>35)

    Iron 36.0 umol/L (9.5-29.9)
    Transferrin 2.5 g/L (2.0-3.2)
    Trans Sat 63% (10-45)
    Ferritin 57 ug/L (30-400)

    So weird – high iron, low B12. Everything else on FBC in order. No symptoms.
    Hemochromatosis genetic testing being done but none in family.

    Any ideas? Test was done none fasting mid day.

    Thanks for reading!!

  81. Erin

    Hi Dr. Matt,

    I am confused about my lab results, and would appreciate any insight you could provide. I have experienced extreme fatigue, low energy, hair loss, amenorrhea, worsening depression, and weight gain over the past couple of years. My labs show severe Vitamin D deficiency, but I’m confused about my iron results. They are:

    Iron Bind.Cap.(TIBC) -364 ug/dl
    UIBC – 316 ug/dl
    Iron – 50 ug/dl
    Iron Saturation – 14%

  82. Jen

    Hi there,
    I have had low iron for the past 5 years and can’t seem to get it up. My Ferritin is 12, iron 68, iron binding 276 and total iron binding capacity 344, transferrin 20%. My vitamin D is 29.
    I have been taking a liquid iron Floralvital. The highest my Ferritin has ever been was 36 in 2016 and the lowest was last Aug at 6.

    My body dose not seem to absorb iron – I also take vitamin C and I also eat a Whole Food Plant Based diet. However my Ferritin was low when I used to eat meat. I also run and exercise about 4x a week.

  83. AFerg

    Hi I have normal levels of everything except:
    Iron – 215 mcg/dl
    Ferritin – 17 – normal 30-424
    Vitamin D – 16 ng/ml – normal 20-80

    I could really use some help figuring out what this might be. Thank you!

  84. Peggy Hinkle

    My total iron is 205, ferritin is 62. In December 2021, my ferritin was 18. I have felt better, esp more clear headed, with ferritin higher. My new anti-aging doctor told me to stop taking so much iron without any explanation. I dropped it down to once a week… but don’t feel as good as I did while taking it daily. HemeVite. Is 205 really that high/dangerous? Thank you – just happened upon your site while doing a search.

  85. Kesha

    Hello I hope all is well. Please help me understand my labs. I’m exhausted and have been for several years. Dark circles under my eyes. No energy. Started taking iron for awhile not too long didn’t seem to help. My right side hurts around liver and gallbladder. Ultrasound done. Normal. Colonoscopy done. Normal.
    Thyroid nodules no antibodies. Dr says labs are “within normal limits”. I feel so tired that I wanna quit but I believe there is hope. I’m just so exhausted.
    TSH 2.390
    IRON 210 High
    53.0 High
    FERRITIN 6.4
    HGB 12.3 g/dL
    HCT 37.9
    MCV 84.2 fL
    MCH 27.3

  86. Aimee S


    Can you please help me interpret my blood work, as I’ve struggled as a women with heavy periods with ID for 15 years.
    Iron Serum 166 ug/dL
    TIBC 398 ug/dL
    Unsat. Iron Binding Capacity 232 ug/dL
    Transferrin % 42
    Transferrin 284 mg/dL
    Ferritin 15ng/mL
    Red Blood Count 4.83
    Hemoglobin 14.7
    Hematocrit 44.3

    I’d love to hear your thoughts on these numbers and where I’m at with my ID. I am currently taking Slow Fe every other day since these findings. Prior to that I was taking a Women’s One a Day. Thanks for your thoughts!

  87. Rachel Traficante

    Please help if you can. My son is a college distance runner, averaging 65-80 mile weeks as well as 2 days week in the gym lifting. He is 21 yrs old and a vegan/vegetarian. He began struggling with performance about March 2022 during track season. Complaints have been general fatigue, heart rate increasing too quickly and general fogginess. He cut his season short, took 2 weeks off and began training for a marathon scheduled early June. After two weeks rest, he was back to his old self, hitting his paces in workouts. Did great in the marathon. Took two weeks off and began cross country season training. Did well the first month back and then as soon as the heavier workouts hit, once again, he couldn’t hit his targeted paces. NCAA was requiting bloodwork and it was the first time he had it done.
    Iron 263
    Transferrin 281
    TIBC 351
    Transferrin sat 74
    Ferritin 24.7
    HCT and HGB were normal

    Per his coaches suggestion he has been taking an iron supplement. He has been on it for almost two weeks. My son has noted that he is sleeping much better. My concern is the high saturation level and I’d very much appreciate your input.

  88. Kass

    Thank you for this fabulous article!
    I have had hair loss for years, and am starting to see a correlation with my iron storage. Not on birth control, very conscious whole foods diet, do not use cast iron. Would love your suggestion – these are fasting results.
    Iron, Total: 240
    Ferritin 14
    B12 404
    T4 1.4
    T3 3.0

    My integrative practitioner suggested i taking milk thistle as it binds to iron.
    Please advise, thank you!

  89. kristina


    Can you help interpret my iron results?

    Iron – 425
    Binding Capacity – 490
    Saturation – 87
    Ferritin – 8

    1. rose

      Either you took iron just before the test or you need more testing beyond iron. Copper, D, retinol, B12, folate. Dietary change.

  90. Tiffany

    Hello Dr Matt, Wow! I’m so happy to see this article!! Would you be able to help me with these labs? A short background, I’m an active 54 year old female. Not overweight. I workout 3-4 times and week and eat healthy (I’m a registered dietitian). At the end of June I was sitting at my desk and the tops of my feet and calves started burning!! They were also swollen. It went away but I still have been having symptoms of tingling and swelling in those areas but mostly when I am sitting. I’ve also been losing my hair like crazy, I noticed it starting about a year ago but the last 6 months have been bad. I went to a dermatologist who said I have androgenic alopecia but no women in my family have hair loss. I also started hormone replacement therapy 2 years ago of 10mg estradiol and 65mg testosterone injection monthly and 100mg progestone cap each day. This has helped my menopausal symptoms immensely. I went to my primary and they did a lot of labs and sent me to a neurologist as they thought I might have a nerve in my back (although I have no back pain) that is injured. I had MRI which was normal. They didn’t really say anything about my labs but I’ve been reviewing them. I was not fasting.
    Ferritin 46 (ref 8-252)
    iron 173 (ref 39 – 150)
    TIBC 435 (ref 241 – 421)
    Hemoglobin 14.3 (ref 12 – 16)
    Mg 1.9 (ref 1.8 – 2.4)
    I’m wondering if this has anything to do with my hair loss and the continuing feeling of tingling and swelling in my lower legs. I’m not sure where to go from here… Thanks so much!!

    1. Dr. Matt

      I would look into your hormones, Testosterone, Dht, estrone, estradiol, DHEA. Testosterone injection one time per month is sure to set you out of balance. Lower more consistent dosing is how I prescribe. Testosterone can greatly effect iron metabolism.

  91. Graham Maxwell

    I’m a male, 44 yes old, 6’8″ tall, 110kg, lean, very active job.
    I’m on TRT, 200mg p/w testosterone enanthate (im a big guy) and do micro dosing every other day.
    My irons been changing over last 4 years, now
    my levels are (im in Australia)
    Heamogloben 173 g/L
    RBC 5.63
    HCT 0.52
    Serum iron 46.0 umol
    Transferrin 2.04 g/L
    Transferrin saturation 90%
    Ferritin 77 ug/L

    Transferrin and ferritin has been dropping consistently and serum and saturation increasing the same.
    Can’t figure this out due to the ferritin dropping even though it seems I have increasing iron overload.
    I’m also positive for one gene for hemochromatosis (carrier, not sure which SNP it is). Does this effect it?

    Hopefully you can help

  92. Kathleen Studebaker

    HI there, I see that many people are asking for your advice and I want to say it’s very kind of you to offer it for free to so many. My problem is hair loss. I’m a 40yo female, and have been more-or-less vegan for 20 years. Over the past year my hair loss has really increased (I’m losing 300+ hairs/day now). Had some (non-fasting) blood tests done and I guess my “normal” ferritin is actually quite low. My question: how much iron should I take daily and do I need to take anything else (e.g. the lactoferrin I’ve heard mentioned here)? Oh also I’m very active 🙂 I’m now taking some hair-related supplements that have about 25mg iron/day (started them after the tests). Thank you!

    My iron levels:
    Iron Bind.Cap.(TIBC) 388 ug/dL (250 – 450 ug/dL)
    UIBC 290 ug/dL (131 – 425 ug/dL)
    Iron, Serum 98 ug/dL (27 – 159 ug/dL)
    Iron Saturation 25 % (15 – 55 %)
    Ferritin, Serum 17 ng/mL (15 – 150 ng/mL)

  93. Trish

    Hi Dr Matt,
    I was wondering if you could let me know your thoughts on my iron situation. I am a 39 year old healthy female. I had a very heavy menstrual cycle where I lost over a pint of blood. I had my ferritin checked about 2 weeks after that and it was at 6 ng/ml, so I started taking oral iron supplements. After 3 weeks of that, these are my labs:
    Ferritin: 11.4 ng/ml
    Iron: 76 ug/dL
    UIBC: 302 ug/dL
    Calculated TIBC: 378 ug/dL
    Iron saturation: 20%
    Hgb: 12.2 g/dL
    HCT: 38.5%
    RBC: 4.56 x 10(6)/uL
    The rest of my CBC is wnl except RDW at 15.5%
    Also, I am a runner. I run about 20-30 miles per week. For the last few months I felt a lack of endurance. I’m about to start marathon training again and I want to make sure any iron issues are resolved. I feel like my ferritin is still very low, especially for the amount of physical activity that I partake in. Is it too soon to know if my bloodwork has stabilized after 3 weeks of oral iron? Thank you for your input.

  94. Megan

    I have had been on the low and sometime below normal side of Ferritin for a long time and take Reactive Iron for it and then iron Saturation is also typically low. My current blood tests really caught me off guard as my iron and saturation came back high.
    Here are the results.
    Iron: 252
    Transferrin Serum: 287
    Total Fe Bind Cap: 399
    %Fe Saturation: 63
    Ferritin : 22
    I am uncertain as to what this means. This is a new one for me. Any help would be greatly appreciated.

    1. Dr Matt

      Consider looking into testing Vitamin D and A levels. Also, maybe look at taking a more comprehensive formula for iron repletion support like Blood Vitality (www.optimizeiron.com).

  95. Jeff Roman

    Hello. My 13-year son is very active — he’s a runner, lifts, active in other activities and eats a mostly vegan, whole foods diet. He also uses whole food supplements including Sun Warrior protein powders. He has not been himself this season so we just wrapped up a full round of blood work. We are concerned about his results and any feedback would be appreciated. We can’t find anyone to get him into in a reasonable amount of time and the “interwebs” have us concerned. Thank you!

    Saturation %: 54
    Ferritin: 14ng/mL
    Iron Binding: 407
    Iron Total: 219 mcg/dL

  96. Gin

    I had iron deficiency in the past (iron as low as 21, ferritin as low as 4) and have been taking 65 mg iron supplements 3x a week since April 2022. I got back my blood test results yesterday
    Iron 141
    TIBC 318
    Iron saturation 44%
    Ferritin 23
    Ferritin still seems a bit low. But iron seems to be approaching high. What is happening? Should I be continuing iron supplements?

  97. Sunny

    Hi – Thanks for the focus on low ferritin. Our family is working with my daughter to help her with low ferritin. She is now a professional athlete suffering from low ferritin (mostly low teens) for over 10 years since middle school ferritin at 39. She is not anemica and most of her labs (CBC, ferritin, and iron panel) have been normal other than ferritin for the last six years. (She does not have CBC or iron panel for the four years previous other than ferritin mostly in teens.)
    Hepcidin tested normal.
    She has taken just about every iron supplement available from isolate, food based, and liquid forms of iron without success of raising ferritin over 20. Her diet is vegetarian but excellent and takes NSF approved supplements (multi, C, B12, D, Omega Algea, magnesium, and probiotic. No oral contraceptives. Extremely light periods.
    She trains in a remote area so not access to functional physicians to help her solve this mystery of why her body does not seem to be absorbing the iron supplements.

  98. Michael

    How about men? Results below indicate increasing serum iron with decreasing ferritin levels. Definitely was taking too much zinc during the pandemic without enough copper (stopped many months ago). Maybe that produced a deficiency that requires copper supplementation to balance.

    Iron Serum
    2020 – 144 mcg/dl (49-199)
    2022 – 211 mcg/dl (49-199) HIGH

    Ferritin (downward trend)
    2017 – 63 ng/mL
    2020 – 43 ng/mL
    2022 – 33.9 ng/mL

    Iron Saturation
    2020 – 41% (20-55)
    2022 – 55% (20-55) BORDERLINE HIGH

    2020 – 352 ug/dl (260-490)
    2022 – 384 ug/dl (260-490)

    1. Dr. Matt

      You definitely could have over ridden your copper. I have had plenty of patients come in who did that during COV with all the zinc.

      Check your copper, retinol, vitamin D, ceruloplasmin.

      1. Michael

        Thanks Dr. Matt: Ceruloplasmin and Copper serum is in the low range “normal”, D high. Everything else in the middle.

        Copper was high/Iron low in a metals urine challenge test a few months ago. Life is complicated. Some recommend hair analysis for evaluating the metals.

        Ceruloplasmin, S –
        23.1 (19-31 mg/DL)
        Vitamin D 25 Hydroxy
        92.4 (30 – 100 ng/mL)
        Zinc, S
        79 (60-106 mdb/dL)
        Vitamin A
        71.6 mcg/dL (32.5-78.0 mcg/dL)
        Copper, S
        78 mcg/dL (73 – 129 mcg/dL)
        Transferrin, S
        305 mg/dL (200-360 mg/dL)

  99. Dr.Matt

    She may want to try out Blood Vitality (www.optimizeiron.com) in tandem with Vitamin A (not beta carotene but preformed Vitamin A), vitamin D3 with K2..this would be first line.

    Is she getting her iron saturation, TIBC, serum iron/transferrin checked along with her ferritin? Copper, retinol, iodine would also be good to check.

    Vegetarian and competitive running in my experience generally do not allow for peak performance.

  100. Bev Bearden

    Thank for this wonderful discussion. Information on this topic is hard to find and very confusing.
    For the last 7years my labs have been consistently showing high iron serum (150-250) and ferritin on the low normal scale (17-47) but mostly on huvering on the lower side. My last lab a month about was iron serum 157 and ferritin 25. I am a carrier of hemochromatosis gene. When I received my labs my Dr recommended that I gstart taking iron so I ordered your blood supplement but then ahe changed her mind and said that because of the hemochromatosis I should not take any iron. I am super confused. I have lots of symptoms of fatigue, hair loss, muscle aches,headache, and joint pain, brain fog, and the works. Through the years I have tested for all kinds of auto immune disease but nothing comes back abnormal. When I saw your post I thought maybe low ferritin could be to blame. Any wisdom would be greatly appreciated. Sincerely Bev

    1. Dr. Matt

      What is your iron saturation and tibc?

      Also I would get your retinol, copper, ceruloplasmin checked.

      What is your age? Menstruating?

  101. Holly

    Question, I have always struggled with my Ferritin being low. I lost my thyroid in 2013 and have had issues since. A 4 month systemic infection from the surgery caused me to develop Fibromyalgia. Also, was anemic (low hgb) and diagnosed with pernicious anemia. I take B12 shots twice a month to get my levels where I can actually function. Eventually my ferritin was checked and had a few iron infusion to help my ferritin to get to 70. When it’s at 70 I feel really good.

    Now, I am having problems still with my ferritin – doctors won’t prescribe Iron Infusions – and my B12 levels won’t stay up with my shots. My ferritin now is 37, B12 is 600 (I need at least 800) but my Iron Saturation is at 61%. Can you give me some information on what you feel about this? I have tried oral iron, B12 and neither will get into my gut that way. I have to do injections but IV is a much better route. I used to be very good at eating clean so I don’t have the inflammatory issues with my Fibromyalgia. I am going to get back on being better with that – NO dairy. soy, gluten, sugar.

    My levels now:
    IRON, TOTAL 153

    1. Dr. Matt

      Your food routine is huge. I know it’s tough but keep putting out before yourself the benefits of making these adjustments, it is worth it.

      If no thyroid, are you taking T4 and T3, thyroid can really effect iron.

      Also have you looked at hydrochloric acid (Hcl) supplementation with meals? The right probiotics and enzymes and colostrum could all potentially be very helpful.

      Sublingual B12 in the right can still raise levels even In Pernicious anemia. Also you really want to think about all your fat soluble vitamins and making sure they are sufficient give the absorption issues.

      1. Kc

        Good evening, Dr Matt-

        My lab work has had my drs stumped for a few years now.
        One physician said they tend to run opposite when they should run in tandem.
        I’ve recently been referred to hematology for 6 years of persistent findings of hypogammaglobulinemia (no m- spike)

        Recent labs

        Ferritin Serum 8.7
        Iron 173
        TIBC 457
        % FE Sat 36

        K 5.2
        NA 132

        C02 22

        RDW-SD 54.3
        RDW- CV 16.8

        All other labs are relatively witching normal limits


        I am 44 year old female with joint pain and fatigue and shortness of breath and heart palpitations.


  102. Marie

    H!i! Wondering if you could help me interpret my latest results? Curious as to why the %saturation may be high (52), Ferritin 18, Iron total 175, and iron binding capacity at 336. I fasted and do not take an iron supplement. I am on hormonal birth control – Skyla. Hope that information is helpful. Thanks so much!

  103. Yarely

    Hello I was curious if you could help me. I currently see a hematologist and looking into seeing a rheumatologist soon. I’ve been dealing with anemia for pver 2 years now. I take iron twice a day with vitamin C, I have also alternated to twice a day early in the morning. I have had iron infusions but they help only for the moment and make me feel worse to be honest. I also take a Vitamin D 50,000 iu weekly. I have been tested for autoimmune disease that came back borderline positive. My thyroid has been tested various times and it is normal. I have been having severe pain where my kidneys are but CT was clear. I’m extremely tired, have shortness of breath, rapid heartbeat and brain fog.
    My recent lab work showed these numbers.
    MCHC: 32.7 g/dl
    RDW: 15.4%
    MPV: 8.7fl
    HGB: 12.8 g/dl
    HCT: 39.1%
    Ferritin: 6 ng/mL
    Iron Serum: 77 mcg/dL
    Iron binding: 321 mcg/dL
    Iron saturation: 24%
    Vitamin D: 25NG/ML
    Creatine: 0.60 mg/dL
    BUN/Creatinine Ratio: 25+

  104. Akasha

    I have been trying to figure out why I have been having extended hair loss for awhile now. I am on birth control but have been for almost 15 years but planning to come off of it. I have been supplementing iron due to low Ferratin levels. In May 2022 my Ferratin was 17 and now I have been supplementing since then and just this week me Ferratin only reads 24. But interesting that they told me fasting wasn’t needed. I did fast when it was at 17. But not this last time. Here are my iron levels below the that was also tested at the same time. I have actually been only supplementing iron every other day and did not take anything 12 hours before test. But now I feel like maybe I need to retest since I did eat something small this last blood test? I passed out the last time when I didn’t eat so then they said I didn’t have to fast. My doctor is sweet but very new in career and she seems unsure as what steps for me to take next so I’m feeling a bit lost.

    October 2021

    Ferratin- 17 in May 2022

    October 2022
    Iron-238 mcg
    Iron binding capacity- 392mcg
    Saturation- 61%
    Ferratin 24

  105. Alfonso

    Hi! I’m Wondering if you could help me interpret my latest results? Curious as to why the Saturation % may be high,Iron high but Ferritin normal:Fasting blood draw
    IRON:192 H
    IRON SAT:62% H
    My Doctor says to go donate blood when serum Iron is high.I went to donate blood but I feel a deficiency now.
    Checked B12/Folate levels after giving blood along with Zinc/Copper/Ceruloplasmin:

  106. Sherri

    Hi Dr. Matt 😊
    I am a 52 year old women, 5’2, 117lbs and fit. Recently my blood results of iron were high at 267, and the ferritin was normal at 100. Here are a list of my meds, which may or may not affect these levels.
    *Trazadone 300mg
    *Progesterone 200mg
    *Celexa 20mg
    *Bio B12 injections 1mg
    *Testosterone pellets 137mg – the pellets include additives such as estradiol etc.

    Any advice you could give would be incredibly helpful!

    Thank you!

  107. Vil

    Hi Dr Matt,
    I have been having issues with low ferritin levels and anemia for while. I have Graves’ disease which is well managed. I started taking iron supplements for 4 months now in order to raise my Ferritin levels which were below normal range (as I recall 10). I just had a blood test and I am surprised to find out that ferritin is still not optimal and on the low side but Iron is high now. Is this due to iron overload, should I stop supplementing? If I stop with the iron supplements, how can i raise ferritin levels?
    Here are my results:

    CBC all normal
    Ferritin – 26 ng/Ml
    Iron, Total – 198 mcg/dl High (range 40-190)
    Iron Binding Compacity – 344 mcg/dl
    % Saturation – 58 High (range 16-45%)

    Thank you!

  108. Todd

    I’ve had a number of blood tests over the past couple years with some concerning results. The latest include:
    % Saturation – 58 (high)
    Ferritin – 11 (low)
    Iron Binding Capacity 379 (normal)
    Iron, Total – 219 (high)
    Stool Calprotectin 240 (high)
    Things with my physician seem to be moving very slowly, and I’d love some insight. Thoughts?

    Many thanks in advance.

    1. Dr. Matt

      Definitely want to look at diet and support digestive healing to lower your GI inflammation. Also, look at lactoferrin and vitamin to support iron metabolism.

  109. Sarah

    IRON, TOTAL 77
    3 months of iron supplements went to
    IRON, TOTAL 226
    Told me to stop the iron because I’m not converting and then never addressed it again. Still abnormally fatigued. My esthetician NP also does functional medicine and, in generally conversation during my injections, suggested taking chelated iron supplements instead of FeSO4. PCP seems to think that maybe that’s just how my ferritin is, and that it’s not that low. Says that it’s not likely the cause of my fatigue. Any thoughts on this?

  110. mandy sockwell

    Glucose 85 MG/DL
    BUN 12 MG/DL
    Creatinine 0.75 MG
    Sodium 139 MMOL
    Potassium 4.8 MMOL
    Chloride 103 MMOL
    CO2 19 MMOL/L L
    Calcium 9.5 MG/DL
    Total Protein 7.1 G/DL
    Albumin 4.6 G/DL
    ALT 13 IU/L
    AST 17 IU/L
    Alk Phos 52 IU/L
    Total Bili 20.0
    IRON 325 UG/DL HH
    Iron Binding Capacity 487 UG/DL H
    Iron Binding Capacity (unsaturated) 162 UG/DL
    Iron Sat Percent 67 %

  111. Doug

    Hi Doc,

    I just had test results come in for a morning fasting blood draw:

    Ferritin – 34.3 ng/mL (28-397)
    % Saturation – 48.8% (20-55)
    Direct TIBC – 383 ug/dL (261-462)
    Iron – 187 ug/dL (49-181)

    I also tested positive for HFE Gene Pathogenic Variant (H63D Heterozygote). I am taking https://globalhealing.com/products/iron, and am wondering if I should stop. I do seem to yawn a lot, which I’ve always heard is symptom of iron deficiency. My thyroid hormones are normal, but TSH slightly elevated. Any advice/thoughts you have would be appreciated.

    1. Coleen Unger

      Hello, i an totally confused with my TIBC results.
      I am hypothyroid with Hashimotos
      Ferritin leveltotal iron = 26.2
      TIBC Profile
      Iron = 220
      Transferrin = 263
      Saturation = 60
      TIBC = 368
      Thyroid levels all within range
      I an not sure if i am anemic or have Hemochromatosis.
      My hair is really getting thin.
      Can someone tell me what my results mean.
      I need to start a partucular diet if i have Hemochromatosis and take herbs for liver health. Thank you

  112. Jane


    Please help me to understand my blood test results:
    IRON, TOTAL 155 45-160 mcg/dL
    % SATURATION 52 H Reference Range: 16-45 % (calc)
    I’ve been diagnosed with hemochromasis (C282Y). I used to donate blood, but after my last blood donation in 2020 my ferritin level is low.

  113. M Glenda Y

    Thank you so much for this website and the information on the website.
    I was lightheaded and sometimes dizzy, and have palpitations sometimes.
    My heart checked out fine at the cardiologist and my thyroid levels are normal.
    My Kidney and Liver functions are Normal.
    I am a female, 21 years and heavy periods.
    At fasting:
    My TIBC is 430 ug/dL – Normal
    My UIBC is 390 ug/dL – Normal
    My Iron is 41 ug/dL – Normal
    My Ferritin is 5 ng/mL – Low
    My Transferrin is 369 mg/dL – High
    My Iron Saturation is 10 % – Low
    My Haemoglogin is 11.6 g/dL – Normal
    Can you kindly help interpret this please.
    Many many thanks and appreciations.
    Thank You.

  114. Elaine Snowbeck

    My levels are:

    Iron 243, iron binding, 406, saturation 60, Ferretin 10. This is new as my iron was fine last year.
    I think my doctor is taking this too lightly. Two weeks ago she had me take iron supplements, but with the high iron she wants me to increase my iron food intake and stop taking the supplements. I already have a very high iron diet and use cast iron pans.
    Where do I go from here?

  115. Ron

    This is very helpful as I was a little befuddled by my results.
    Ferritin 39
    Iron 175
    IBC 338
    Saturation % 50
    Based on what I read here I believe I should probably increase dietary iron so that ferritin will rise some and iron will then gravitate more to optimal levels?
    Thank you for any input.

  116. Marianne

    I am a 48 year old female with no known medical issues. I have suffered with Restless Legs Syndrome for about 30 years. It runs in my family in both parents sides. I have been taking Pramipexole for about 10 years. I am not taking any other medications. I am currently trying to taper off Pramipexole after I read about augmentation in dopemine agonists medications and I would like to avoid this, also my RLS have worsened since taking the medication. I went to my general practitioner 2 weeks ago to ask about weaning from Pramipexole and I had my labs done at the same appointment as per my research I read that for RLS sufferers ferritin levels should be above 100 and increasing iron could help with RLS symptoms. My ferritin came back as 47, what was puzzling though was my iron was 150 (range 37-145) and iron saturation was 51% (range 20-50%) so my doctor wants to have an appointment to discuss my high iron, however I do not eat iron rich foods, or take supplements and I drink a ton of coffee so I’m confused on how my iron could be high. I also have symptoms of low iron, thinning hair, brittle nails and fatigue. I posted this on a RLS support group and I was advised to email this organization. Any insight you could offer would be great. Thank you!

  117. Colleen

    I am a 42 year old female. Generally healthy, work out daily, take supplements/vitamins.
    Symptoms include fatigue, brain fog, low motivation, irritability, POTS, numbness/tingling in fingers, poor temperature control.
    Labs are as follows:
    25OH, Vit D = 60.5
    B12 = 1550
    Folic acid = 9.53
    TSH, free T4 = 1.55
    Ferritin = 30
    Iron = 181
    Iron saturation = 67
    TIBC = 269
    Hgb = 14
    Copper = 64
    Ceruloplasmin = 19
    Zinc = 99
    Thanks for your help!

  118. Jodi

    HI! I was wondering if you can help me..my Ferritin 582 and transferritin 186..I have been very weak and fatigue and my joints are bothering me. what does this mean?

  119. Meg Rowe

    Hello! I was wondering if you could help me with this. My son is almost 9 years old and he was first diagnosed with IDA around 4-5 years old. He received PO Iron supplementation and they over shot the mark so he had to stop. At a 6 month f/u his labs were WNL and iron was completely discontinued. Flash forward to now, he has been eating ice a lot, tires easily, not interested in sports anymore, has dark/blue circles under his eyes bilaterally and he isn’t as hungry as normal. Blood tests revealed the following:
    Hgb 12.7
    Hct 39.5
    MCV 73 (low)
    MCH 23.6 (low)
    TIBC 367
    UIBC 337
    Serum Iron 30
    Iron Saturation 8% (CRITICAL LOW)
    Ferritin 27

    Any thoughts about the labs above especially relatively normal(ish) labs but a random critical thrown in there. In addition, my sisters and I as well as 1 (out of 2) nephew have been diagnosed with Natural Killer Cell Deficiency. I decided not to test him thus far, but now I wonder if I should.
    Thank you!!!

  120. Kate

    Hello, Thank you for posting this! I have been so puzzled by my results. I’m planning to retest on Monday. My recent results indicate that I have hashimoto’s. (I knew I had low thyroid/ but this showed 359 TPO antibodies, so I assume.) My thyroid levels are normal and I am treated with dessicated thyroid.

    My results also show high Iron (212) and %saturation (61) but normal TIBC 347 and Ferritin. (43) I had been taking a lot of Airborne that week to stave off sickness. Could that cause high iron? I am a woman, 48, of northern european descent. Do you offer zoom medical appointments, by any chance? I have an appointment with an endocrinologist but the first available is in March.

    Hopefully, retests on Monday will show something better.

    1. Dr. Matt

      Hi Kate, If you haven’t resolved your condition, we can do a zoom consult to see what may be getting overlooked. Email: info@drwholeness.com

      To start though:
      Checking vitamin A, ceruloplasmin, copper, B12, Folate, D all could be helpful. Also, lactoferrin.

      Give yourself a 48 hour wash out period without any high supplementation before getting retested.

  121. Kem

    Hello can anyone explain my blood test results thank you i was tested back in December, But cant get into the doctors until February .
    10/1/22 18/7/22 13/12/22
    Iron 15 8 22
    TIBC 61 68 73
    Saturation 24 12 30 %
    Ferritin 17 12 7 ug/L

    EOS 0.34 0.66 0.81

    TSH 1.8 2.6 3.7

  122. Mark Schanlan

    Hello Matt. 67 yr old male, diagnosed with Hemochromatosis approx 15 years ago. Also have Thrombocytopenia (platelet count consistently just below normal). Have kept my ferritin number in the “normal” range (100-300) during that time. Last 4 tests: TIBC 217-242, Saturation 87%-93%, Total iron 209-224, Hemoglobin 15.1-17.1. The high saturation began 2 1/2 years ago. My hematologist says that as long as total iron is low that saturation % doesn’t matter. My readings (Pierre Brissot) seem to indicate that the sat % is an issue even at lower iron levels. We are currently trying to get me under 50 to see if that drops the sat% (doc is amenable to that). Any thoughts on my high sat/low iron situation?

  123. Daniel

    hi Dr. Matt,
    Have had a feeling of fullness with reduced meal sizes, especially with animal protein and fats. Discomfort in upper right abdominal area, sometimes feeling of scratching while urinating. Have ruled out infections, stones, ultrasound came out normal. Changed my diet and over the past 3 weeks, my Alanine aminotransferase decreased from 81 U/L to 67 and 37. I have had a high ferratin level through out the three tests, around 279. My iron is on the lower end at 11 umol/L. Could this indicate an inflamed body? What additional test would you recommend?
    Thank you

  124. Sami

    I am extremely fatigued, anxiety, panic, shortness of breath, heart palpitations, dizzy for the last 6+ months. I just received my lab results and my doctor doesn’t think this is a concern. Thoughts? Should I take iron supplement?
    Ferritin 8.4
    Iron 97
    Transferrin 246
    Total iron binding capacity 244
    %iron saturation 28%

  125. Areil

    Ferritin 23ng
    iron 79ug
    Transferrin 275mg
    Saturation 23%
    TIBC 343
    My Hemacrit/Hemoglobin is always under by 1 – 1.5, but doc never seems to think it can be responsible for my symptoms. Are these normal numbers? Please help me interpret. Thanks.

  126. priscilla

    Hi- just got BW done for routine check up. RBC was 5.14 (normal was up to 5.10), platelets 622 (normal up to 450) MPV and MCHC slightly low. Dr then wanted iron test done. I DID NOT FAST for this and for about a week prior started taking Iron Supplements because they thought i had anemia. Iron results are Iron 407, Ferritin 5, normal unsaturated binding capacty.
    My diet for years was horrible , I ate red meat 5 times a week and bacon every day, sedentary lifestyle and rarely drank water. Could this cause it? i just started (2 weeks ago) on a low fat diet, drinking 8 glasses of water a day and walking 45 minutes a day with intense hikes on weekend.

    could continuing these things help w/the #’s? could the iron supplement i took and the fact i did not fast cause the #’s?

  127. Emily K Converse

    I know this thread old, but I’m desperate. As far back as I can remember my absolute lymphocytes have been low, sometimes they are normal. My red blood cells have been either low or on the low end of normal (4.23) with anything below 4 considered low. Low hct low mcv, low a/g ratio low albumin, Extremely low ferritin it was 12 (doctors where baffled how I was still functioning, had to have 5 iron fusions) and high iron saturation. I get random, unprovoked, no injury hematomas, and lumps (feel like bruises but no color change). For example I got a hematoma back in June around the 22nd, its now Feb 10th and I still have the hematoma, which is the biggest one I’ve ever had about the size of a fist, which has got smaller but is now hard (assumed it’s calcifying no, and no doctor will drain it for me). I have recently completed my iron infusions, but still having symptoms. The hematoma I spoke of has even caused an indent where my vein is. I was told by a surgeon that my veins are basically weak as when they did a mri it showed that it was leaking hence the hematoma, and they are confused by it as I didn’t have an injury what so ever. I’ve been tested for so many blood disorders as well and no answers. I do suffer from extreme fatigue, half the time I’m either sleep or fighting to not go to sleep. Any suggestions would be appreciated.

  128. Holly M

    Looking for help understanding these numbers.
    December 21 – Iron 6, iron sat 0.9, ferritin 85 | WBC and Neutrophils elevated
    Jan 31 – Iron 21, iron sat .28, ferritin 29 | WBC and Neutrophils elevated

    Symptoms are increasingly worse, daily exhaustion (debilitating), headaches, aura, nausea, dizziness, brain fog/lack of mental clarity. My ADHD meds literally stopped working at max dose. Digestive issues (rectal bleeding, diarrhea or a lot of what seems like undigested food).


  129. Christina

    If anyone can please help me with my results as i am super confused. Two almist 3 years ago i had lab work done showing my iron was 179 but tested negitive for Hemochromatosis. I did do blood draws and ended up anemic then got prego and pf course aftwr having son c section stayed anemic but here i am a year later and now my iron is bavk to 169. Heres my results from a 12 hour fast. I will say i use to be a heavy drinker but quit almost 3 years ago.

    Iron 169
    Ferritin 23
    Iron sat 49%
    My TSH 0.52
    I did have a few other things come up abnormal

    A/g ratio 2.4 high
    Bun creatinine 26 high
    Carbon dioxide 19 low

    But liver and kindy fuction showed normal.
    Ast 19
    Alt 18
    Egfr 122
    Protein total 6.7

    What can i do to fix all this?

  130. John

    I read your article with great interest and am now hoping you can give me some advice.
    I have secondary polycythemia caused by androgen therapy since 2017. I have been having Phlebotomy for the last two years and have gradually felt more and more tired. Eventually, last month, a doctor tested my Ferritin levels which were 19ug/l
    I’ve been put on 210mg Iron fumerate 2 tablets per day and this week my Ferritin level has recovered to 67ug/l. But I feel worse at the moment. My legs are hurting where they ache so much and am still feeling exhausted. Is this because my body is trying to deal with the extra iron?
    I thought the phlebotomy was to blame but on further research, see it’s more likely the high RBC because Hepcidin is taking more of my iron stores to the extra blood cells, so phlebotomy should actually help keep it in control. I’m supposed to be under a haemotologists care but have never actually spoken to him, an assistant calls me once a year, asks how and am. I tell them I’m exhausted but they’ve never tested my Ferritin levels. Just say we’ll speak to you again in a year 🙁
    My haematocrit at it’s highest point 2 years ago was 0.59

  131. Stephanie

    Physical this week w/ bloodwork, Dr. sending me for a retest in a week for iron, TIBC, and iron saturation because of their numbers below. I don’t take iron supplements; severe fatigue and brain fog in last few months. Dr. didn’t explain what it all means re: test results, but curious to know before next appt.:

    Iron 189 ug/dL
    TIBC 475 ug/dL
    Iron Saturation 40 %
    Ferritin 8 ng/mL

    Other results:
    RBC 4.22 M/µL
    Hemoglobin 12.7 g/dL
    Hematocrit 38.80 %
    MCV 91.9 fL
    MCH 30.1 pg
    MCHC 32.7 g/dL
    RDW-CV 13.1 %
    WBC 6.7 x1000/µL
    Platelets 287 x1000/µL
    MPV 10.6 fL
    ANC(Abs Neutrophil Count) 3.86 x 1000/µL

  132. Sherri Crowley

    Hi, could you help me understand what this means? I have Hashimoto’s thyroiditis, but my Functional Medicine thyroid Doctor and my PCP both didn’t seem to have any clue what is going on and just said stay away from any vitamins / supplements with iron and limit foods like red meat:

    Feb. 27, 2023
    Iron, Total: 232 (ref range 40-190 mcg/dL)
    TIBC: 365 (ref range 250-450 mcg/dL calc)
    % Saturation: 64 (ref range 16-45% calc)
    Ferritin 23 (ref range 16-232 ng/mL)

    November 29, 2022
    Iron, Total: 156 mcg/dL (ref range: 51-146 mcg/dL)
    TIBC: 333 (ref range: 240 – 450)
    Ferritin: 61 (ref range: 10 -109 ng/Ml)

  133. Bryn Tanner

    Could you please help me understand my iron results, my ob/gyn was very confused as well.

    Iron Bind Cap – 462
    UIBC – 131
    Iron – 331
    Iron saturation – 72
    Ferritin – 17
    Symptoms are fatigue and hair loss.

    Thank you!

  134. Lyn McCarty

    I was diagnosed with hypothyroidism in 2017. I have been taking medicine for my thyroid and hormone replacement since then. I have labs done once a year. This year my iron was high. My doctor doesn’t seem too concerned but I am. Would you look at these values and tell me if I need to get another opinion?

    Iron Bind.Cap.(TIBC)
    Current Result: 303

    Current Result: 116
    Flag: Low

    Current Result: 187
    Flag: High

    Current Result: 59

  135. Robyn Contreras

    Dr Matt… can you help?
    My ferritin is 12
    Iron total 204
    TIBC 318
    Saturation 65
    Hemoglobin 12.9 Hematocrit 38.6.
    I am miserable and have all the symptoms of iron deficiency. Palpitations, hair loss, shortness of breath, anxiety, fatigue, dizziness, light pink eyes, etc. I’m in menopause, have fibroids and on BHRT. When I bleed it’s very heavy. I recently did my own iron blood work because Drs will not test for ferritin if hgb is normal. Am I iron deficient?

  136. Dayan

    Hi . I’m glad there’s more people here I have high iron high saturation and low ferritin .
    My hair is falling . I had the same a year ago and my doctor just told me I had to stop eating spinach. My diet is mostly vegan so I don’t understand why my iron is high. I take birth control pills barely get my period the pill I take is qlaira. Also my b12 is low
    Iron :242h range (40-190)
    Iron binding 413 range (250-450)
    Saturation 59 range (16-45)
    B12 : 505 range (650-1340)
    Please help doctors that I’ve visited don’t seem to care .
    I take birth control because I have polisystic ovaries

  137. Uz

    What should I do in my case? Should I supplement more iron?

    Iron 91 (NORMAL)
    TIBC 352 (HIGH)
    TIBC 443 (HIGH)
    Saturation 21%

  138. Margaret Embody

    Thank you for creating this article! I am a laboratory student and I was curious about my own labs. Nobody really covers the counterintuitive stuff like this! I have low ferritin but normal/slightly elevated serum iron and TIBC. The compensatory liver response, and pooling of iron in the peripheral blood due to increased transferrin synthesis makes perfect sense! Thanks!


  139. Scott Sadeghian


    I am a 55 year old healthy male with very low ferritin but otherwise normal bloodwork and no major symptoms of anemia (though I do not have great endurance).

    Ferritin: 10
    Iron: 87
    Iron Sat %: 21
    TIBC: 417.

    After 2 months of supplementing 4 days per week with 65 mg, my ferritin barely moved, but my other data points shifted:

    Ferritin: 16
    Iron: 169
    Iron Sat: 45
    TIBC: 373.

    My hematocrit remains about 46%, my hemoglobin in always 14- 16, though jumped to 16.7 and my RBC remains about 5.

    I stopped supplementing because iron hi and it didn’t seem to move the needle on my ferritin. Any thoughts on what is going on or what I can do to increase ferritin? Or do I even need to bother if I seem fine?


  140. Liz

    Hi Dr! My iron test results are a little confusing!
    Total iron 140 (40-190mcg/dl)
    Iron binding capacity 454 H (250-450mcg/dl)
    Saturation 31 % (14-45)
    Ferritin 16 (16-154 ng/ml)
    Transferrin 337 ( 188-341 mg/dl)

  141. ShielaAnn

    I have always had low ferritin, tried iron supplements, the liquid, it all but nothing improved my iron or myHemoglobin (which has not been over 12 since I was in high school). I ended up having an iron injection – Injectafer ( 2 doses 1 or 2 weeks apart- i cant remember back in November 2020. At the day of my IV, my numbers were:
    WBC- 4.5
    RBC- 3.72
    RDW -14.6
    total iron- 32
    TIBC – 405
    Iron Saturation- 8%

    afterwards everything went up and was high or normal. in June 2021-
    ferritin- 257
    total iron- 125
    TIBC – 242
    Iron Saturation 52
    UIBC- 117

    April 2022- Ferritin fell to 69, Total Iron 94, iron saturation 31%, and TIBC- 300

    this month, started to feel how i did before the injection. had labs rerun, and these were my results:
    WBC- 6.1
    RBC- 4.2
    RDW -12.3

    ferritin- 25
    total iron- 97
    TIBC – 304
    Iron Saturation- 32%

    is it normal for ferritin to drop 2 years after injection? Also, everything else seems high or normal, so what could be going on?

  142. Ellie

    Hello Dr. I hope You can help me understand what’s going on, I was hospitalized a week ago due to stroke like symptoms, had a lot of fluids via IV, also had blood thinner injections 2 times, and when I got home I took iron pill a day before labs, usually feel dizzy very tired and loosing a lot of hair, lab results came back
    Glucose high – 106
    Chloride high- 107
    Iron Bind.Cap.(TIBC)- high 456
    Iron high- 278
    Iron saturation high- 61
    Ferritin low- 8

  143. em

    I had iron studies done 3 times in the last year. Twice results showed high iron and high saturation index, but my ferritin is normal (low end) and once all was within range but low end. I had hemochromatosis gene tests (H63D, C282Y) that are negative. What could do explain my high iron with normal ferritin and variable results? Is it normal for iron saturation to vary so much?
    Aug 2021:
    Iron: 35 umol/L
    Total iron binding: 45 umol/L
    Iron saturation index 78%
    No ferritin measured

    April 2022:
    Iron: 10 umol/L
    Total iron binding: 58 umol/L
    Iron saturation index 17%
    ferritin: 20 ug/L

    May 2022: *UNITS DIFFERENT*
    Iron: 193 mcg/dL
    Total iron binding: 329 mcg/dL
    Iron saturation index 59%
    ferritin: 27 mcg/dL

  144. Beth

    Hi! I’ve been trying to understand my levels & can’t come across any solid answers!!

    Symptoms of joint pain, fatigue, hair loss, weight gain, irregular heart rate.
    I know I have atleast one copy of H63D gene mutation. (Negative for C28Y, & haven’t been able to find testing for S65C/ lesser common hemochromatosis mutations)

    Ferritin 18 ng/ml
    Transferrin 325 mg/dl
    Transferrin Saturation 43%
    TIBC 518 ug/dl
    Iron 221 ug/dl

    1. Dr. Matt

      Beth, you may want to look into Vitamin A and lactoferrin to support iron utilization. Given your TIBC and ferritin it does suggest iron is an issue. Also, if you are taking iron give it a 48 wash out period before getting your lab tests done. Add copper and ceruloplasmin to the labs as well.

  145. Jessica

    My daughter has been struggling with low iron and ferritin. She is having breath holding spells due to low iron.

    After 5 months on iron supplements

    Iron is at 98
    Iron saturation 25
    Tibc 385
    Transferrin 258
    Ferritin 19

    Also showing polychromasia +1 on her cbc now.

  146. Megan


    My 4 year old daughter we discovered had low iron just before she started kindergarten. Then when she started kindy the teachers queried whether she had a thyroid issue as her neck had a roll in it. Took her for ultrasound and x ray. Apparently thyroid is okay but she has enlarged adenoids.
    We have increased the iron in her diet and pairing with vitamin c as well as taking Natures Way Vita Gummies with vitamin c. It’s been 4 months and her ferritin has decreased. I’m so confused.

    Both tests were fasting.
    Iron 7 (8-27) (umol/L)
    Ferritin 64 (20-200) (ug/L)
    Transferrin 2.38 (1.75-3.18) (g/L)
    Transferrin Saturation 12 (5-45) (%)

    Iron 6
    Ferritin 136
    Transferrin 2.09
    Transferrin Saturation 11

    Low results on below also:
    Haemoglobin 112
    White cell count 5.47
    Haematocrit 0.32
    Monocytes 0.22

    She also had her thyroid tested in January
    TSH 1.75 (0.80-6.60) (mIU/L).

    She is an active kid who gets puffed easy.

    I’ve just bought the Maltofer syrup for iron to try that instead of the gummies. I’m just confused how we have gone backwards.

    Any ideas or suggestions?

  147. Rebecca

    Hi there. I was diagnosed with heterozygous hemochromatosis about 8 months ago. One allele from Dad and a different one from Mom (C282Y and H63D). I am currently perimenopausal and just stopped bleeding after about 18 days. Feeling terrible, I went to my doctor and had labs drawn.

    Iron 174
    TIBC 302.4
    Transferrin 216
    Transferrin Saturation 58
    Ferritin 15
    Anion Gap 6.0
    Protein 6.3
    Hemoglobin 12.3
    Hematocrit 36.3
    Neutrophils 1.5
    Monocytes .2
    Eosinophils 0
    Basophils 0
    Lymphocytes .9
    WBC 2.7
    Again, hormones within range of perimenopause. I can’t seem to get anyone to make sense of all this. Getting labs re-checked in 2 weeks to see if things have come back to normal. So complicated, and I am medical. I’m a P.T.

  148. Jennifer C

    Here’s my test results I’m a 36 year old female i initially made an appointment because my bowels were unusual
    Your Value
    491 ug/dL
    Standard Range
    250 – 450 ug/dL
    Your Value
    189 ug/dL
    Standard Range
    131 – 425 ug/dL
    Your Value
    302 ug/dL
    Standard Range
    27 – 159 ug/dL
    Your Value
    62 %
    Standard Range
    15 – 55 %
    Your Value
    7 ng/mL
    Standard Range
    15 – 150 ng/mL
    Your Value
    1.3 %
    Standard Range
    0.6 – 2.6 %

  149. Nicole

    I came across this website and find it very helpful (along with the comment section)
    I will not tire you with my symptoms, but was wondering if you could assist with interpreting my lab results. I am a 36 year old female and have thalassemia trait. Results:
    Iron (Fe) 163 mg/dL (normal range 37-145)
    Ferritin 15 mg/L (normal range 15-150)
    B12 283 pf/mL (normal range 191-663)
    Folic acid 3.6 ng/mL (normal range 3.9-26)
    Vit. D 34 ng/mL
    I am concerned with the iron overload
    Thanking you in advance for your attention to this matter

  150. Karen

    Can you help interpret my levels please?

    Iron, serum 35
    Transferrin/tibc 362
    % iron saturation 6
    Ferritin 7

    TSH 3.2
    Free T4 0.64
    Free T3. 3.53
    Thyroperoxidase antibody 3.2

  151. Beth

    Hi Dr. Matt!
    I am a 40 year old woman. I had blood work done after I fainted one day and the only thing we found was my iron was off. I had high saturation, high overall iron and on the lower side ferritin. Took another blood draw and found the saturation and overall iron went up. I was taking an iron supplement, but very sporadically. I was told to stop taking that and we would run tests. In a non fasting test, my iron levels returned to normal but my ferritin went down to 7. We ran the tests again and my ferritin is at 11, but my total iron was back up to 201 and saturation at 64 (this was very similar to blood work done 6 months ago). I do have one of the hemochromatosis genes.
    Any guidance would be helpful. I’ve been really tired lately, taking naps when able.

    1. Dr. Matt

      Potentially the amount of transferrin iron transport proteins is not quite sufficient for the amount of iron your tissues need. So, taking lower dose iron with complementary nutrients to maximize utilization could prove much more valuable than taking iron high dose by itself. Also, making sure you are getting enough complete protein food sources. Vitamin A, lactoferrin can also be helpful for some. Check out http://www.bloodvitality.com

  152. Michael

    Dr. Matt!

    Please help… It appears I fit the description of this article.. However, my primary Doctor suggested I have Hemochromatosis and not to take iron supplements.. Is that true? I don’t have symptoms, but it appears I need to increase my Ferritin with the supplement you recommend. 17 seems really low, but iron is a bit high. Here are the numbers from my physical last month.

    If I do take a supplement, will it greatly increase iron?

    34 YO Male, athlete

    Below Range
    17 Ng/mL

    Above Range
    184 Mcg/dL

    Iron % Saturation
    Above Range
    54 % (Calc)

    Iron Binding Capacity
    In Range
    343mcg/dL (calc)

    In Range

    Thank you!

  153. Cin

    Doctor, my serum iron level is 137 mcg/dl (CLLF 274 mcg/dL, CTLF 411 mcg/dL and IST 33%)
    However, my ferritin is only 14. 6 ng/mL
    T4 is 1.22 ng/dL,
    TSH is 4,27 microUI/mL
    T3 1.06 ng/mL
    Methylmalonic acid 0.11 microml/L
    Vitamin D only 27 ng/mL
    LDL 94 mg/dL
    HDL 91 mg/dL

    My hemogram is more on the low value side, but not under.

    I can’t tell any symptoms of deficiency. I feel really good. I’m 46 and my periods are regular. I never have period cramps or discomfort. I never have headaches. I don’t feel the need of having naps during the day, and I’m very active (I train capoeira, I walk a lot and I do some weightlifting). I’m also not aware of any health issues, allergy or intolerance. I don’t take any meds – not even painkillers (because I don’t need to).

    Why do you think my serum iron is high and ferritin is low? Do I need to treat it with daily supplements? I do take multivitamins once or twice a week and I consume nutritional yeast every day).
    I cook most of my food from scratch and I eat a lot of plants, specially beans, tofu, avocados and dark leaf greens. I haven’t eaten meat, eggs and milk for over 13 years.

  154. Tanya

    Hi, I just got my labs back:
    Iron, total is 210
    % saturation is 53
    Ferritin 21
    I do have hashimotos and hypo and on thyroid meds. I had a series of iron infusions 7 years ago. What do these numbers mean? Thanks!

  155. Rochelle

    Hi there. I went to emergency recently with (frequent and very obvious) palpitations and a very high heart rate. I have had palpitations now & then for years but they have increased significantly and are now often very noticeable. I have had a high heart rate (not related to exercise and I don’t drink coffee, not on any meds or illicit drugs) around 4 times within the last month however on the morning on went to hospital, it had jumped up a huge amount (and I had just been lying in bed). I have had some ECG’s done, a chest xray (normal), wore a holter monitor for 24 hours and had blood tests. I did have some kind of upper respiratory thing going on when i went to hospital (no coughing or sneezing but definitely had come down with something). I am post menopausal (confirmed by blood tests).
    A cardiologist (who I have not seen) has reviewed the holter readings and the conclusion on the report is: Sinus rhthym with occasional ectopy and ventricular ectopy. My arrythmia classification falls under the ‘occasional’ category (p.s. murphy’s law, when I had to wear the holter monitor, my heart issues (tachycardia as well as the arrythmia) had calmed down a lot).
    I saw a GP today (not my usual one) and she said they won’t be referring me to a cardiologist. She said sometimes they don’t know what causes arrythmia and high heart rate (both have calmed down now – and I haven’t have a high heart rate for around 3 days now). I asked for a copy of all my blood test results.

    Now reading my results at home (and I was told by my GP all the results are normal) I see I am within normal range for iron but it’s right on the borderline. I can also see my iron has dropped since March 2022. My S Trf Sat level has been marked as low (but she didn’t say anything about it).
    Before looking at my blood results, i thought that maybe my HR and palpitations went beserk recently because I had come down with something (and my blood results did indicate I had an infection or inflammation – and they did pick up a UTI and I have now finished the antibiotics). And/or it was related to my hormones.

    Should I go back to the GP and point out these results (she never said anything about these results)? And can I correct my iron levels through diet? Or are my iron stores too low that I may need iron injections?

    S Iron – 5 umol/L (normal range 5-30). Compare with March 2022 – 20
    S Trf – 2.4 (within normal range)
    S Trf Sat – 8 % (normal range 10-45)
    S Ferritin – 127 ng/ml (normal range 30-500). Compare with March 2022 – 55
    Note: I have read that ferritin levels can increase temporarily during inflammation and infection. So that 127 reading may have dropped now. I have also read that “researchers suggest that ferritin below 100 ng/mL may warrant further evaluation of iron insufficiency”

  156. elois

    I have hypothryrodism Hashimotos, but still tired taking levo. I don’t take any other supplementals drink plenty water and a healthy diet. Dr says I have high iron but its just barely high but the Ferritin is low and saturation is high. Can someone explain?
    Ferritin 33
    Iron 173
    TIBC 283
    Iron Sat 61%
    Vit D -OK
    B12 1121

  157. Ana

    I have
    Ferritin 19
    Iron 48 umol/l
    Iron Saturation Index 0.71

    What could it be?
    Looks like it impossible. That what the doctor said.
    Made the test couple of times.

  158. Vicky Ridley

    Hi I have been diagnosed with periodic limb movement disorder (PLMD) which disrupts my sleep cycles & appear to have had it for around 30 years with only a definite diagnosis recently. I have been told by my sleep disorder consultant that ferritin needs to be at least 100 ug/L but was 27 ug/L 3 months ago, after which I supplemented with ferrous fumarate & have just had a retest & it has gone down to 19 ug/l..
    This also happened about 12 years ago when i was tested.
    My other test results:
    B12 272 ng/L
    Serum iron 12.9
    Transferrin 2.63 g/L
    Transferrin saturation 20%
    Haemoglobin 140g/L
    The sleep consultant requested i was referred to a haematologist, which my GP refused to do until I’d done a three month iron supplementation & here we are.
    Any advice on how to increase ferritin without iron overload in my serum greatly received! Enough stores of ferritin & it could be all i need to control the PLMD & avoid strong drugs.
    Many thanks

  159. Cori

    Hi Dr.,
    Hoping you see this since you haver a ton of comments on here. Thank you for your time.

    We were referred to Hematology/Oncology for my 23 month old. They couldn’t get him in until after the holidays but really have no information from the doctors. These are his labs.
    RBC 3.06
    HB 8.7
    HCT 28.3
    MCV 92.5
    RDW 19.8
    Iron Total 88
    Iron Binding 328
    Saturation 27%
    Ferritin 18

    His levels have dropped over the past 6 months. They were all low and have continued to decline. This is the first blood test where they checked iron. B12 and folate came back fine. We initially started trying to get answers because he isn’t growing. He’s under the 1st percentile and has severe leg pain. We would go for walks and he wouldn’t be able to walk when we got home. He wakes up in the middle night crying and screaming ‘help me’ and grabbing his legs. We just want some sort of answers. Or at least some sort of direction on what to expect. Thank you!

  160. Bridget Sloane

    Thanks for this article! I’m struggling to understand my iron…

    Ferritin – 37 (16-232)
    Iron, Total – 149 (40-190)
    Iron Binding Capacity – 333 (250-450)
    % Saturation – 45 (16-45)

    It looks like my iron is ok, but my ferritin is on the low side. Not sure how to raise ferritin if my total iron looks ok and % saturation is at the top of the range. I’m not sure if I actually need iron or not. I do have hypothyroidism (Hashimoto’s) an being treated for that and take methylated B-12. If you have any insight, that would be great!

  161. Laurie

    Dr Matt. I am a very concerned mother to a 9yo boy who has historically had low Ferritan. We recently started supplementing with Iron and Vit C at night and 4 months later we redid his bloodwork and his Ferritin dropped to 17 from 19 yet his Total Iron is almost at top of range at 161 and Saturation is at max of range at 48%. I made a follow up with his pediatrician but I have a feeling she will be clueless. I am not sure if I should continue giving iron (we only do every other night). His Vit D also dropped from 48 to 40 while supplementing with 2000iu a day. He follows such a healthy diet and I cannot understand why he has so many issues (precocious puberty, whole body low density, fatigue). I just want to help him. Would a Ferritin only supplement help?

  162. Anna

    I’m struggling to interpret my levels, please help me understand if you can.
    Red Blood Cell Count: 3.56 (3.80-5.10)
    White Blood Cell Count: 4.8 (3.8-10.8)
    Hemoglobin: 10.8 (11.7-15.5)
    Hematocrit: 32.8 (35.0-45.0 %)
    Iron Total: 203 (40-190)
    Iron Binding Capacity: 293 (250-450)
    % Saturation: 69 (16-45 %)
    Ferritin: 13 (16-154)
    TSH Reflex Free T4: 3.15

    From what I’m understanding is first my thyroid has gone up dramatically, I’ve always been in the 1.05- 1.24 range and I immediately noticed this change, I’ve been gaining weight with no changes to my diet except I’m eating meat now because my doctor was concerned about my ferritin levels being low. I’ve also been taking iron pills twice a day (324 mg total) and I don’t understand how my iron is high and my ferritin is still low. What does the % saturation mean ? I also noticed an increase in that too, only a couple months ago in august it was within normal range.
    I’m experiencing very intense brain fog everyday and extreme weakness, I cant even sit in class and concentrate and I’ve been having a lot of trouble sleeping at night because I feel so much weakness, shortness of breath and low heartbeat. I’m losing hair as well. I don’t know what to do because the iron supplements are not helping as much as they should.

  163. Jessica

    4 y/o F. having a lot of medical anxiety so I apologize in advance. From my family doc visit and blood results of 12/27/23 I was referred to hematology and met the doctor on 1/29/24. He prescribed an iron supplement which I took Monday and today (Wednesday). Both times my stomach didn’t tolerate it well and I threw it up. Sorry tmi I know. He also tested ferritin again at my visit which is increasing on it’s own before I started the supplement. I didn’t feel confident with his opinion and asked my family doc to write me an order for analysis of the HFE gene which I had sent out on Monday the 29th as well and should take 4-6 days to come back, which I am anxiously anticipating to receive. Should I continue taking the iron until those results come back? His next step is to start IV iron infusion if my ferritin levels aren’t around 100 in four weeks at my next visit. I’m more confused than when I started this all and just want to feel better and have more energy, and be more informed on my health.
    Iron: 203
    UIBC: 91
    IBC: 294
    Saturation: 69%
    Ferritin: 60
    Ferritin: 84
    I’ve seen similar results a common occurrence of the H63D variant and wondered if this could be the culprit, but I’m clueless and just want more info on what’s going on with me.

  164. Michael E

    I need some help. I just had blood work done and my Iron, Iron Saturation UBIC were out of the normal range
    Iron at 184 UG/DL
    Iron Saturation at 69%
    TIBC was normal at 267 UG/DL
    UIBC was low at 83 UG/DL
    Ferritin Leve was normal at 84.8
    What does this mean?
    I’m very dificent in Vitamin D and my Vitamin B12 Levels came back low as well. Could this be effecting the above numbers?
    Thyroid was check and that is in the normal range at 0.567
    Any insight would be appreciated

  165. Megan Travis

    Hello Dr. Matt, I am 26 weeks pregnant and just received my blood tests back. My ferritin is VERY low (7 L) and my iron total is normal (164) my red blood cell count is low (3.69 L) and my % saturation is normal (34). I am weaning off a medication that ruined my life and health so it’s hard for me to take any supplements. I do take iron on its own and started that about a month ago. I have intense leg weakness, extreme fatigue, and dizziness. I have not of fear around my baby and delivery. Any suggestions?

  166. Maddy Dodd

    Hi Dr Matt
    I have a lot of low iron symptoms – poor concentration / memory, severe cramping in my calves while doing vigorous exercise etc and have had 2 sets of blood tests a week apart. The first was just for ferritin and was 13ug/L (previously around 50 for number of years so still on the low side)
    10 days later:( after eating more iron rich foods) and continuing with multivit which contains 3.75mg of iron (of the 8.75mg needed for postmenopausal woman)
    Ferritin : 19 ug/L (30-204)
    Iron 29.1 umol/L (Above range which is 8.8-27)
    Saturation of iron binding capacity 72.8umol/L (Above range 45-70)
    UIBC 43.7umol/L (20-62)
    Blood tests don’t suggest anemia, though haemoglobin has lowered and red cell distribution width has increased.

    Am I heading for anemia?
    Am I low in iron as the ferritin results show?
    And if so why is my iron too high? What does that mean?

    I rarely eat red meat but ate much more plus other iron rich foods in the intervening period.
    Both tests were fasting tests first thing in the morning and I didn’t take supplements before them.

    Was going to take gentle iron supplement of 10mg which is iron bisglycinate, as my gut isn’t good, but now not sure what to do?

    Many thanks

  167. Robin J

    My ferritin was low and I had severe symptoms. My vision was blurry I had brain zaps, I couldn’t judge space, I had shortness of breath, I was nauseous, dizzy, I had migraines, I can go on and on. It was terrifying and my kids thought I was going to die. This was around the time that you wrote this post. I googled trying to save my life while multiple doctors missed it. In fact they did not even test serum iron much less ferritin. I ended up testing myself and treating myself and I am worlds better.

  168. VJ

    I too have low ferritin but higher than normal serum iron. I won’t give figures as I’m Uk based so the parameters are different. I’m just wondering if it’s safe to take iron supplements (Three Arrows been suggested sourced in US and I have bought it, but one doctor told me not to take 🤷‍♀️) or if that will just up the serum iron rather than ferritin levels. I’m also hashimotos therefore low ferritin inhibits the thyroid replacement working at its best! I’ve been veggie for nearly 40 years but now eat beef and chicken liver pate in desperate attempt to raise ferritin too!

  169. AG612

    At sixty, I have discovered that I have both Hemochromatosis genes. For the last two years have felt like my health and body are not normal or right, including a sudden propensity to gain fat after a lifetime of thinness. I hurt in my muscles and joints to a degree that makes it hard to move or exercise, or even sleep comfortably. I feel tired and a pronounced weakness in all my muscles even though throughout my adult life I have been stronger than most women. All these changes occurred many years past menopause. I also have Hashimoto’s treated with T4/T3 and LDN. I see a NP as my primary care but am nervous that maybe she is missing something important.
    Here are my recent labs:
    TSH: 1.530
    T3(Free) 2.7
    T4 (Free, direct) 0.97
    TIBC 211
    UIBC 84
    Iron 127
    Iron Saturation 60
    Ferritin 62

    My NP ordered one therapeutic phlebotomy three months ago. The tech said they would not allow me to donate blood because at the time my iron saturation levels were so low (82) and now after that phlebotomy they are even lower (60). I go to see the NP again next week but would appreciate your take on my situation. Thank you.


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