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.

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

71 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.

    Reply
    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.

      Reply
    2. Angela

      Hello,
      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.

      Reply
      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.

        Reply
  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!

    Reply
    1. Dr. Matt

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

      Reply
  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?

    Reply
    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,

      Reply
  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,
    Alex.

    Reply
    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.

      Reply
  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

    Reply
    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.

      Reply
  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

    Reply
    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.

      Reply
      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.

        Reply
  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!!!!

    Reply
    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.

      Symptoms?

      Antidepressants? Birth control?

      Reply
  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!

    Reply
    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.

      Symptoms?

      Antidepressants? Birth control?

      Reply
  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!

    Reply
    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.

      http://Www.optimizeiron.com

      Reply
      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.

        Reply
        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.

          Reply
  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.

    Reply
    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.

      Reply
    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.

      Reply
      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.

        https://drwholeness.myshopify.com/collections/nutritional-supplements/products/blood-vitality-1

        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.

        Reply
  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

    Reply
    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.

      Reply
  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.

    Reply
    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.

      Reply
      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.

        Reply
        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.

          Reply
  13. Sarah

    Hi!
    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?

    Reply
    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/

      Reply
  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

    Reply
    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.

      Reply
      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?

        Reply
  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

    Reply
    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?

      Reply
      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

        Reply
  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

    Reply
  17. Josh P

    Hi,

    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

    Reply
    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.

      Reply
  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

    Reply
  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.

    Reply
  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!

    Reply
    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.

      Reply
  21. Michael

    Hi,

    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.
    Michael

    Reply
    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.

      Reply
  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.

    Reply
    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.

      Reply
  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

    Reply
    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.

      Reply
  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:
    TRANSFERRIN 275
    IRON PLASMA 219 high
    TIBC 385
    PERCENT SATURATION 57 high
    FERRITIN 10 low

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

    Reply
    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.

      Reply
  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.

    Reply
  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?
    Ferritin–11.8
    FE–204
    TIBC–353
    UIBC–149
    %FESAT–57.790
    TSH– .930
    FT4— .65

    Lipid Panel:
    CHOL–223
    Trig–135
    LDLC–134
    HDL–62
    LDL/HDL–2
    CMP–All normal range

    HBA1C–5.00
    INSULIN- 7.0

    Reply
  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:
    Ferritin–11.8
    FE–204
    TIBC–353
    UIBC–149
    FESAT%– 57.79
    TSH– .930
    FT4– .65
    CMP–All normal range
    LIPID panel
    CHOL–223
    Trig– 135
    LDLC– 134
    HDL– 62
    LDL/HDL–2
    A1C–5.00
    INSULIN–7.0
    Any insight would be greatly appreciated! Thank you!

    Reply
  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!

    Reply
  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!

    Reply
  30. Lauren

    Hello,
    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.

    Reply
  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%

    Reply

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