Diagnosis of anemia: transferrin, ferritin, iron-binding ability of serum (LSS, LSS)
Transferrin is a blood protein whose function is the transport of iron.
Carrier of iron, siderophilin.
Siderophilin, transferrin, TF.
G / l (grams per liter).
What biomaterial can be used for research?
How to prepare for the study?
- Do not eat for 8 hours before the study, you can drink clean still water.
- Stop taking medications containing iron 72 hours before the study.
- Eliminate physical and emotional stress for 30 minutes before the study.
- Do not smoke 30 minutes before analysis.
Transferrin - the main protein carrier of iron in blood plasma. It is formed in the liver from amino acids that are absorbed from food during digestion. Transferrin binds to iron, which comes with food or in the destruction of red blood cells, and transfers it to organs and tissues (to the liver, spleen). Transferrin is able to attach more iron than it weighs.
Iron is an important trace element in the body. It is part of hemoglobin, a protein that fills red blood cells and allows them to carry oxygen from the lungs to organs and tissues. Iron is also part of the muscle protein myoglobin.
Normally, the body contains 4-5 g of iron, about 3-4 mg (0.1% of the total) circulates in the blood in conjunction with transferrin. As a rule, 1/3 of the transferrin binding centers are filled with iron, the remaining 2/3 remain in reserve. Indicators such as total iron binding capacity of serum, latent iron binding capacity of serum, and percentage of transferrin saturation reflect the degree of “occupancy” of transferrin with iron.
With iron deficiency, transferrin levels increase so that it can contact even a small amount of iron in serum.
The amount of transferrin in the blood also depends on the state of the liver, human nutrition and intestinal function. If liver function is impaired due to a significant increase in scar tissue (cirrhosis) in it, then the level of transferrin decreases. With a lack of protein food in the diet or a violation of the absorption of amino acids due to inflammation in the intestine, transferrin also does not form in sufficient quantities.
What is the study used for?
- In order to evaluate iron metabolism in detail (together with the test for serum iron and the total - sometimes latent - iron-binding ability of serum - a combination of these analyzes allows you to calculate the percentage of transferrin saturation with iron, that is, to determine how much iron carries blood). This indicator most accurately characterizes the exchange of iron.
- To assess the supply of iron in the body.
- To determine if anemia is caused by iron deficiency or other causes, such as a chronic illness or vitamin B deficiency12. With iron deficiency, its level in serum decreases, but the level of transferrin rises.
- To evaluate liver function.
When is the study scheduled?
- If any deviations are found in the general analysis of blood, analysis for hemoglobin, hematocrit, the number of red blood cells.
- If you suspect iron deficiency or excess iron in the body.
- If you suspect iron overload (hemochromatosis). Symptoms of hemochromatosis: joint and abdominal pain, weakness, fatigue, decreased sexual desire, heart rhythm disturbances.
- If you suspect a chronic liver disease or changes in intestinal absorption.
What do the results mean?
Reference values: 2 - 3.6 g / l.
Interpretation of the results is usually carried out taking into account the remaining indicators reflecting the metabolism of iron.
Reasons for increased transferrin levels
- Iron-deficiency anemia. It is usually caused by chronic blood loss or inadequate consumption of meat products.
- Third trimester of pregnancy. A decrease in iron and an increase in transferrin are normal in this case.
Reasons for lower transferrin levels
- Chronic diseases: systemic lupus erythematosus, rheumatoid arthritis, tuberculosis, bacterial endocarditis, Crohn's disease, etc.
- Lack of protein in the body associated with malabsorption in the intestines, chronic liver disease, burns.
- Chronic inflammatory bowel disease.
- Hereditary hemochromatosis. In this disease, an increased amount of iron is absorbed from food, which is deposited in various organs, causing damage.
- Thalassemia is a hereditary disease leading to anemia in which the structure of hemoglobin is altered.
- Acute liver disease.
- Cirrhosis of the liver.
- Glomerulonephritis is an inflammation of the kidney tissue.
- Inadequate administration of iron preparations (increased dosage).
- Congenital deficiency of transferrin.
What can influence the result?
- Estrogens, oral contraceptives lead to an increase in the level of transferrin.
- ACTH, corticosteroids, testosterone can reduce the amount of transferrin.
- Ferritin levels drop with a lack of iron, but remain normal if it is accompanied by inflammation. Therefore, for the diagnosis of iron deficiency in these situations, the combined appointment of tests for ferritin and transferrin can be used.
Who prescribes the study?
General practitioner, therapist, hematologist, gastroenterologist, rheumatologist, nephrologist, surgeon.
Iron-binding ability of blood serum
Iron-binding ability of blood serum (LSS) is an indicator characterizing the ability of blood serum to bind iron.
Iron in the human body is in complex with protein - transferrin. LSS shows the concentration of transferrin in serum. The iron-binding ability of blood serum changes with a violation of the metabolism, decay and transport of iron in the body.
For the diagnosis of anemia, the determination of the latent iron-binding ability of blood serum (LVSS) is used - this is an LSS without serum iron. The norm of latent LSS is 20–62 μmol / L.
An increase in LVSS occurs with iron deficiency, iron deficiency anemia, acute hepatitis, and late pregnancy.
A decrease in LVSS occurs with a decrease in the amount of proteins in the plasma (with nephrosis, starvation, tumors), with chronic infections, cirrhosis, hemachromatosis, thalassemia.
Iron is an element that is a component of hemoglobin, and is involved in the transport of oxygen, and also provides the work of many enzymes. Iron enters the body with food and is absorbed in the intestines, entering the bloodstream. In the blood, iron is mainly associated with proteins - transferrin, ferritin, hemosiderin, which store and carry this element. In free form, very little iron circulates in the blood. The indicator "total iron" means the determination in the blood of the concentration of iron associated with transferrin and ferritin, and does not take into account the iron in the composition of hemoglobin. Determining the concentration of total iron in the blood reveals anemia, diseases of the digestive tract and liver, as well as some chronic pathologies.
Indications for the determination of total iron in the blood are the following conditions:
- Diagnosis of anemia,
- Diagnosis of excess iron in the body (hemochromatosis, hemosiderosis, iron poisoning),
- Monitoring iron intake
- Acute and chronic infectious diseases,
- Systemic inflammatory processes,
- Violations of iron absorption, hypovitaminosis,
- Poor nutrition
- Digestive tract disorders.
Normally, the concentration of total iron in the blood in adult men is 10 - 31.3 μmol / L, and in women - 9 - 24.3 μmol / L. In newborns up to a month, the level of iron in the blood is normally 17.9 - 44.8 μmol / L, in children of 1 month - 1 year - 7.2 - 17.9 μmol / L, in children 1 - 14 years old - 9, 0 - 21.5 μmol / l, and in adolescents over 14 years of age - as in adults.
An increase in the level of total iron in the blood is observed in the following conditions:
- B12-deficient and folic deficiency anemia,
- Hemolytic anemia,
- Aplastic anemia,
- Sideroblastic anemia,
- Liver disease (hepatitis, etc.),
- Excessive intake of iron preparations or the use of large amounts of iron with food,
- Repeated blood transfusions,
- Lead poisoning.
A decrease in the level of total iron in the blood is observed in the following conditions:
- Iron-deficiency anemia,
- Iron deficiency in food
- Disorders of iron absorption against the background of pathologies of the digestive tract (low acidity of the gastric juice, chronic diarrhea, intestinal tumors, steatorrhea, a removed stomach or part of it),
- Chronic hemorrhage (due to bleeding, and in women also with heavy menstruation),
- Chronic hepatitis
- Cirrhosis of the liver,
- Obstructive jaundice,
- Nephrotic syndrome
- Chronic renal failure
- Uterine fibroids,
- Malignant neoplasms,
- Acute and chronic infections (especially purulent) and inflammatory processes,
- Periods of increased body need for iron (pregnancy, breastfeeding, period of active growth, high physical activity).
Iron Exchange Study Prices
- Iron complex 3 indicators (iron, transferrin,% saturation of transferrin with iron) 1500 rubles.
- The study of the level of blood haptoglobin 600 rubles.
- The study of the level of iron in blood serum 250 rubles.
- The study of the level of serum transferrin 550 rub.
- The study of the level of ferritin in the blood 550 rubles.
- The study of the level of erythropoietin in the blood (ELISA) 1200 rubles.
- Unsaturated iron binding capacity 250 rub.
Laboratory studies of iron metabolism play an important role in determining the cause of a widespread pathological condition - anemia. Anemia is not a disease, but a pathological syndrome that has many causes. Conducting a general blood test allows you to diagnose anemia and, in some cases, suggest its cause. The success of the treatment of anemia depends on how correctly the cause is established during the examination of the patient.
Iron in the body plays an important role in the regulation of metabolism, oxygen transport processes, maintaining immunological resistance. Deficit gland - The most common cause of anemia, from which 30% - 60% of the population suffers in our country. Iron deficiency conditions are the cause of reduced efficiency, increased susceptibility to viral diseases. Measuring only the content of iron in blood serum, it is impossible to obtain complete information about the causes of impaired iron metabolism. This requires the determination of transferrin, ferritin, and unsaturated iron binding ability in the blood.
Transferrin - iron-binding transport protein. Transferrin is synthesized in liver cells and in small amounts in lymphoid tissue, mammary gland, ovaries and testicles. Transferrin synthesis is stimulated by estrogens, corticosteroids and low serum iron.
Ferritin - A protein that provides the deposition of iron in the body. Its concentration in serum reflects the stores of iron in the body. Low ferritin levels are the first sign of reduced iron stores. The concentration of ferritin increases in the acute phase of inflammation and in these cases is not an indicator that reveals iron deficiency.
The diagnostic value of the determination of serum iron:
Iron reductionat healthy people as a result of changes in the daily rhythms of iron content, with infections, inflammatory processes, malignant neoplasms, with hemodialysis, with erythropoietin.
Iron increase: with idiopathic hemochromatosis (occurs with increased absorption of iron, not related to the needs of the body), secondary hemochromatosis (with increased absorption of iron, multiple blood transfusions), with anemia associated with impaired synthesis of porphyrins (intoxication with lead, tin), acute hepatitis, cirrhosis (iron enters the bloodstream from damaged liver cells).
The diagnostic value of the determination of transferrin:
to detect latent iron deficiency, iron overload, as well as in patients with renal failure in the treatment of erythropoietin.
A decrease in the concentration of transferrin is observed with: infections, septic conditions, oncological diseases, with thalassemia, megaloblastic anemia (vitamin B12 and folic acid deficiency), with hemochromatosis, with protein loss (malabsorption syndrome, nephrotic syndrome), with hemodialysis.
Iron transferrin saturation percentage better reflects latent iron deficiency than OGSS and iron concentration.
The diagnostic value of ferritin with a decrease in serum concentration:
with acute blood loss, in women - with heavy menstruation, inflammatory bowel disease, pregnancy, vegetarianism, hemodialysis patients. To monitor treatment while taking iron-containing drugs.
Latent (unsaturated) iron binding capacity of serum (VLSS, NLSS, UIBC) - an indicator used to detect iron deficiency in the body. The main indications for use: differential diagnosis of anemia, liver disease (acute hepatitis, cirrhosis), nephritis, evaluation of treatment with iron preparations, various chronic diseases, pathology of the gastrointestinal tract and the associated violation of iron absorption.
It is necessary to refrain from physical exertion, taking alcohol and drugs, changes in diet within 24 hours before taking blood. It is recommended to donate blood for examination in the morning from 8 to 10 hours on an empty stomach (8-hour fasting). At this time, you must refrain from smoking. If nevertheless there was little physical activity, you need to rest for at least 15 minutes before donating blood.
The following procedures should not be performed before blood donation: injections, punctures, general body massage, endoscopy, biopsy, ECG, X-ray examination, especially with the introduction of a contrast agent, dialysis. Exclude the use of corticosteroids, oral contraceptives, as well as refuse to take the following drugs: asparaginase, anticoagulants, chloramphenicol. It is advisable to take the morning medication after taking the blood (if possible).
For the correct interpretation of the results, it is necessary to notify the attending physician about taking multivitamin preparations and medicines containing iron.
It is very important that these recommendations are strictly followed, since only in this case reliable results of a blood test will be obtained.
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The rate of transferrin in the blood
During the analysis, the iron-binding ability of blood serum is also evaluated. This characteristic does not show the content of transferrin in the blood, but the amount of iron that can contact it. This indicator serves as the basis for calculating the saturation coefficient, the norm of which varies from 15 to 50.
Causes of a change in the level of transferrin in the blood
The synthesis of transferrin occurs in the liver and is dependent on its functional state, reserves in the body of iron and the need for it. When the concentration of iron decreases, the amount of synthesized transferrin increases.
An increase in serum transferrin levels may indicate iron deficiency in the body. The consequence of failure is iron deficiency anemia. The reasons for the change in the level of transferrin in the blood can be the use of oral contraceptives, androgens, estrogens, glucocorticoids.
Can iron be more than normal? Iron people with celtic genes
- The formation of red blood cells - red blood cells - in the bone marrow. Compounds of this metal are included in their main component - hemoglobin, with the help of which oxygen is delivered to organs and tissues.
- The functioning of skeletal muscles and heart muscle. Muscle tissue contains the protein myoglobin, which binds oxygen in order to spend it during oxygen starvation or during physical exertion.
- Detoxification of the body - the substance is part of the enzymes produced by the liver to destroy poisons and toxins.
- Cell division - this trace element is involved in the synthesis of DNA molecules that store and transmit genetic information.
Signs of anemia are weakness, poor health, decreased performance, dizziness, and pallor of the skin.
Change in skin, hair and nails - with a lack of this substance, the skin peels and crackes. The nails become thin, and concavities and white transverse stripes form on their surface. Hair loses its shine and falls out.
Changes in the mucous membranes. With iron deficiency, inflammation of the gums, palate, tongue, and jams form in the corners of the mouth. Dry mouth, nose, and swallowing appear.
Unusual taste preferences. Patients eat inedible objects - chalk, clay, raw meat and cereals. There is an addiction to pungent odors of gasoline, solvent, paint.
A bluish tint of the sclera - the white coat of the eye. If there is a lack of an element, atrophy of the eye tissues occurs through which the vessels are visible.
Muscle weakness. It becomes difficult for patients to perform the usual actions, they have muscle pains.
Decreased immunity. In case of iron deficiency infections “stick” more severely than usual.
The most common causes of this condition are:
- Improper nutrition. Diets that exclude meat and cereals, which mainly contain this element.
- The wrong combination of products. If you drink iron-containing coffee products, you should not hope that they will benefit. Coffee contains tannin, which prevents the absorption of compounds of this metal. Another option is a combination of products containing calcium and iron, such as buckwheat and milk.
- Diseases of the stomach and duodenum. In this case, the substance simply cannot be absorbed from food. A sharp decrease in the concentration of this element in the blood is often the first sign of inflammatory processes and malignant tumors of the gastrointestinal tract.
- Blood loss, especially persistent, for example, caused by heavy menstruation or hemorrhoids. In this case, the body continuously produces new red blood cells, which the glandular reserve spends.
- Infections and other diseases accompanied by the death of red blood cells.
- Pregnancy. During this period, the trace element is spent on the formation of organs and tissues of the fetus.
- Reinforced physical activity.
- Diseases of the liver and kidneys that affect the absorption of iron and the production of proteins that bind and carry it throughout the body.
Such a deviation is observed in people living in mountainous areas with rarefied air and among climbers after staying in the mountains. In the mountains, in order to prevent oxygen starvation, the body intensely captures this element in order to produce hemoglobin.
But the most common reason is a hereditary disease hemochromatosis, causing the accumulation of this metal. A defective gene that leads to the disease is called "Celtic" because it is often found in people from Scandinavia and other northern countries. There are such patients in Russia.
With hemochromatosis, liver lesions occur, accompanied by yellowness of the skin and eyes, itching, subcutaneous hemorrhage. The work of the pancreas, nervous system and heart is disrupted. Joints become inflamed.
It is impossible to cure a genetic trait. The only thing that remains for patients is to exclude iron-containing products from the diet as much as possible. Another way is donation, in which the body loses part of the blood and is forced to constantly spend reserves of this substance.
Analysis of iron in blood serum
The normal iron content in the blood allows the body to function fully. Everyone needs to monitor the level of iron, but most importantly it is for children and adolescents, pregnant and lactating women, as well as the elderly.
The normal iron content in the blood for adult women is in the range from 9 to 30 μmol / L, for men from 12 to 31 μmol / L.
The main indicator of iron stores in the body is ferritin, which contains iron phosphates. It is found in all cells of the body and performs an important function of maintaining iron in a biologically useful form.
A blood test for ferritin helps diagnose iron deficiency anemia and anemia accompanying infectious, rheumatic and tumorous diseases. The normal value of ferritin in the blood for adult men is 20–250 μg / l, and for women is 10–120 μg / l.
An increase in ferritin levels is characteristic of hemochromatosis, liver diseases, leukemia, breast cancer and infectious and inflammatory diseases. Taking oral contraceptives can also trigger an increase in ferritin levels. Low ferritin is a consequence of iron deficiency (iron deficiency anemia). With a decrease in ferritin levels, it is necessary to find out what causes this result.
Blood iron tests in Krasnoyarsk and Nazarovo can be done in one place - the Center for Laboratory Technology "ABV". You can sign up for change by calling 8-800-234-40-01 and 202-69-01, as well as on the website.
Call: tel. 8-800-234-40-01 (the call is free), 8 (391) 202-69-01.
Elevated blood transferrin
Most often, an elevated level of transferrin in the blood is a manifestation of iron deficiency anemia, but it can also be “physiological” in the third trimester of pregnancy.
An increase in blood levels of transferrin may indicate:
- iron deficiency and precede development within a few months or days of anemia,
- taking oral contraceptives and estrogens.
Serum Iron Binding Assay
The ability of blood serum to bind iron is called the iron-binding ability of serum (LSS). It shows the concentration of transferrin protein in the blood serum and changes when there is a violation of the metabolism, decomposition and transport of iron in the body.
An increase in the level of LSS indicates iron deficiency, iron deficiency anemia, acute hepatitis. It is also possible in late pregnancy. A decrease in LSS is evidence of a decrease in the amount of protein in the plasma (with nephrosis, starvation, tumors), as well as in chronic infections, cirrhosis, hemachromatosis, thalassemia.
The analysis of serum iron binding ability is carried out by the method of determination of serum iron binding latency (LSS), which is LSS without serum iron.
Low blood transferrin levels
The most common cause of low levels of transferrin in the blood is liver disease with signs of hepatocellular insufficiency, for example, cirrhosis, chronic hepatitis. In addition, neoplastic processes, protein loss with nephrotic syndrome of any origin and other processes in the body can cause transferrin deficiency.
A decrease in the level of transferrin in the blood may indicate:
- chronic inflammatory processes,
- cirrhosis of the liver,
- protein loss in nephrotic syndrome, burns, gastroenteropathies (malabsorption syndrome),
- taking glucocorticoids and androgens,
- malignant tumors
- hereditary atransferrinemia (rarely),
- conditions that are accompanied by an increase in oncotic pressure (hepatocellular disease, multiple myeloma),
- multiple blood transfusions (overloading the body with iron).
In what other cases, it is necessary to determine the concentration of iron and its exchange
Decreased hemoglobin. A decrease in the indicator below 120-140 g / l in women and 130-160 g / l in men is an indication for such an analysis. Research is being done to rule out other types of anemia not related to iron deficiency.
Bleeding, heavy menstruation and other conditions accompanied by hemorrhage. Analyzes will show whether it is necessary to restore “iron” reserves with the help of drugs.
Preparing for pregnancy. During the period of gestation, the consumption of this substance increases, since the trace element is needed not only by the mother, but by the growing baby. Pregnancy against the background of iron deficiency leads to impaired formation of the organs of the child.
Past infections, operations, serious illnesses that could also cause a decrease in the reserves of this element in the body.
Professional sports. For athletes, the consumption of trace elements is increased, so they need to periodically take "iron" tests.
- Ferritin is a compound found in various organs and tissues. Its task is to create stocks of the element, from which, if necessary, you can take this trace element.
- Serum iron is a form of trace element found in the liquid part (serum) of the blood. It is a substance that is not spent on the production of hemoglobin and is not deposited as reserves in ferritin.
|Indicator||Norm for adults|
|Whey iron||Women - 6.6-26.0 μmol / L|
|Men - 11.0-28.0 μmol / L|
|Ferritin||Women 10-120 mcg / L|
|Men - 20-250 mcg / L|
Transferrin. The ions of this metal are toxic, therefore they bind in the blood to the transferrin protein. The task of the compound is to transport the trace element that came from food or formed from dead red blood cells.
The concentration of this protein increases with iron deficiency anemia and in the third trimester of pregnancy. Lowering the level is caused by: lupus, rheumatism, tuberculosis, heart disease, diseases of the gastrointestinal tract, liver and kidney diseases.
Unsaturated Iron Binding Ability of Serum (NLSS) - demonstrates how much substance can in principle bind the available transferrin volume. The indicator rises with anemia, pregnancy, hepatitis. A decrease is observed with protein deficiency and hereditary diseases of blood formation.
Serum Latent Iron Binding Capacity (LVSS) is the difference between the volume of bound metal ions and the amount that could theoretically be related. The indicator rises with iron deficiency, hepatitis and in later pregnancy. Reduced LVSS are caused by kidney diseases, tumors, some infections, and hereditary metabolic disorders.
Having added the indicators of serum iron and NZHSS, you can get the total iron binding capacity (OZHSS). Dividing the serum iron index by OZHSS gives the coefficient of transferrin saturation, expressed as a percentage.
OGSS = serum iron
Transferrin saturation coefficient = serum iron / OZHSS x 100%
|Indicator||Norm for adults|
|Transferrin||2 - 3.6 g / l.|
|Transferrin saturation coefficient||15 to 50%|
|Lhss||20 - 62 μmol / l|
|HDD||Women - 12.5-55.5 μmol / L|
|Men - 12.4-43.0 μmol / L|
|OZhSS||45.3 - 77.1 μmol / L|
What to do with poor analyzes
The remaining examinations are prescribed depending on the causes of the identified violations.
To treat iron deficiency, the patient is prescribed iron-containing preparations and mineral-vitamin complexes that improve the absorption of this trace element. You can raise the level of this substance by eating foods rich in it.
Pomegranate, contrary to popular belief, contains quite a bit of iron - only 0.3 mg. Apples - a microelement there are only 0.1 ml -10 g there are also not shining with this indicator. In addition, the microelement is found in fruits in difficult to digest form.
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The lowest reference values of transferrin in the blood are determined in children in the first year of life - 1.33-3.32 g / l. From 1 year to 14 years, they range from 2.04 to 3.67 g / l.In adolescence (14-20 years), gender differences become significant, for girls, the rate of transferrin in the blood is higher, since they have regular blood loss during menstruation, their test values are normal - from 1.93 to 4.21 g / l, while in boys - from 1.83 g / l to 3.63 g / l. These differences persist until menopause.
Reference values for women - 2.5-3.8 g / l, for men - 2.15-3.66 g / l. After 60 years, this difference disappears, and the amount of transferrin decreases slightly: the norm is 1.9-3.47 g / l. During pregnancy, the concentration of this protein gradually increases and by the end of the third trimester the test values are approximately 50% higher than normal. An unbalanced diet with an insufficient content of protein products: meat, fish, eggs, dairy products leads to physiological deviations from the norm.
Transferrin level increase
The main reason for the increase in the level of transferrin in the blood is iron deficiency, which accompanies iron deficiency anemia. The lack of a trace element in this case can be caused by its lack in the daily diet (for example, when refusing animal products), impaired absorption in the intestines (with celiac disease, colitis and other diseases), chronic blood loss. However, if the diet is deficient not only in iron, but also in proteins, the level of transferrin may not increase, since amino acids are necessary for its synthesis. The concentration of transferrin in the blood increases with acute viral hepatitis, true polycythemia, after hemodialysis procedures, during the administration of anabolic drugs, androgens, estrogens, and oral contraceptives.
Transferrin level reduction
Transferrin is a negative otrophase protein, so the cause of lowering its level in the blood can be an infectious disease (pharyngitis, sinusitis, tonsillitis, tuberculosis), collagenoses (rheumatism, dermatomyositis, systemic lupus erythematosus), as well as other inflammatory processes (Crohn’s disease, pancreatitis, myocarditis ) The amount of this glycoprotein in the blood decreases with insufficient synthetic liver function due to acute organ diseases: cirrhosis, hepatitis (except for viral), and liver failure. Also, transferrin production decreases with insufficient intake of building material - proteins and amino acids - due to an inadequate diet, malabsorption in the intestines or excessive excretion by the kidneys. Other causes of a decrease in the level of transferrin in the blood may be hemochromatosis, thalassemia, atransferrinemia, frequent blood transfusions, an improperly selected dosage of iron preparations, and the use of corticosteroids or testosterone.
A blood test for transferrin, along with the study of OZHSS and LZHSS, is of great diagnostic value in disorders of iron metabolism. The results are in demand in many areas of clinical practice, especially in hematology. If the indicators deviate from the reference, it is necessary to contact the specialist who appointed the analysis. Treatment is selected individually and is aimed at eliminating the causes of the imbalance, that is, the treatment of the underlying disease. The physiological decrease or increase in transferrin is corrected by introducing into the diet products with a sufficient content of protein and iron - red meat, fish, seafood, whole eggs. It is worth remembering that the absorption of these components from plant foods is worse. Reduced transferrin may be associated with intense physical activity, which resulted in the destruction of red blood cells and an increase in the amount of free iron. The restoration of indicators in this case occurs after 10-12 days, this must be taken into account when preparing for the study.
Where and from what is transferrin formed?
By its nature, transferrin is a glycoprotein. It has a molecular weight of about eighty kilodaltons.
Transferrin - a protein, that is, amino acids will be monomers for its synthesis. In the liver and reticuloendothelial system, the formation of this protein occurs.
The main functions of transferrin
In the structure of transferrin, there are two sites that are able to connect with iron. That is, the main function of this glycoprotein is the transfer of this trace element to organs and tissues.
Fe2 + enters the body with food. Then it oxidizes to Fe3 +. So, the carrier protein is able to bind only the oxidized form of this trace element.
The following are interesting facts about this indicator and not only:
- Transferrin is also called siderophilin, which literally stands for loving iron.
- 1 gram of transferrin is able to bind 1.4 milligrams of Fe.
- Iron has a positive charge, therefore, to bind it in a siderophilin molecule, a negatively charged bicarbonate is additionally required.
- If the body does not have this trace element (iron), then this protein can also bind Cr2 +, Mn3 +, Cu2 +.
- There is siderophilin polymorphism that can be detected by electrophoresis. For example, type C is found in people of the Caucasian race, and type D is found in Africans.
- There are other indicators characterizing the metabolism of iron in the body and having some relation to transferrin: the ability of serum to bind iron, the percentage of transferrin saturation, etc.
- Fe plays an important role in our body. This element is involved in the formation of a molecule of another transport protein - hemoglobin. Who does not know - hemoglobin transports gases between different tissues. In addition, iron is part of the myoglobin, located in the muscles, playing the role of an oxygen depot there. Proteins such as cytochromes also have this trace element in their composition. Their main function is to provide cells with energy, as well as to neutralize toxic compounds.
- The body should receive 10 - 15 micrograms of Fe per day. In some conditions, the need for this trace element increases, for example, during pregnancy.
- If the body has an insufficient amount of amino acids, then the processes of transferrin synthesis will be reduced.
- Free Fe ions can contribute to the formation of radicals, which will damage cell membranes.
What is the essence of the analysis of determining siderophilin in the blood
One of the main more affordable methods for determining siderophilin in the blood is turbidimetry.
This method will require blood serum. To get it produced centrifugation of bloodthat the patient passed. For this, venous blood is most often taken.
To the patient's blood serum add reagentcontaining antibodies to human transferrin. If serum transferrin is present antibodies will specifically bind to him. Thus turbidity appears the resulting mixture. From this turbidity, siderophilin concentration will be further calculated.
According to the calculated indicator, which is proportional to the degree of turbidity, is the concentration of transferrin in the blood.
The turbidity of the solution with the test serum is compared with a blank sample, in which it is known that there is no siderophilin.
Features of preparation for analysis to determine the protein carrier iron
In order for the results to reflect the processes that actually occur, the patient needs to prepare correctly.
The rules are simple, so it’s easy for the patient to follow them:
- blood should be donated in the morning by drinking plain water if necessary. You can’t have breakfast in the morning. Since blood should be given on an empty stomach. This means night fasting for 10 hours,
- a couple of hours before blood sampling is recommended refrain from one of the bad habits - smoking,
- on the eve before the delivery of biological material it is important to maintain emotional calm,
- physical rest is also important. There are situations when after a run the indicators change,
- the doctor needs to be informed about which medicines, dietary supplements the patient is taking. They may contain iron, respectively, the reliability of the results will change.
Sometimes patients do not inform the doctor about medications, as a result of which the indicator will be within normal limits. The doctor will not notice real deviations due to the inaccuracy of the information received. In the future, for example, Fe deficiency may worsen and lead to serious consequences. The patient will regret that he did not inform the doctor about important information then.
What is transferrin and where does it come from?
Iron, which enters the gastrointestinal tract with food, is usually in the trivalent form (Fe +++), however, in order to fully absorb in the intestine, it must recover to the divalent form (Fe ++), which happens under the influence of numerous factors (vitamin C, enzymes, intestinal microflora, etc.). After trivalent iron becomes divalent, in the cells of the mucous membrane of the duodenum 12 it must again return to its original form (Fe +++), which allows it to connect with ferritin and, using a specific transferrin protein, go to its destination (to the organs and tissue).
To saturate transferrin with iron in the transport protein molecule, there are special areas (spaces) that are ready to accept Fe ions. Depending on this, transport protein can be present in the body and move in one of four different forms, each of which allocates its own place for iron:
- Mono-iron transferrin A (ferrum occupies exclusively A-space),
- Mono-iron transferrin B (localization of iron extends only to the B-space,
- Dijelaceous transferrin (both spaces are occupied by iron).
2 iron ions can fit on a transport protein molecule, and when a transferrin carrying these ions meets a cell with a butterfly-like transferrin receptor on its surface, it will certainly “notice” it, bind, penetrate the cell and give it iron by separating it from yourself. It should be noted that the transport protein, having delivered this chemical element, does not give it away (Fe) to everyone, each iron-binding space gives iron its specific tissue: erythron and placenta use iron in the A-space, the liver and other organs take Fe from space B.
Saturation of transferrin with iron is carried out in the area responsible for the absorption of this chemical element in the body, that is, mainly in the mucosa of the duodenum 12, or at the sites of death of red blood cells during digestion by macrophages.
Other transport protein abilities
Trasferrin, possessing the ability to combine with ferric ions, is not only involved in delivering this metal to organs and tissues in reserve (ferritin) or to the bone marrow to participate in erythropoiesis (synthesis of red blood pigment, hemoglobin, in new red blood cells) :
- He “knows how to recognize” reticulocytes (young red blood cells) that are involved in the synthesis of hemoglobin.
- An important task of transferrin is to select ferric iron ions released after the decay of the erythrocytes (and, accordingly, the hemoglobin in them), which in a free state pose a danger to the body due to its high toxicity.
- Transferrin, being part of the β-globulin fraction, refers to the proteins of the acute phase. He is involved in providing an immune response programmed from birth. The main place of permanent residence of transferrin is the mucous membrane, where it, “searching for” and binding iron, deprives the pathogens of the microorganism from using it and thereby creates unacceptable living conditions for them.
- The ability of transferrin to bind metals is not very useful when plutonium enters the body, which transport protein binds instead of iron and carries it “in reserve” to the bones.
The main producers of transferrin in the body are the liver and brain. The gene responsible for the production of the “vehicle” for ferrum is located on the third chromosome. A sharp deficiency (to a complete absence) of transport protein is a serious, but, fortunately, rare hereditary pathology (autosomal recessive pathway), accompanied by severe hypochromic anemia called atransferrinemia.
Determination of protein transporting iron
Transferrin analysis is performed in a plasma or serum sample taken, like all biochemical analyzes, in the morning on an empty stomach. Meanwhile, transport protein research methods create certain difficulties, since they require the participation of special laboratory equipment and not always available test kits. However, the lack of equipment does not imply a denial of Tf analysis; in any case, the patient will not be left without examination.
An alternative way to solve this problem is to determine the transferrin saturation coefficient by iron - an analysis that is better known as the total iron binding capacity (OGSS) of blood serum (plasma), indicating the concentration of transferrin in the blood. In general, how much iron bound transferrin, so saturated with it. In percentage terms, in healthy people, this value is at least 25-30%. This means that in the normal state of the body, approximately 35% Tf should be involved in the binding and transfer of iron to organs and tissues.
Most often, in the determination of transferrin, there is a need for differential diagnosis of various iron deficiency conditions, accompanied by:
- Reduced serum iron concentration,
- High transport protein
- Reduced transferrin saturation with iron.
The rates of transport protein and the degree of transferrin saturation with iron are conveniently shown in the table that we present below. Meanwhile, the reader should keep in mind that the range of reference values depending on the place of analysis can be narrowed or expanded, therefore, the comparison of the results of determining a particular indicator should be made in accordance with the data of the laboratory conducting the study.
Female people have a special relationship with iron and its transport, so they have about 10% more protein-transporting Fe, than peers of the male sex. During pregnancy (III trimester), one can expect a 1.5-fold increase in the level of transferrin, while in old age its concentration, on the contrary, is lowered and no longer has sex. In inflammatory processes, transferrin acts as a negative acute phase protein, its level in inflammation is reduced.
In addition, the determination of transferrin in the blood can be performed in other units - μmol / L, then its norm for adults will be in the range 23 - 43 μmol / L (in males) and 21 - 46 μmol / L (in “weak "Half). The situation is similar with total transferrin (OZHSS) in the blood, the norm of which, expressed in the same units as Tf, will be 26.85 - 41.17 μmol / L. The saturation of transferrin with iron in pregnant women increases in tune with a decrease in the content of iron itself in the blood.
Below is a table showing indicative numbers of normal levels of transferrin in the blood. Each laboratory relies on the data recommended by the reagent manufacturer.
Table 1. Transferrin norm.
|First week of life||1.3 - 3.6 g / l|
|First year of life||2.0 - 3.6 g / l|
Therefore, a study of the siderophilin level in dynamics should be performed in the same clinical diagnostic laboratory.
Definition of OZHSS
Increased or decreased values of OZHSS does not mean that in these cases the level of Tf will be increased or decreased. The presence of transferrin does not increase its binding to iron or, conversely, a low level of transport protein does not reduce its binding ability. The complex mechanism that occurs during the absorption, distribution and consumption of iron is difficult to imagine in a small article, so we will provide information informing about pathological conditions in which the level of OZHSS is increased or decreased.
Increase overall binding ability:
- IDA (iron deficiency anemia),
- Hormonal birth control pills
- Damage to hepatocytes (liver cells) in acute inflammatory diseases (hepatitis) and cirrhosis,
- Excessive load of the body with iron (diet, ferrotherapy for a long time),
- Frequent blood transfusions,
- Pregnancy (in the later stages, closer to childbirth),
A decreased OZHSS is noted in cases:
- Reducing the concentration of total protein, which is often a consequence of starvation diets, malignant neoplasms, nephrotic syndrome,
- The chronic influence of some kind of infectious agent, constantly “living” in the body,
- Hemosiderosis, as a result of numerous blood transfusions,
- Iron deficiency conditions.
The transferrin saturation coefficient with iron depends on the concentration of Fe in the body: if there is an excess of iron, the OZHSS indicator will be increased both in numerical and in percentage terms. This occurs in pathological conditions involving increased erythrocyte breakdown and increased hemolysis, or with iron poisoning, if treatment with Fe preparations is too active.
Reasons for increased transferrin levels
An increase in the amount of Fe carrier protein occurs when this trace element is lacking in the body. Therefore, the main reason for the high content of siderophilin in the blood is iron deficiency anemia.
There are various causes for this type of anemia:
- big blood loss
- slight loss of blood over time,
- low iron content in the body, for example, due to the low consumption of foods rich in this trace element.
It has already been said that during pregnancy, the need for Fe increases. Accordingly, if the expectant mother has not changed her diet, that is, has not increased the content of this trace element in food, then she will have a deficiency. This leads to the fact that the level of siderophilin will also be increased. However, when filling the deficit, all indicators of the exchange of this trace element should return to normal.
False overestimation of the content of the carrier protein can lead to:
- exercise stress,
- high estrogen content
- taking medications such as carbamazepine, danazole, mestranol.
Ferritin is a protein that can bind a large amount of iron, and therefore is the main form of storage of iron in the body. Most ferritin is found in the liver, spleen and bone marrow, since it is these organs that consume iron to build other substances. Normally, a small part of ferritin circulates in the blood, and this amount is proportional to its total content in the body. Consequently, ferritin reflects iron stores in the body.
In addition, ferritin is an acute phase protein, therefore, its concentration in the blood increases not only with an excess of iron in the body, but also with inflammatory processes.
Indications for determining the level of ferritin in the blood are the following conditions:
- Distinguishing different types of anemia from each other,
- Diagnosis of iron deficiency or excess (hemochromatosis) in the body,
- Estimation of iron stores in the body,
- Chronic infectious and inflammatory diseases,
- Malignant neoplasms,
- Evaluation of the effectiveness of iron therapy.
Normally, the blood ferritin level in adult men is 20 - 250 ng / ml, in adult women before menopause - 10 - 120 ng / ml, and after menopause - 30 - 400 ng / ml. The normal blood ferritin level in children of different ages is as follows:
- Newborns up to 1 month old - 200 - 600 ng / ml,
- Infants 2 - 5 months - 50 - 200 ng / ml,
- Children 6 months - 15 years old - 7 - 140 ng / ml,
- Adolescents over 15 years old - as in adults.
An increase in the level of transferrin in the blood is observed in the following conditions:
- Anemia (megaloblastic, sideroblastic, hemolytic, thalassemia),
- Anemia in chronic diseases,
- Liver biopsy
- Liver diseases (cirrhosis, carcinoma, hepatitis, alcohol damage),
- Iron overload (blood transfusion, hemodialysis, hemochromatosis, etc.),
- Infectious diseases (osteomyelitis, urinary tract infections, etc.),
- Acute and chronic inflammatory diseases (rheumatoid arthritis, systemic lupus erythematosus),
- Malignant tumors (leukemia, lymphoma, neuroblastoma, lymphogranulomatosis, pancreatic cancer, breast).
A decrease in the level of ferritin in the blood is observed in the following conditions:
- Iron-deficiency anemia,
- Iron deficiency in the body due to insufficient intake with food or increased spending (growth period, pregnancy, etc.),
- Digestive tract diseases (celiac disease, malabsorption syndrome, gastritis, etc.),
- Chronic blood loss.
Unsaturated (latent) iron-binding ability of serum (NZHSS, LZHSS)
Unsaturated (latent) iron-binding ability of serum (NZHSS, LZHSS) is an indicator reflecting the deficiency of iron in the body. The fact is that normally transferrin is only 30% saturated with iron, but the additional amount of iron that this protein can attach is called the unsaturated iron-binding ability of serum. That is, in fact, NJSS is how much iron theoretically transferrin can attach.
In the past, mathematically, after determining the NLSS and total iron, the total iron binding capacity of the serum (OLCS) was calculated, but now this indicator can be replaced by determining the concentration of transferrin, since the OLCS indirectly reflected the level of blood transferrin.
Indications for determining NSSS are the following conditions:
- Assessment of iron stores in the body and diagnosis of iron deficiency,
- Detection of hemochromatosis,
- Distinction of iron deficiency anemia from chronic diseases,
- Systemic diseases of the connective tissue (systemic lupus erythematosus, scleroderma, etc.),
- Blood loss
- Gastrointestinal tract diseases
- Evaluation of the quality of food.
Normally, NLSS in adult men is 12.4 - 43 μmol / L, and in women - 12.5 - 55.5 μmol / L.
An increase in the level of NSSS is characteristic of the following conditions:
- Iron deficiency anemia,
- Latent iron deficiency in the body due to a lack of this element in food,
- Chronic blood loss (including with heavy menstruation),
- Acute hepatitis
- Cirrhosis of the liver,
- Digestive tract diseases
- True polycythemia (erythremia),
- Late pregnancy,
- Period of active growth.
Haptoglobin is a protein that binds hemoglobin and prevents its breakdown and excretion from the body. Haptoglobin is synthesized in the liver and lungs, and its concentration in the blood rises with inflammation and destructive processes. In addition, when hemoglobin is released from decaying red blood cells, haptoglobin binds to it and forms a complex that does not pass through the renal filter. Due to this, iron is stored in the body and is used to synthesize new hemoglobin molecules, and damage to the kidneys by iron compounds is also prevented.
Haptoglobin is an indicator of acute inflammatory process and hemolysis (decay) of red blood cells. Therefore, the determination of the concentration of this protein is carried out in case of anemia, suspected red blood cell hemolysis and acute inflammation.
Indications for determining the level of haptoglobin in the blood are the following conditions:
- Evaluation of the severity of erythrocyte hemolysis during transfusion of incompatible blood,
- Suspected red blood cell hemolysis,
- Anemia (to identify or exclude the hemolytic nature of anemia),
- Examination of people with artificial heart valves,
- Hypertension in pregnant women,
- Comprehensive assessment of acute phase proteins.
Normally, the concentration of haptoglobin in the blood of adult men under 60 years old is 14 - 258 mg / dl, in women under 60 years old - 35 - 250 mg / dl. In women older than 60 years, the level of haptoglobin in the blood ranges from 60 - 273 mg / dl, and in men over 60 years of age - 40 - 268 mg / dl. In children of different ages, the normal level of haptoglobin is as follows:
- Children from birth to 1 year: boys - 0 - 300 mg / dl, girls - 0 - 235 mg / dl,
- Children 1 - 12 years old: boys - 3 - 270 mg / dl, girls - 11 - 220 mg / dl,
- Adolescents over 13 years old - as in adults.
An increase in the level of haptoglobin in the blood is observed in the following conditions:
- Acute inflammatory processes in the body,
- Injuries and operations
- Tissue necrosis (burns, frostbite, compression, etc.),
- Malignant tumors (myeloma, Hodgkin's disease),
- Nephrotic syndrome
- Narrowing of the biliary tract
- Collagenoses (lupus erythematosus, vasculitis, rheumatoid arthritis, etc.),
- Taking glucocorticoids.
A decrease in the level of haptoglobin in the blood is characteristic of the following conditions:
- Genetically determined haptoglobin deficiency,
- Hemolytic anemia,
- Hemolytic disease, including blood transfusion,
- Cirrhosis and other serious liver diseases,
- Folic Acid and Vitamin B Deficiency12,
- Hemolysis of red blood cells in malaria, artificial heart valves, endocarditis, active sports, etc.,
- Glucose-6-phosphate dehydrogenase deficiency,
- Infectious mononucleosis,
- Malabsorption syndrome,
- The period of pregnancy and newborn,
- Hereditary spherocytosis,
- Ineffective erythropoiesis (erythrocyte synthesis),
- Reception of estrogen hormones.
Low transferrin values
Patients constantly wonder: why is transferrin lowered? The answer will be presented below.
There are many reasons leading to a decrease in the level of this transport protein. The main ones are:
- autoimmune pathology, for example, systemic lupus erythematosus,
- protein deficiency in the body, which occurs when there is a violation of the absorption of nutrients in the intestine or increased protein loss due to, for example, nephrotic syndrome. A deficiency of amino acid polymers leads to a lack of building material (amino acids) for the synthesis of a sufficient amount of transferrin,
- hemochromatosis - a disease in which excess Fe settles in organs and tissues, damaging them,
- liver pathology places of synthesis of the studied transport protein, as mentioned earlier, can lead to a decrease in its concentration in the blood,
- there are a number of hereditary diseasesin which there is a decrease in siderophilin in the blood. These include: thalassemia - a violation of the synthesis of hemoglobin chains, a congenital deficiency of the carrier protein Fe.
Since siderophilin belongs to beta-globulins, in the presence of an inflammatory process in the body, its content in the blood will be below normal. For a more accurate assessment of the reserves of the Fe level, ferritin is additionally determined in this case. The concentration of this protein in the blood does not depend on the presence of inflammation.
Ceruloplasmin is an enzyme protein containing copper, which is why it is an indicator of the copper content in the human body. Ceruloplasmin is involved in the exchange of copper and iron in the body, oxidative and antioxidant reactions of the inflammatory process. Since copper is important for the normal functioning of the liver and maintaining the level of iron, the determination of ceruloplasmin concentration is used to diagnose liver diseases, Wilson-Konovalov’s disease, Menkes syndrome.
Indications for determining the concentration of ceruloplasmin in the blood are the following conditions:
- Diseases of the central nervous system for no clear reason,
- Unexplained hepatitis or cirrhosis of the liver,
- Diagnosis of genetic diseases (Wilson-Konovalov disease, Menkes syndrome, aceruloplasminemia),
- Completely parenteral nutrition
- Iron-resistant anemia
- Identification of ceruloplasmin deficiency.
Normally, the level of ceruloplasmin in the blood in adults is 15 - 45 mg / dl. In pregnant women, the level of this indicator rises by 2 to 3 times relative to the norms for adults. The normal content of ceruloplasmin in the blood in children, depending on age, is as follows:
- Newborns up to 3 months - 5 - 18 mg / dl,
- Children 6 - 12 months - 33 - 43 mg / dl,
- Children 1 - 5 years old - 26 - 56 mg / dl,
- Children 6 to 7 years old - 24 to 48 mg / dl,
- Children 7 to 18 years old - 20 - 54 mg / dl.
An increase in the level of ceruloplasmin in the blood is characteristic of the following conditions:
- Acute inflammatory and infectious processes in the body,
- Necrosis (death) of any tissue (burns, compression, heart attacks, etc.),
- Malignant tumors (cancer of the breast, lungs, gastrointestinal tract, bones),
- Hodgkin's disease
- Rheumatoid arthritis,
- Systemic lupus erythematosus,
- Liver diseases accompanied by stagnation of bile (cirrhosis, hepatitis, etc.),
- Reception of estrogen hormones.
A decrease in the level of ceruloplasmin in the blood is characteristic of the following conditions:
- Wilson-Konovalov disease,
- Menkes syndrome
- Diseases of the liver, accompanied by a violation of protein synthesis,
- Aceruloplasminemia (genetically determined complete absence of ceruloplasmin in the blood),
- Inadequate intake of copper with food,
- Malabsorption syndrome,
- Nephrotic syndrome
- Parenteral nutrition for a long time.
Other indicators of iron metabolism
Ferritin - a protein molecule in the form of which Fe is stored in cells and tissues. Its amount directly reflects the content of this trace element. That is, if it is not enough in the body, then this indicator will be below normal values.
The results of determining this indicator in the blood will be affected by increased physical activity, the use of alcohol and certain medications.
When diagnosing conditions associated with a lack of Fe, it is often used iron transferrin saturation coefficient. This coefficient is calculated as follows:
Saturation of siderophilin Fe = Fe serum / ОЖСС * 100%, where ОЖСС - total iron binding capacity of serum.
Normally, this coefficient is 15 - 45%. With a deficiency of this microelement in the body, this indicator will be reduced.
OZHSS - an indicator that shows the amount of Fe, which is able to contact siderophilin. That is, this is the maximum that is able to bind to the transport protein siderophilin.
Normally, this characteristic of the exchange of Fe is 40 - 62 micromoles per liter in males, and in women - 40 - 75 micromol / l.
There is another concept serum latent iron binding capacity. This indicator shows how much trace element can be associated with other proteins, not necessarily siderophilin. This serum index is calculated as the difference between the OZHSS and the serum iron content.
45-60% is allocated to the latent ability of serum to bind Fe.
To understand all these complex and confusing indicators should the doctor.Based on them, on the data of examination, complaints, instrumental methods of research, a diagnosis is made. For the doctor to do everything right, the patient must trust him and not hide anything from him.
Thus, there are enough indicators by the level of which it is possible to assess the state of iron metabolism. This trace element plays an important role in our body, entering the structure of hemoglobin, myoglobin, cytochromes. It is especially necessary to monitor the iron content in the body of pregnant women.
And in order for the results to accurately reflect the exchange of Fe, you need to know the rules for preparing for blood donation at the level of siderophilin in the blood, which were described above. The interpretation of the results should be entrusted to a competent specialist who will take into account everything, and will not assume a diagnosis, only having the data of one study.