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What Does the Iron, TIBC, and Ferritin Panel test?

Medically reviewed on June 27, 2022 by Jordan Stachel, M.S., RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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Iron plays an integral role in overall health and well-being. It is used for certain hormones and plays a primary role in synthesizing hemoglobin, the protein in red blood cells responsible for transporting oxygen [1].

Having too much or not enough iron absorption can contribute to a wide range of health problems like liver disease, hemolytic anemia, kidney disease, etc. While you generally don’t have to worry about your iron levels, underlying health conditions can lead to health complications.

An important step in bettering your health is knowing not just how your iron is used, but also how it is stored and how well it gets transported through the body. That’s where the iron, TIBC, and ferritin panel comes in. Learn more about what an iron, TIBC, and Ferritin Panel is and what it tests for from the experts at Everlywell below.

What is the Iron, TIBC, and Ferritin Panel?

The iron, TIBC, and ferritin panel comprises a simple blood test that can help you and your providers determine if you are getting enough iron and if your body is using the stored iron properly. You or your provider might consider this panel if you took a complete blood count, or CBC test, that showed low levels of hemoglobin and/or hematocrit [2]. Hematocrit is essentially the ratio of healthy red blood cells compared to total blood count [3]. Alternately, your healthcare provider may order the iron, TIBC, and ferritin panel if you show potential signs of an iron deficiency or iron overload (known as hemochromatosis).

What does the Iron TIBC, and Ferritin Panel measure?

Iron

Iron tends to be the focus of the panel. As mentioned, iron is the mineral that the body uses to synthesize hemoglobin. It is also used to create the protein myoglobin, which carries oxygen to the muscles specifically.1 As every single cell, tissue, and organ in the body relies on oxygen, not having enough iron (and thus, not enough hemoglobin) can result in a lack of healthy red blood cells, an iron disorder condition known as “anemia.” Iron deficiency anemia can contribute to a wide range of health issues [3].

Your body can’t make its own iron, so all your iron must come from your diet. That is fairly easy considering the number of foods that naturally contain iron, as well as the manufactured foods that are fortified with iron. However, underlying problems can prevent proper absorption of iron. Chronic blood loss can also contribute to depleted iron stores [3].

On the other hand, the body has its own means of regulating iron usage and storage, but underlying problems can result in an iron overload. This is typically caused by an inherited condition called hemochromatosis. Too much iron is toxic and can lead to organ failure, particularly in the liver and heart, and a wide range of other problems [1].

Iron test results are measured in micrograms per deciliter (mcg/dL).

Total Iron-Binding Capacity (TIBC)

While the serum iron test measures the current iron levels in the blood, it can potentially provide too limited of a view. This is where total iron-binding capacity (TIBC) comes into play. The total iron-binding capacity essentially measures how well the blood can transport iron throughout the body and how much blood is able to attach to iron [4].

This test is like a transferrin test, which basically measures the same thing. Transferrin is a protein produced in the liver that regulates the amount of iron absorbed by the blood. A TIBC test is related to the amount of transferrin that can freely attach to iron in the blood [4].

TIBC levels are inverse to iron levels. For example, if you have an iron deficiency, your iron levels will be low, but TIBC will be high. Conversely, if you have an iron overload, iron levels will be high, but TIBC will be low. Considering transferrin is made in the liver, TIBC levels may also be low if you have liver disease or any damage to your liver [4].

Ferritin

Ferritin is a type of blood protein that contains iron. Understanding how much ferritin is in the blood can help you determine how much iron the body stores and how efficiently it stores that iron [5].

A test that shows low levels of ferritin in the blood indicates that iron stores are low, which usually correlates with iron deficiency anemia. On the other hand, ferritin levels that are higher than normal can indicate an excess of stored iron in the body. That can indicate hemochromatosis, but it could also point to:

  • Rheumatoid arthritis and other inflammatory conditions
  • Hyperthyroidism
  • Liver disease

High ferritin levels could also potentially indicate certain forms of cancer [5]. Ferritin test results are measured in micrograms per liter (mcg/L) [5].

Symptoms of abnormal iron levels

It’s worth understanding the symptoms of iron deficiency so that you know if you might need an iron, TIBC, and/or ferritin panel in the first place. In its earliest stages, iron deficiency anemia doesn’t present any noticeable symptoms, or the symptoms may be so mild that you can ignore them. However, as iron stores deplete and red blood cells suffer, symptoms may become more severe [6].

Some common signs of iron deficiency include:

  • Extreme physical fatigue and weakness
  • Pale skin (including the gums and under the lower eyelids)
  • Heart palpitations, shortness of breath, and chest pain
  • Headaches, dizziness, lightheadedness
  • Cold feet and hands (regardless of weather or indoor temperature)
  • Brittle nails and damaged hair
  • Inflammation or soreness of the tongue
  • Poor appetite
  • Sudden cravings for ice, dirt, starch, and other non-nutritive substances [6]

Hemochromatosis can be difficult for some people to spot. In some cases, it does not present any real symptoms. Hereditary hemochromatosis often does not show any symptoms until later in life. Many symptoms of hemochromatosis also overlap with other common health conditions [7].

If you have hemochromatosis, you may experience:

  • Memory fog
  • Joint pain
  • Abdominal pain
  • Extreme physical fatigue and weakness
  • Impotence
  • Loss of libido
  • Skin color that appears gray or bronze
  • Heart failure
  • Liver failure

Left untreated, hemochromatosis can lead to iron continually building up in the organs, particularly the liver, pancreas, and heart. That can result in heavy organ damage that may eventually result in serious health issues, like organ failure, diabetes, heart problems, and reproductive issues [7].

Knowing the iron levels in the blood and how well the body uses that iron is essential to understanding your overall health and well-being. An iron, TIBC, and ferritin panel can provide a comprehensive look at your iron levels and iron usage to identify potential deficiencies, all with a simple blood sample. If you think you may have too much or too little iron, consult your healthcare provider.

What Causes Hemochromatosis?

What is Iron Deficiency Anemia?

How to Test for Hemochromatosis: A Complete Guide

Why am I tired all the time?

References

1. Iron. NIH. URL. Accessed June 27, 2022.

2. Transferrin and Iron-binding Capacity (TIBC, UIBC). Testing. URL. Accessed June 27, 2022.

3. Hematocrit test. Mayo Clinic. URL. Accessed June 27, 2022.

4. Total iron-binding capacity (TIBC) and transferrin test. NHS UK. URL. Accessed June 27, 2022.

5. Ferritin test. Mayo Clinic. URL. Accessed June 27, 2022.

6. Iron deficiency anemia. Mayo Clinic. URL. Accessed June 27, 2022.

7. Hemochromatosis. Mayo Clinic. URL. Accessed June 27, 2022.

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