Low transferrin... Confused

Hi, I recently got blood work done and am very concerned about my results. I have been a very heavy drinker on and off for 8 years. Anyway, I started experiencing hair loss last fall, and I finally went in to see a doctor last month. He did a complete metabolic panel and CBC. Anyway, they just called and said I am iron deficient and need to take iron supplements. I received the lab results later in the mail, and I went over all of the numbers to discover some concerning things. All of my liver function tests came out great, but I am still concerned that this could indicate liver problems.

MCV: 103.4 - (normal range: 81-99) *I know this can be caused from heavy drinking alone, or it can be caused from liver disease. My vitamin B-12 levels were great, so I know I am not lacking there.

Ferritin: 61 - (normal range: 11-306.8)

Iron: 33 (normal range: 65-175)

Transferrin: 187 (normal range: 250-380)

I realize, from what I have read, that normally with low transferrin, iron is high. Mine are both low. My saturation is 17%, and I think anything below 20% is abnormal... I don't know if this is a strong indicator of liver disease or what can cause this! Does anyone know? Again, I had nothing abnormal on my liver tests. My AST and ALT were not elevated at all, albumin was on the high side of normal, and my alkaline phosphatase was a little low. I don't know what to think, but I called the doctor back because he didn't even mention any of that. I have read if you have low transferrin that taking iron can be dangerous, so I have stopped that! Now, I am being referred to a hematologist but am looking for any experience or insight in the meantime. I haven't drank any alcohol at all in 19 days and plan on cutting it out for good, btw.

[Dr. Kokil Mathur]

Hi!
To assess a patient’s iron status, measurements of iron, TIBC (total iron binding capacity) and measurement of ferritin are performed. Transferrin is a substance that transports iron in the plasma. If the saturation is below 20%, the amount of iron carried by transferrin is decreased. In this situation it is also expected that the absolute serum iron will be low. Normally in iron deficiency, iron is low, TIBC is high, percent saturation is low and ferritin is low. The iron can be low due to poor diet or due to inability of gut to absorb iron as seen in malabsorption syndromes, IBS etc. Once the cause is found and corrected, then the lost iron is replaced by iron therapy, either in form of pills, capsules or syrups, or as injectable preparations. Consult your PCP regarding this. You should ideally consult a hematologist for this. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.

[krob27]

Thanks for responding! I guess I'm mostly concerned about the low transferrin. Like you said, in iron deficiency, TIBC is usually high. So, would this mean that I'm not truly iron deficient? I have read that taking iron supplements with low transferrin can be dangerous and put me at risk for iron overload.. I don't know what to do. I am still waiting for a referral to see a hematologist and am scared that this could all point to a liver problem - the low transferrin. It seems from what I have read that low iron and low transferrin, together, is an unusual phenomenon.  

[helyanna]

Do you have any chronic infection? I may have 'secondary anemia' possibly due to chronic infection. My hematologist said that I do not need iron supplement. I have also read that excess iron is even dangerous if one does not have iron deficiency.

[krob27]

I haven't been diagnosed with anything yet. Do you also have low transferrin? I have read that sometimes when low iron is seen with low transferrin, doctors will sometimes misdiagnose iron deficiency and advise the patient to take iron supplements, which can be dangerous. So, I am just holding off on that for now. I am taking multivitamins without iron. With chronic infection, would you white blood cell count be high? Mine is on the lower end of normal, so I can't imagine that I have an infection.

[helyanna]

I don't have iron deficiency. So said a hematologist. My soluble transferrin receptor is good. Ferritin is over 50, but it is not a good indicator, because I have chronic infection. Tansferrin has not been measured for me. I have lots of red cells and my total hemopglobin is high. The hematologist said, that I may have hemoglobinopathy, ie abnormal hemoglobin molecules.

No, I didn't have defects in my hemoglobin molecules, I didn't have beta thalassemia. But possible alpha tahlassemia could not be studied with the hemoglobin fraction test. So, I have diagnised myself that I have secondary anemia.

White cell count may be high during an infection, but it may also be low due to wearing off too many cells. My white cell count is normal, but sometimes I have lymphocytosis (more lymphocytes than neutrophils).

[krob27]

Oh, I see. I guess I'm not familiar with all of that. It sounds like we have different types of anemia.