Well, as I said, we’re going
to hit microcytic anemias.
And with microcytic anemias,
this will be the only time for you in
which you would even perhaps think about
considering doing an
iron study, clear?
“So Dr. Raj, you’re saying with
macrocytic, you won’t do iron studies?”
Normocytic, you won’t do iron studies?
And even if you did, well, with
macrocytic and then normocytic,
the iron studies will
come back to be?
So under microcytic, obviously we’re
going to work through iron quite a bit.
Iron deficiency anemia, anemia of chronic
disease, and sideroblastic anemia.
Then, what about the thalassemias?
It has nothing to do with the
heme component, right?
Don’t worry, we’ll talk
more about this as well.
Now, before we get into any of
that, I need you to make sure
or I need to make sure you have a
proper understanding of this graph.
It will tell you all the
relevant iron study labs
that you want to know
for microcytic anemias.
The first thing that you want
to do always is serum iron.
Number one, serum iron.
Number two, when iron gets into
your body, then it’s stored.
And by storage, I don’t mean
what’s going on here with the
liver and such or bone marrow.
But what I’m referring to is the
fact that here, you have ferritin.
So ferritin, think of this as more or less
being kind of like your macrophage, okay?
So literally, it’s going to consume
the iron that is then coming in.
And in the meaning, of course, you
already know about iron, which is Fe.
When you put it into your
mouth, it’s in the form of?
That’s your ferric, right?
And what’s another name
clinically of ferric?
So ferric, so that’s
And that’s something that we’ve
discussed in basic pathology.
But ferric is what you’re consuming, but
that which is used by the body is ferrous.
Keep that in mind.
Because at some point, you need to
convert that ferric into ferrous.
All right, now, this iron
is in your ferritin.
Remember, this is perfectly normal.
So second lab test for iron study
will be ferritin, number two.
Next, where are you going to go with this is
going to be communication with the liver.
So the liver, think of it, the liver
as being this really the sensor
of the ferritin.
And it will measure or assess how
much iron is in my ferritin.
And if there is enough
iron in your ferritin,
then the liver is going to produce just the
right amount of transferrin, number three.
But understand that you will not be
measuring laboratory-wise transferrin.
Transferrin is now called,
on your labs, as TIBC.
Total iron binding capacity.
All I’m doing here is setting up
the organization of this graph
with a different and
important iron study labs.
Number, serum iron.
Number two, ferritin.
Ferritin has an inverse
relationship with the liver.
Meaning to say that if you have
too much iron and ferritin,
then you’ll have decreased TIBC.
Remember transferrin is not what
they’re going to put in your labs.
But you know that transferrin is equivalent
to total iron binding capacity.
Next, number four,
do not get your binding
capacity confused with
this little box that we see
on the left, the column.
And this column that you see here is
your iron which is being saturated.
So number four, it’s called
It’s very, very easy to
confuse your transferrin
with your transferrin
Hence, they call it transferrin.
But laboratory wise, it’s
total iron binding capacity.
These are the four that we’ll
keep playing around with.
At this point, all I’m doing,
laying down the foundation
as to how to play with these.
What are they again?
Number two, ferritin.
Inverse relationship with TIBC.
And number four, saturation.