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What is the significance of high serum iron (186) and low ferritin (19)?

The % saturation is 53 and the TIBC is 351.

That pattern appears to be excess iron in the blood (at top of the standard range), but stores (ferritin) appear depleted though still within the standard range.

Assess whether the patient had recent iron supplementation or blood transfusion to increase serum levels.

Inquire about past reductions in iron intake (e.g., vegetarian diet or other restrictions) which may deplete ferritin over time.

Also, inquire whether the patient was a blood donor. Researchers note a decrease in ferritin after 10 blood donations, and some people donate every 8 weeks. When ferritin dropped below 15 ug/L, they were supplemented with iron. 1

Hemoglobin levels should also be assessed and should rebound fairly quickly after iron supplementation if needed.

Also, look at the history of these markers for trends

Iron supplementation should be done judiciously and discontinued once ferritin levels are in and maintained within an optimal range.


  1. Alvarez-Ossorio L, Kirchner H, Klüter H, Schlenke P. Low ferritin levels indicate the need for iron supplementation: strategy to minimize iron-depletion in regular blood donors. Transfus Med. 2000 Jun;10(2):107-12.