Serum ferritin test - what should I expect?

I have the beta-thalassemia trait and in fact it has been passed on to more than the expected 50% of my children.

I have had numerous blood tests over the years and in each case it concludes that I am slightly anaemic, until I show them the carrier card I was given after the initial diagnosis many years ago. Then, in each case, I am told that I must be OK, without any suggestion of further investigation.
 
Recently I had problems associated with anaemia - a noticeable lack of energy and unsteadiness in particular - and so my GP arranged a normal blood test. The result was the same as expected, and then I reminded my GP about my BTT and he told me to disregard the conclusion. It seems to me that this is quite usual - there seems to be an assumption in every case that BTT carriers aren’t ever truly anaemic.

However, this time, after considering this situation, my GP suggested that I take a further test, for ferritin in my blood serum. When the result came through, I was told by the surgery that the result was “normal”, but nobody seems to have compared the two tests. It may have been normal for someone with “normal” blood, but should I not be expecting a slightly higher level of ferritin that would help to balance out my iron deficiency?

Incidentally, I once took a DNA test for family history reasons and this showed no evidence of any distant ancestors coming from the usual “thalassemia zone”.

Thanks for your advice,
Alec.

Hi Alec,

Did the doctor just run ferritin? Iron studies would have been preferable. There can be other nutritional deficiencies that also contribute to anaemia.

Was 25-hydroxyvitamin D tested?

Many thanks for that tip, Melissa. To be honest I have never been given the complete test result, only the comment that it was "normal", whatever that might be. Regarding other deficiencies, I do have a particularly well-balanced diet following the usual recommendations, and spend much of my time outdoors during the summer.

I can easily find out more, because the GP's surgery has a special line for test results, so I will ask for the complete analysis. Are there any guidelines as to what levels I should expect to find?

AlecF,

Iron deficiency and thal minor are not related. One can have thal minor and perfectly normal iron stores. The anemia of thal minor is caused by the underproduction of healthy red blood cells and the hemoglobin deficiency that is a result of the thal minor. Iron deficiency can be present, along with thal minor, but your normal ferritin suggest that isn't a problem. Quite often, the anemia can improve if vitamin B-12 and L-methylfolate supplements are taken.

As far as any test of iron, as with all thal minors, a complete iron panel is best for determining if your iron levels are normal. This may have already been done. Tests should include serum iron, serum ferritin and total iron binding capacity. Together, a good picture of the iron situation can be seen.

Many thanks, Andy. that gives me a better idea as to what to ask about my test results, especially whether that complete iron panel is covered.
Alec.

I decided to call the test results line at my local GP surgery, to ask for more detailed information, and I should have done that before as they were extremely helpful. The following morning I received a 7-page printout, with 37 results in all.

The first one was as expected for a BT carrier - the standard full blood count showing the red blood cell count and their distribution width to be "above the high reference limit", and the mean cell volume and cell haemoglobin level to be below it. There followed a bone profile, serum C reactive protein level, urea and electrolytes and liver test levels - a full page of seeming normality.

Next, serum ferritin level 187, serum prostate specific antigen level 1.9 and TDSH level 1.43, all within normal limits. Serum B12 was 266, so I guess no need for a supplement here. Hopefully the same with Serum vitamin B12 at 266?  Serum B12/foliate level was 6.5. Haemoglobin A1c level 36.6, HbA1c level 5.5%.

Finally, on a subsequent separate test, Transferrin saturation index was 34%, serum transferrin level2.3g/l,Serum iron level 19.9, saturation of iron binding capacity 57.7, and UIBC 37.8.

That sounds quite comprehensive to me, although I have nothing to compare it with. Is there any important test which they may have missed?

I don't think anything was missed, but your B-12 is barely in range and thal minors do better when their B-12 is closer to the high end of normal.  B-12 can really help with energy levels, too.

Thanks, Andy
That was very helpful, I have been keeping the B12 tablets in a cupboard and it's good to know that they are worth taking. The Folate will stay in there, though!
Alec