Editing Iron overload (section)

===Blood test===

Blood tests are usually the initial test if there is a clinical suspicion of iron overload. Serum [[ferritin]] testing is a low-cost, readily available, and minimally invasive method for assessing body iron stores. However ferritin levels may be elevated due to a variety of other causes including obesity, infection, inflammation (as an [[acute phase protein]]), chronic alcohol intake, liver disease, kidney disease, and cancer.<ref name="NEJM Olynyk" /><ref name="Blood 2007">{{cite journal |last1=Waalen |first1=Jill |last2=Felitti |first2=Vincent J. |last3=Gelbart |first3=Terri |last4=Beutler |first4=Ernest |title=Screening for hemochromatosis by measuring ferritin levels: a more effective approach |journal=Blood |date=1 April 2008 |volume=111 |issue=7 |pages=3373–76 |doi=10.1182/blood-2007-07-102673|pmid=18025154 |pmc=2275006 }}</ref><ref name="BMJ 2015">{{cite journal |last1=Koperdanova |first1=Marianna |last2=Cullis |first2=Jonathan O. |title=Interpreting raised serum ferritin levels |journal=BMJ |date=3 August 2015 |volume=351 |pages=h3692 |doi=10.1136/bmj.h3692|pmid=26239322 |s2cid=44923011 }}</ref> In males and [[postmenopausal]] females, normal range of serum ferritin is between 12 and 300&nbsp;ng/mL (670 pmol/L) .<ref name="medline">[https://www.nlm.nih.gov/medlineplus/ency/article/003490.htm Ferritin] by: Mark Levin, MD, Hematologist and Oncologist, Newark, NJ. Review provided by VeriMed Healthcare Network</ref><ref name="medscape-ferritin">{{cite web|url=http://emedicine.medscape.com/article/177216-workup#c8|title=Hemochromatosis Workup|author=Andrea Duchini|website=[[Medscape]]|access-date=2016-07-14}} Updated: Jan 02, 2016</ref><ref name="molar">[[Molar concentration]] is derived from mass value using molar mass of 450,000 g•mol−1 for ferritin</ref> In premenopausal females, normal range of serum ferritin is between 12 and 150<ref name="medline" /> or 200<ref name="medscape-ferritin" /> ng/mL (330 or 440&nbsp;pmol/L).<ref name="molar" /> In those with hemochromatosis, the serum ferritin level correlates with the degree of iron overload.<ref name="NEJM Olynyk" /> Ferritin levels are usually monitored serially in those with hemochromatosis to assess response to treatment.<ref name="NEJM Olynyk" />

Elevations in serum levels of the iron transporter protein [[transferrin]] saturation as well as increased red blood cell [[mean corpuscular volume]] and [[mean corpuscular hemoglobin concentration]] usually precede ferritin elevations in hemochromatosis.<ref name="NEJM Olynyk" /> Transferrin saturation of greater than 45% combined with an elevated ferritin level is highly sensitive in diagnosing HFE hemochromatosis.<ref name="NEJM Olynyk" /> [[Total iron binding capacity]] may be low in hemochromatosis, but can also be normal.<ref>[http://www.labtestsonline.org/understanding/analytes/tibc/test.html labtestsonline.org TIBC & UIBC, Transferrin] Last reviewed on October 28, 2009.</ref> There are cases of iron overload with normal transferrin saturation.