In hereditary hemochromatosis, which pattern is expected on an iron panel?

• A. Iron high, TIBC low, Transferrin saturation high, Ferritin low
• B. Iron low, TIBC high, Transferrin saturation low, Ferritin high
• C. Iron high, TIBC high, Transferrin saturation low, Ferritin high
• D. Iron normal, TIBC normal, Transferrin saturation normal, Ferritin normal

Answer: (A)

In iron overload from hereditary hemochromatosis, the body stores too much iron, so the iron panel shows increased serum iron and increased ferritin as a reflection of higher iron stores. Transferrin saturation goes up because there’s more iron circulating relative to the binding capacity of transferrin, and the total iron-binding capacity (TIBC) tends to be low or reduced since the available transferrin binding sites are overwhelmed. Put together, you’d expect high iron, high transferrin saturation, high ferritin, and low TIBC. The listed pattern would be off if ferritin is low, because ferritin should be elevated in iron overload.