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Iron

The role of iron in the body

Iron is necessary for:

  • Hemoglobin synthesis (oxygen transfer).
  • Formation of myoglobin (oxygen in the muscles).
  • Work of enzymes (participation in metabolism and immunity).

Norms of iron in the blood

(depending on the lab, but on average):

  • Whey Iron:
  • Men: 12-30 mmol/l.
  • Women: 9-27 mmol/l.
  • Ferritin (iron reserve):
  • Men: 30-400 ng / ml.
  • Women: 15-150 ng / ml.
  • Total iron binding capacity: 45-70 mmol/l.

Important! It is necessary to interpret the tests taking into account the symptoms and other indicators (hemoglobin, red blood cells, etc.).

When should I see a doctor?

If you have:

  • Increased ferritin (>300-500 ng / ml).
  • High serum iron.
  • Symptoms of overload (fatigue, joint pain, diabetes, hyperpigmentation).

Treatment is provided by: hematologist, hepatologist, or rheumatologist (depending on the cause).

Iron deficiency (iron deficiency anemia)

Symptoms:

  • Weakness, fatigue, dizziness.
  • Pallor of the skin and mucous membranes.
  • Shortness of breath, tachycardia.
  • Brittle nails, hair loss.
  • Perversion of taste (desire to eat ice, chalk).

Reasons:

  • Blood loss (menstruation, ulcers).
  • Lack of iron in food.
  • Malabsorption (gastritis, celiac disease).

Excess iron (hemochromatosis, poisoning)

Symptoms:

  • Fatigue, joint pain.
  • Skin pigmentation (gray-brown tint).
  • Liver enlargement, cirrhosis.
  • Diabetes mellitus (‘bronze diabetes’).
  • Heart failure.

Reasons:

  • Hereditary hemochromatosis.
  • Overdose of iron preparations.
  • Multiple blood transfusions.

Where is iron stored in the body?

Iron in the body is found in two main forms: functional (used in processes) and reserve (deposited).

1. Main iron storage locations:

  • Ferritin (the main depot) – found in almost all cells, but most of all in:
  • Liver (main storage).
  • Spleen (destruction of old red blood cells and recycling of iron).
  • Bone marrow (used for the synthesis of new red blood cells).
  • Muscles (in the form of myoglobin).
  • Hemosiderin is a less accessible form that accumulates when there is an excess of iron (for example, in hemochromatosis).

2. Other forms of iron:

  • Hemoglobin (in red blood cells) is ~60-70% of all iron.
  • Myoglobin (in the muscles) – reserves for muscle work.
  • Transferrin (transport protein) – transports iron in the blood.

What happens when iron storage is disrupted?

  • Deficiency → depleted ferritin reserves → reduced hemoglobin → anemia.
  • Excess iron accumulates in the liver, heart, and pancreas toxic organ damage.

Important: The level of ferritin in the blood reflects the body’s iron reserves.

How to remove excess iron from the body?

Excess iron (hemochromatosis, iron overload) is dangerous because iron accumulates in the liver, heart, pancreas, and other organs, causing them to be damaged. Basic methods of deduction:

1. Bloodletting (phlebotomy)

The most effective method for hereditary hemochromatosis.

  • How it works: Removing the blood (500 ml) reduces iron levels, as the body uses up the reserves to produce new red blood cells.
  • Frequency:
    • At the beginning of treatment-1-2 times a week.
    • After normalization of ferritin levels-3-4 times a year.
  • Control: Regular tests for hemoglobin, ferritin, and serum iron.

2. Chelation therapy (if bloodletting is not possible)

It is used if phlebotomy is contraindicated (anemia, heart disease).
Medication:

  • Deferoxamine (administered intravenously or subcutaneously).
  • Deferasirox (tablets used for chronic iron overload).
    How it works: Chelators bind iron and remove it in the urine or feces.

3. Diet to reduce iron

What to limit/exclude:

  • Heme iron (better absorbed):
    • Red meat (beef, lamb).
    • Liver and other by-products.
  • Vitamin C (increases iron absorption – – avoid citrus fruits, juices, and vitamin C supplements during meals.
  • Alcohol (especially red wine – increases iron absorption and damages the liver).
  • Iron-rich foods (some cereals, bread).

What you can eat:

  • Dairy products (calcium reduces iron absorption).
  • Tea, coffee, cocoa (tannins and polyphenols reduce the absorption of iron).
  • Whole grains, legumes, and nuts (they contain phytates that reduce iron absorption).

4. Control of concomitant factors

  • Do not use iron-containing dietary supplements or multivitamins.
  • Be careful with vitamin and mineral complexes (avoid iron supplements).
  • Treat the underlying disease (if the iron overload is secondary, for example, with frequent blood transfusions).

5. Regular monitoring

  • Tests: ferritin, serum iron, OZHSS, liver tests (ALT, AST).
  • Instrumental diagnostics:
    • MRI of the liver (assessment of iron overload).
    • Elastometry (FibroScan) – if fibrosis / cirrhosis is suspected.