Cited by 48Iron Metabolism and DisordersClinical Laboratory Practices and Quality ControlHemoglobinopathies and Related Disorders

Reference distributions for serum iron and transferrin saturation: a practical, simple, and clinically relevant approach in a large cohort

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Ritchie, Robert F., Palomaki, Glenn E., Neveux, Louis M., Navolotskaia, Olga, Ledue, Thomas B., Craig, Wendy Y.·2002·Journal of Clinical Laboratory Analysis

Abstract

The principal considerations driving iron status evaluation are clinical concern for anemia and the possibility of iron‐storage disease. Most often, the circulating levels of transferrin (or total iron binding capacity) and serum iron are measured and the percentage of transferrin saturation (TSAT) is then computed. Optimally, reference ranges for these analytes should exclude the effects of the acute phase response, nutritional status, estrogen effect, specific genetic disorders, liver disease, and blood transfusion. The current study reports reference ranges for serum iron and TSAT within a cohort of over 55,000 Caucasians from northern New England, tested in our laboratory between 1994 and 1999. Measurements were standardized against serum reference material (SRM) 937 (for iron) and certified reference material (CRM) 470 (also called reference preparation for proteins in human serum (RPPHS)) (for transferrin), and analyzed using a previously published approach. Individual cases with evidence of inflammation (C‐reactive protein ≥10 mg/L), or iron overload (TSAT >80% for males and >70% for females) or serum iron values <5 μmol/L, were removed. Among the referent individuals, iron and TSAT levels rose slightly until the teen years, at which time levels in males increased while those in females remained essentially constant. Between 20 and 70 years of age, males had 10–15% higher iron levels and 15–20% higher TSAT levels than females. When values were expressed as multiples of the age‐ and gender‐specific median levels, the serum iron and TSAT observations fit log‐Gaussian distributions reasonably well from the 20th to 99th centile, and the 10th to the 99th centile, respectively. After normalization, the Gaussian parameters can be used to assign a corresponding centile to an individual's measurement, simplifying interpretation. These data provide new and more detailed reference ranges for serum iron and TSAT. J. Clin. Lab. Anal. 16:237–245, 2002. © 2002 Wiley‐Liss, Inc.

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  1. Ritchie RF, Palomaki GE, Neveux LM, Navolotskaia O, Ledue TB, Craig WY. Reference distributions for the negative acute phase proteins, albumin, transferrin and transthyretin: a practical, simple and clinically relevant approach in a large cohort. J Clin Lab Anal 1999;13:273-279.
  2. Ritchie RF, Palomaki GE, Neveux LM, Navolotskaia O, Ledue TB, Craig WY. Reference distributions for immunoglobulins A, G and M: a practical, simple and clinically relevant approach in a large cohort. J Clin Lab Anal 1998;12:363-370.
  3. Ritchie RF, Palomaki GE, Navolotskaia O, Neveux LM, Ledue TB, Craig WY. Reference distributions for the negative acute phase proteins, albumin, transferrin and transthyretin: a practical, simple, and clinically relevant approach in a large cohort. J Clin Lab Anal 1999;13:273-279.
  4. Thompson DK, Haddow JE, Smith DE, Ritchie RF. Serum protein changes in women with early breast cancer. Cancer 1981;48:793-798.
  5. Dotchev D, Liappis N, Hingerland H. Sex-specific differences of serum proteins in adults and influence of oral hormonal contraceptives on serum protein compositions. Clin Chim Acta 1973;44:431-435.

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Authors
Ritchie, R. F., Palomaki, G. E., Neveux, L. M., Navolotskaia, O., Ledue, T. B., & Craig, W. Y.
Affiliations
Foundation for Blood Research (US)
Corresponding author
Ritchie, Robert F.
Venue
Journal of Clinical Laboratory Analysis
Publisher
Wiley
Published
2002-01
Volume
16
Issue
5
Pages
237-245
ISSN
  • 0887-8013 (ISSN-L)
  • 1098-2825
OpenAlex
W2119231723
Cited by
48
References
34
Citations by year
2026: 3 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 4 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 1 · 2014: 1 · 2013: 3 · 2012: 2
FWCI
1.07
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Laboratory Analysis (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
  • Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
  • Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
Keywords
serum iron, transferrin saturation, reference values, reference distribution, iron status, anemia, iron overload, iron storage disease, C-reactive protein, sex differences, age differences, certified reference materials
MeSH terms
Acute-Phase Proteins, Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Infant, Iron, Male, Middle Aged, New England, Reference Values, Transferrin, Cohort Studies, Age Distribution, Sex Distribution

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