Ask a doctor on the topic of Internal medicine

Transferrin and pill

July 19, 2013 | 20,00 EUR | answered by Dr. med. Frauke Gehring

I received my test results today from a recent blood sample. The following values were abnormal:
Name Unit Norm My Value
25-OH-Vitamin D CIMA ng/ml 30-100 24
Iron colorim. ug/dl 60-180 44 - Ferritin in norm
GPT/ALAT n. IFCC photom. U/l less than 35 58
Transferrin turbid. mg/d 200-360 340
Transferrin saturation percent 16-45 9
Zinc mg/l 0.70-1.30 0,68

I am taking the pill Valette. Various sources indicate that the pill can increase the transferrin value.
My doctor did not elaborate on this. She diagnosed an iron deficiency and prescribed iron infusions.
The prescription reads 62.5 mg Ferrlecit. I am supposed to receive 6 infusions, one per week.

My concern: What if I do not have an iron deficiency and the transferrin is elevated due to the pill, causing the saturation to be incorrect as well.
Could I end up with an iron overload from 6 infusions? (If that is unlikely, I would be willing to try the infusions)

To what extent does the pill alter transferrin levels? Only slightly, for example so slight that even without the pill I might be around 300, or very significantly?

I am simply unsure because my doctor was very quick to offer infusions (knowing I am on the pill), but did not comment further on the other values except for: "eat more and go out in the sun more". I found that almost rude because I do not appear undernourished (75 kg at 1.68m), and I eat normally. I assume she mentioned going out in the sun due to the vitamin D deficiency. She did not want to hear that I have values in the lower reference range regardless of the season. This is the first time I have a value below the norm, even though I spend a lot of time outdoors!
After all, I do not go to the doctor for fun but because I have symptoms. I am paying for part of the tests myself as I have been struggling with deficiencies like zinc for a long time.

Dr. med. Frauke Gehring

Good morning,

Unfortunately, you did not mention what symptoms you have and how old you are.

Vitamin D is so important, especially for protecting against osteoporosis, that I would consider it sensible for you to take it (e.g. with Vigantoletten), even if your levels are in the lower reference range.

On the other hand, I see iron differently: although transferrin levels are only slightly elevated by the pill, I do not see this as significant because your ferritin levels are within the normal range. Serum iron levels are not a reliable indicator of iron deficiency, as they can fluctuate (e.g. decrease during infections). However, since your storage iron levels (ferritin) are within the normal range, I only see a need for iron supplementation if you are constantly feeling fatigued, if your Hb levels are below the norm.

If so, only a small amount of iron would be necessary, and taking one capsule per day for a month would likely be sufficient. Infusions are only given in cases of severe deficiency, as they can potentially cause permanent skin discoloration, severe pain and greatly increase iron levels, which would not be beneficial in your case.

You would not necessarily experience harmful iron overload, but you would be taking more iron than you need. If you are to pay for the infusions yourself, perhaps the desire to earn money is a reason for recommending them.

In any case, I would recommend only taking capsules at most.

Best regards, Dr. Frauke Höllering, Specialist in Internal and General Medicine