Diagnosing Iron Deficiency: What Tests Can You Expect?

If you’ve been experiencing symptoms that may indicate anemia, then your doctor may run a series of appropriate tests to make a definitive diagnosis. Let’s get right to it and take a look at what you can expect when being tested for ID and IDA.

Physical Exam

One of the first things that your doctor will do is a physical exam, looking for signs of iron deficiency, such as:

  • Check your skin for paleness;
  • Check your fingernails – thin, fragile, pale, ridged, concave or spoon shaped;
  • Check your tongue, cheeks, gums, lips, and the roof and floor of your mouth for inflammation;
  • Listen to your heart to check for abnormalities such as an irregular or rapid heartbeat;
  • Listen to your lungs to check for rapid or uneven breathing;
  • Check the size of your spleen and liver by feeling your abdomen.

Depending on your symptoms, your doctor may also do a pelvic or rectal exam to check for bleeding.

Blood Tests

As far as diagnostic testing goes, your doctor will order a complete blood count (CBC) before any other testing to measure different elements of your blood. They’ll be looking at the size and colour of your red blood cells, as well as the amount. This is because red blood cells will appear widely different in size, shape and colour if you have iron deficiency anemia. A CBC also checks the following:

  • Hemoglobin – This iron-containing protein carries oxygen throughout the body and gives the blood cell its red colour. Hemoglobin levels of 12 – 17 g/dl for females and 13 – 18 g/dl for males is considered normal;
  • Hematocrit B – Given as a percentage, this is a measure of the amount of space (volume) red blood cells occupy in the blood. For example, a hematocrit of 40 means that 40% of the blood volume is red blood cells. Hematocrit levels of 37% – 51% for females and 43% – 52% for males is considered normal.

 In addition to CBC, your doctor may also check the following:

  • Ferritin – Indicates the amount of iron stored in your body (iron reserve);
  • Serum Iron – Measures the amount of circulating iron in your blood;
  • Total Iron-Binding Capacity (TIBC) – Measures iron levels in your blood, along with the ability of proteins (primarily transferrin) to transport iron;
  • Transferrin Saturation – Indicates your body’s ability to bind iron and transport it to various sites where it is needed, such as the bone marrow or liver. In a healthy patient, about 20% – 40% of available transferring sites are used to transport iron.

People often discover that they are anemic through routine screening at the doctor’s office or after they begin to experience symptoms of anemia. Iron deficiency is progressive; appropriate testing will help your doctor confirm whether or not you have ID or IDA and hopefully identify the underlying cause.

Content and advice provided on The Iron Maiden is for information purposes only and should not serve as a substitute for a licensed health care provider, who is knowledgeable about an individual’s unique health care needs

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6 thoughts on “Diagnosing Iron Deficiency: What Tests Can You Expect?

  1. Val Clark says:

    I have been told that my iron is low:
    Iron Satur…

    I have taken Proferrin at the beginning but then what was rising fell off so Dr. said try ferrous gluconate, still not much improvement. Dr. keeps asking me if notice any bleeding, I don’t see evidence, have had an occult Fit test that was negative I am 63, have AFIB and taking warfarin and Type 2.

    Is there anything more I can do. I eat meat. I am so tired and i seem to be getting more tired.

  2. Leona, RN & Blood Specialist says:

    Hi Val,

    Sometimes the source of one’s iron deficiency is a long standing issue, or something that is resolved yet the iron stores have not been repleted.

    As always, your primary physician drives your care and knows your situation best. It sounds like you may have stage two iron deficiency and may benefit from intravenous iron.

    Please consider downloading the Symptoms Checker, complete it and take it to your physician to discuss. You may also consider reviewing the article on available iron supplements, to assist in the selection of one that fits you and your lifestyle better.


  3. Cindy Thiele says:

    I am a vegetarian, I have chronic low Ferritin level 21, 17 etc
    WBC 4.6 RBC 4.4 and Hemoglobin 126 seem to be close to normal
    I am tired all the time. taking supplements Feramax, iron rich food, what improves
    Ferritin level ?

  4. Leona, RN & Blood Specialist says:

    Hi Cindy,

    Great question and good on you for being a health care consumer by trying to find answers to your questions. So, with Celiac disease you know that you are part of an “at risk” population… When replenishing iron, the same protocols apply. Oral iron supplements, Iron rich diet and iv iron replenish your hemoglobin, then the iron in your bone marrow then finally the iron stored in your liver. Anecdotal studies have shown that when a Ferritin Level is less than 20 it’s difficult to replenish your iron stores using oral supplementation alone. In my experience, I have given intravenous iron until the Ferritin Level is greater than 100 and start iron supplementation with a maximum dose of FeraMAX (3 opened capsules) then recheck the patient’s lab results. It is best to check with your primary healthcare provider for the best route to take for your specific situation.


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