In iron studies with inflammation, which tests help interpret iron status?

• A. Ferritin alone is sufficient to interpret iron status.
• B. Hepcidin level is the primary determinant of iron status during inflammation.
• C. Transferrin saturation and CRP (and soluble transferrin receptor if needed).
• D. Only serum iron level is needed.

Answer: (C)

Inflammation can distort iron markers, so ferritin alone isn’t reliable for judging iron status when inflammation is present—the ferritin level can stay normal or rise even if iron stores are low. The best approach is to use transferrin saturation, which reflects how much iron is actually available for use, together with CRP to gauge the degree of inflammation. This combination helps distinguish true iron deficiency from changes caused by inflammatory sequestration of iron. If ambiguity remains, checking soluble transferrin receptor can help: it tends to rise with iron deficiency but is less affected by inflammation, so it supports diagnosing iron deficiency when TSAT and ferritin results are discordant. In contrast, relying on ferritin alone or on serum iron by itself can mislead in the setting of inflammation.