High sideremia, low sideremia, normal values, meaning, treatment

By Cristiano Antonino On Mar 26, 2023

Sideremia expresses the amount of so-called ‘circulating iron’, i.e. that bound to transferrin (protein responsible for iron transport)

It can be detected by a simple venous blood test.

Iron functions and absorption

Iron is essential for life as it is involved in the body in numerous biochemical reactions.

When complexed with porphyrin, it forms heme, a prosthetic group that becomes part of numerous proteins, including haemoglobin in red blood cells, which is necessary for oxygen transport.

Iron is mainly absorbed in the duodenum and the proximal part of the jejunum.

Iron is mainly found in food in the form of the ferric salt (Fe3+). Iron absorption is favoured by the acidic environment in the stomach.

Approximately 10-20 mg of iron is introduced daily through the diet, and of this about 10 per cent is absorbed.

A diet rich in meat represents an extraordinary source of supply.

Certain substances, such as tannates, found in tea for example, bind iron extremely effectively and significantly inhibit its absorption.

Phytates also inhibit its absorption. The simultaneous intake of ascorbic acid, on the other hand, promotes the reduction of ferric salt to ferrous salt and facilitates its absorption.

Why is it useful to know the sideremia?

Sideremia makes it possible to establish the state of iron reserves in the body, so it is useful in all situations in which it is necessary to know this information to diagnose a pathology.

In clinical practice, sideremia is generally assessed along with

ferritinemia: the concentration of ferritin, the main protein involved in iron storage;
transferrinemia: the concentration of transferrin, the main iron transport protein in the blood;
total iron binding capacity (TIBC): an indirect measure of the ability of transferrin to bind iron.

Normal values

Normal ferritin values are as follows:

adult men: 65 to 176 mcg/dL
adult women: 50 to 170 mcg/dL
children: 50 to 120 mcg/dL
neonates: 100 to 250 mcg/dL

Sideremia values may vary depending on :

gender;
age;
time of day when the test is carried out;
laboratory;
presence of active menstrual flow;
intake of large amounts of tea, red meat or certain medications or iron supplements during the test period.

Causes of a decrease in sideremia (hyposideremia)

A decrease in sideremia indicates a decrease in iron and can occur in various conditions and diseases:

malnutrition;
diet with iron-deficient foods
intestinal malabsorption;
celiac disease;
chronic diarrhoea;
diabetes;
advanced age;
laxative abuse;
anaemias;
alcoholism;
gastrectomy;
achlorhydria;
increased iron utilisation (rapid growth, in infants or adolescents);
physiological losses of iron with menstruation;
pregnancy;
both overt and occult haemorrhages;
infectious diseases;
tuberculosis;
lung abscess;
bacterial endocarditis;
tumours;
intake of ACTH, testosterone, colchicine and methicillin;
acute myocardial infarction.

Causes of an increase in sideremia (hypersideremia)

An increase in sideremia indicates iron overload and can occur in various conditions and diseases:

excessive administration of iron with supplements and medication;
excessive iron diet (rare, common only in children);
multiple and prolonged transfusions;
hemochromatosis;
hemosiderosis;
poor iron utilisation in the bone marrow due to aplastic; hypoplastic and megaloblastic anaemias;
cell destruction of iron storage organs (hepatitis);
lead poisoning;
haemolytic syndromes ;
thalassaemia;
pernicious anaemia;
sideroblastic anaemia;
chronic alcoholism;
nephropathies;
hepatopathies;
liver cirrhosis.

Symptoms associated with low sideremia

Symptoms associated with iron deficiency anaemia are:

feeling of severe tiredness and weakness
dyspnoea (difficulty breathing);
difficulty in performing even mild exercises;
brittleness of the nails;
tachycardia (increased heart rate);
tachypnoea (increased respiratory rate);
dizziness;
difficulty concentrating;
increased thirst;
blurred vision;
splenomegaly (increased spleen volume);
pain in the spleen (left flank);
claudicatio intermittens: difficulty walking;
confusional state;
feeling of fainting;
low body heat, especially in the extremities (hands and feet);
noticeably pale appearance of the skin.

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Symptoms associated with high sideremia

increased blood sugar, triglycerides and liver transaminases;
joint pain;
disorders of the adrenals and thyroid gland;
enlarged liver and spleen;
fatigue and lack of energy;
mood disorders (anxiety and nervousness);
abdominal pain;
tachycardia;
arrhythmia;
hair loss;
sexual dysfunction (loss of libido, irregular or absent menstrual cycle in women or impotence in men).