Total iron binding capacity of serum. Ozhss: what is this? Diagnosis of iron deficiency in hypothyroidism

Reduced levels iron deficiency can lead to anemia, provoke a decrease in red blood cell production, microcytosis (reduced red blood cell size) and hypochromia, in which red blood cells become pale color due to lack of hemoglobin. One of the tests that helps assess the status of iron in the body is the “total iron-binding capacity of serum.” It measures the amount of all proteins in the blood that can bind iron particles, including transferrin, the main iron transport protein in plasma.

Iron (abbr. Fe) is a substance necessary to support life. Thanks to it, the body forms normal red blood cells, since this element is the main part of hemoglobin, which is part of these blood cells.

It binds and attaches oxygen molecules to itself in the lungs and gives them to other parts of the body, taking waste gas - carbon dioxide - from the tissues, bringing it out.

To provide body cells with iron, the liver produces the protein transferrin from amino acids, which transports Fe throughout the body. When Fe stores in the body are low, transferrin levels increase. Conversely, as iron stores increase, the production of this protein decreases. U healthy people

one third of the total amount of transferrin is used to transport iron.

Fe residues that are not used for cell construction are stored in tissues in the form of two substances, ferritin and hemosiderin. This reserve is used to produce other types of proteins, such as myoglobin and some enzymes.

Iron tests Tests showing the body's iron status may be performed to determine the amount of iron circulating in the body. circulatory system , the ability of the blood to transport this substance, as well as the amount of Fe stored in the tissues for the future needs of the body. Testing can also help differentiate various reasons

anemia.

Analysis for TIBC (total iron-binding capacity of blood serum) - since transferrin is the primary iron-binding protein, the TIBC norm is considered a reliable indicator.
Analysis of Fe levels in the blood.
Unsaturated Iron Binding Capacity (UNIBC) – measures the amount of transferrin that is not bound to iron molecules. NIHS also reflects general level transferrin. This test is also known as "latent serum iron binding capacity".
Calculation of transferrin saturation is made in accordance with its saturation with iron molecules. This allows us to find out the proportion of transferrin saturated with Fe.
Serum ferritin levels reflect the body's iron stores, which are stored primarily in this protein.
Soluble transferrin receptor testing. This test can be used to identify iron deficiency anemia and distinguish it from secondary anemia, the cause of which is chronic disease or inflammation.

Another test is the zinc-bound protoporphyrin test. This is the name of the precursor of the part of hemoglobin (heme), which contains Fe. If there is not enough iron in the heme, protoporphyrin binds to zinc, which is shown by a blood test. Therefore, this test can be used as a screening test, especially in children. However, measuring zinc-bound protoporphyrin is not a specific test for detecting Fe problems. That's why increased values of this substance must be confirmed by other tests.

To study iron may be prescribed genetic tests HFE gene. Hemochromatosis is genetic disease, in which the body absorbs more Fe than necessary. The reason for this is the abnormal structure of a specific gene called HFE. This gene controls the amount of iron absorbed from food in the intestines.

In patients who have two copies of the abnormal gene, excess iron accumulates in the body, which is deposited in various organs. Because of this, they begin to break down and function incorrectly. The HFE gene test identifies various mutations that can lead to diseases. The most common mutation in the HFE gene is a mutation called C282Y.

General blood test

Along with the above tests, the doctor examines the data from a general blood test. These tests include hemoglobin and hematocrit tests. Reduced values of one or both tests indicate that the patient has anemia.

Calculations of the average number of red blood cells (average cell volume) and the average number of hemoglobin in red blood cells (average cellular hemoglobin) are also included in the complete blood count. Fe deficiency and accompanying insufficient hemoglobin production create conditions in which red blood cells decrease in size (microcytosis) and become paler (hypochromia). At the same time, both the average cell volume and the average cellular hemoglobin are below normal.

Allows you to determine problems with iron by counting young red blood cells, reticulocytes, the absolute number of which is reduced in iron deficiency anemia. But this number increases to normal level after the patient undergoes therapy with iron-containing drugs.

When are Fe tests prescribed?

One or more tests may be ordered when CBC results are out of range normal values. This often happens when reduced values hematocrit or hemoglobin. The doctor may also refer the patient for Fe tests if the following symptoms are present:

Chronic fatigue and fatigue.
Dizziness.
Weakness.
Headache.
Pale skin.

Determination of iron content, THC and ferritin may be prescribed if the patient has symptoms of excess or Fe poisoning. This can manifest itself as joint pain, lack of energy, abdominal pain, and heart problems. If a child is suspected of having eaten too many iron tablets, these tests can help determine the extent of the poisoning.

A doctor may prescribe an iron test if the patient suspects a chronic excess of iron in the body (hemochromatosis). In this case, they are assigned additional research HFE gene to confirm the diagnosis of this hereditary disease. This suspicion may be supported by cases of hemochromatosis in the patient’s relatives.

Decoding the results

Fe deficiency in women and men can manifest itself due to insufficient intake of this substance with food, insufficient absorption nutrients. Increased needs of the body during certain conditions also lead to iron deficiency, including pregnancy, acute or chronic blood loss.

Acute excess iron may occur as a result of consuming large quantities iron-containing food additives. This happens especially often in children. Chronic excess Fe may also be a consequence excessive consumption this substance together with food, and also appear as a result of hereditary diseases (hemochromatosis), frequent transfusions blood and for some other reasons.

The values of the results for the iron status of the body are indicated in the following table:

Disease	Fe	OZhSS/transferrin	NZHS	% transferrin saturation	Ferritin
Iron deficiency	Downgraded	Above normal	Increased	Below normal	Downgraded
Hemochromatosis	Increased	Downgraded	Downgraded	Increased	Increased
Chronic diseases	Downgraded	Downgraded	Decreased/normal	Below normal	Normal/increased
Hemolytic anemia	Above normal	Normal/reduced	Decreased/normal	Increased	Increased
Sideroblastic anemia	Normal/increased	Normal/reduced	Decreased/normal	Increased	Increased
Iron poisoning	Increased	Fine	Below normal	Increased	Fine

IN mild stage iron deficiency, the consumption of reserves of this substance occurs slowly. This means that Fe in the body functions normally, but its reserves are not replenished. Serum iron may be normal at this stage, but ferritin levels are usually low.

As iron consumption continues, its deficiency increases, and therefore the supply of Fe gradually comes to an end. To compensate for this deficiency, the body increases the production of transferrin to increase Fe transport. Thus, the level of iron in plasma continues to fall, and transferrin and TGSS continue to increase. As this condition progresses, fewer red blood cells are produced and their size also decreases. As a result, iron deficiency anemia develops. This problem can be easily solved by ensuring that the body receives foods containing sufficient quantity necessary for the body iron and increasing its deficiency.

Latent (unsaturated) iron-binding capacity of serum (LZhSS, NJSS, UIBC)- an indicator used to identify iron deficiency in the body. Main indications for use: differential diagnosis anemia, liver diseases (acute hepatitis, cirrhosis), nephritis, evaluation of treatment with iron supplements, various chronic diseases, pathology gastrointestinal tract and associated iron malabsorption.

Normally, transferrin is saturated with iron by approximately 30%, and the additional amount of iron that can bind to transferrin is called the latent (unsaturated) iron-binding capacity of the serum.

LVCC or NIBC - represents the difference between the total iron-binding capacity (TIBC) and the actual saturation of transferrin. This is expressed by the formula: LZhSS (NZhSS) = OZhSS - Serum iron. - Total iron binding capacity of serum (TOIBC, Total Iron Binding Capacity, TIBC) iron, which can attach transferrin until complete saturation. It is established as the sum of indicators - Serum iron + latent (unsaturated) iron binding capacity of serum (LZhSS, NJSS - from the English. Unsaturated Iron Binding Capacity, UIBC). Due to the precise molar ratio of iron binding by transferrin, the determination of TIBC can be replaced by direct quantitative measurement of transferrin.

OZhSS - reflects the content of the transferrin protein in the serum (see "Transferrin (Siderophilin)", which transports iron in the blood.
Under physiological conditions, transferrin is saturated with iron at approximately 30% of its maximum saturation capacity. The LVSS indicator reflects the amount of iron that transferrin can attach to achieve maximum saturation. The determination of this iron is carried out after saturation of transferrin by adding excess iron (ferric chloride is added). Unbound iron is removed, and the iron bound to transferrin is processed acetic acid, after which iron is released. This iron is reduced with hydroxylamine and thioglycolate. Next, the reduced iron is calculated. It is possible to determine unbound iron ions by reaction with ferene. The difference between the amount of excess iron ions (unbound to iron-binding sites) and the total amount of iron ions added to the serum is equal to the amount of iron ions bound to transferrin, which is expressed as serum LVSS.

An increase in PVSS is observed in iron deficiency anemia, in contrast to other types of hypochromic anemia. This increase in transferrin content in iron deficiency anemia is associated with an increase in its synthesis, which is a compensatory reaction in response to tissue iron deficiency.

TIBC stands for total iron binding capacity of serum. OHSS analysis is laboratory test, reflecting the ability of transferrin, that is, a specific blood protein, to bind free iron. Analysis is performed during diagnosis and differential diagnosis anemia.

If the vital blood pressure increases, we can draw conclusions about low iron levels in the blood, which is characteristic feature iron deficiency anemia. Whey binds more iron than is normally required. If the indicators of the overall life-saving value are low, then this is the result of an increase in serum iron, which accompanies hyperchromic anemia (that is, the accumulation of excess iron), infection or malignant formations in organism.

Let's learn more about what it is - OZHSS?

Transferrin

Transferrin is produced by liver cells. If its functions change (for example, due to deficiency, with hepatitis or cirrhosis), then the concentration of the carrier protein decreases significantly, which means that the readings of the OZHS test also change.

Serum iron concentration and TLC are the basis for calculating the transferrin saturation coefficient.

It must be said that the use of such groups of drugs as corticotropin, asparaginase, testosterone, chloramphenicol, and cortisone can reduce CVSS. Oral contraceptives and estrogens help improve results. The life-saving blood pressure also decreases as a result of taking iron-containing drugs, which is why you need to stop taking them about a week (at least five days) before taking blood.

So, in this article we will figure out what it is - OZHSS.

Method for determining iron binding capacity

The main methods by which the TLC of blood serum is determined include colorimetric analysis and absorption spectroscopy. Nowadays, the first method is most widely used, which consists in introducing iron in excess quantities into the analyzed serum. Some part of it binds to the carrier protein, and the iron that has not entered into contact is removed. Based on a certain amount of it, one can draw a conclusion about the value of the life cycle. It is increased, as well as decreased, it happens often.

Alternative method

Since the described method (despite the high degree of reliability) is quite lengthy and requires a lot of labor, some laboratories use alternative method an analysis that separately determines what the iron content is in the unsaturated iron binding capacity (unsaturated iron binding capacity) and in the blood serum. These indicators are summed up, resulting in indicators of life-savings insurance. In this regard, quite often the simultaneous determination of TI, serum iron and NIH occurs in many laboratories.

If the OJSS is elevated, what does this mean? This question interests many.

Hypothyroidism and associated iron deficiency

Hypothyroidism is a condition determined by long-term and persistent hormone deficiency thyroid gland. Its opposite is thyrotoxicosis. The extreme manifestation of symptoms in adults is myxedema, and in children - cretinism.

Any type of anemia is not a disease in itself, but it can be accompanying symptom with a list of diseases, and they, in turn, can be interconnected with primary lesion blood system and proceed independently of it. That is why it is not possible to strictly classify anemia. The basis for their structuring is the principle of practical expediency. To do this with maximum convenience, anemia is divided by color indicator as a single classification criterion. Serum iron OZHS is an important indicator.

The condition of iron deficiency is probably known to many people, but few people realize that dysfunction of the thyroid gland can cause it. This became known not so long ago; moreover, not everyone Russian doctor knows about similar complication, therefore, does not pay attention to the content of hemoglobin and red blood cells in the patient.

In addition, scientists have determined that initial iron deficiency is the cause of the development of hypothyroidism. For this purpose, the TCV in the blood is determined. We have already explained what this is.

2 types of violations

Iron dysfunction has two directions:

To hypothyroidism - decreased function;

To hyperthyroidism - an increase in the functioning of the organ.

It is now an absolutely proven fact that hypothyroidism can cause poor absorption of iron due to its deficiency. There is some debate regarding hyperthyroidism; this combination is much less common than the combination of anemia and hypothyroidism (50% of cases, even if the anemia is mild). What is this - OZHSS? This frequently asked question patients.

How is iron absorbed?

To understand the mechanism of the influence of thyroid hormones on iron absorption, you need to understand the essence of this process. The body can synthesize iron, but since its reserves in the body are small, it must be obtained from the food a person eats to avoid shortages.

Iron is found in food in a trivalent oxidized state and is part of the composition of proteins and salts of organic acids. This form of it is not absorbed by the body. In order for the release of salts and proteins from the content of salts and proteins and the transition of iron into a divalent digestible form to take place, it is necessary sour juice stomach and vitamin C.

It is absorbed into small intestine and in duodenum. In the absence of conversion of iron into an absorbable form, it is simply excreted from the human body through feces. And the transformation occurs when active influence ascorbic acid.

The lack of thyroid hormones also causes a decrease in stomach acidity through a decrease in the number of parietal cells that excrete hydrochloric acid, because of this, iron does not turn into the required form and is not absorbed by the body. As a result, iron deficiency anemia occurs. When the OJSS is elevated, what does it mean? What leads to this?

Causes of anemia in hypothyroidism

A lack of iron in the body can manifest itself not only due to the fact that its absorption is impaired. It occurs in the following cases:

With a low intake of iron from food (for example, with a vegetarian menu);

In women with heavy menstruation;

With malabsorption syndrome;

For bleeding digestive tract, having a hidden nature (for example, with hemorrhoids or a bleeding ulcer);

For celiac disease;

At frequent bleeding from the nose;

With frequent endless blood donations;

With serious blood loss;

In case of a suicide attempt by opening the veins, which was not completed;

At mental disorder which consists of constant bloodletting.

These conditions are not normal, so it is necessary to see a doctor. If you do not identify the cause of anemia, then you will not be able to correct your health.

What does chronic iron deficiency lead to?

Chronic lack of iron provokes disruptions in the functioning of the thyroid gland. Because of reduced content the deiodinase enzyme is blocked, converting T4 into the more active T3. Eventually biological effect hormones decrease, signs of hypothyroidism appear. At the same time, the activity of another important enzyme decreases: we are talking about thyroid peroxidase, which is directly involved in the synthesis of thyroid hormones. This enzyme is also characterized by iron dependence.

The nature of the course of anemia (VHS is reduced) in hypothyroidism and the causes of the development of the disease have been scientifically proven. In addition, there is information that during hypothyroidism, indicators of the total mass of red blood cells may decrease, but such a process cannot be masked along with a parallel decrease in blood plasma.

Diagnostics

The iron deficiency type of anemia that accompanies hypothyroidism is quite mild. Sometimes an increase in MCV can be observed, and when deciphering blood tests, in some cases wrinkled red blood cells may be present, having irregular shape. The bone marrow exhibits characteristics of erythroid hypoplasia. A careful study of the kinetics of iron reveals that its indicators and plasma clearance data decrease. The same process is observed during the maturation of red blood cells with utilization. In patients with hypothyroidism, a disease such as atrophic gastritis is often found, which results in a lack of iron or vitamin B12. Based on these data in clinical picture changes may occur.

If you have hypothyroidism, you should not forget about these data. Sometimes a routinely prescribed general blood test gives the doctor a reason to think about whether the patient has hypothyroidism. Since thyroid hormones are directly involved in regulating hematopoiesis, their lack is reflected in the fact that blood parameters change. In this case, anemia can be cured only if the main pathology that provokes it is successfully treated.

We looked at the OZHS indicator. What it is is now clear.

Iron binding capacity of blood serum

Iron binding capacity of blood serum (IBC) is an indicator characterizing the ability of blood serum to bind iron. Iron in the human body is complexed with a protein - transferrin. VSS shows the concentration of transferrin in the blood serum. The iron-binding capacity of blood serum changes when the metabolism, breakdown and transport of iron in the body is disrupted. To diagnose anemia, they use the determination of the latent iron-binding capacity of blood serum (LIC) - this is the LBC without serum iron. The norm of latent FSS is 20-62 µmol/l.

An increase in the level of LVSS occurs with iron deficiency, iron deficiency anemia, acute hepatitis, on later pregnancy.

A decrease in LVSS occurs with a decrease in the amount of proteins in the plasma (with nephrosis, starvation, tumors), with chronic infections, cirrhosis, hemachromatosis, thalassemia. Ferritin

Ferritin is the main indicator of iron reserves in the body, plays important role in maintaining iron in a biologically useful form. Ferritin contains iron phosphates. Ferritin is found in all cells and fluids of the body. A blood test for ferritin is used to diagnose iron deficiency anemia and diagnose anemia accompanying infectious, rheumatic and tumor diseases.

The normal level of ferritin in the blood for adult men is 30-310 mcg/l. For women, the normal blood test for ferritin is 22-180 mcg/l.

Excess ferritin in the blood may be a consequence the following diseases:

# excess iron in hemochromatosis;

# alcoholic hepatitis and other liver diseases;

# acute and chronic infectious and inflammatory diseases (osteomyelitis, lung infections, burns, rheumatoid arthritis);

# mammary cancer.

Ferritin levels increase when taking oral contraceptives and fasting. Low ferritin is a consequence of iron deficiency (iron deficiency anemia).

Treatment for low Ferritin is always prescribed only by a doctor: it is necessary to find out exactly what disorders led to a decrease in ferritin in a blood test.

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The latent iron-binding capacity of serum is a laboratory indicator that reflects the potential ability of blood serum to bind additional amounts of iron.

Synonyms Russian

Unsaturated iron-binding capacity of serum, NISH, LVSS.

SynonymsEnglish

Iron indices, iron profile, unsaturated iron binding capacity, UIBC.

Research method

Colorimetric photometric method.

Units

μmol/L (micromoles per liter).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for research?

Do not eat for 8 hours before the test; you can drink clean still water.
Stop taking medicines containing iron 72 hours before the test.
Avoid physical and emotional stress and do not smoke for 30 minutes before the test.

General information about the study

Iron - important trace element in organism. It is part of hemoglobin, which fills red blood cells and allows them to carry oxygen from the lungs to organs and tissues.

Iron is included in muscle protein myoglobin and some enzymes. It is absorbed from food and then transferred by transferrin, a special protein that is formed in the liver.

Usually the body contains 4-5 g of iron, about 3-4 mg (0.1% of the total) circulates in the blood “in conjunction” with transferrin. The level of transferrin depends on the functioning of the liver and on the person’s diet. Normally, 1/3 of the transferrin binding centers are filled with iron, the remaining 2/3 remain in reserve. The latent serum iron binding capacity (LIC) reflects how much transferrin is “unfilled” with iron.

This parameter can be calculated using the following formula: LVSS = TGSS - iron in serum (TGSS is the total iron-binding capacity of blood serum - an indicator characterizing the maximum ability of transferrin to be “filled” with iron).

With iron deficiency, there is more transferrin so that this protein can bind to the small amount of iron in the serum. Accordingly, the amount of transferrin “not occupied” by iron increases, that is, the latent iron-binding capacity of the serum.

On the contrary, with an excess of iron, almost all transferrin binding centers are occupied by this trace element, therefore the latent iron-binding capacity of the serum decreases.

The amount of serum iron can vary significantly depending on different days and even within one day (especially in the morning), however, the life-span and life-sustaining vascular resistance normally remain relatively stable.

On early stages Iron deficiency sometimes does not show any symptoms. If a person is otherwise healthy, then the disease can make itself felt only when hemoglobin decreases below 100 g/l. Usually these are complaints of weakness, fatigue, dizziness, and headaches.

What is the research used for?

To determine the amount of iron in the body and its relationship with blood proteins (together with a test for iron in serum, sometimes with a test for PVSS and transferrin). These studies make it possible to calculate the percentage of transferrin saturation with iron, that is, to determine exactly how much iron the blood carries. This indicator most accurately characterizes iron metabolism.

The purpose of such tests is to diagnose iron deficiency or excess. In patients with anemia, they help determine whether the disease is due to iron deficiency or other causes, e.g. chronic disease or vitamin B12 deficiency.

When is the study scheduled?

When any deviations are detected in general analysis blood test, hemoglobin test, hematocrit, red blood cell count (together with serum iron test).
If you suspect a deficiency or excess of iron in the body. With severe iron deficiency, shortness of breath, pain in the chest and in the head, weakness in the legs. Some people have a desire to eat unusual products(chalk, clay), burning of the tip of the tongue, cracks in the corners of the mouth. Children may have learning difficulties.
If you suspect iron overload (hemochromatosis). This condition manifests itself in different ways, such as joint or abdominal pain, weakness, fatigue, decreased sexual desire, heart rhythm disturbances.
When monitoring the effectiveness of treatment for iron deficiency or excess.

What do the results mean?

Reference values: 20 - 62 µmol/l.

Interpretation of the results of analysis for LVSS, as a rule, is made taking into account other indicators that assess iron metabolism.

Reasons for increasing the life insurance ratio

Anemia. It is usually caused by chronic blood loss or insufficient consumption of meat products.
Third trimester of pregnancy. In this case, serum iron levels decrease due to increased iron requirements.
Acute hepatitis.
Multiple blood transfusions, intramuscular iron administration, inadequate administration of iron supplements.

Reasons for the decrease in life insurance

Chronic diseases: systemic lupus erythematosus, rheumatoid arthritis, tuberculosis, bacterial endocarditis, Crohn's disease, etc.
Hypoproteinemia associated with absorption disorders, chronic liver disease, burns. A decrease in the amount of protein in the body leads, among other things, to a drop in the level of transferrin, which reduces the life-sustaining blood pressure.
Hereditary hemochromatosis. In this disease, too much iron is absorbed from food, the excess of which is deposited in various organs, causing them to become damaged.
Thalassemia – hereditary disease, in which the structure of hemoglobin is changed.
Cirrhosis of the liver.
Glomerulonephritis is inflammation of the kidneys.

What can influence the result?