Total iron-binding capacity of serum. Ozhss: what is it? diagnosis of iron deficiency in hypothyroidism

Lowered levels iron can lead to anemia, a decrease in red blood cell production, microcytosis (a reduced size of red blood cells), and hypochromia, in which red blood cells become pale color due to lack of hemoglobin. One of the tests that helps assess the state of iron in the body is "total serum iron-binding capacity." It measures 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 sustain life. Thanks to him, 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 the 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 iron throughout the body. When Fe stores in the body are low, transferrin levels increase.

Conversely, with an increase in iron stores, the production of this protein decreases. At healthy people one third of all transferrin is used for iron transport.

Fe residues that are not used for cell building are stored in tissues in the form of two substances, ferritin and hemosiderin. This stock is used to make other types of proteins, such as myoglobin and certain enzymes.

Iron Tests

Tests showing the iron status of the body can be done to determine the amount of iron circulating in the body. circulatory system, the ability of the blood to carry this substance, as well as the amount of Fe stored in the tissues for the future needs of the body. Testing can also help distinguish different reasons anemia.

To assess the level of iron in the blood, the doctor prescribes several tests. These tests are usually performed simultaneously to provide a comparative interpretation of the results needed to diagnose and/or monitor Fe deficiency or excess in the body. The following tests are used to diagnose iron deficiency or excess in the body:

• 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 the level of Fe in the blood.
• Unsaturated iron-binding capacity - measures the amount of transferrin that is not bound to iron molecules. The NWSS also reflects general level transferrin. This test is also known as "latent serum iron-binding capacity".
• Transferrin saturation is calculated according to its saturation with iron molecules. This allows you to find out the proportion of transferrin saturated with Fe.
• Serum ferritin values ​​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 a chronic disease or inflammation.

Another test is an analysis for protoporphyrin associated with zinc. This is the name of the precursor of a part of hemoglobin (heme), which contains Fe in its composition. 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, measurement of zinc-bound protoporphyrin is not a specific test for detecting Fe problems. That's why elevated values of this substance must be confirmed by other analyses.

For the study of iron may be prescribed genetic tests the 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 absorption of iron from food in the intestines.

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

General blood test

Together with the above tests, the doctor examines the data of the general blood test. These studies include tests for hemoglobin and hematocrit. Decreased values ​​of one or both tests indicate that the patient has anemia.

Calculations of the average number of erythrocytes (average cell volume) and the average number of hemoglobin in erythrocytes (average cellular hemoglobin) are also included in the complete blood count. Fe deficiency and the accompanying insufficient production of hemoglobin 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 identify problems with iron by counting young erythrocytes, 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 ordered?

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. Also, the doctor may refer the patient to tests for Fe if the following symptoms are present:

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

Determination of the content of iron, OZhSS and ferritin may be prescribed if the patient has symptoms of excess or poisoning of Fe. This can be manifested by joint pain, lack of energy, abdominal pain, heart problems. If a child is suspected of having taken too many iron tablets, these tests 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, assigned additional research HFE gene to confirm the diagnosis of this hereditary disease. Cases of hemochromatosis in relatives of the patient may speak in favor of such a suspicion.

Deciphering the results

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

An acute excess of iron can result from the use of a large number iron-containing food additives. This is especially common in children. Chronic excess of Fe can also be a consequence overuse this substance along 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-containing status of the organism are indicated in the following table:

Disease	Fe	TIBC/transferrin	NWSS	% transferrin saturation	ferritin
iron deficiency	Downgraded	Above normal	Upgraded	Below normal	Downgraded
Hemochromatosis	Upgraded	Downgraded	Downgraded	Upgraded	Upgraded
chronic diseases	Downgraded	Downgraded	Decreased / normal	Below normal	normal/increased
Hemolytic anemia	Above normal	OK / low	Decreased / normal	Upgraded	Upgraded
Sideroblastic anemia	normal/increased	normal / low	Decreased / normal	Upgraded	Upgraded
iron poisoning	Upgraded	Fine	Below normal	Upgraded	Fine

IN mild stage deficiency of iron, the consumption of reserves of this substance is slow. This means that the 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.

Since the consumption of iron continues, its deficit increases, and therefore the supply of Fe gradually comes to an end. To compensate for this deficiency, transferrin production is increased in the body to increase Fe transport. Thus, plasma iron levels continue to fall, while transferrin and TIBC continue to rise. 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 the intake of products containing enough necessary for the body iron and increasing its deficiency.

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

Normally, transferrin is saturated with iron by approximately 30%, and the extra amount of iron that can bind to transferrin is called the latent (unsaturated) serum iron-binding capacity. LZhSS or NZhSS - represents the difference between the total iron-binding capacity (OZHSS) and the actual saturation of transferrin. This is expressed by the formula: LZhSS (NZhSS) \u003d OZHSS - Serum iron.

Total iron-binding capacity of serum (OJSS, Total Iron Binding Capacity, TIBC) - maximum amount iron, which can attach transferrin to full saturation. It is set as the sum of indicators - Serum iron + latent (unsaturated) iron-binding capacity of serum (LZhSS, NZhSS - from the English Unsaturated Iron Binding Capacity, UIBC). Due to the exact molar ratio of iron binding by transferrin, the determination of TIBC can be replaced by a direct quantitative measurement of transferrin.

OZhSS - reflects the content of protein-transferrin in serum (see "Transferrin (Siderophilin)", which carries iron in the blood.
Under physiological conditions, transferrin is saturated with iron by about 30% of the maximum capacity for saturation. The LVVR reflects the amount of iron that transferrin can attach to achieve maximum saturation. The determination of this iron is carried out after transferrin saturation with the addition of excess iron (ferric chloride is added). Unbound iron is removed and bound to transferrin is processed acetic acid followed by the release of iron. This iron is reduced with hydroxylamine and thioglycolate. Next is the calculation of reduced iron. It is possible to determine unbound iron ions by reaction with ferene. The difference between the amount of excess iron ions (not bound 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 the LVVR of the blood serum.

An increase in FBC is observed in iron deficiency anemia, in contrast to other types of hypochromic anemia. Such an increase in the content of transferrin 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 serum iron-binding capacity. The analysis of the OHSS 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 FBC rises, we can draw conclusions about the low content of iron in the blood, which is hallmark iron deficiency anemia. Serum binds more iron than is normally required. If the values ​​of TIBC are low, then this is the result of an increase in serum iron that accompanies hyperchromic anemia (that is, the accumulation of iron in excess), 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 insufficiency, with hepatitis or cirrhosis), then the concentration of the carrier protein decreases significantly, which means that the readings of the OZhSS test also change.

Serum iron concentration and TIBC are the basis for calculating the transferrin saturation factor.

It must be said that the use of such groups of drugs as corticotropin, asparaginase, testosterone, chloramphenicol, and cortisone can reduce TI. Oral contraceptives and estrogens contribute to the increase in results. The TIBC also decreases due to the intake of iron-containing drugs, which is why about a week (at least five days) before taking blood, they should be stopped.

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

Method for determining iron-binding capacity

The main methods by which the TIBC of blood serum is determined include colorimetric analysis and absorption spectroscopy. Now the first method is most widely used, which consists in the fact that iron is introduced into the analyzed serum in excess. Some of it binds to the carrier protein, and the iron that does not bind is removed. According to a certain amount of it, one can draw a conclusion about the value of the OZHSS. Raised, as well as lowered, it happens often.

Alternative Method

Since the described method (despite the high degree of certainty) is quite lengthy and labor intensive, some laboratories use alternative method an analysis that separately determines what the iron content is in the FIA ​​(unsaturated iron binding capacity) and in the blood serum. These indicators are summarized, as a result, the indicators of the OZHSS are obtained. In this regard, quite often there is a simultaneous determination of TIBC, serum iron and NFA in many laboratories.

If OZhSS is increased, what does it mean? This question interests many.

Hypothyroidism and related iron deficiency

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

Any kind of anemia is not a disease in itself, but it can be concomitant symptom with a list of diseases, and they, in turn, can be both interconnected with primary lesion blood system, and flow 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 index as a single classification feature. Serum iron TIBC is an important indicator.

The state of iron deficiency is probably known to many people, but few people realize that a malfunction of the thyroid gland can cause it. It 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 erythrocytes in the patient.

In addition, scientists have determined that the initial iron deficiency is the cause of the development of hypothyroidism. To do this, determine the OZHSS in the blood. What it is, we have already explained.

2 types of violations

Violation of the functioning of iron has two directions:

To hypothyroidism - a decrease in function;

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

An absolutely proven fact at present is that hypothyroidism can cause poor absorption of iron due to its lack. Concerning hyperthyroidism, there are disputes, such a combination is much less common than the combination of anemia and hypothyroidism (50% of cases, even if the anemia is mild). What is it - OZhSS? This frequently asked question patients.

How is iron absorbed?

To understand the mechanism of the influence of thyroid hormones on the absorption of iron, 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 supplied to the body from the food a person eats in order to avoid a shortage.

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

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

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

Causes of anemia in hypothyroidism

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

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

In women with profuse menstruation;

With malabsorption syndrome;

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

With celiac disease;

At frequent bleeding from the nose;

With frequent immense donor blood donations;

With severe blood loss;

When attempting suicide by opening the veins, which was not completed;

At mental disorder consisting in constant bloodletting.

These conditions are not normal, so you need to see a doctor. If you do not identify the cause of anemia, then you will not be able to correct your well-being.

What does chronic iron deficiency lead to?

Chronic lack of iron provokes malfunctions 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 impact hormones are reduced, signs of hypothyroidism appear. In parallel, the activity of another significant enzyme decreases: we are talking about thyroperoxidase, 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 (lowered FBC) in hypothyroidism and the causes of the development of the disease have been scientifically proven. In addition, there is information that during hypothyroidism, the 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 rather mild. Sometimes it is possible to trace an increase in MCV, and when deciphering blood tests, in some cases, shriveled red blood cells may be present, having irregular shape. In the bone marrow, the characteristics of erythroid hypoplasia are found. A careful study of the kinetics of iron reveals that its indicators and clearance data from plasma are reduced. The same process is observed during the maturation of erythrocytes with utilization. In patients with hypothyroidism, a disease such as atrophic type gastritis is very often found, which results in a lack of iron or vitamin B12. Based on these data in clinical picture changes may occur.

In the presence of hypothyroidism, these data should not be forgotten. Sometimes a routinely prescribed complete blood count gives the doctor a reason to think about the presence of hypothyroidism in a patient. Since thyroid hormones are directly involved in the regulation of hematopoiesis, their lack is reflected in the fact that blood parameters change. In this case, anemia can be cured only if the main pathology provoking it is successfully cured.

We have considered the indicator of OZHSS. What it is is now clear.

Iron-binding capacity of blood serum

The iron-binding capacity of blood serum (IBC) is an indicator that characterizes the ability of blood serum to bind iron. Iron in the human body is in combination with a protein - transferrin. YCC measures the concentration of transferrin in the blood serum. The iron-binding capacity of blood serum changes in violation of the metabolism, breakdown and transport of iron in the body. For the diagnosis of anemia, the determination of the latent iron-binding capacity of blood serum (LJCC) is used - this is JCC without serum iron. The rate of latent JSS is 20-62 µmol / l.

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

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

Ferritin is the main indicator of iron stores 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 body fluids. A blood test for ferritin is used to diagnose iron deficiency anemia and to diagnose anemia that accompanies infectious, rheumatic, and neoplastic diseases.

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

An excess of ferritin in the blood may be due to 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.

An increase in ferritin levels occurs when taking oral contraceptives and starvation. Low ferritin is a consequence of iron deficiency (iron deficiency anemia).

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

Russian synonyms

Unsaturated iron-binding capacity of serum, NZhSS, LZhSS.

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 study, you can drink clean non-carbonated water.
• Stop taking medicines containing iron, 72 hours before the study.
• Eliminate physical and emotional overstrain and do not smoke for 30 minutes before the study.

General information about the study

Iron - important trace element in organism. It is part of the hemoglobin that 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 carried 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 amount) circulates in the blood "in conjunction" with transferrin. The level of transferrin depends on the functioning of the liver and on the nutrition of the person. Normally, 1/3 of the binding centers of transferrin are filled with iron, the remaining 2/3 remain in reserve. The latent serum iron-binding capacity (LBI) reflects how much transferrin is "not filled" with iron.

This parameter can be calculated according to the following formula: LIBC = TIBC - serum iron (TIBC is the total iron-binding capacity of blood serum - an indicator that characterizes the maximum ability of transferrin to "fill up" with iron).

In iron deficiency, transferrin becomes larger so that this protein can bind to the small amount of iron in the serum. Accordingly, the amount of transferrin "not occupied" by iron, that is, the latent iron-binding ability of serum, also increases.

Conversely, with an excess of iron, almost all the binding centers of transferrin are occupied by this microelement, so the latent iron-binding capacity of the serum decreases.

The amount of serum iron can vary considerably depending on different days and even within one day (especially in the morning hours), however, OZHSS and LZhSS 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 only make itself felt when hemoglobin drops below 100 g / l. Usually these are complaints of weakness, fatigue, dizziness, headaches.

What is research used for?

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

The purpose of these tests is to diagnose iron deficiency or excess. In patients with anemia, they allow us to find out whether the disease is due to iron deficiency or other causes, for example chronic disease or deficiency of vitamin B 12 .

When is the study scheduled?

• When any deviations are found in general analysis blood test, hemoglobin test, hematocrit, red blood cell count (along with a serum iron test).
• If you suspect a deficiency or excess of iron in the body. With a severe lack of iron, there is shortness of breath, pain in 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 an overload of the body with iron (hemochromatosis). This condition manifests itself in many ways, such as pain in the joints or in the abdomen, weakness, fatigue, decreased sexual attraction, cardiac arrhythmias.
• When monitoring the effectiveness of the treatment of iron deficiency or excess.

What do the results mean?

Reference values: 20 - 62 µmol/l.

The interpretation of the results of the analysis for LZhSS, as a rule, is made taking into account other indicators that evaluate iron metabolism.

Reasons for the increase in OVSS

• Anemia. It is usually caused by chronic blood loss or insufficient consumption of meat products.
• Third trimester of pregnancy. In this case, the level of iron in the serum decreases due to an increase in the need for it.
• Acute hepatitis.
• Multiple blood transfusions, intramuscular iron administration, inadequate administration of iron preparations.

Reasons for lowering the OZhSS

• Chronic diseases: systemic lupus erythematosus, rheumatoid arthritis, tuberculosis, bacterial endocarditis, Crohn's disease, etc.
• Hypoproteinemia associated with malabsorption, 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 TIBC.
• hereditary hemochromatosis. With this disease, too much iron is absorbed from food, the excess of which is deposited in various organs, causing their damage.
• 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?