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Iron is stored in macrophages with storage protein apoferritin. It is also used for the synthesis of certain enzymes. Most of the iron is incorporated into hemoglobin and myoglobin. Together, iron and apo-transferrin form transferrin, but occasionally the terms transferrin and apo-transferrin are interchangeably used as the bond formed between them is non-covalent. It binds to iron and delivers it to various tissues, mainly bone and liver. Apo-transferrin is an iron-transporting protein present in the blood. The ferric iron is then picked up by apo-transferrin. Before being transported into the blood, the ferrous iron is converted to ferric form by hephaestin. Ferroportin is a transporter present on the basolateral surface of enterocytes. The absorbed iron can be stored along with apoferritin, an iron storage protein, in the enterocytes, or can be absorbed into the blood through ferroportin.
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The heme form of iron is absorbed directly through a heme transporter. The ferric form is enzymatically reduced to ferrous form and then absorbed in the gut by the divalent metal ion transporter located on the apical surface of the intestinal epithelium. The elemental iron is released from its bound form in the food by the action of hydrochloric acid in the stomach. The food we consume has iron in two forms, heme and non-heme. TIBC is used in both iron deficient and overload scenarios to establish the diagnosis. The most common cause of death in hemochromatosis is liver cirrhosis and ventricular arrhythmias. The disrupted homeostasis of iron metabolism results in the deposition of iron in various organs of the body, causing liver cirrhosis, bronze diabetes, neurological deficits, and arrhythmias. If left untreated, severe iron overload is potentially fatal, resulting in organ damage. The most common iron overload disorder is hemochromatosis. Iron overload conditions can be hereditary or acquired. Iron deficiency anemia, which is normocytic in early stages and microcytic in later stages, is the most common type of anemia worldwide. Anemia is classified based on the mean corpuscular volume (MCV) into microcytic, normocytic, or macrocytic anemia. One of the tests included in the iron panel is TIBC. Iron panels are routinely run in patients with anemia.
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