Iron Status Assessment in Clinical Health Contexts

Assessing iron status is fundamental to clinical care owing to iron’s central role in oxygen transport, energy metabolism and immune function. Iron deficiency and overload both carry serious health implications, ranging from anaemia and impaired cognition to cardiomyopathy and organ toxicity. Clinicians employ biochemical, haematological and, increasingly, non-invasive techniques to characterise iron stores and erythron availability. Common measures include serum ferritin, transferrin saturation and soluble transferrin receptor, each reflecting distinct compartments of iron metabolism. Advances in point-of-care testing and biomarker integration now permit a more nuanced differentiation of iron deficiency, inflammation-driven anaemia and hereditary iron-loading disorders. Effective iron assessment informs targeted interventions such as dietary optimisation, oral or parenteral supplementation and chelation therapy. Emerging optical and microfluidic platforms promise rapid and field-friendly screening, expanding diagnostic reach into resource-limited settings. The convergence of traditional assays with novel biomarkers enhances early detection, guides personalised therapy and supports population health strategies to address iron-related morbidity worldwide.

Research from Nature Portfolio

Innovative optical detection of zinc protoporphyrin in the lip microcirculation offers a non-invasive approach to screen for iron deficiency without venepuncture. Dual-wavelength fluorescence spectroscopy distinguishes low-intensity zinc protoporphyrin emission from background tissue signals, achieving sensitivity and specificity exceeding 90 per cent in trial cohorts. This method holds promise for rapid, community-level screening where laboratory infrastructure is scarce. Separately, population-based analysis of soluble transferrin receptor has revealed its prognostic value beyond anaemia. Elevated circulating levels predict all-cause mortality and the development of chronic kidney disease independently of ferritin and haemoglobin status. These findings underscore soluble transferrin receptor as a dynamic marker of unmet cellular iron demand, with implications for risk stratification and long-term monitoring.

Iron Status Assessment in Clinical Health Contexts publication trend

The graph below shows the total number of articles in iron status assessment in clinical health contexts across all publications each year (not limited to Nature Index journals).

Technical terms

Serum ferritin: A protein complex that stores iron; serum concentration reflects body iron reserves.

Soluble transferrin receptor (sTfR): A truncated form of the cellular transferrin receptor released into the bloodstream; indicates erythroid iron demand.

Zinc protoporphyrin (ZPP): A haem precursor that accumulates in red blood cells under iron-limited conditions; serves as a non-invasive fluorescence marker of functional iron deficiency.

sTfR/log ferritin index: A calculated ratio combining cellular iron demand and stored iron measures to assess the full spectrum of iron status.

References

1. Non-invasive detection of iron deficiency by fluorescence measurement of erythrocyte zinc protoporphyrin in the lip. Nature Communications (2016).
2. Soluble transferrin receptor can predict all-cause mortality regardless of anaemia and iron storage status. Scientific Reports (2022).
3. Association of soluble transferrin receptor/log ferritin index with all-cause and cause-specific mortality: National Health and Nutrition Examination Survey. Frontiers in Nutrition (2024).
4. Increased Serum Soluble Transferrin Receptor Levels Were Associated With High Prevalence of Cardiovascular Diseases: Insights From the National Health and Nutrition Examination Survey 2017–2018. Frontiers in Cell and Developmental Biology (2022).
5. Causes of Moderate and Severe Anaemia in a High-HIV and TB-Prevalent Adult Population in the Eastern Cape Province, South Africa. International Journal of Environmental Research and Public Health (2023).