Deironing process from notes of Larry Dunn:

Iron content based on staining reactions are usually graded "0 - 4". So you have a significant amount of iron (with a 3), but there was room for more. The quantitative determination of iron in the liver is more of a hard and fast number. In the stages leading to iron deficiency anemia the first stage is iron depletion where iron stores begin to be depleted but there is still plenty to support normal RBC production and normal Hgb/hematocrit are present. Stage II is referred to as "iron deficient erythropoiesis"(RBC production). During this stage, iron content based on the staining reaction is "0", meaning there is no detectable iron. At this stage, FEP(free erythrocyte porphyrins) become increased as the earliest marker that the person has iron deficient erythropoeisis (aside from performing a bone marrow)(FEP is not a routinely ordered test)The heme part of hemoglobin consists of ferrous iron + a porphyrin compound (protoporphyrin IX). As soon as we run out of iron, there is still plenty of the porphyrin being produced, so the free(extra) erythrocyte porphyrin increases. During stage II, Hgb/HCT are still normal. Stage III is iron deficiency anemia with a decreased Hgb/HCT (Hgb<10). When HH patients are de-ironed and their Hgb/Hct doesn't "bounce back", they have reached stage three. At this point iron stores(zero) are not able to maintain a normal rate of erythropoeiesis. Stage II ferritin levels are  usually between10-20. Stage III levels are usually less than 10. Individuals may vary in their numbers. We are all unique and don't respond "exactly" the same when it comes to evaluating lab numbers. What happens in the liver to the stored iron? If the iron-ferritin-hemosiderin physiology is the same in the liver as it is in the bone marrow (I don't know why it would be different), then the iron stores (including hemosiderin) are also gone in the liver. I think that the Hgb/HCT levels that don't "bounce back" are the best indicators of de-ironing, because that is the body's way of saying "where's the iron?" Ferritin levels can fluctuate at times, and although it is usualy a reliable indicator of iron stores, individual results may be misleading. I am not a doctor, I am a Medical Technologist who is also a teacher of Medical Technology(explains why I can't get to the point sometimes). The info I have shared is pretty solid based on current Hematology sources. I am just passing it on. If I have missed something or  misrepresented something, then I hope Dr. Clayton or Dr. Sullivan will set us(me) straight.

Larry Dunn M.S., MT(ASCP)



Clinical Hematology and Fundamentals of Hemostasis; Harmening,PhD;1997;pp. 97-112

Textbook of Hematology; McKenzie,PhD;1996;pp.123-144

Clinical Diagnosis and Management by Laboratory Methods; Henry, MD;1996 pp.617-620.