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Melissa, B.S. Biology/Psychology
Category: Health
Satisfied Customers: 1335
Experience:  B.S. Biology/Psychology - University of Georgia
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i had a blood test which showed my iron level was ...

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i had a blood test which showed my iron level was 27
mcv-76.3 mch-24.4 mchc-31.9 rdw-17.7 and tbili-1.7 all of these were marked as abnormal. i am often fatigued which I know could be the iron but I also have joint pain daily and it is often symmetrical with some swelling in my knee joints. I have tried every iron pill I can find but they all make me sick. what could this be indictative of.
Submitted: 9 years ago.
Category: Health
Expert:  Melissa replied 9 years ago.

First, to explain the blood test results:

  • Iron is a mineral that plays a role in hemoglobin formation in blood, which is responsible for binding oxygen in red blood cells, which is then carried to the rest of the body to nourish it with oxygen. Normal range is 50-150 µg/dl; yours is 27, which is too low and indicates anemia.
  • MCV stands for "mean corpuscular volume," or the average size of your red blood cells. Low values suggest iron deficiency, and high values indicate either a B12 or folate deficiencies. The normal range is from 80 - 100 fl, and yours was 76.3, which is only slightly low
  • MCH stands for "mean corpuscular hemoglobin," and measures how much hemoglobin you have in your red blood cells (which, again, carries oxygen). Ideal range is from 27 - 33 pg, and, again, your reading is lower at 24.4, which means you don't have enough hemoglobin.
  • MCHC stands for "mean corpuscular hemoglobin concentration," and is similar to MCH, but is a measure of the concentration of hemoglobin in the red blood cells. Normal range for this is 32 - 36 %, and yours is slightly low at 31.9%, which just confirms that you have an iron deficiency anemia.
  • RDW is "red cell distribution width," and measures the variation in size of your red blood cells, as these can sometimes be too large or too small to work efficiently in some people. Together with other values, such as MCV, it can be used to help find the cause for anemia. Normal range is 11.0 - 15.0, so yours is high at 17.7. This means that you have you have too high of a variation in sizes of your RBCs (red blood cells). Too many of them might be immature, or it might indicate a certain type of anemia, particularly, pernicious anemia.
  • tbili is "total bilirubin" levels. Tbili is a product from the breakdown of hemoglobin from red blood cells. The normal levels are between 0.1 and 1.2 mg/dl, with yours being high at 1.7. High levels mean that the liver is not doing its job in removing this waste product out of the blood, and can possibly indicate things like liver dysfunction or blockages, liver damage

Obviously, from these results, you have an iron deficiency type of anemia. Hemoglobin complexes in red blood cells attract and bind oxygen molecules so that blood can carry oxygen to the rest of the cells of the body. Since hemoglobin is made up of iron and you lack iron, you also lack hemoglobin and thus, can't carry enough oxygen to your tissues. This is called anemia, and isn't a disease itself, but usually a symptom of an underlying disease can result in such symptoms as cold intolerance, fatigue, depressed immune function, and brittle nails, pain, among others.

Usually, when your MCV is less than 81, you have what's called "microlytic anemia." When the RDW values are also elevated in microlytic anemias, the main causes are either iron deficiencies (from nutritional, malabsorption, and bleeding problems), or a genetic disease called Thalassemia. There are 4 main groups of causes of anemia.

  1. Iron deficiency. This can be caused by some type of blood loss, such as with a gastrointestinal bleed, and rarely these days, poor diet.
  2. Vitamin and/or mineral deficiencies, such as vitamin B12, folic acid, copper, and other minerals
  3. Production problems caused by a secondary illness. Infections and inflammation can lead to anemia, for example, as can blood disorders like leukemia, lymphoma and other diseases of the bone marrow, cancer, lupus, or arthritis.
  4. Hemolysis, or breakdown of red blood cells caused by sickle cell, hemoglobinopathies, spherocytosis, elliptocytosis (oval ), or autoimmune disorders (which can be diagnosed with a Coombs test).

Further diagnostic tests used in combination with the blood test you've just had, including reticulocyte count, coombs antibody test, serum haptoglobin test, and enzyme deficiency and liver function tests might be helpful to determine the cause of your anemia (and as you can see here:, the potential causes are numerous). The best treatment will depend on the cause and nature of what's causing the anemia in the first place and might include iron supplements, vitamin supplements, erythropoetin meds, and antibiotics (if indicated).

Additionally, if iron pills make you sick, try taking over-the-counter "Slow-Fe," which is slow release iron tablets. Because they are slow release, people are able to tolerate them better. If this still does not work, you may need to switch to intramuscular or IV forms of iron, as well as foods that are rich in iron (raisins, meats, fish, poultry, eggs, legumes, and whole grain bread.

I hope this helps!


Melissa, B.S. Biology/Psychology
Category: Health
Satisfied Customers: 1335
Experience: B.S. Biology/Psychology - University of Georgia
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