Also Known As
sTfR
Transferrin Receptor
TfR
Serum Transferrin Receptors
This article was last reviewed on
This article waslast modified on October 2, 2019.
At a Glance
Why Get Tested?

To detect iron deficiency anemia and distinguish it from anemia caused by chronic illness or inflammation

When To Get Tested?

When iron deficiency anemia is suspected

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

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Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called "normal" values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Soluble transferrin receptors are proteins found in blood that can be elevated with iron deficiency. This test measures the amount of soluble transferrin receptors to help detect and evaluate iron deficiency and aid in the diagnosis of iron deficiency anemia.

Iron is an essential nutrient absorbed from the diet. Transferrin is the main protein in the blood that binds to iron and carries it to tissues and cells throughout the body. About 80% of iron is transported to the bone marrow, where it is incorporated into the hemoglobin in red blood cells (RBCs), and the rest is mostly stored in other cells and tissues as ferritin and hemosiderin.

When transferrin binds to iron, they form a complex. These complexes bind to transferrin receptors found on the surface of cells and the iron is then transported into the cells. Transferrin receptors are cleaved from the surface of cells, enter the bloodstream, and become soluble transferrin receptors (sTfR).

The number of transferrin receptors found on the surface of cells correlates with the level of iron within cells. When the iron level drops, the cells produce more transferrin receptors. As more receptors are produced, more are cleaved from cell surfaces and enter the blood, increasing the level of soluble transferrin receptors. Thus, measuring the level of sTfR is one way of evaluating the amount of iron available in the body.

Red blood cells have a lifespan of about 120 days. Because of this, the bone marrow must continually produce new RBCs. If there is insufficient iron taken in through the diet and/or increased iron loss (e.g., bleeding), iron reserve stored in the body is decreased. Over time, this can lead to iron deficiency, as the amount of iron stored in the body exhausts and the demand for iron exceeds the supply. As a result, fewer RBCs are produced and those newly formed RBCs are also smaller (microcytic) and contain less hemoglobin (hypochromic). This is a condition called iron deficiency anemia.

Usually, a ferritin test is used to evaluate the amount of iron reserve in the body and to help diagnose iron deficiency anemia. However, the ferritin level can be elevated when an individual has inflammation or a chronic disease, such as autoimmune disorders or some cancers. In these conditions, the ferritin test is not useful as it may falsely indicate adequacy in iron reserve and therefore a test for soluble transferrin receptors may be ordered.

Accordion Title
Common Questions
  • How is the test used?

    The soluble transferrin receptor (sTfR) test is primarily ordered to help distinguish between anemia that is caused by iron deficiency and anemia that is caused by inflammation or a chronic illness (so-called anemia of chronic disease or inflammation). It is not a routine test but may be ordered if other tests that evaluate the amount of iron in the body do not provide conclusive information.

    Typically, a group of iron tests is ordered to evaluate iron availability if a person has anemia and/or if iron deficiency is suspected. These tests may include iron, transferrin, TIBC (total iron-binding capacity, which is either measured or calculated based on the level of transferrin), transferrin saturation (calculated based on levels of iron and TIBC), and ferritin.

    Ferritin is usually the preferred test to evaluate stored iron, but it is an acute phase reactant, which means that it may be increased with inflammation or with chronic diseases such as autoimmune disorders, some cancers, and chronic infections. In these cases, ferritin may not be a good measure of stored iron. Since sTfR is not an acute phase reactant, it may be ordered as an alternative to ferritin if a chronic illness is present or suspected.

  • When is it ordered?

    The soluble transferrin receptor test is not routine but may be ordered along with or in follow up to other iron tests when you have a normal or near-normal ferritin level but iron deficiency is still suspected. It may be ordered as an alternative to ferritin when you have a chronic illness and/or inflammation is present or suspected.

     This test may be ordered when you have general signs and symptoms of anemia, such as:

    • Weakness, fatigue
    • Lack of energy
    • Paleness


    Or when you have signs and symptoms more specific for iron deficiency anemia, such as:

    • Brittle or spoon-shaped nails
    • Swollen or sore tongue
    • Cracks or ulcers at the corners of the mouth
    • Difficulty in swallowing
    • Craving to eat unusual non-food substances such as ice or dirt (also known as "pica")


    This test may also be ordered when a complete blood count (CBC) shows decreased hemoglobin and small red blood cells (low MCV).

  • What does the test result mean?

    The level of soluble transferrin receptor (sTfR) will be increased with iron deficiency. If you have anemia and your sTfR level is elevated, then it is likely that you have iron deficiency anemia. If your level is within the normal range, then it is more likely that the your anemia is due to another cause, such as chronic disease or inflammation.

    If you are being treated for iron deficiency anemia, decreasing sTfR levels in a series of tests indicates an increase in iron reserve.

    A low level of sTfR may be seen with hemochromatosis (a condition associated with iron overload) or protein malnutrition, but the test is not usually used to monitor these conditions.

  • Is there anything else I should know?

    African Americans may have moderately increased sTfR levels, as will people who live at higher elevations.

    Birth control pills may affect the test results.

    This testing may not be useful if you have an inherited disorder that affects hemoglobin production or function, such as thalassemia or sickle cell anemia. Test results may be elevated in people with red blood cell breakage (hemolysis) or recent blood loss and will not be accurate in those who have had a recent blood transfusion.

    An elevated sTfR level is not as specific for iron deficiency as is, for example, a very low level of ferritin.

  • Why not just order an iron test?

    A single iron test does not provide the full picture of the amount of iron that you have stored and available. It is usually necessary to evaluate the results of several related iron tests together. Ferritin is usually the preferred test to evaluate stored iron, but it is an acute phase reactant, meaning that it may be increased with inflammation or chronic diseases, such as cystic fibrosis patients who often have inflammation or infections, as well as people with diabetes who are treated with insulin. In these cases, ferritin may not be a good measure of stored iron as it may falsely indicate adequacy in iron reserve. The soluble transferrin receptor test is not a routinely order test, but since it is not an acute phase reactant, it may be ordered as an alternative to ferritin to evaluate stored iron when a chronic illness is present or suspected.

  • Can I have iron deficiency if I feel fine?

    Yes. Early deficiency usually will not cause any symptoms and when symptoms do emerge, they may be mild or nonspecific enough – such as fatigue – that they are attributed to something else.

  • How long does it take for results to become available?

    Soluble transferrin receptor testing requires specialized equipment and is not offered by every laboratory. Your sample may be sent to a reference laboratory and it may take a few days for results to be available.

  • Why does my doctor want to send a second sTfR test to the same laboratory as the first test?

    Test methods and reference (normal) ranges for sTfR will vary slightly from laboratory to laboratory. Your healthcare provider may prefer to send your samples to the same laboratory to make results more directly comparable.

  • Should I just take iron supplements?

    You should consult with your healthcare provider first. If you are anemic and/or at risk of anemia, then supplements may be useful. Excess iron in the body can cause health problems.

View Sources

Sources Used in Current Review

Soluble Transferrin Receptor (sTfR), Serum. Mayo Clinic Laboratories. Available online at https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/84283. Accessed May 2019.

Transferrin Receptor. Medscape. Available online at https://emedicine.medscape.com/article/2086300-overview. Accessed May 2019.

Iron-Deficiency Anemia. American Society of Hematology. Available online at http://www.hematology.org/Patients/Anemia/Iron-Deficiency.aspx. Accessed May 2019.

Transferrin. University of Rochester Medical Center. Available online at https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=transferrin. Accessed May 2019.

Anemia of Chronic Disease. National Organization for Rare Disorders. Available online at https://rarediseases.org/rare-diseases/anemia-of-chronic-disease/. Accessed May 2019.

Sources Used in Previous Reviews

Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 972-973.

(© 1995-2011). Unit Code 84283: Soluble Transferrin Receptor (sTfR), Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/84283. Accessed September 2011.

Lehman, C. and Roberts, W. (Updated 2011 April). Anemia. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/Anemia.html?client_ID=LTD. Accessed September 2011.

Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 1066-1067.

Clarke, W. and Dufour, D. R., Editors (© 2006). Contemporary Practice in Clinical Chemistry. AACC Press, Washington, DC. Pp 407-408.

Conrad, M. (Updated 2011 May 26). Iron Deficiency Anemia. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/202333-overview. Accessed September 2011.

González-Costello, J. and Comín-Colet, J. (2010 December 30). Iron Deficiency and Anaemia in Heart Failure: Understanding the FAIR-HF Trial. Medscape Today News from Eur J Heart Fail. 2010;12(11):1159-1162. [On-line information]. Available online at http://www.medscape.com/viewarticle/734494. Accessed September 2011.

Wish, J. (2006 September). Assessing Iron Status: Beyond Serum Ferritin and Transferrin Saturation. Clin J Am Soc Nephrol 1: S4–S8, 2006. [On-line information]. Available online at http://cjasn.asnjournals.org/content/1/Supplement_1/S4.full.pdf+html. Accessed September 2011.

Chen, Y. (Updated 2011 February 28). Iron deficiency anemia. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000584.htm. Accessed September 2011.

World Health Organization, Centers for Disease Control and Prevention (2007) Accessing the Iron Status of Populations. World Health Organization [On-line information]. Available online at http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/9789241596107/en/. Accessed October 2011.

Harmening D. Clinical Hematology and Fundamentals of Hemostasis, Fifth Edition, F.A. Davis Company, Philadelphia, 2009, Pp 120-130.

2015 review performed by Christina P. Nickel, MHA, MLS(ASCP)cm, Laboratory Quality Manager, Bryan Medical Center.

Centers for Disease Control and Prevention. Normal Iron Absorption and Storage. Available online at http://www.cdc.gov/ncbddd/hemochromatosis/training/pathophysiology/iron_cycle_popup.htm. Accessed on 9/16/15.

Mayo Medical Laboratories. Soluble Transferrin Receptor (sTfR), Serum. Available online at http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/84283. Accessed on 9/16/15.

(July 2009) Gupta, S. Uppal, B., and Pawar, B. Is soluble transferrin receptor a good marker of iron deficiency anemia in chronic kidney disease patients? PubMed. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859486/. Accessed 9/16/15.

(Mar 2013) Bableshwar, RS., Roy, M., Bali, A., Patil, PV., Inumella, S. Intensive method of assessment and classification of the bone marrow iron status: a study of 80 patients. PubMed. Available online at http://www.ncbi.nlm.nih.gov/pubmed/23924552. Accessed 9/16/15.

(2012) Infusino, I., Braga, F., Dolci, A., Panteghini, M. Soluble Transferrin Receptor (sTfR) and sTfR/log Ferritin Index for the Diagnosis of Iron-Deficiency Anemia A Meta-Analysis. American Journal of Clinical Pathology. Available online at http://ajcp.ascpjournals.org/content/138/5/642.full. Accessed 9/16/15.

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