Also Known As
Transferrin Receptor
Serum Transferrin Receptors
Formal Name
Soluble Transferrin Receptor
This article was last reviewed on
This article waslast modified on
March 20, 2018.
At a Glance
Why Get Tested?
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?


You may be able to find your test results on your laboratory's website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab's website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab's website or portal, or contact your healthcare practitioner in order to obtain your test results.

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 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 and a test for soluble transferrin receptors may be ordered.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

Accordion Title
Common Questions
  • How is it 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 a person has symptoms of anemia such as:

    • Weakness, fatigue
    • Lack of energy
    • Paleness

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

    It may be ordered when a person has a normal or near normal ferritin level, but iron deficiency is still suspected. It may be ordered as an alternative to ferritin when a person has a chronic illness and/or inflammation is present or suspected.

  • What does the test result mean?

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

    A decreasing sTfR level indicates an increase in iron reserve in a person being treated with iron supplements. A low level of sTfR may be seen with hemochromatosis (a condition associated with iron overload), but the test is not usually used to monitor this condition.

  • Is there anything else I should know?

    Those of African American descent may have moderately increased sTfR levels, as will those who live at higher elevations.

    Testing may not be useful in those who have inherited disorders that affect hemoglobin production or function, such as thalassemia or sickle cell anemia. Test results may be elevated in those 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.

    When a person is not iron deficient, the amount of sTfR present in the blood reflects the rate of red blood cell production by the bone marrow. Soluble transferrin receptor testing is not routinely performed to evaluate this process.

  • Why not just order an iron test?

    A single iron test does not provide the full picture of the amount of iron that a person has 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. In these cases, ferritin may not be a good measure of stored iron. 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.

  • Can my test for sTfR be performed in my doctor's office?

    No. Testing requires specialized equipment and is not offered by every laboratory. Your test may be sent to a reference laboratory.

  • 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

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 through Accessed on 9/16/15.

Mayo Medical Laboratories. Soluble Transferrin Receptor (sTfR), Serum. Available online at through 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 through 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 through 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 through Accessed 9/16/15.

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 through Accessed September 2011.

Lehman, C. and Roberts, W. (Updated 2011 April). Anemia. ARUP Consult [On-line information]. Available online at through 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 through 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 through 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 through Accessed September 2011.

Chen, Y. (Updated 2011 February 28). Iron deficiency anemia. MedlinePlus Medical Encyclopedia [On-line information]. Available online at through 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 through Accessed October 2011.

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

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