Feeling dizzy and exhausted but lab reports show normal iron levels? UK surgeon shares 5 blood markers to get tested for

If you experience constant fatigue and dizziness but your bloodwork indicates normal iron levels, your deficiency might be at its early stages.

Feeling constantly exhausted, dizzy or unusually forgetful can be frustrating - especially when blood tests come back “normal” and offer no clear answers. But iron deficiency isn’t always obvious on standard reports. In many cases, symptoms begin when your iron stores start to run low, long before blood iron or haemoglobin levels fall. Understanding which markers to look at can make all the difference in getting an accurate diagnosis and timely care.

Dr Rajan recommends blood tests you should undergo to check your iron status accurately. (Pixabay)

Dr Karan Rajan, a UK-based surgeon and popular health content creator, is breaking down the key iron markers you should consider testing if you’re experiencing symptoms of iron deficiency - such as dizziness and persistent exhaustion - despite blood reports showing “normal” iron levels. In an Instagram video shared on December 18, the surgeon highlights that even when standard iron levels appear normal, storage iron is often the first to decline, and he outlines the specific tests needed for an accurate diagnosis.

Important iron markers

Dr Rajan explains that if you’re experiencing symptoms of iron deficiency despite “normal” blood reports, it may be worth checking your storage iron levels, as these are often the first to decline. He states, “If you've been told that your iron is normal, but you still feel exhausted, forgetful, have a low mood, this is what you should ask your doctor to check on your blood panels. The first thing to drop isn't iron in the blood, it's the storage iron.”

The surgeon outlines the following markers you should get tested for:

Ferritin

According to Dr Rajan, ferritin is the most sensitive marker and low levels can signal depleted iron stores long before the onset of anaemia. He states, “Ferritin is the earliest and most sensitive marker. Low ferritin equals empty iron reserves even before anaemia develops.”

Transferrin saturation

According to PubMed, transferrin is the crucial iron carrying protein and its saturation shows the percentage of iron-carrying protein that is actually loaded with iron. The surgeon explains that transferrin saturation reflects how much iron is actively circulating in the body and readily available for use.

Total iron binding capacity (TIBC)

TIBC is a blood test measuring the blood's ability to transport iron, primarily via the protein transferrin, according to Cleveland Clinic. Dr Rajan explains, “High TIBC means that your body is desperately trying to grab on to more iron.”

CRP

CRP is not directly linked to iron levels, but it is a key marker of inflammation. Checking CRP is important because inflammation can interfere with ferritin readings, potentially leading to misleading results. Dr Rajan explains, “Ferritin can be falsely high if inflammation is present. You need a combination of CRP and ferritin for accuracy.”

Haemoglobin and MCV

The surgeon points out that these are late-stage markers, meaning they tend to remain within the normal range until iron deficiency has significantly progressed, making them among the last indicators to fall.

How to improve iron absorption naturally?

Dr Rajan cautions against starting iron supplements at the first sign of symptoms without a proper diagnosis, noting that excess iron can be harmful and should only be taken when directed by a doctor.

He also recommends some simple ways to improve your iron absorption naturally. They include:

• Pair iron rich foods with vitamin C.
• Reduce teas and coffees with meals.
• Cook in cast iron.
• Check for gut issues affecting absorption - H. pylori, coeliac disease, low stomach acid
• Consider timing - iron supplements are best absorbed in an empty stomach, but if you get nausea, you can pair it with a light snack.

Dr Rajan concludes by highlighting, “Low iron is a spectrum. You can get a constellation of symptoms that appear before the classic low energy and dizziness symptoms.”

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. It is based on user-generated content from social media. HT.com has not independently verified the claims and does not endorse them.