Saturazione della transferrina : c’era una volta il test

Despite the growing interest in hepcidin and other new biomarkers, guidelines and clinical pathways continue to recommend traditional markers, such as serum transferrin saturation (TS) and ferritin, as laboratory tests for the diagnostic evaluation of iron-related disorders. Here we aimed to critically evaluate the diagnostic role of TS relying on the highest level of available evidence by a comprehensive literature search. The role of TS in iron deficiency (ID) and iron overload (IO) syndrome as well as a risk marker was evaluated. The low accuracy of TS in the diagnosis and management of ID conditions does not permit recommending its use, even if recently published guidelines still consider the TS investigation as a complementary test for serum ferritin. If an IO is suspected, TS is often used even if it may not be the best test for detecting this condition. Nevertheless, clinical guidelines strongly recommend the use of TS as a first-level test for performing genetic diagnosis of hereditary emochromatosis. Recent data indicating elevated TS as a risk factor for diabetes mellitus, cancer, and total mortality may provide useful additions to the debate over whether or not screen for IO using TS.