Assessment of Iron Levels in Settings of Infections in Patients with Normal Hemoglobin

During our daily routine in laboratory, we noticed that in patients with changes in white blood cell (WBC) count, which are accompanied by elevated levels of C-reactive protein (CRP), a decrease in the levels of iron is found, even though the hemoglobin concentration is within the reference range. We aimed to figure out if low levels of iron are related to infections and whether they are signs of anemia and aimed to evaluate the possible correlations between iron levels and WBC and CRP.

We performed a descriptive and retrospective study including 159 outpatients with signs of infections and with normal concentration of hemoglobin, from January 2023 through December 2024. We used Jamovi Statistical Software version 2.3.28. We used the Shapiro-Wilk test for normal distribution and F-test for variances. We tested differences with Mann-Whitney and ANOVA for non-parametric variables between two or more groups, respectively. We performed Pearson's correlations and did the linear regression analysis. A two-sided p-value equal to or less than 0.05 was considered statistically significant.

The study included 70 women (44%) and 89 men (56%), with a median age of 27 years (1 - 91 years) and 32 years (1 - 91 years), respectively. Based on one-way ANOVA or Mann-Whitney test for independent samples, we found differences in iron levels between children, adults, and elderly (p < 0.001) and differences between nor-mal and elevated levels of WBC (p = 0.019). We also found correlations between iron and CRP (r = -0.255, p = 0.001), iron and WBC (r = -0.337, p < 0.001), and CRP and WBC (r = 0.189, p = 0.017). Based on regression anal-ysis, CRP and WBC can both serve as a predictor of serum iron levels, with a probability of 15.2%.

We conclude that there is a correlation between iron levels and CRP and WBC and that low levels of iron are related to settings of infections.