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Updated: Feb 22, 2026

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Divide or subtract: transferrin saturation versus unbound iron binding capacity (UIBC).

Arne Åsberg1, Ann Elisabeth Åsberg2, Øyvind Skadberg1

  • 1Department of Medical Biochemistry, Stavanger University Hospital, Stavanger, Norway.

Scandinavian Journal of Clinical and Laboratory Investigation
|February 20, 2026
PubMed
Summary

Unbound iron binding capacity (UIBC) offers superior accuracy for diagnosing iron deficiency compared to transferrin saturation (TSAT). UIBC is also less affected by inflammation, making it a more reliable indicator.

Keywords:
Ferritininflammationironiron deficiencytransferrin

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Area of Science:

  • Clinical Chemistry
  • Hematology
  • Diagnostic Medicine

Background:

  • Plasma transferrin saturation (TSAT) is a traditional marker for iron deficiency but is influenced by inflammation.
  • Plasma ferritin is a preferred indicator of iron deficiency, yet TSAT is still widely used.
  • The behavior of unbound iron binding capacity (UIBC) during inflammation is not well understood.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of UIBC and TSAT for iron deficiency.
  • To assess the impact of inflammation on UIBC, TSAT, and ferritin levels.
  • To compare UIBC and TSAT as indicators of iron deficiency in a large patient cohort.

Main Methods:

  • Cross-sectional analysis of data from 21,681 patients.
  • Investigation of the relationship between UIBC, TSAT, ferritin, and C-reactive protein (CRP).
  • Comparison of diagnostic accuracy using ROC curves with ferritin thresholds (15, 20, 30 µg/L) as reference standards in a non-inflammatory subpopulation (CRP ≤ 1 mg/L).

Main Results:

  • UIBC demonstrated significantly less variation with CRP levels compared to TSAT and ferritin.
  • UIBC exhibited superior diagnostic accuracy for iron deficiency compared to TSAT (AUC 0.894 vs. 0.850, using ferritin < 20 µg/L).
  • UIBC values around 60 µmol/L corresponded to a ferritin level of 20 µg/L, indicating iron deficiency.

Conclusions:

  • Calculating UIBC provides a more accurate assessment of iron deficiency than TSAT.
  • UIBC is a more robust diagnostic marker for iron deficiency, especially in the presence of inflammation.
  • UIBC represents a superior method for utilizing plasma iron and total iron-binding capacity measurements for diagnosing iron deficiency.