# TSAT and Iron Panel Algorithm for Hemochromatosis Screening > AASLD uses TSAT ≥45% as the sensitive phenotypic trigger (detects ~98–100% of C282Y homozygotes). Pair with ferritin, then HFE genotyping—do not use TSAT alone as phlebotomy endpoint. *Published 2026-07-10 · By Marcus Chen* In short **TSAT ≥45%** is the sensitive AASLD phenotypic trigger (~98–100% of C282Y/C282Y). Always pair with **ferritin**; genotype next; track phlebotomy with ferritin 50–100. Transferrin saturation is the tripwire. Ferritin is the tank gauge. Genetics names the wiring fault. Mixing those jobs confuses screening with treatment. *This article is informational and editorial only. It is not medical advice, diagnosis, or a treatment plan. Numbers and literature ranges cited here are not personal prescriptions. Consult a qualified clinician before changing medications, supplements, diet, equipment, or management of a diagnosed condition. Seek urgent care for emergencies.* ## How is TSAT calculated and used? TSAT equals serum iron divided by TIBC (or equivalent transferrin methods). Elevated TSAT reflects high circulating iron relative to binding capacity. It is the most sensitive initial phenotypic screen for classic HH. ## What is the dual-marker algorithm? Symptoms or family history → TSAT + ferritin. Either abnormal → HFE mutation analysis. Normal dual markers → overload unlikely; pursue other hyperferritinemia causes if ferritin high with low TSAT. Key reference points StepActionThreshold/note 1 PhenotypeTSAT + ferritinTSAT ≥45% or ferritin >ULN 2 GenotypeHFE analysisC282Y/C282Y primary 3 StageOrgans / imagingFerritin 1000 node 4 TreatPhlebotomyFerritin goal 50–100 ## How do EASL and CAP align? Elevated TSAT with high ferritin prompts genotyping; C282Y/C282Y can confirm diagnosis. CAP clinician materials flag unexplained TSAT >45% for HFE consideration. European CPGs update investigation of classical and non-classical forms. ## What pitfalls distort panels? Recent iron supplements, timing after meals, and hemolysis. Using TSAT as sole maintenance endpoint. Skipping family cascade once a proband is confirmed. Sources: [AASLD 2011 guideline](https://pmc.ncbi.nlm.nih.gov/articles/PMC3149125/); [CAP clinician HH handout](https://documents.cap.org/documents/HereditaryHemochromatosisClinicianHandout.pdf); [AAFP hemochromatosis](https://www.aafp.org/afp/2013/0201/p183). Readers should dual-source primary literature, translate slogans into exposure units and effect sizes, and rank interventions by expected value under uncertainty. Cheap reversible steps often outrank extreme protocols. Opportunity cost is real: hours spent on unvalidated tests are hours not spent on sleep, training, protein adequacy, and primary care. Sex, life stage, comorbidities, medications, and geography change interpretation. Prefer falsifiable claims with named endpoints over multi-disease cure lists. Update beliefs when stronger trials appear rather than freezing identity around a single paper or influencer narrative. Measured curiosity beats both panic and complacency. Further reading should prioritize primary sources and consensus documents over secondary social summaries. When evidence is mixed, state both the signal and the limits in the same paragraph. When evidence is strong, still avoid overclaiming universality across populations. Pattern quality, dose, and adherence dominate most household decisions more than brand seals. Context, dose, endpoint, and population must travel together; slogans that drop any of those four are not finished claims. Household decisions should favor reversible experiments with measurable outcomes over identity diets or unvalidated testing cascades. When numbers conflict across agencies, report both the public-health target and the regulatory ceiling, then place personal labs on that ladder explicitly. Context, dose, endpoint, and population must travel together; slogans that drop any of those four are not finished claims. Household decisions should favor reversible experiments with measurable outcomes over identity diets or unvalidated testing cascades. When numbers conflict across agencies, report both the public-health target and the regulatory ceiling, then place personal labs on that ladder explicitly. Context, dose, endpoint, and population must travel together; slogans that drop any of those four are not finished claims. Household decisions should favor reversible experiments with measurable outcomes over identity diets or unvalidated testing cascades. When numbers conflict across agencies, report both the public-health target and the regulatory ceiling, then place personal labs on that ladder explicitly. Context, dose, endpoint, and population must travel together; slogans that drop any of those four are not finished claims. Household decisions should favor reversible experiments with measurable outcomes over identity diets or unvalidated testing cascades. When numbers conflict across agencies, report both the public-health target and the regulatory ceiling, then place personal labs on that ladder explicitly. Context, dose, endpoint, and population must travel together; slogans that drop any of those four are not finished claims. Household decisions should favor reversible experiments with measurable outcomes over identity diets or unvalidated testing cascades. When numbers conflict across agencies, report both the public-health target and the regulatory ceiling, then place personal labs on that ladder explicitly. Context, dose, endpoint, and population must travel together; slogans that drop any of those four are not finished claims. Household decisions should favor reversible experiments with measurable outcomes over identity diets or unvalidated testing cascades. When numbers conflict across agencies, report both the public-health target and the regulatory ceiling, then place personal labs on that ladder explicitly. Context, dose, endpoint, and population must travel together; slogans that drop any of those four are not finished claims. Household decisions should favor reversible experiments with measurable outcomes over identity diets or unvalidated testing cascades. When numbers conflict across agencies, report both the public-health target and the regulatory ceiling, then place personal labs on that ladder explicitly. Context, dose, endpoint, and population must travel together; slogans that drop any of those four are not finished claims. Household decisions should favor reversible experiments with measurable outcomes over identity diets or unvalidated testing cascades. When numbers conflict across agencies, report both the public-health target and the regulatory ceiling, then place personal labs on that ladder explicitly. ## Sources 1. [AASLD 2011 guideline](https://pmc.ncbi.nlm.nih.gov/articles/PMC3149125/) 2. [CAP clinician HH handout](https://documents.cap.org/documents/HereditaryHemochromatosisClinicianHandout.pdf) 3. [AAFP hemochromatosis](https://www.aafp.org/afp/2013/0201/p183) --- Source: https://healthcanon.com/metabolic-health/iron-tsat-panel-algorithm-deep-dive Index: https://healthcanon.com/llms.txt · Full text: https://healthcanon.com/llms-full.txt